LECTURER: MRS. AYAA SICCILLY.

DNM, DCM, BMS, BME.

HEALTH SERVICE MANAGAMENT

HEALTH SERVICE MANAGEMENT

INTRODUCTION.
Healthcare is an expansive industry that ranges from
preventative care, to emergency services, to follow-up
and rehabilitation. Health care organizations are complex
and dynamic. The nature of organizations requires that
managers provide leadership, as well as supervision and
coordination of employees. Organizations are created to
achieve goals that are beyond the capacity of any single
individual. This is more so in health care organizations
where the scope and complexity of tasks carried out in
provision of services are so great that individual staff
operating on their own can’t get the job done. Managers
are therefore needed to make sure and be certain that
organizational tasks are carried out in the best way
possible to achieve organizational goals and that
appropriate resources including financial and human
resources, are adequate to support the organization.

Health service:
It is the profession that provides leadership and direction
to organizations that deliver personal health services and
to divisions, department, units or services within that
organization. The aim for teaching Health Services
Management (HSM) is to equip the students with
relevant skills that will enable them to effectively manage
health services.

Management means getting things done. It’s working

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

Concepts of Health service management

 Leadership: is the process of influencing others towards
a goal. (Bennie and Nanas, 1985)

 Leader: is an influential person who has the ability to

lead a group or department without having a formal
appointment.

 Manager: is a formally and officially responsible

individual for the work of a given group. For example;
ward in charge, principal of a school is officially
responsible to ensure that the unit accomplishes its tasks
well.

 Authority: is the legitimate right to a manager or a

leader by an organization in order to command
subordinates and to act in the interest of an organization
to achieve its goals.

 Power: is to influence others to act. Or it’s the ability to

impose the will on others to bring about certain behavior.
(This power can be rewarding power, coercive power)
  Nursing management: is the process of working
through nursing personnel to promote and maintain
health, prevent illness and suffering. Therefore, the role
of nurse manager is to plan, organize, direct and control
available resources in order to provide effective care to
groups of clients efficiently.

MANAGEMENT

 Management therefore is a process which enables

organizations to achieve their objectives by planning,
organizing and controlling their resources including
gaining the commitment of their employees through
motivation.

 OR: Management is a process that enables

organizations to achieve their objectives through human
and other resources (getting things done).
 OR: It is the process to fore-cast, to plan, to organize, to
command, to coordinate and to control.

 OR: It is defined as a local process which consists of

planning, controlling, coordinating process. (Eelbreach
1957)

 OR: It is defined as an operation initially dissected by

analysing the managerial activities i.e., planning,
organizing, staffing, directing, leading and controlling.
(Koontz Odenel 1976,)

 OR: It is also defined as an element that helps Health

Workers to manage various resources used in health
services, effectively and effectively.

NB: The principle underlying the definitions is

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

Therefore, management enhances teamwork as opposed

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

The manager who is stiff causes “a red tape” i.e., a

breakdown in organization. In proper management
information should flow from subordinates to the
supervisors and vice-versa. In management, there is
control of resources including human resources for
remembrance. Resources including human resources are
considered under 4m’s i.e.,

 Manpower

 Material
 Money

 Movement

Manpower resources cannot be bought from shelves like

any other resources. This means manpower is not always
available particularly in the right kind. Management has
been applied since the beginning of civilization. In
communities, people have always worked together to
grow crops, build temples, etc.

Theories of Management

There are two majors but opposing schools of thought in

management: scientific management and the human
relations– based approach. As its name implies, the
human-relations approach emphasizes the interpersonal
aspects of managing people, whereas scientific
management emphasizes the task aspects.

Scientific Management
Almost 100 years ago, Frederick Taylor argued that most
jobs could be done more efficiently if they were analysed
thoroughly (Lee, 1980; Locke, 1982). With a well-
designed task and enough incentive to get the work
done, workers could be more productive. For example,
Taylor promoted the concept of paying people by the
piece instead of by the hour. In health care, the
equivalent would be by the number of patients bathed or
visited at home rather than by the number of hours
worked. This would create an incentive to get the most
work done in the least amount of time.

Taylorism stresses that there is a best way to do a job.

Usually, this is also the fastest way to do the job (Dantley,
2005). The work is analysed to improve efficiency. In
health care, for example, there has been much discussion
about the time it takes to bring patients to radiology or to
physical therapy versus bringing the technician or
therapist to the patient. Eliminating excess staff or
increasing the productivity of remaining employees is
also based on this kind of thinking. Nurse managers who
use the principles of scientific management will pay
particular attention to the type of assessments and
treatments done on the unit, the equipment needed to
do this efficiently, and the strategies that would facilitate
efficient accomplishment of these tasks. Typically, these
nurse managers keep careful records of the amount of
work accomplished and reward those who accomplish
the most.

Human Relations–Based Management

McGregor’s theories X and Y provide a good example of

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

PRINCIPLES OF HEALTHCARE MANAGEMENT

In HSM work involves more than one person and as a result,

two or more complementary principles must be applied to
management namely; Division of labour team approch and
convergence of work.

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

Team approach

This is the way in which management attains or brings about a

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

Convergence of work

It means that activities the various people who do the work,

come together in order to achieve the objectives. The activities
should be designed and directed in such a way that they
support each in moving towards a common goal. It also implies
that work impressions are the way in which members of the
team interact with one another; it should contribute to the
success of each activity and general effectiveness.

In general, health activities are studied described and

performed under 3 main sub-headings mainly.

 Service activities

 Developmental activities

 Support activities

A service activity e.g., immunization usually requires some

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

Substitution of resources.

It’s also widely applied in the effective use of resources after

when resources that are normally used to provide services
become too expensive. Here the cheaper alternatives are used
to produce intended results.

Delegation It’s also one of the principles of management in

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

Henry Fayol’s principle of management

1. Authority with corresponding responsibility: If responsibilities

are allocated, then the post holder needs the requisite
authority to carry out the duties. He/she should be responsible
for his /her actions. It is not uncommon in some organizations
to find powerless managers.

2. Specialization/division of Labour: This is a principle of work

allocation/specialization so that individuals do activities which
they are best suited for hence more efficiency of the
organization.
3. Discipline: For an enterprise to prosper there must be orderly
behavior for all its employees. Employees must adhere to the
rule’s standards of the organization.

4. Unity of command: This is the idea that an employee should

receive instructions from only one supervisor. This
generalization still holds even where we are involved with team
and matrix structures which involve reporting to more than one
boss. The basic concern is that tensions and dilemmas arise
where we report to two or more bosses.

5. Unity of direction: There should be only overall manager and

only one plan to which everybody adheres to. Subordination of
individual interest to the general organization’s interest. This
principle denotes that one employee’s interest or those of one
group should not prevail over the organization as a whole.

6. Staff Remuneration: The staff remuneration should be as fair

as possible in view of the organization’s costs and profitability.

7. Scalar chain/line of authority: The line of authority in the

organization runs from top to bottom in a straight line.
Communications should normally follow this path, although
managers should be able to communicate across the
organization to peers at the same level of authority.

8. Order: To run well as organization, there should be a place

for everything. Orderliness also implies steady evolutionary
movement rather than wild anxiety provoking unpredicted
movement

9. Equity: Fairness and a sense of justice should pervade the

organization in principle and practice. An organization runs best
when there is friendliness among employees and managers and
when managers act fairly towards others.

10. Stability of staff: Employee turnover is unhealthy for

organizations because time is needed for employees to adapt to
their work and perform effectively. Stability of tenure promotes
loyalty to the organization.

11. Initiative: At all levels of the organization, zeal, enthusiasm

and energy are enabled by employees having the scope for
personal initiative. Subordinates should be given the
opportunity to conceive and execute plans as long as they are in
line with the overall organizational plan.
12. Team work: For proper organizational functioning, there is
need for building and maintaining harmony among the
workforce, team work and sound interpersonal relationships.

13. Centralization /delegation: There should be a balance

between centralization and delegation. Authority and
responsibility should not be too centralized in one manager.

Qualities of a good manager

 1. A good manager is that one who knows when, where,
what and how to act i.e., good manager is

 Flexible

 Kind

 Patient

2. Knows the importance of accountability

3. A good manager must be able to account for whatever

he/she has used or done.

4. Should be transparent

5. Able to consult because he’s not working in isolation

6. Should be polite and able to share knowledge with others

7. Should be knowledge i.e., up dated and never challenged.

8. Be able to think creatively to provide a vision for the

company and solve problems

9. Be calm under pressure and make clear decisions

10. Possess excellent two-way communication skills

11. Have the desire to achieve great things

12. Be well informed and knowledgeable about matters relating

to the business

13. Possess an air of authority

Management styles

Management styles are mainly categorised in form of 3 Ds

Directing style

Managers tell people what to do, how to do it and when to

have it completed. They assign roles and responsibilities, set
standards and define expectations. The people who use this
style are called Autocratic (or authoritarian) managers i.e., they
make all the important decisions and closely supervise and
control workers. Managers do not trust workers and simply give
orders (one-way communication) that they expect to be
obeyed. For example: When quick decisions are needed in a
company like in a time of crises or When controlling large
numbers of low skilled workers.
Discussing style

Managers using this style take time to discuss relevant business

issues. People present ideas, ask questions, listen, and provide
feedback, challenge assumptions and coach as needed. It’s

important to make sure ideas are fully discussed and debated.

Managers often perform the role of facilitator, making sure the
discussion stays on track and everyone has a chance to
contribute. The people who use this style called Paternalistic
managers.

Delegating/democratic style

Managers using this style usually explain or get agreement on

what has to be accomplished and when it must be completed.
The how-to-do-it part of the equation is left up to the
employee. Responsibility and authority are given to employees
to get the job done.

Other styles:

Persuasive management style

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

Laissez-faire management style

A laissez-faire manager is seen as more of a mentor than a

manager. With laissez-faire management, employees are
empowered to take charge and managers take a backseat role
so that employees can flourish creatively.
There are five primary functions of management, these are;

Functions of management

 Planning: this the systematic way of making decisions that will

affect the future of the organization. It involves foreseeing the
effects of current actions in the long run in the future.

 Organizing: this involves determination of the activities that

need to be done in order to reach the organizational goals.
These activities should also be assigned to proper personnel.

 Staffing: Is the process of hiring and retaining suitable work

place for the organization.
 Directing: this is concerned with leadership, communication,
motivation and supervision so that the employees perform their
activities in the most efficient way in order to achieve
organizational goals.

 Controlling: this consists of those activities done to ensure

that the events do not deviate from the pre-arranged plans. For
example, establishing standards for work performance,
measuring performance, taking corrective actions to correct any
deviations.

Other functions of management

 Decision making: This function is critical to all the

aforementioned management functions and means making
effective decisions based on consideration of benefits and
drawbacks of alternatives.

 Motivating: Stimulating individuals to put more efforts in their

duties.

Purpose of management in healthcare

1. The aim of all managers is the same regardless of rank and
type organization – to increase productivity. This means
effectiveness and efficiency that is achieving organizational
goals and achieving them at low cost.

2. Effective management therefore is the concern of a

corporation president, a medical superintendent, a
commissioner in the ministry, a church Bishop, a school head
prefect, and others.

Skills required for effective management

 Conceptual skills- to set a vision see the “big picture”.

 Communication skills

 Human skills

 Problem solving skills

 Planning skills

 Negotiation skills

 Leadership skills
 Technical skills e.tc.

The skills mix required for various management levels

(organization hierarchy).

Top- level management;

 Conceptual skills

 Communication skills

 Planning skills

 Advocacy skills

 Negotiation skills

 Leadership skills

Mid- level management

 Planning skills

 Communication skills

 Coordination skills

First level management

 Technical skills
 Supervisory skills

 Demonstration skills

 Recruitment, maintaining and firing of staff. This is vital to

ensure that you have competent and enough staff to do the
available tasks.

 Formally evaluate performance of staff on a regular basis for

example through appraisal, support supervision and provide
feedback accordingly.

 Recommend staff for promotion or further study which will

motivate the staff and also enable the organization to have staff
with expertise.

 Prepare and adhere to the proposed budget so as to ensure

appropriate resource utilization and minimize loss/wastage.

 Assign and program the work of staff members so as to

prevent role conflict.

 Should be able to handle problems/conflicts occurring at work

place.

 Plan for the activities of the organization

 Empower the employees through assigning responsibilities or
delegation.

 Motivate workers so as to better perform their roles which will

lead to attainment of organizational objectives.

 Create a suitable environment for retention of the staff which

also motivates them.

 Advocate for staff to the high-level managers

Characteristics/qualities of a good manager or leader

 Knowledgeable: since the management problems are complex

and many faced, a manager should be knowledgeable in order to
process the information into useful data for decision making and
also differentiate between facts and non- facts.

 Decisiveness: a manager should have the ability to prompt and

desirable decisions.

 Ability to handle conflict: should be able to listen, positively

respond to criticism and handle conflict and differences in a
constructive manner.
 Emotional stability: he should be able to adjust to life, calm,
cool and calculated reaction to undesirable situations and
obstacles.

 Honesty & Integrity: are crucial to get your people to believe

you and buy in to the journey you are taking them on

 Have vision: know where you are, where you want to go and
enrol your team in charting a path for the future

 Inspirational: inspire your team to be all they can by making

sure they understand their role in the bigger picture

 Ability to Challenge: do not be afraid to challenge the status

quo, do things differently and have the courage to think outside
the box

 Communication Skills: keep your team informed of the

journey, where you are, where you are heading and share any
roadblocks you may encounter along the way.

Management cycle
LEADERSHIP

Definitions

Leadership.

It is the ability to influence and secure the cooperation of others

to work to achieve certain goals.

It implies:

 Influencing others to willingly carry out ones wishes

 Accept one’s advice and direction

Leadership.

The art of mobilizing others to want to struggle for shared

aspirations/Goals.

 The ability to inspire others to struggle to achieve shared

objectives and fulfill shared aspirations/Goals.
 The ability of gaining commitment rather than commanding
obedience, enlisting support rather than giving orders.

Leadership

A relationship through which one person influences the

behaviour of other people

 A social process in which one individual influence the

behaviour of others without the use or the threat of violence (of
any kind).

Introduction

Leadership, according to WHO, is one of the six building

blocks of health systems and it is clearly seen in the following
areas:

service delivery,

human resources for health,

health information systems,

pharmaceuticals,

health financing.
For the case of Uganda, available literature suggests that
leadership is lacking at all levels in the health care system and
where there are leaders, they generally lack skills. And so, as we
discuss health services management, it is essential to be aware
that human resource is few, and only a few of the few are health
managers – many of whom may not have the required leadership
and management skills. - More will talk about in HRH and the
critical shortage.

Leadership does not mean dominating the subordinates as it is

the case with leadership; however, the leader’s job is to get work
done by other people, and make people willingly want to
accomplish something. So effective leadership means effective
and productive group performance.
A leadership style is a leader's way of providing direction,
implementing plans, and motivating people. There are many
different leadership styles but commonly used are;

1. Autocratic/authoritarian leadership.
2. Democratic leadership/participative/consultative.
3. Laissez-faire style/free- rein/ultraliberal/delegative.

Autocratic/authoritarian leadership:

 Autocratic leadership: (also called directive, controlling, or

authoritarian). The autocratic leader gives orders and makes
decisions for the group. For example, when a decision needs to
be made, an autocratic leader says, “I’ve decided that this is the
way we’re going to solve our problem.” Although this is an
efficient way to run things, it usually dampens creativity and
may inhibit motivation

The autocratic leadership style allows managers to make

decisions alone without the input of others or consultation of
their team member’s even if their input would be useful.
Managers possess total authority and impose their will on
employees. No one challenges the decisions of autocratic
leaders. This leadership style is found in large bureaucracies like
police, army and prisons.

Characteristics of autocratic leaders

 Have high concern for work than for the people who perform
the work.

 Set rigid standards and methods of performance and expect

the subordinates to obey the rules and follow them
subordinate/followers are motivated by coercion
 Decision making is basically for the manager with no
subordinate involvement

 Emphasis is on difference in status that is I and You.

 Information must always flow from top to bottom

 Should never be criticized nor their action

Advantages of autocratic style

 Quick Decisions:

An autocratic style of leadership can be effective in work

environments where decisions need to be made quickly. The sole
responsibility rests with the leader, and she makes the decision
without the need to consult others.

 Close Oversight:

In an autocratic work environment, the leader typically keeps a

close watch on the activities of the workers. This eliminates the
tendency for workers to relax at work that may occur with more
lenient management styles. The result can be increased
productivity and speed, as workers who fall behind are quickly
identified and corrective measures are taken. Quality may
improve, as the employees' work is monitored constantly. Time
wasting and the need to waste resources is also reduced.

 It's Easier to Set Policy:

This is because in autocratic leadership style, there are no

opposing political ideologies to stand in the way of policy
making.

 Less time consuming especially in decision making and taking

action.

 Very efficient especially in times of crisis

Disadvantages of Autocratic or dictatorial leadership

 One way communication without feedback leads to

misunderstanding, and communications breakdown.

 An autocratic leader makes his own decisions which can be

very dangerous in this age of technological and sociological
complexity.

 It fails to develop the worker's commitment to the objectives

of the organization.
  It creates problems both with employee morale and
production in the long-run; due to their resentment.

. An autocratic leader, demands and expectations from his

subordinates which make the employees fear the leader.

 It is unsuitable when the workforce is knowledgeable about

their jobs and the job calls for team work and cooperative spirit.

 Limited Freedoms and Access to Information especially for the

employees/subordinates.

 Motivation of employees is compromised since they do not

exercise their rights.

 Employees are less creative.

Democratic leadership/participative/consultative
Definition: Is a type of leadership style in which members of the
group take a more participative role in the decision-making
process. There is redistribution of power and authority between
employees and managers to provide employee involvement in
decision-making.

Democratic leaders share leadership. Important plans and

decisions are made with the team. Although this is often a less
efficient way to run things, it is more flexible and usually
increases motivation and creativity. Democratic leadership is
characterized by guidance from rather than control by the leader.
Democratic leadership attempts to manage with democratic
principles, such as self determination, inclusiveness, equal
participation and deliberation.

Characteristics

 Leader is people oriented

 Togetherness is emphasized

 Delegation of tasks to other employees and subordinates along

with full responsibility makes them accountable for their actions
and tasks as well empowered.

 Openness to feedback (initiatives and otherwise) from the

managers and subordinates.

 Members’ suggestions and guidance direct the effective

management of the organization.

 Emphasis is on ‘we ‘rather than ‘I’ and ‘You’

.  Communication flows in all directions that is from up and

bottom

Advantages:
 All the people involved use their skills together for the
completion of a certain task and hence, almost all ideas are taken
into consideration and carefully debated.

 Communication gap is reduced. Tension between the leader

and team members is decreased as a result of which fear of
rejection and denial also reduces – this makes all sorts of issues
addressable.

 A positive work environment is created. This means that a

culture of junior workers getting a fair amount of responsibility
and challenges is encouraged. When there are the right vibes
among employees, work becomes more pleasurable.

 Promotes cooperation and team worker among the members of

the organization.

 Employee turnover reduction. A democratic leadership makes

people feel empowered at work as it is essentially performance
based. A majority of the workers appreciate this method of
management as it secures them a safe future with the company.
 Delegation of Responsibility is achieved whereby a democratic
leader will delegate responsibility among members of his or her
team to facilitate member participation in making decision.

Disadvantages:

 Some managers adopt democratic leadership to please their

subordinates but fail to follow the technique in its entirety. They
might simply take in all the ideas and end up never
implementing them.

 The decision-making process might be delayed which may

affect organizational progress.

 May create a feeling of frustration and ill-will especially

among some employees whose decisions/suggestions are
undermined.

Laissez-faire style/free- rein/ultraliberal/delegative

/permissive/ nondirective.
Definition Is a type of leadership style in which leaders are
hands-off and allow group members to make the decisions. This
type of leadership involves little direction and lots of freedom
for workers.

The laissez-faire (“let someone do”) leader does very little

planning or decision making and fails to encourage others to do
so. It is really a lack of leadership. For example, when a decision
needs to be made, a laissez-faire leader may postpone making
the decision or never make the decision. In most instances, the
laissez-faire leader leaves people feeling confused and frustrated
because there is no goal, no guidance, and no direction. Some
very mature individuals thrive under laissez-faire leadership
because they need little guidance. Most people, however,
flounder under this kind of leadership.
The leaders sit back and watch the activity or results take effect.

Characteristics of Laissez-Faire Leadership Laissez-faire

leadership is characterized by:

 Very little guidance from leaders

 Complete freedom for followers to make decisions

 Leaders provide the tools and resources needed

 Group members are expected to solve problems on their own.

Advantages:

 Allows visionary workers the opportunity to do work they

want to do free from interference.

 No work for the leader

 Instils a sense of responsibility among team members

especially those who are self driven.

 Best leadership style where employees are highly motivated

and achievement oriented.

Disadvantages

 less group satisfaction

 Less group/work productivity since workers may not possess
the necessary skills to complete a job.

 Poor quality of work since workers lack direction from leaders

and also lack the guidance and support of the leader

 Jobs fall back on someone else or are not completed since

there is lack of clear job description Bureaucratic style

 Emphasizes rules and routine

 You must use "appropriate" forum or channels

 It is red-tape leadership Basis of leadership style Ultimately,

the leadership style one adopts springs from one's ideas and
feelings about human nature.

Factors that influence the leadership style to use

• Manager’s personal background: that is his/her personality,

knowledge, values, ethics and experiences the manager has or
what she/he thinks will work.

• Staff being supervised: the style varies depending upon the

individual staff and what will best respond to.
• Organization: that is the traditions, values and concerns of the
organization highly influence the manager on which style to use

General principles of leadership

The principles will help leaders to be effective and directed
followers towards goal attainment
 Know yourself and seek improvement. This is through
understanding your being, to seek improvement it means
you continuously strengthen your attribute through reading,
self study
 Be technical proficient
 Seek responsibility state, responsibility for yourself action
 Make sound and timely decision
 Set an example, be good role model to the followers
 Ensure that tasks are understood, supervised and
accomplished
 Train your followers as a team
 Use the full capability of your organization
 Keep your followers informed
Factors that affect efficient leadership
Lack of devotion on part of the leader
Task/position centered approach
 Conflicts between needs and expectations
Failure to get feedback
Inflexibility in decision making
Unwillingness to accept criticism
Qualities of a good leader
Flexibly Vision confident
competent credible action oriented
hopeful able to lead trust worthy
and follow
optimistic caring ability to bring
out the best in
people
 

The 5ps of leadership

 pay attention to what is important
 praise what you want to continue
 punish what you want to stop
 pay for the results you want
 promote the people who deliver those results
The key aspects of quality (FACET)
 focus
  authority
 courage
 empathy
 timing
The difference among these three styles:

A democratic leader tries to move the group toward its goals;

An autocratic leader tries to move the group toward the leader’s

goals;

Laissez-faire leader makes no attempt to move the group.

Characteristics of effective leaders:

 They display honesty and integrity: consistency between

words and actions.

 They are never destructive: they never back-stab

 They have clarity of vision and direction: leaders must know

where they are going for others to willingly join them.

 They are able to inspire: ability to communicate the vision

with enthusiasm, energy and a positive attitude about the future
  They are competent: leaders must be capable and effective;
they must have a record of achievement.

 They display commitment and produce quality work: they see

their work as a reflection of themselves.

 They are supportive and service oriented rather than bossing

oriented: genuinely interested in their collaborators, ready to
listen and able to inspire, promote and support their continuous
development.

 They treat people as individuals and equals: Never belittle.

See value in everyone.

 They believe in people: those who don't trust anybody end up

not being trusted by anybody

 They are able of treating people in terms of their potential

 "Treat a man as he is and he will remain as he is. Treat a man

as he can and should be and he will become as he can and
should be". (Wolfgang Goethe)

 They are continuously learning: the more they learn and

know, the more they realize they don't know.  They inspire
others to continuously learn and grow.
 They are flexible and pragmatic: they grasp and adopt new
ideas.

 They are change oriented, able and ready to take risks.

 They are able, ready and quick in recognising their own

mistakes.

 They are able to accept, without blaming them, their

collaborators mistakes: to them, the only real failures are the
mistakes (the experiences) not learned from.

 They listen to others: they know and accept their own

limitations. Pursue others' ideas

 They give credit to others: constantly and consistently.

 They have sense of humour, irony and self-irony: these are

signs of intelligence and can protect against dogma, arrogance
and self-righteousness.

 Humour can help to change perceptions.

 laugh freely: Being able of laughing at ourselves preserves us

from becoming too boring; from being too full of ourselves and
from taking ourselves too seriously.
Differences between a management and a leadership
FUNCTIONS OF MANAGEMENT IN DETAILS

PLANNING

Planning is the first step in the management process and every

manager is expected to understand its essence in order to be
successful in their managerial role. Planning is particularly
important because of scarce resources and uncertain
environment with competition for those resources.
Definition: Planning is a decision-making activity requiring the
process of ascertaining objectives and deciding on activities to
attain those objectives.

Or: is the process of preparing for change and coping with

uncertainty by formulating future courses of action.

Or: is ensuring that the important organizational objectives are

accomplished as and when desired.

Or: is having a specific aim/purpose and coming up with

ways/methods for the achievement of the goals.

Reasons for planning/purpose of planning

 To successfully achieve the organizational goals and objectives

through the set strategies.

 To ensure effective resource utilization including human

resource so as to prevent resource wastage.

 To better cope with situational crisis since this was anticipated

and hence planned for.
 To ensure effective control of the resources especially human
resource.

 To guide decision making since it specifies the action and

steps to be taken in order to achieve the organizational goals. By
enabling the managers to make decisions on current and future
activities.

 To enable anticipation of problems and thus facilitating smooth

flow of organizational operations.

 To identify gaps and areas requiring change; this will be

addressed for the better of the organization. This can be
achieved through periodic review of the organizational
activities.

 To give meaning to work since employees will work towards a

well-defined goal.

Characteristics of a good plan

 Should be simple and comprehensive so that all the employees

can grasp its significance and thus easily put into action. It
should as well be detailed enough so that it can cover all aspects
of the operation necessary to achieve the objectives.
  Should have clear, well-defined and easily understood
objectives.

 A good plan should also be well balanced and flexible. That is

the existing resources are well allocated for proper utilization so
that the short-term gains are not achieved at the cost of long-
term gains.

 Should also be flexible enough to incorporate any changes in

the resources.

 Time bound. That is should be established for a specific

period of time.

 Actionable; a good plan should be have set out strategies for

achieving organizational goals which are practical.

 Should incorporate all the departments within the organization

to promote unity and focus on the overall objective i.e., involve
participation by subordinates.

Principles of effective planning

 Aims of organization in the plan must be clear, reasonable and

attainable.
 Involve subordinates in the planning process. This will ensure
acceptance of the plans by those who are to implement it.

 Assign planning responsibility to the right people that is those

who are involved with the operation.

 Do not be over optimistic with the anticipated results but rather

see what is there than what you want to see.

 Keep the plan flexible but putting under constant review and
adjustment where necessary.

Levels of planning

There are basically three levels of planning associated with the

different managerial levels: these are; Strategic planning/long
term planning:

 Conducted by top management like chief executive officers,

directors, presidents, vice-presidents

 Involves determining the direction in which the organization

should be run

 Long-range/term planning (a period of up to 10years)

 Deals with total assessment of the organization’s capabilities,
it’s strengths and weaknesses. Intermediate planning:

 Coves a time frame of about 6months to 2years

 Conducted by middle management which includes department

heads

 Middle managers have to refine broad objectives into more

workable and realistic plans.

Operational planning:

 These plans are responsibilities of lower management like unit

supervisors.

 Short range plans covering a time span from 1week to one

year

 These are more specific and determine how a specific job is to

be completed in the best way

Planning process/steps in planning

Assessment

This involves collecting adequate data about the organization so

as to answer questions of:
 Where are we?

 What do we have to work with?

 Where do we want to be?

 How do we get there?

This information is then analysed and interpreted as a

meaningful whole. Assessment will also help the manager to
identify needs of the organization as well as its strengths and
weaknesses.

Establish and clearly define goals/objectives:

This portion of the planning process should include a detailed

overview of each goal, including the reason for its selection and
the anticipated outcomes of goal-related projects. For example,
the objective of the hospital is to provide quality health care.

Identify resources

Each goal should have financial and human resources attached

for its achievement or completion.

Priority setting
There is need to priotise the objectives as well as resources in
regard to their importance. The tasks deemed most important
will be approached and completed first. The prioritizing process
may also reflect steps necessary in completing a task or
achieving a goal.

Development of strategies

These are measures set up for the achievement of the

organizational objectives. This step also involves assigning
timeline for the achievement/accomplishment of a task.
However, there should also be consideration of the abilities of
the staff in assigning them duties or work as a strategy for
achievement. It is also necessary to formulate policies, rules and
regulations as a way of controlling organizational activities.

Implementation of the plan:

This is the action stage of the planning process where all the
identified strategies are implemented/put into action for the
attainment of the organizational goals. However, this stage will
require a combination of all skills and coordination of all
factors.
Evaluation of the plan:

The plan should be re-evaluated periodically so as to measure its

progress and effectiveness in order to correct any deviations and
make adjustments where necessary. This can also be done
through requesting a monthly progress report from department
heads.

Benefits of planning

 Planning provides performance standards which assist in the

development potential and standards for measuring the progress
of the organization are essential in organizational control.

 Improves the competitive strength of the company since

deviations are easily identified basing on the set standards and
thus addressed in regard to the expected standard.

 There is reduced risk and uncertainty since these are

anticipated early enough and strategies to overcome them are
put up accordingly.

 Promotes proper and effective utilization of the organizational

resources hence minimizing wastage.
 Planning enables manager to focus on the future than the
present hence giving them purpose and direction.

 Provides a framework for decision making. Knowing the

organizational objectives and methods to achieve them
eliminates ambiguity in the decision-making process.

 Proper planning motivates the workers especially if they are

involved in the planning process.

ASSIGNMENT: OUTLINE 10 LIMITATIONS OF

PLANNING

LIMITATIONS OF PLANNING.

Limitations of Forecasting

Is the basis of planning. We have studied that facts and data

should be reliable and accurate, for successful planning,
otherwise planning will not be successful.

Similarly, even if the timings of the forecasts will be lengthy,

then the accuracy of planning will be much lesser and success
will be doubtful.
 Flexibility

Planning lacks sufficient flexibility.

So, the managers become non-enthusiastic and they do not take

full interest in the business enterprise. As comprehensive
planning will be, it will be equally non-flexible, the reason being
that necessary revision in planning, in consonance with the
circumstances, becomes necessary

Time-Consuming and Expensive

Planning is regarded as a time consuming and expensive

process, the reason being that facts and data are collected for
planning, these are analysed and tested also, on which a lot of
time, energy and money are to be spent. Besides, many times,
the collection of data and forecast preparation takes so much of
the time that the opportunities for profit slip from the hand.

Thus, the advantages of planning are low as compared to

spending of time, energy, and money for it. And limitations
of strategic planning are high.
Hence, the Cost of planning should not be more than its
contribution.

Difficulty in Selection of Best Alternative

The best of the various alternatives is selected in the Planning

process.

But, if viewed practically, it is difficult, the reason being that it

is difficult to decide, which is the best among the available
alternatives.

Who will decide? Not only that, the best today to us, may not
possibly appear to be the best tomorrow, rather some work may
appear the best tomorrow, in accordance with the changing
circumstances.
Thus, many difficulties arise in the selection of the best
alternatives in planning.

Stiffness Initiatives

The employers, stifle the feelings of initiation among the

employees, due to rigidities of planning, which compels the
managers and employers to follow and act, according to the
decided systems, methods, programs, policies, rules and plans,
in which they cannot make any type of changes and revisions, in
their personal capacity.

As a result, the initiatives of officers and employees start

stifling.

Planning chokes the throats of initiatives of the employees and

compels the managers to act strictly.

Related: 8 Main Nature and Scope of Venture Capital

(Explained).

Emergencies

During the occurrence of emergencies, planning is either not

possible or else difficulties are faced in their implementation,
due to which planning is to be left, the reason being that at such
times, much of thinking and understanding is not possible and
decisions are to be taken quickly. So, the advantages and
disadvantages of planning in an organization is a very essential
role.

Frustrating Work

In real life, preparing plans is frustrating to work.

Sometimes, planning remains unsuccessful, since this is a

frustrating task. Sometimes planning remains unsuccessful in
difficult and frustrating works.

Opposition to Changes
It is a reality that managers often oppose changes in Planning.
Most of the managers give more importance to the present than
the future, and they show disinterest towards changes,
whereas planning is a dynamic process and regular changes
are required, according to the circumstances.

Such an outlook of the managers also brings setbacks for future

planning.

Related: 14 Principles of Planning in Management (With

Examples).
Lack of Adequate Mental Ability or Intelligence

Planning is basically a mental system and intellectual function.

Hence, the special type of intellectual aptitude and memories are

required for the formulation of plans.

But it is beyond the capacity of an officer of General

Intelligence and as a result success of planning becomes
doubtful.

Physiological Barriers

An important barrier in formulation and implementation of plans

take like most of the people, executives also give more
importance to the present then the future, the reason being that
present is more secure than the future and is more desired also.

Besides, several such things are included in plans, which are

opposed by executives, on the plea that these are not
implementable.
DAY TO DAY PLANNING ACTIVITIES OF THE NURSE
MANAGER

 A practical day to day planning by the nurse manager has great

value in managing her unit.

This is what she is expected of:

 At the beginning of each day, make a list of actions to be

completed for the day. Cross off the actions as they are
achieved / completed or at the end of the day.

 Carry over actions which are not completed to the next day
either do them first or decide whether those need to be done at
all.

 Plan ahead for the meetings. Distribute agenda in advance.

 Identify developing problems and put them in appropriate

portion of the management plans.
 Review the plan on a scheduled basis with the key managers
so that each knows the personal responsibilities for the activities.

 Review the appropriate portions of the development plan with

the subordinate managers when they are counselled.
Department, unit or clinic plans be reviewed at the same time

.  Plan for educational programs for student educational

experiences in the division of nursing.

 Plan for evaluation of clinical administrative practices to

decide whether the objectives were achieved.

Organisation as a management function

Introduction:

When two or more people co-operate to perform a task, it is

usually convenient to divide responsibility so that each of them
takes care of certain aspects of the job. Organization involves
grouping people together in a stable yet working pattern.
Definition: This is the planned design of the corporate structure
showing the relationships between employees and the function
each should perform to make the organization work effectively
towards given objectives. OR is the process of combining the
work, which individuals or groups have to perform with the
facilities necessary for its execution using available resources.

Principles of organization

1. Scalar principle: The lines of authority should be clearly

stated and should run from the top to the bottom of the
organization. This line of command is referred to as chain of
command. The major decisions are mad and policies formulated
at the top and they filter down through various management
levels to the workers.

2. Unity of command: Each person in the organization should

report to only one boss. And each person should know how he
reports to and who reports to him. This process eliminates
ambiguity and confusion that can be caused, when a person has
to report more than one superior.
3. The responsibility and authority of each supervisor should be
established clearly and in writing. This will clarify the exact role
of the supervisor as to limits to his authority. Authority is
defined as the formal right to require action from others.
Responsibility is the accountability of that authority. With
clearly defined authority and responsibilities, it will be easier for
the supervisor to trace and handle problems and make quick
decisions when necessary.

4. The higher authorities are responsible for the acts of their

subordinates. The executive cannot dissociate himself from the
acts of his subordinates. Hence, he must be accountable for the
acts of his subordinates.

5. The authority and responsibility should be delegated as far

down the hierarchical line as objectively as possible. This will
place the decision-making power near the actual operations.
This gives the top management more free time to devote into
planning and overall policy making.

6. The number of levels of authority should be as few as

possible. This would make the communication easier, clear and
the decision making faster. A longer chain of command results in
‘run a round.

7. The principles of specialization should be applied wherever

possible. Precise division of work facilitates specialization
which then leads to efficiency and quality. Every person should
be assigned a single function whenever possible

8. The line functions and staff functions should be kept separate.

The line functions are those that are directly involved with the
operations that result in the achievement of company objectives.
Staff functions are auxiliary to the line functions and offer
assistance and advice.

9. The span of control should be reasonable and well

established. The span of control determines the number of
positions that can be coordinated by a single executive. The span
of control could be narrow with relatively few individuals who
report to the same manager or wide with many subordinates
under the supervision of the same manager.
10. The organization should be simple and flexible. It should be
simple because it is easier to manage and flexible because it can
quickly adapt to changing conditions. It should be such that it
easily expanded or reduced at times of demand.

Advantages/ benefits of good organization

 Facilitates attainment of organizational objectives through

proper coordination of all activities

 A minimal conflict among employees since the chain of

command is clear for everybody.

 Overlapping and duplication of work is eliminated since work

is distributed among employees accordingly

 There is decreased likelihood of run-around. This can occur

when we don’t know who is responsible for what. This is
avoided since responsibilities are clearly established.

 Facilitates promotions since the organizational chart clearly

points the positions of all individuals relative to one another.
  It aids wage and salary administration. Compensation
administration policies get easier to apply since there is a clear
stipulation on the benefits of certain jobs in the company.

 Communication is simplified sine the lines of communication

and flow of authority is quite clear in the organizational chart.

 Good organization provides a basis for effective planning in

the short and long run like expansions and contraction of
activities.

 There is increased cooperation and sense of pride. The

employee has adequate freedom within the domain of his
responsibility and authority since they are all clear to him thus
boasting morale.

 It encourages creativity. Because of the sense of belonging

and high morale and with the help of clear-cut accountability,
recognition of skill and appreciation for contribution, it
encourages resourcefulness, initiative and a spirit of innovation
and creativity.
 Organisation structure This is the arrangement and
interrelationship of the component parts and positions within the
institution.

OR: this is the network of horizontal and vertical relationships

among the members of a group designed to accomplish common
objectives.

OR: it is a system of formal relationships that govern the

activities of people in an organization.

Importance of organization structure

 Is the foundation upon which the whole structure of

management is built.

 It specifies division of work which helps define teams who

work closely together.

 Promotes hierarchy in the organization since it provides a clear

chain of command and defines which employees report to which
managers.
 It shows different areas of specialization indicating hierarchy
and authority structure.

 A structure helps define exactly who the correct decision

maker for each employee is.

NB: an organization structure is represented by a chart drawing

known as the organization chart.

Types of organization structure

Line organization

This is the simplest type of organization where the authority is

embedded in the hierarchal structure, and it flows in a direct line
from top of the managerial hierarchy down to different levels of
managers and subordinates and down to operative level of
workers.

The line organization can be a pure line or departmental line

type. In pure line type set-up, all similar activities are performed
at any one level. In departmental line organization, the
respective workers and supervisors are grouped on a functional
basis e.g., academics, research, and finance etc.

A line organisation structure

Medical director

Hospital administrator

Principal nursing

officer In-charge OPD

In- charge Maternity

In- charge medical ward

Ward nurses

Advantages of line organization

 Is simple to understand and operate

 Responsibility, authority and accountability are all clear-cut,
easily assignable and traceable

 Communication is fast, easy and feedback can be acted upon

faster

 Due to small structural size, discipline among all can be

maintained easily and effective control can be easily exercised

 Applicable to small sized organizations enabling people to

know each other better and tend to feel close to each other.

Disadvantages of line organization

 It is rigid and inflexible and there is a tendency to become

dictatorial.

 The growth of the organization in regard to work and size

makes the structure less effective

 Line officers being involved in day-to-day operations make

them have little time for systematic and strategic planning
  Due to strict accountability, different departments may be
more interested in their self interests, rather than overall
organization interests and welfare.

 There is no provision for specialists and specialization which

is essential for growth and optimization.

II) Line and Staff organization structure

III) Matrix organization Organisation charts

An organization chart is a graphical portrayal of the various

positions in the organization and the formal relationships among
them.

Types of organizational charts

There are many but are broadly classified into two;

i) Vertical charts:
 Called top to bottom chats
 Lowest position is shown at the bottom.
 Widely used
ii) Horizontal Charts:
 Called left to right chart
 Highest position is placed at the extreme right and lowest
is at the extreme left.

Advantages/ Uses of organizational charts

 Shows clearly the various positions and how they relate
to one another
 Shows at glance the lines of authority and responsibility
 Provides a basis of planning organizational change
 Provides guidance to outsiders to whom they should
contact
 Serves as a valuable guide to the new personnel
 Helps to point out inconsistencies and deficiencies
 Provides a framework for classification and evaluation of
personnel
 Provides clues to the lines of promotion
 It facilitates communication.

Principles of Organization Charts

  Should have a clear title
 Should clearly show the lines of authority
 Positions of equal ranks must be shown at the same level
 Solid lines must be used to indicate the line of authority
 Staff relationships indicated by dotted lines
 Complete chart should be on a single sheet
 Colours may be used to indicate different departments

Limitations of Organization Charts:

 Fails to recognize informal relationships

 Does not represent flexibility

 It introduces bureaucratic rigidity in the formal relationships

 Shows the relationship which is supposed to exist rather than

what actually exist

 Fail to show how much authority and responsibility an

individual can exercise due to over simplification

 Poorly designed charts cause confusion and misunderstanding

 They may create superiority and inferiority feelings and lead to
conflicts in the organization

Staffing function of management

The managerial function of staffing involves staffing the

organization structure through proper and effective selection,
appraisal and development of the personnel to fill the roles
assigned to the employers/workforce. According to Theo
Haimann, “Staffing pertains to recruitment, selection,
development and compensation of subordinates

Staffing is the management activity that provides for

appropriate and adequate personnel to fulfill the organization’s
objectives. The nurse manager decides how many and what type
of personnel are required to provide care for patients.

Usually, the overall plan for staffing is determined by nursing

administration and the nurse manager is in a position to monitor
how successful the staffing pattern is as to provide input into
needed change. Staffing is a complex activity that involves
ensuring that the ratio of nurse to patient provides quality care.

The situation of a nursing shortage and the high activity levels

of admitted patients to acute care areas complicate this process.
Staffing depends directly on the workload or patient care needs.
An ideal staffing plan would provide the appropriate ratio of
caregivers for patients’ individual needs based on data that
predict the census.

The staffing function of management.

The staffing function consists of the following sequential

steps;

1. Analyse the job - by preparing job description, job

specification and job analysis

2. Actual recruitment – This would explore all the internal and

external sources from where the required personnel can be
recruited.
3. Employee selection – This crucial step involves using such
techniques as would identify and isolate the suitable people who
would eventually be selected.

4. Retention – When the right people have been hired, they must
be retained so that they stay with the organization for a long
time. This step discusses such factors that are influential in
maintaining the work force.

5. Training and development – This consists of all such

programmes that assist in continuous growth and development
of employees.

6. Performance appraisal and career development - This step

involves devising methods that would judge an employee’s
performance over a period of time and providing opportunities
to employee’s performance over a period of time and providing
opportunities to employees to develop their careers and
managerial talents.

JOB DESCRIPTION
This is a systematic, organized and written statement of ‘who
does what, when, where, how and why’, and is a tangible
outcome of job analysis. It describes the work to be performed,
the responsibilities and duties involved, conditions under which
the work is performed, the relationship of one job with other
similar or dissimilar jobs and the skill, education, and
experience required. A job description is used for a variety of
purposes such as recruitment and selection, job evaluation etc. A
job description generally contains the following data;
 Job identification: It includes job title, code number of the job
if any, the department or division to which the job belongs.

 Job summary: It is a brief summary, in a sentence or two,

explaining the contents of the job, its hazards or any other
specific aspects.

 Duties performed: It is a comprehensive listing of the duties

together with the importance of each duty and the percentage of
time devoted to each major duty. Included are any other
additional responsibilities like custody of money, training of
subordinates etc.

 Supervision: If supervision is required, then it gives the

number of persons to be supervised along with their job titles
and extent of supervision involved and whether it is general
supervision or close supervision.

 Machines, tools and equipment used: This will include the type
of machinery handled and the type of raw materials used.
 Working conditions: It gives us the working environment in
which the job holder must work. Here are listed any special
working conditions in terms of cold, heat, noise levels, dust,
fumes and any other hazards that might pose a risk to life and
the probability of such a hazard occurring.

Importance of job description

 Reduces confusion and misunderstandings

 Communicates to workers in clear terms as to what they are

required to do.

 Gives greater job satisfaction as the worker knows what is

expected of him

 Useful in recruiting, training and placement of right workers

to the right jobs

 Reduces discrimination and assist in objective performance

appraisal.

Directing function of management

Introduction

This is a management function performed but top-level

management in order to achieve the objectives of an
organization. It is considered life-spark of the organization
which sets in motion the action of people because planning,
organizing and staffing are the mere preparations for doing the
work.

Definition

These are the steps a manager takes to get subordinates and

others to carry out the organizational plans or to achieve
organizational objectives.

OR: Directing means giving instructions, guiding, counselling,

motivating and leading the staff in an organization in doing
work to achieve organizational goals.

Directing involves:

 Telling people what is to be done and explaining how it is to

be done
 Issuing instructions and orders to the subordinates

 Inspiring them towards achievement of the organizational

objectives

 Supervising the subordinates’’ activities

 Providing leadership and motivation

Importance of Directing

 It guides and helps the subordinates to accomplish the given

tasks as expected

 It provides the necessary motivation to the subordinates to

complete the work satisfactorily and striving to do the best

 It helps in maintaining discipline of the workers through the

continued supervision of their work

 Helps to integrate the various activities carried out in the

organization.
  The leadership involved in directing helps to create an
appropriate work environment and build up of team work

Process of directing/ steps of directing

 Defining the objectives

 Organizing the effort

 Measuring work

 Developing people

Elements of directing

 Communication: Is the process of passing information,

experience, opinion etc from one person to another. It is a bridge
of understanding. Communication involves exchange of ideas
and information in order to create mutual understanding. It is a
process of telling, listening and understanding. A manager has to
explain the plans and orders to his subordinates and to
understand their problems. He must develop a sound two- way
communication system so as to be always in touch with his
subordinates. Sound communication fosters mutual
understanding and coordination among different units of the
organization.
 Leadership: This may be defined as a process by which a
manager guides and influences the work of subordinates in
desired direction. Leadership is the process of guiding and
influencing subordinates for the accomplishment of desired
goals. It involves the integration of organizational interests with
personal goals. A person can be an effective manager when he
possesses the qualities of a good leader. It is through leadership
that a manager can build up confidence and zeal among his
subordinates. In order to guide his subordinates in the desired
direction, a manager should adopt an appropriate style of
leadership. The pattern and quality of leadership determines the
level of motivation. Leadership is always related to a particular
situation.

 Motivation: Means inspiring, stimulating or encouraging the

subordinates with zeal to work. Positive, negative, monetary,
non- monetary incentives may be used for this purpose.
Motivation implies inspiring the subordinates to work with zeal
and confidence. No administrative action can succeed unless the
subordinates are motivated to contribute their best efforts to the
common task. In order to activate and actuate his subordinates to
work in the desired manner, a manager has to make use of
appropriate incentives. Various financial and non-financial
incentives are available to a manager for this purpose.
Motivation is a continuous process of understanding and
satisfying human needs.

 Supervision: This implies overseeing the work of

subordinates by their superiors. It is the act of watching and
directing work and workers. This is ensuring that work is being
done as planned. Every manager has to supervise the work of his
subordinates to see that they do their work as desired.
Supervision is one important element of the process of directing.
But supervision is particularly important at the operating level
management. The supervisor is in direct personal contact with
the workers and he acts as the link between workers and
management. The communicates the policies, plans and orders
of management to the workers he also brings workers’
grievances, suggestions and appeals to the notice of
management effective supervision is essential for the
accomplishment of desired goals. The purpose of supervision is
to ensure that subordinates perform their tasks according to
prescribed procedures and as efficiently as possible.

ORGANIZATIONAL STRUCTURE OF HEALTH

SERVICES IN UGANDA

The National Health Care System

This constitutes the institutions, structures and actors whose

actions have the primary purpose of achieving and sustaining
good health. It is made up of public and private sectors.

The Public Sector includes: -

 Government health facilities under the Ministry of Health

(MOH)
 Defense Ministry’s Health services

 Internal affairs Ministry’s (Police and Prisons)

Health Services

 Local Governments’ Health Services.

The Private sector includes: -

 Private Health Providers (PHPs)

 Private Not for Profit (PNFPs) Providers

 Traditional Health Practitioners

Sector Organization, function and management

The MOH provides leadership for the health sector and takes the
leading role and responsibility in the delivery of curative,
preventive, promotive, palliative and rehabilitative services to
the people of Uganda. There has been decentralization with
districts and Health Sub districts (HSD) playing key roles in
delivery and management of health services at district and HSD
respectively. The health services are structured into:
The Ministry of Health and National Level Institutions The
core functions of the MOH are: -

1. Policy analysis, formulation and dialogue

2. Strategic planning

3. Setting standards and quality assurance

4. Resource mobilization

5. Advising other ministries, departments and agencies on

health-related matters

6. Capacity development and technical support supervision

7. Provision of nationally coordinated services including: health

emergency preparedness and response and epidemic prevention
and control.

8. Coordination of research

9. Monitoring and evaluation of the overall health sector

performance.

National Autonomous Institutions

Most functions of the MOH have been delegated to autonomous

institutions.

These include: -

Specialized clinical services

 Uganda Cancer Institute

 Uganda Heart Institute Specialized Clinical Support Services

 Uganda Blood Transfusion Services (UBTS)

 Uganda Virus Research Institute

 National Medical Stores

 National Public Health Laboratories

Regulatory bodies /authorities

 National Drug Authority

 Medical and Dental Practitioners Council

 Allied Health Professional’s Council

 Pharmacy Council

 Nurses and Midwives Council

 Uganda National Research Organization (UNHRO)

coordinates national research activities.

 Health Service Commission managers human resources for

health

 Uganda Aids Commission (UAC) guides multi-sectoral

response to HIV/AIDS.

Hospitals
 Hospitals represent the top end of a continuum of care
providing referral services, for both clinical and public health
conditions to the district health services. They play an important
complimentary role to primary care and constitute an important
and integral part of the National Health System.

Hospital Infrastructure

In Uganda hospitals services are provided by public, private not

for profit and private institutions. The degree of specialization
varies between hospitals. Public hospitals are divided into three
groups, according to the level of services available and their
responsibilities, general, regional referral and national referral
hospitals. Private hospitals are designated general hospitals, but
the services they offer vary with some providing specialist
services, usually found only in referral hospitals.

General Hospitals

These hospitals provide preventive, promotive, curative

maternity, inpatient services, surgery, blood transfusion,
laboratory and medical imaging services. They also provide
service training, consultation and operational research in support
of community- based health care programmes. Examples of
general hospitals include Kitagata, Itojo, Ishaka Adventist and
Comboni.

Regional Referral Hospitals (RRHs)

These offer specialist clinical services such as psychiatry, Ear,

Nose and Throat (ENT), Ophthalmology, higher level surgical
and medical services, and clinical support services (laboratory,
medical imaging and pathology). They are also involved in
teaching and research. This is in addition to services provided by
general hospitals examples of RRHs include, Mbarara, Masaka,
Fort-Potal, Mbale and KIUTH.

National Referral Hospitals

These provide comprehensive specialist services and are

involved in health research and teaching in addition to providing
services offered by general hospitals and RRHs.

District health care system

The 1995 Constitution and the 1997 Local Government act

mandates the district local government to plan, budget and
implement health policies and health sector plans, local
governments have the responsibility for the delivery of health
services, recruitment, deployment, development and
management of human resources for district health services,
development and passing of health related by laws and
monitoring the overall health sector performance. The local
governments manage public general hospitals and health centres
and also provide supervision and monitoring of all health
activities including those in the private sector in their respective
areas of responsibility.

Health Sub-district

This is the immediate lower level after the district in the

hierarchy of district health services organization. The health sub-
district is mandated with planning, organization, budgeting and
management of health services at this and lower health centre
levels. It carries an oversight function of overseeing all curative,
preventive, promotive and rehabilitative health activities
including those carried out by the PNFP, and PFP service
providers in the HSD. Conscious of the central role of the HSD
in the delivery of the Uganda National minimum health care
package (UMHCP), high priority was given to the HSD during
the health care strategic plan II. This was ensured through
preferential allocation of the necessary personnel and elements
of health infrastructure for making HSDs effective. The
leadership of the HSD is located in an existing hospital or HC
IV (Public or PNFP).

Other functions of HSD

 Provision of second level referral services for the HSD

including life-saving medical surgical and obstetric emergency
care (such as blood transfusion, caesarean section, and other
medical and surgical emergency interventions.

 Provision of the physical base of the HSD management team.

Health Centre III

This is usually based at sub county level and headed by a

clinical officer with the following purposes: -
  Provision of basic preventive, promotive and curative care
services to communities in its catchment area

 Support supervision to HC II in its catchment area

 Act as first level referral services for sub counties

 Support community-based activities including training and

supervision of community health workers.

Health Centre II

These are based at parishes (  500 people) and provide the

following services

 They provide the first level of interaction between the formal

health sector and communities

 They provide only outpatient care and community outreach

services

 Health education

 Collection of basic statistics

 They are usually headed by an enrolled nurse or midwife.

Village Health Teams (H. C. I).

A network of village health teams (VHTs) has been established
in Uganda which is facilitating health promotion, service
delivery, community participation and empowerment in access
to and utilization of health services.

Roles of VHTs

 Identifying the community’s health needs and taking

appropriate measures

 Mobilizing community resources and monitoring utilization of

all resources for health.

 Mobilizing communities for health interventions such as

immunization, malaria control, sanitation and promoting health
seeking behavior.

 Maintaining a register of members of households and their

health status.

 Maintaining birth and death registration.

 Serving as a link between the community and formal health

providers

 Community based management of common childhood

illnesses including malaria, diarrhea and pneumonia, as well as
distribution of any health commodities availed from time to
time.

The district Health Officer and district Health Management

Team

The district health services are headed by a district health officer

(usually a medical officer with additional training in
management). Together with other health officials of the district,
he is concerned with the overall management of the district
health services. Other members of the district health
management team usually include: -

 District Biostatistician

 District Health Educator

 District Nursing Officer

 District Stores Manager (Medical)

 District Cold Chain Manager

 District Environmental Health officer

 District Laboratory focal person

 District Tuberculosis and leprosy supervisor

 District vector control officer

 Heads /In charges of HSDs in the district

 Any other member deemed necessary by the DHO.

Functions of district management team

The district health officer using his district health management

team is responsible for all health-related activities in the district
including: -

 District Planning: The DHO is responsible for coordinating all

health service planning in the district in cooperation with other
district officials.

 Supervision of district health activities: Supervision of all

government and PNFP health facilities through regular visits,
and advice to staff concerned and ensuring that appropriate
records are kept. Supervision of all special health programmes
such as the expanded programme on immunization (EPI), TB
and Leprosy control and family planning among others

 Training of health personnel: Any basic training in the district

should be coordinated by the DHO’s office. The DHO is also
responsible for the continuing education of all health staff in the
district and supporting the training of community-based health
workers.

 Clinical work: Basing on his expertise, the DHO can also

routinely take part in clinical work, especially when there is
shortage of health workers

In summary, the functions of the DHO are summarized in the

scheme below; -

 Administration/supervision

 Training

 Clinical work

 Planning

Health Care setting

Management Position

1. Ward
In charge

2. Special Clinic
In charge
 3. Outreaches
Coordinator

4. Records Department
Director of Medical Reports

5. Nursing
Senior /Principal Nursing Officer

Summary Organization of health services in Uganda

Currently health care system can be viewed as with 8 levels:

Form the top – bottom

1. The ministry of health: charged with the responsibility of

setting policies and standards and guidelines, resource
mobilisation, capacity building, technical supervision,
monitoring and evaluation as well as overall regulation.

2. National referral hospitals: currently three (Mulago, Butabika

and Mbarara)- which provide comprehensive specialist services
and are involved in teaching and research.
3. Regional Referral hospitals: Serve a region – target to serve
about 3 million people- offer specialist services, teaching and
research.

4. District hospitals: these target to serve a district – They

provide preventive, promotive, outpatient curative, maternity,
inpatient health services, emergency surgery, blood transfusion,
laboratory and other general services.

5 Health sub-districts and HCIV -for delivery of the minimum

package to the HSD.

6. Health centre 3: The HC III offers continuous basic

preventive, promotive and curative care and provides support
supervision of the community and HC II facilities under its
jurisdiction.

7. Health centre 2: Represents the first level of interface between

the formal health sector and the communities.

8. Village Health Team (Health Centre I): Facilitates the process

of community mobilization and empowerment for health action.
Each village would have a VHT comprised of 9-10 people to be
selected by the village (LCI).
HUMAN RESOURCE MANAGEMENT

INTRODUCTION TO HRM

HRM has been seen by some scholars as having the purpose of

ensuring that the employees of a company are used in such a
way that the employer obtains the greatest possible benefit from
their abilities and in return the employees obtain both material
and psychological rewards from their work Any organization
will exist to either make a profit or offer a service or goods This
is achieved by using the factors of production, namely:

 Human resources

 Land

 Capital

 Entrepreneurship Of all these HR is definitely the most

important since all the others depend on it.

HRM Involves:

 Acquiring the right number of employees for the organisation

 Deploying them to their right places

 Directing them from in their day-to-day operations

 Ensuring that they keep on the right track for which they were
recruited

Definitions

Health work force means health human resource

Health care delivery is a holistic and integrated health care.

Management means; planning, coordinating, directing and

controlling delivery of business of an organization that is getting
things done through other people.

HRM specialist is a professional HR manager while a Line

manager is one with a supervisory control and authority over a
number of people.

Concepts of HRM

HRM promoters the following concepts in order to attain the

objectives of the organisation.

 Strategic integration: this refers to the integration of HRM

policies into organisation wide strategic plans such as; selection,
training, and development into a coherent whole. This strategic
approach requires top management to assume full responsibility
for seeing that there is strategic fit between business and HR
strategies.

 Commitment: This refers to voluntary identification with the

organizational goals which (David Guest) terms a strong belief
in and acceptance of an organisation’s goals and values.

 Flexibility: This comprises of functional and numerical

flexibility. Functional flexibility encompasses multi-skilling
Numerical flexibility includes; downsizing and performance
related pay.

 Quality: It includes behaviours and practices which ensure

quality and productivity at all levels.

 Mutuality: It among others connotes mutuality of purpose,

intent and ownership of and organisation’s core values.

 Coherence: This refers to the development of a mutually

reinforcing, supporting, interactive and interrelated set of human
resources and employment policies and programmes that;
Jointly contribute to the organisational strategies. Match
resources to the organizational needs. Foster improvements in
performance that lead to an organisation’s competitive
advantage.

Shift from personnel management to HRM:

 There was a shift from “personnel management” to HRM in

the 1980’s

 Personnel management was seen as an approach which

managed personnel issues on a day-to-day basis looking at
salaries, wages, training, recruitment, dispute resolution etc

 It looked at personnel issues as and when they arose

 HRM on the other hand looks at both the interests of the

organisation and those of the personnel.

 Whereas PM will concentrate in managing a dispute, HRM

concentrates in ensuring that disputes do not arise.

 HRM can be said to have developed from PM with a move

towards planning and integration of management tasks into the
organization’s strategy.
The functions of HRM: There are basically 4 functions of
HRM

 Planning

 Organizing

 Leading

 Controlling

Planning Function

This involves planning in advance what quantity of human

resources is needed for adequate performance of the tasks at
hand,

Organizing Function This involves deployment of the workers

by assigning them to their tasks and departments. This is done
after giving them the relevant tools for the tasks

Leading Function This involves the HR managers providing

effective leadership that encourages the workers to be more
productive. Thus, the managers must

 Monitor the workers

 Handle or minimize conflicts amongst the workers

 Ensure both downward and vertical communication within the

organisation

Controlling Function This involves the regulation of activities to

ensure that every thing happens as earlier planned, otherwise
corrective measures should be instituted through training,
promotion, demotion, dismissal, disciplinary action etc

HRM Responsibilities/ practices

 Human Resource Planning (HRP); - This involves demand

analysis and supply analysis

 Recruitment and selection

 Induction and Orientation

 Job analysis

 Performance management;

 Appraisal

 Reward management

 Motivation

 Employee relations
 HR career development,

 Training and development

 Organisation development

 Communication.

Human Resource Planning (HRP)

It is planning for the future personnel needs of an organization

required to meet its overall goals, taking into accounts both
internal activities and factors in the external environment.

 This involves demand analysis and supply analysis

 Organizations need to do human resource planning so they

can meet business objectives and gain a competitive advantage
over competitors.

 Human resource planning compares the present state of the

organization with its goals for the future

 Then identifies what changes it must make in its human

resources to meet those goals

Planning procedures: -
a) Planning for the future needs: -deciding how many people
with skills the organization will need.
b) ) Planning for the future balance: -number needed vs employ
who can stay with the organization.
c) Planning for recruiting or laying off employees and
d) Planning for the development of employees, so as to be sure
the organization has a steady supply of experienced and
capable personnel.

Human Resource Planning Process

The process consists of three stages:

 Forecasting

 Goal setting and strategic planning

 Program implementation and evaluation

HUMAN RESOURCE, STAFF RECRUITMENT AND

SELECTION.
It is the process of developing a pool of potential employees in
accordance with a human resource plan which an organization
can depend on when it needs additional employees.
It includes: -

 Job description: -Job analysis – the process of gathering,

analysing, and recording clear ideas regarding the activities and
responsibilities required in the job firm.

 Position description: - description of the management position,

covering the title, duties and responsibilities & its position in the
organization chart.

 Hiring /job specification: - is a written description of the

education, experience, and skills needed to perform a job or fill
a position effectively

Sources for recruitment: -

Internal sources or recruitment from within (peer recruitment)

Advantages

 Individuals are already familiar with the organization and its

members (well informed) and this knowledge increases the
likelihood they will succeed

 Fosters loyalty and inspires greater effort among organization

members
 Usually less expensive

Disadvantages: -

 Limits the pool of available talent

 Reduces the chance that fresh points will enter the organization

 May encourage complacency among employees who assume

seniority assures promotion

External sources or recruitment from outside

Methods of recruitment:

 Direct methods-from educational & professional training

institutes

 Indirect methods-formal advertisement/ announcement using

mass media (radio, news paper...)

 Third party methods-using commercial or private employment

agencies, state agencies, professional associations.

Legal considerations: -

 Prohibiting discrimination by race, sex, age, colour, national

origin
 Equal employment opportunity for example to both public and
private sectors.

 Affirmative action: for female and minorities

 Equal pay: like pay for like jobs

 Comparable worth: the principle that different jobs that require

comparable skills and knowledge deserve comparable pay.

Recruitment procedure

This takes the following steps:

 Vacancy identification;

 Sourcing for a candidate by advertising;

 Collecting and screening applications;

 Appointment – interviews, selection & placement;

 Induction;

 Probation

Selection

Involves mutual decision whereby the organization decides

whether or not to make a job offer and the candidate decides
whether or not to accept the job. The seven steps in the selection
process: -

1) Completed job application: - indicates applicant’s desired

position, provides information for the interviews

2) Initial screening: - provides a quick evaluation of applicant’s

suitability. In the information exchange the organization may
exaggerate its strength and candidate may overestimate his/her
quality.

3) Testing: - measures applicant’s job skills and the ability to

learn on the job. Provide realistic job review (strength and
weaknesses).

4) Back-ground investigation: - checks truthfulness of

applicant’s resume on application form.

5) In depth selection interview: -find out more about the

applicant as an individual (explore the facts and get the attitude
of the applicant and his/her family to the job and to the
company).
6) Physical examination: -for effective performance, to protect
staff from communicable disease, to avoid unjust worker’s
compensation claims.

7) Job offers in actual practice emphasis differs from low level

to high level profession

Appointment

The appointment letter should contain the following important

a) The job title;

b) Responsibilities;

c) Duty station;

d) Job grade;

e) Benefits;

f) Contract duration;

g) Effective date of commencement;

The new staff should accept in writing & sign employment

contract.

Types of appointment
 Fixed-term contract: It is an appointment whose duration is 1-2
yrs., renewable;

 Temporary: It is an appointment of a maximum of 3 months

contract;

 Permanent and pensionable: It is an appointment which is

only terminated by retirement e.g., the civil service;

INDUCTION AND ORIENTATION

Induction is an orientation programme aimed at introducing new
employees and settles them in their new jobs

The process involves:

 Organization background;

 Organization programs and activities;

 Organization mission;

 Organization structure;

 Introduction to staff;

 Organization policies;

 Administrative and financial procedures

Orientation or socialization of staff It is designed to help the
new employees fit into the organization smoothly.

Three types of information are conveyed: -

1) General information about the daily routine activities.

2) A review of the organization- history, purpose, operations,

products/services, expected contribution of the employee to the
organization.

3) Detailed presentation of the organization’s policies, rules,

benefits, brochure

Employee concerns: -

 Anxious to the new environment and worry how they will

perform in the job

 Feel inadequate experience in relation to job (organization)

and experienced employees

 How to along with other employee

 Personal and family problems

Solution;
Effective socialization programs: - provide information,
introduce, encourage questions

JOB ANALYSIS

Job Analysis The process of obtaining information about jobs

by determining what the duties, tasks, or activities of jobs are.

HR managers use the data to develop job descriptions and job

specifications that are the basis for recruitment, training,
employee performance appraisal and career development.

The ultimate purpose of job analysis is to improve

organizational performance and productivity.

Common techniques of Job Analysis

• Questionnaire

• Check List

• Individual interview

• Observation

• Group interview

• Technical conference
• Dairy/self-description/self-report

• Critical incident

• Document scanning i.e., scanning individual records.

STAFF APPRAISAL

Performance Appraisal; The process by which an employee’s

contribution to the organization during a specified period of time
is assessed.

Performance Feed-back: Let’s employees know how well they

have performed in comparison with the standards of the
organization.

Characteristics of a Good Appraisal System

 Criteria

 Validity

 Reliability

 Freedom from bias: errors

Practicality Performance appraisal

It is the process of reviewing individuals past productive activity
to evaluate the contribution they have made toward attaining
management system objectives. It is a continuous activity, of
learning from experience.

OR: Performance Appraisal is the systematic evaluation of the

performance of employees and to understand the abilities of a
person for further growth and development.

Performance appraisal is generally done in systematic ways

which are as follows

1. The supervisors measure the pay of employees and compare it

with targets and plans.

2. The supervisor analyses the factors behind work

performances of employees.

The employers are in position to guide the employees for a

better performance.

Types: -

 Informal appraisal: - feedback on day-to-day performance

(strength / weakness)
 Formal systemic appraisal: - A systemic feedback about
performance (semi-annually or annually).

 Purpose:

To formally rate current performance and give constructive

feedback

 To recognize outstanding performance

 To identify candidates for promotion (merits)

 To locate employees who need additional training

 It is important for managers to differentiate between the

current performance and the probability (potential performance)
of employees.

 Who is responsible for formal performance appraisal (rating

employee)?

1. Manager’s rating – commonest

2. Group of manager’s rating – a managerial committee,

second commonest and more effective than a single
manager.

3. Group of peers rating – co-workers

 4. Employees rating of bosses

5. Combination of methods

Basic requirements of a good performance appraisal

measure

1. Relevance – judgment about how much a particular

performance measures contribute to assessing a given job.

2. Accountability – how much influence the individual

employed has over the performance being assessed.

3. Reliability – how consistently a measure of performance

applied to the same employee by different appraisers.

4. Validity – the extent to which the measure of performance

actually reflects that performance.

5. Fairness – the extent to which the measure of performance

among employees solely on the basis of difference in
performance.

6. Practicality – is the extent to which measure of performance

can be applied without undue time and effect.

Objectives of Performance
Appraisal Performance Appraisal can be done with following
objectives in mind:

 To maintain records in order to determine compensation

packages, wage structure, salaries raise, etc.

 To identify the strengths and weaknesses of employees to

place right men on right job.

 To maintain and assess the potential present in a person for

further growth and development.

 To provide feedback to employees regarding their

performance and related status.

 It serves as a basis for influencing working habits of the

employees.

 To review and retain the promotional and other training

programmes.

Accomplishments of performance Appraisal

It is said that performance appraisal is an investment for the

company which can be justified by following advantages:
  Promotion: Performance Appraisal helps the supervisors to
chalk out the promotion programmes for efficient employees. In
this regards, inefficient workers can be dismissed or demoted in
case.

 Compensation: Performance Appraisal helps in chalking out

compensation packages for employees. Merit rating is possible
through performance appraisal. Performance Appraisal tries to
give worth to a performance.

Compensation packages which include bonus, high salary rates,

extra benefits, allowances and pre-requisites are dependent on
performance appraisal. The criteria should be merit rather than
seniority.

 Employees Development: The systematic procedure of

performance appraisal helps the supervisors to frame training
policies and programmes. It helps to analyse strengths and
weaknesses of employees so that new jobs can be designed for
efficient employees. It also helps in framing future development
programmes.

 Selection Validation: Performance Appraisal helps the

supervisors to understand the validity and importance of the
selection procedure. The supervisors come to know the validity
and thereby the strengths and weaknesses of selection
procedure. Future changes in selection methods can be made in
this regard.

 Communication: For an organization, effective

communication between employees and employers is very
important. Through performance appraisal, communication can
be sought for in the following ways:

 Through performance appraisal, the employers can

understand and accept skills of subordinatee.

 The subordinates can also understand and create a trust

and confidence in superiors.

 It also helps in maintaining cordial and congenial labour

management relationship.

 It develops the spirit of work and boosts the morale of

employees.

 All the above factors ensure effective communication.

 Motivation: Performance appraisal serves as a motivation

tool. Through evaluating performance of employees, a person’s
efficiency can be determined if the targets are achieved. This
very well motivates a person for better job and helps him to
improve his performance in the future.

Biases during appraisals

Managers commit mistakes while evaluating employees and

their performance. Biases and judgment errors of various kinds
may spoil the performance appraisal process. Bias here refers to
inaccurate distortion of a measurement. These are:

First Impression (primacy effect): Raters form an overall

impression about the ratee on the basis of some particular
characteristics of the ratee identified by them. The identified
qualities and features may not provide adequate base for
appraisal.

Halo Effect: The individual’s performance is completely

appraised on the basis of a perceived positive quality, feature or
trait. In other words, this is the tendency to rate a man uniformly
high or low in other traits if he is extra-ordinarily high or low in
one particular trait. If a worker has few absences, his supervisor
might give him a high rating in all other areas of work

Horn Effect: The individual’s performance is completely

appraised on the basis of a negative quality or feature perceived.
This results in an overall lower rating than may be warranted.
“He is not formally dressed up in the office. He may be casual at
work too!”

Excessive Stiffness or Lenience: Depending upon the rater’s

own standards, values and physical and mental makeup at the
time of appraisal, ratees may be rated very strictly or leniently.
Some of the managers are likely to take the line of least
resistance and rate people high, whereas others, by nature,
believe in the tyranny of exact assessment, considering more
particularly the drawbacks of the individual and thus making the
assessment excessively severe. The leniency error can render a
system ineffective. If everyone is to be rated high, the system
has not done anything to differentiate among the employees.

Central Tendency: Appraisers rate all employees as average

performers. That is, it is an attitude to rate people as neither high
nor low and follow the middle path. For example, a professor,
with a view to play it safe, might give a class grade near the
equal to B, regardless of the differences in individual
performances.

Personal Biases: The way a supervisor feels about each of the

individuals working under him - whether he likes or dislikes
them as a tremendous effect on the rating of their performances.
Personal Bias can stem from various sources as a result of
information obtained from colleagues, considerations of faith
and thinking, social and family background and so on.

Spill overs Effect: The present performance is evaluated much

on the basis of past performance. “The person who was a good
performer in distant past is assured to be okay at present also”.

Recency Effect: Rating is influenced by the most recent

behaviour ignoring the commonly demonstrated behaviours
during the entire appraisal period.

NB: Therefore, while appraising performances; all the above

biases should be avoided.
TRAINING AND DEVELOPMENT OF HUMAN
RESOURCE

It is a process designed to maintain or improve current job

performance of employees?

 Non managers are much more likely to be trained in the

technical skills required in their current jobs; whereas managers
frequently receive assistance in developing the skills required in
future jobs- particularly conceptual and human relation skills.

 Importance: -

 Well trained and experienced people to perform activities-

increasing productivity
 Job satisfaction to the employee
 Training enables personnel gain individual growth and
prevents man power obsolescence and others.

 Training: enhances the capabilities of an employee to perform

his or her current job

 Focuses on the current job

 Examples for a bank teller:

 Training program to correctly identify counterfeit currency

  Training program in the bank’s new computer system used
by tellers to process customer’s transactions

Procedures to determine training needs A pre requisite to

initiate appropriate training effort

1) Performance appraisal: measure work against the standards

2) Analysis of job requirement: Vs the available skill

3) Organizational analysis: effectiveness of organization. Train

those with low performance and high turnover.

4) Employee survey: about problems faced and suggested

actions.

The training needs

 For ordinary people- orientation or induction, on the job

training, sales service or special purpose training

 Supervisory staff need an additional training in personnel

management

 Middle level managers need more theoretical knowledge than

the practical one
 Top managers need to be trained in the fundamental principles
of management and management functions.

A good training program must

 Allow individual differences (ability, interest, emotion)

 Be relevant to job requirements

 Determine the training of employees

 Have suitable incentives

 Be supported by the management

 Teach both the theory and practice simultaneously.

Approaches to training:

 On- the- job training: - job orientations, skill learning

 Coaching- by immediate supervisor (unnecessary influence of

employee by the coach).

 Job rotation-variety of jobs familiarized.

 Internship: -job training combined with related classroom

instruction.
 Apparent ship: - training under guidance of a high skilled co-
worker.

 Offering training/assistant positions by bright managers.

 Planned work activities: -assignments, expose to new

ideas/face...

 Off- the- job training: - training takes place outside the

working place but attempts to simulate actual working
conditions

 Vestibule training: - training on realistic job or equipment.

 Behaviourally experienced training: simulation exercises,

cases, games, role playing; outside the organization.
Training cycl

PERFORMANCE MANAGEMENT
PM has the following advantages to an organisation:

 Assist staff to better understand their jobs;

 Enable staff see their “fit” in the organisation’s mission;

 Develop work objectives;

 Set targets for their performance;

 Improve cross functional work relationships;

 Motivate staff

Practices in performance management

HR Appraisal

It is the measurement of performance standards of HR of an

organization to determine its contribution to outcomes.

Job Evaluation Is the organizational judgment on the importance

or worth of each job to the organization as a whole.

It involves looking at:

 Skills – education, experience, initiative etc;

 Responsibilities – of the job holder;

 Efforts – physical demand, mental demand;

 Job conditions – under which the job holder is working.

Uses of PA

 Review of performance against the job description;

 Improving job performance;

 Mutually identifying strengths and weaknesses;

 Means of agreeing appropriate corrective actions

 Helping to identify individual talents and meet career

development needs.

Promotions, transfers, demotions, and separations

Promotions – moving to a higher position and responsibility

 Often serves as a major incentive for superior managerial

performance 4 0

 The most significant ways to recognize superior performance.

 Therefore: -

 Promotions should be fair - based on merit and untainted

by favouritism.
 Problems: -

 Some may be bypassed: - feel resentful, moral and

productivity decreases.
 Discrimination: - sex, race, are, and, minority.

Transfers - shift to other positions.

Advantages: -

 For experience in various positions.

 To fill vacancies

 To keep promotion ladders open

 To keep individuals interested in the job

 Sometimes, for those with inadequate performance

Problem: - refusal for transfers due to family problems.

Discipline, Demotions, and Separations

 When the organization’s policy is violated or when an

employee falls short of work expectations.

 Usually progresses through a series of steps.

 Warning
  Reprimand
 Probation
 Suspension
 Disciplinary transfer
 Demotion
 Discharge

For poor performance, separation is better than letting the

employee stay on the job. But consider employee rights.

Disciplinary procedure This procedure generally follows the

steps outlined below:

 Verbal warning

 Written warning

 Final written warning

 Dismissal

 Summary dismissal

 Appeal against disciplinary measure

Termination
Reasons for termination of an employee’s services:

1. Provisions of disciplinary procedures;

2. Failure to meet set standards;

3. Consistent poor performance of duties;

4. Inability to carry out the duty of the post as prescribed

5. Certified permanently unable to work by a medical

practitioner;

6. Imprisonment or conviction of an offence

7. Expiry of contract;

8. Temporary or permanent closure of project/organisation;

9. Redundancy of the job performed; Grievance

MOTIVATION

Definitions

Motivation is a psychological feature that arouses an organism

to act towards a desired goal and elicits, controls, and sustains
certain goal-directed behaviours.
OR: It can be considered a driving force; a psychological one
that compels or reinforces an action toward a desired goal.
Motivation is the purpose or psychological cause of an action.

OR: Motivation is an inner drive to behave or act in a certain

manner. "It's the difference between waking up before dawn to
pound the pavement and lazing around the house all day’’. These
inner conditions such as wishes, desires and goals, activate to
move in a particular direction in behavior.

OR: Motivation therefore is getting people to move in the

direction that will achieve particular results

Sources of motivation

Motivation at work can be by self (intrinsic) or by others

especially management (extrinsic) Sources of motivation can be
divided into two types: intrinsic (internal) motivation and
extrinsic (external) motivation.

Intrinsic motivation

Intrinsic motivation refers to motivation that is driven by an

interest or enjoyment in the task itself, and exists within the
individual rather than relying on external pressures or a desire
for reward. Intrinsic motivation is a natural motivational
tendency and is a critical element in cognitive, social, and
physical development. Health workers who are intrinsically
motivated are more likely to engage in the tasks more willingly
as well as work to improve their skills, which will increase their
capabilities.

Sources of intrinsic motivation include:

 Responsibility

 Commitment to reliability and quality

 Commitment to deliver a service

 Desire and willingness to develop and use knowledge,

competence and skills

 Personally set standards of quality

Extrinsic motivation

Extrinsic motivation refers to the performance of an activity in

order to attain an outcome, whether or not that activity is also
intrinsically motivated. Extrinsic motivation comes from outside
of the individual

Sources of extrinsic motivations

 Praise

 Rewards e.g., money or grades

 Challenging and interesting work

 Freedom of action

 Recognition

 Promotion

 Increased pay

 Disciplinary actions

 Constructive criticism and others

NB: Competition is in an extrinsic motivator because it

encourages the performer to win and to beat others, not simply
to enjoy the intrinsic rewards of the activity. A cheering crowd
and the desire to win a trophy are also extrinsic incentives.
Others types include

Positive motivation

This involves proper recognition of employee efforts and

appreciation of employee contribution towards the
organizational goal achievement. Positive motivation improves
the standard of performance, leads to good team spirit and pride,
a sense of cooperation and feeling of belonging and happiness.

Examples of positive motivators

 Praise and credit for work done

 Sincere interest in the welfare of subordinates

 Delegation of authority and responsibility to subordinates

 Participation of subordinates in the decision-making process.

Negative or fear motivation

This motivation is based upon force, fear and threats.

The fear of punishment or unfavourable consequences affects

behavioural changes, like fear of failing in the exam, fear of
being fired or demoted. However, this approach should be
avoided since it creates hostile state of mind which affects sense
of loyalty and cooperation which may result in poor
performance and low productivity.

Motivation theories

1. Instrumentality theory: reward or punishment (carrot or

stick) will make people behave in the desired way

2. Content theory: motivation is about taking action to satisfy

needs and people adapt different behaviours to satisfy these
needs-Abraham Maslow's Hierarchy of Needs, Douglas
McGregor's X and Y motivation theories.

3. The self- fulfilling prophecy: People behave the way they

are treated; treat them as if they were trust worthy and they will
behave trust worthy. In most cases managers have with their
subordinates the relationship they deserve. In more general
terms, we have with people the relationship that we deserve.

Note
 Workers in any organization need something to keep them
working. Most of the time, the salary of the employee is not
enough to keep him or her working for an organization.

 An employee must be motivated to work for a company or

organization. If no motivation is present in an employee, then
that employee’s quality of work or all work in general will
deteriorate.

 People differ on a personality dimension called locus of

control. This variable refers to individual's beliefs about the
location of the factors that control their behavior. At one end of
the continuum are high internals who believe that opportunity to
control their own behavior rests within themselves.

 For such individual’s internal motivation is paramount. At the

other end of the continuum there are high externals who believe
that external forces determine their behavior. For this group
extrinsic motivation is more important.

Motivation process

Steps of the motivation process

 Analysis of the situation requiring motivation: This involves
critically analysing the situation so as to ascertain whether
motivation is necessary. Putting in mind that members of the
group have different needs hence difference in the motivating
factors/need.

 Preparing, selecting and applying appropriate motivators:

This step requires one to list all devices of motivation, a
selection made of such motivators that motivate different people
under different circumstances. Proper timing and extent of
motivation is also considered

 Follow up on the results of application: There is need to

know that the selected motivators are indeed providing the
desired motivation. This can be accomplished by getting and
evaluating the feedback. if these motivators are not showing the
optimum effect, then alternative motivation should be selected
and applied.

Tips for Motivating Employees

Motivated employees make fewer mistakes, have higher

productivity, and tend to remain with a company.
Motivating employees is an element of performance
management. It is accomplished through several important
performance management strategies including:

 Job security: A stable working environment is a very

important trait. Organizations that have a low-turnover rate and
provide employees with job security will have highly motivated
employees. People who are afraid of losing their jobs will be
less motivated to do well and may become disengaged.

 Good pay: Proper compensation, promotions and raises are

always helpful. However, once an employee has reached a
respectable salary other incentive such as a good work
environment, job security, safety, and respect weigh more
heavily.

 Perks or incentives: Keeping employees happy by providing

various perks and incentives. For example, some companies
have corporate events like company picnics or quarterly dinners.
Other companies offer their employees discounted travel fees or
merchandise.

 Continuing education programs/scholarships: Offering

programs such as continuing education classes, tuition
reimbursement, and scholarships show employees that you are
interested in them and their future.

 Opportunities for growth: The opportunity for promotion

and advancements motivates employees to perform well and
achieve their goals.

 Recognition: Recognizing and rewarding employees for

outstanding performance and going above and beyond the call of
duty. This helps employers show their employees that their hard
work does not go unnoticed.

Intrinsic motivators

 Sense of meaningfulness: This reward involves the

meaningfulness or importance of the purpose you are trying to
fulfill. You feel that you have an opportunity to accomplish
something of real value—something that matters in the larger
scheme of things. You feel that you are on a path that is worth
your time and energy, giving you a strong sense of purpose or
direction.

 Sense of choice: You feel free to choose how to accomplish

your work—to use your best judgment to select those work
activities that make the most sense to you and to perform them
in ways that seem appropriate. You feel ownership of your work,
believe in the approach you are taking, and feel responsible for
making it work.

 Sense of competence: You feel that you are handling your

work activities well—that your performance of these activities
meets or exceeds your personal standards, and that you are
doing good, high-quality work. You feel a sense of satisfaction,
pride, or even artistry in how well you handle these activities.

 Sense of progress: You are encouraged that your efforts are

really accomplishing something. You feel that your work is on
track and moving in the right direction.

Motivation strategies

The following are strategies aimed at obtaining an ever-

improving performance through policies and practices that can
inspire and motivate employees.

Valuing employees Involves:

 Investing in their development and success

 Trusting and empowering them

 Making them responsible

 Openness and sincerity

 Financial and non-financial rewards.

Obtaining behavioural commitment

 Creating a high trust environment

 Clarifying, sharing and reinforcing values

 Building commitment

Good Leadership as a motivator

 Honest, competent, open leaders are one of the greatest

motivating factors

 They create and direct energy around them

 They create vision and strategy

 They inspire their collaborators

 They make people want to work with them

Other potential motivators

 Performance management
 Employees development

 Promotion of self-managed learning

TEAM WORK

A team is a group of two or more individuals, who perform

some work-related tasks, interact with one another dynamically,
have a shared past, have a foreseeable shared future, and share a
common fate. OR: A team is a group of people with
complementary skills working towards a common purpose that
they hold themselves mutually accountable.

Teamwork involves different people and different people

working together to maximize their efficiency and reach a
common goal.

In health care setting teamwork is defined as a dynamic

process involving two or more healthcare professionals with
complementary backgrounds and skills, sharing common health
goals and exercising concerted physical and mental effort in
assessing, planning, implementing or evaluating patient care.
Group: Robbins (2001) defines a group as two or more
interdependent individuals who have come together to achieve
particular objectives.

Team: group who work intensively with each other to achieve a

specific common goal.

Team: A small group of people with complementary skills, who

work together to achieve a shared purpose and hold themselves
mutually accountable for performance results.

Teamwork: The process of people actively working together to

accomplish common goals

Achieving organization's objectives

For a team to achieve organization's objectives, individuals

must:

 Get to know one another

 Establish good working relationship

 Determine & establish individual commitment and

accountability Identify problem areas

Team Building Lessons from the Geese

 You might be interested in knowing what science has
discovered about why they fly that way.

Fact: As each bird flaps its wings, it creates uplift for the bird
following. By flying in a ‘V’ formation, the whole flock adds
71% more to its flying range than if each bird flew alone.

Lesson: Teammates who share a common direction and sense

of community can get where they are going quicker and easier
when they travel on shared power (thrust of one another).

Fact: When the lead goose tires, it rotates back into the
formation and another goose flies at the point position.

Lesson: It pays to take turns doing the hard tasks and sharing
the leader’s role. As with geese, people are interdependent on
each other’s skills, capabilities and unique arrangements of gifts,
talents or resources.

Fact: When a goose falls out of formation, it suddenly feels the

drag and resistance of trying to fly alone. It quickly gets back
into the formation to take advantage of the ‘lifting power’ of the
bird immediately in front of it.
Lesson: If we have as much sense as a goose, we will stay in the
formation with those who are headed where we want to go. We
are willing to accept their help and give our help to others.

Fact: In formation, the geese from behind honk to encourage

those in front to keep up their speed.

Lesson: We need to make sure our honking is encouraging. In

groups where there is encouragement, the production is much
higher. The power of encouragement (to stand by one’s heart or
core values and encourage the heart or core values of other) is
quality honking we seek.

Fact: When a goose is sick or wounded, two geese drop out of

the formation to help and protect it. They stay with it until it
either able to fly or dies. Then they launch out on their own with
another formation or catch up with their flock.

Lesson: Stand by one another in times of trouble.

Characteristics of effective teams

 Members communicate their vision & mission to each other

 Plan ahead

 Encourage communication and participation

 Practice team work from the top

 Enhance customer satisfaction

 Encourage creativity and growth

 Members have one or more common goals

 Fosters positive criticism

 Promote a win-win culture

 Members share resources

 Celebrate success & work on improving failures

 Members solve problems together.

 The team allows both individuals and the group to develop and
learn

Key factors to successful performance of a team – The

S.C.O.R.E Approach This approach is described below as:

 S=Strategy
 C=Clear Roles and Responsibility

 O=Open Communication

 R=Rapid Response

 E=Effective Leadership

Strategy

 Have a clear purpose/ mandate of the team and this must be

known/shared by all (Shared Purpose)

 Have clearly articulated values and ground rules that will

guide the operations of the team

 Members must have a clear understanding of risks and

opportunities facing the team

 Members must have clear roles and responsibilities of the

team

Clear Roles and Responsibilities:

 Clear definition of roles and responsibilities

 Responsibility must be shared by all members.

 Set specific objectives to measure individual results

 Design a systematic monitoring and reviews periods through
which members understanding of issues are enhanced.

Open communication:

 Respect for individual differences,

 Open communication environment among team members

Rapid Response

 Rapid response to the team’s problems and organizational

needs as well

 Effective management to change in the internal and external

environment

Effective Leadership

 Team leader who is able to help members achieve the

objective and build the team

 Team leader who can draw out and free up the skills of all
team members, develop individuals Team building pillars

 The effectiveness of a team is facilitated by the interplay of

several factors:

 Sound leadership
 Support from each other

 Clear work processes and procedures

 Trust and openness

 Workplace democracy/participation

 Motivation

 Mutual respect

Stages of Team Development These include the following:

Forming

 At this stage, the group is just coming together and feelings

may still be individualistic.

 It is a period of transition from individual to group member

status.

 In here, members try to learn/understand each other.

 Members form opinion of team mates

 Period in which members guard their interactions (personal

space) because they’re not sure what to expect from other team
members

 During this stage, productivity of the group is low.

 Questions are asked about the task and how it will be done;
who the other members are and if they belong; perceived
concepts, issues and barriers.

 During this stage, people are generally polite and conflict is

usually avoided.

 Individual team members are looking towards the team leader

for direction and guidance.
What should a team leader do at this stage?

 Concentrate on focusing the team;

 Defining goals,
 Roles and responsibilities.
 Set clear expectations
 Setting ground rules
 Developing a climate of trust and respect

 Communication is primarily one-way from the team leader to

team members

Storming

 This is the most difficult stage for a team.

 Characterized by competition and strained relationships

among team members.

 There are various degrees of conflict dealing with issues of

power, leadership and decision- making.

 Conflicts emerge between sub-groups;

 The authority or competence of the leader is challenged.

  Individuals react over the efforts of the leader or group to
control them

 The value and feasibility of the task is questioned.

 Co-operation can take second place as team members try to

individually trust more in their own skills and attributes.

What should the team leader do?

 The leader clarifies team activities, fine- tuning roles and

responsibilities.

 Communication is more multiway between team leader and

team members.

 Return to ground rules if needed.

 Continue to play the ‘traffic cop’ as needed

Norming

 Competition becomes co-operation

 Members realize their commonalities and learn to appreciate

their differences.

 Functional relationships are developed resulting in the

evolution of trust among members.
  Guidelines and ground rules for getting the work done are
established.

 Team members begin to value contribution of others.

 Team members share their feelings and ideas about how to do

the task, how to work out differences and disagreement.

 There is a fresh ability to achieve harmony and express

criticism constructively.

 A sense of team cohesion evolves.

 Personal conflicts are minimized.

 Roles and responsibilities are clearly defined and agreed to.

What should the team leader do?

 Involve the team in setting its own goals and direction.

 Communication is multiway with the team leader acting as an

active member.

Performing

 In the final stage, the team actually gets its work done, making
up for the seemingly ‘lost time’ in the earlier stages.

 Team is acting and working as one.

 Individuals and their contributions are valued, objectives are
clear.

 Members fully understand their individual roles and the roles

of others, problems are being solved and actions implemented.

 During this stage, the team gains insight into:

 How efficiently it is getting the task done,

 What more can be done,
 How things can be done better and if the deadlines are
being met.
 There is close attachment to the team and satisfaction with
the process.

Adjourning

Temporary project team reaches this stage; celebrate their team’s

achievements.

General note on stages of team Development

 Some teams spend very little time in forming, storming and

norming phases.

 If a team is relatively homogeneous and given a well-defined

task, the first three stages might be as short as five (5) minutes.
 If on the other hand, people do not know each other, come
from diverse backgrounds and points of view, and are given a
complex set of tasks; these first stages may take considerable
time over several meetings.

Team leader's role.

The supervisor as team leader plays an important role in a team:

 Sometimes involved in the selection of team members

 Ensures the achievement of standards and the discipline of

team members

 Allocation and scheduling of duties

 Controlling the use of resources

 Directing the formation of team strategy and plans

 Spokesman/negotiator for the team

 Provides an open communication system

 Making follow-ups and encouraging members to do so

 Clarifying objectives and organizational policies to members

Benefits of team work

 Problems solving: A single brain can’t bounce different ideas
off of each other. Each team member has a responsibility to
contribute equally and offer their unique perspective on a
problem to arrive at the best possible solution. Teamwork can
lead to better decisions, products, or services.

 Accomplish tasks faster: A single person taking on multiple

tasks will not be able to perform at a same pace as a team can.
When people work together, they can complete tasks faster by
dividing the work to people of different abilities and knowledge.

 Healthy competition: A healthy competition in groups can be

used to motivate individuals and help the team excel.

 Developing relationships: A team that continues to work

together will eventually develop an increased level of bonding.
This can help people avoid unnecessary conflicts since they
have become well acquainted with each other through team
work.

 Everyone has unique qualities: Every team member can offer

their unique knowledge and ability to help improve other team
members. Through teamwork the sharing of these qualities will
allow team members to be more productive in the future.
 Improved Morale: Teamwork allows employees to take greater
responsibility for decision making and also allows team
members to control more of the work process. This can lead to
improved morale as employees gain more authority and
ownership over the projects they are working on. The extra
responsibility can lead to a more rewarding work environment
and lower turnover. Working on a team also gives employees a
greater sense of belonging and of recognition, which helps them
take more pride in their work, and their company.

Dangers of team work

 Teamwork may have an "unintended effect of fermenting

hostility toward the managerial goal of making the teams fully
self-managing.

 There is a potential of "social loafing" (i.e., an individual's

doing less work in a team than what he/she would normally do
working individually). In order to minimize social loafing,
management can make individual performance more visible
while in a team setting. This can be done by forming smaller
teams, specializing specific tasks to certain individuals, and
measuring individual performance.
  Possible development of the dependence syndrome among
team members

 Minority views and opinions may be easily neglected or

frustrated

 There is delay in decision making

How to Improve Teamwork in the Workplace

Once you have your team in place, here are a few general tips to
make sure the collaborative process runs smoothly:

 Don't let individuals get lost in the shuffle. Even though a

team is a collaborative effort, each member should be allowed to
feel a sense of ownership and accomplishment. Members should
be rewarded for a job well done, and given encouragement and
guidance when they need additional help completing a task.

 Let each team member actively take part in the decision-

making process. Making each member feel integral to the
group's success is crucial for the team's morale.

 Minimize the importance of rank; instead take advantage of

the entire group's talents and skills to contribute to its overall
success. However, there must be one clear leader who can make
the final decision if the team can't agree.

 Keep the balance of work equal. One or two team members

shouldn't be shouldering the burden for the entire group.
Everyone should have a manageable and relatively equal
workload.

 Build a foundation of trust and mutual respect. Each team

member should be encouraged to share his or her opinions
openly and respect everyone else's point of view - even if they
don't agree with it.

 Maintain open lines of communication. Everyone in the team

should share ideas or express concerns with one another and
with the company's management.

 When conflicts arise, take a positive approach. Avoid

confrontation and blame. Keep your focus on the issues.

Discuss the Features of a Bad Team

 Frustration (Self-denial, lack of commitment and motivation)

 Conflicts

 Un clear roles
 Dominance by some parties

 Expression employees wear on their faces (Unhappy show

less team work)

 Openness and honesty (Lack of confiding in managers, fearful

characters show less team work

Problems encountered with work processes

Working with teams present several problems in different areas

as follows:

Problems Decision making

 Clarity of individual responsibilities

 The extent to which decisions need to be made by consensus

 How decisions are made in the absence of an individual

Problems with processes

 How are decisions taken? Are authority levels clear?

 Are communication processes across the team working?

 Are structures, content and processes in meetings effective?

 How are problems and conflicts resolved?

 How is activity coordinated? Are reporting procedures
understood and adhered to?

Problems with goals

 Do people understand and accept the team's primary task?

 What are the team's priority objectives? Do all agree?

 How are conflicts in priorities handled?

Problems with roles

 What do team members expect of each other?

 Have these expectations been shared? Do they match?

 Do individual objectives fit with the team's overall objectives?

 Are there areas of overlap or duplication between team roles

that could produce conflict?

Problems with relationships

 How do team members treat and feel about each other?

 Are people's individual needs recognized and respected/

 Does the team climate allow for open debate and sharing of
concerns?
 Do the team and leader encourage feedback on team and
individual performance?

CONFLICT AND CONFLICT RESOLUTION

Conflict is an expressed struggle between at least two

interdependent parties

OR: A battle, contest or opposing forces existing between

primitive desires and moral, religious or ethical ideas (Webster’s
Dictionary)

OR: A state of incompatibility of ideas between two or more

parties or individuals A conflict is an inherent incompatibility
between the objectives of two or more characters or forces.

OR: Any discontent or dissatisfaction that affects the

organizational performance

OR: It is a painful state or condition of an individual where

he/she experiences an intense emotional tension as a result one
having to choose between two equally desirable or equally
undesirable goals which are contradictory in nature.

OR; is a simultaneous occurrence of two opposing ideas

between two individuals or within the same individual.
OR: A conflict means a painful emotional state, which results
from a tension between opposed and contradictory wishes.
(Douglas and Holland)

NB: A Conflict is a natural and inevitable part of human social

relationship that occurs at all levels of society as a result of
differences in opinion or wishes

NB: Conflict is not the same as a problem. It only becomes a

problem after failing to resolve it. In many cases, conflict in the
workplace just seems to be a fact of life. We've all seen
situations where different people with different goals and needs
have come into conflict. The fact that conflict exists, however, is
not necessarily a bad thing: As long as it is resolved effectively,
it can lead to personal and professional growth. In many cases,
effective conflict resolution can make the difference between
positive and negative outcomes.

Classification of conflict

 Motivational conflict

 Interpersonal conflict

 Intrapersonal conflict
 Internal and External conflict

Motivational conflict It results from the simultaneous

occurrence of desires which cannot all be achieved.

It is divided into the following categories

 Approach – approach conflict

 Avoidance – avoidance conflict

 Approach - avoidance

 Multiple approach – avoidance conflict

Approach – approach conflict

It is the conflict that occurs when a person is forced with two

attractive alternatives, while only one of them can be selected
i.e., an individual is at the intersection of two options in that as
soon as something happens either to change his direction or
location slightly, he will move towards one of the goals. E.g.,
there are two courses that you want to take, but they are
scheduled for the sometime. Approach – approach conflicts are
usually easy to resolve but they become serious, if the choice of
one alternative means losing of an extremely attractive
alternative.
Avoidance – avoidance conflict

It arises when a person faces two undesirable situations and

avoidance of one expose you to the other. These types of
conflicts are very difficult to resolve and create intense
emotions. For example, a woman trying to choose between
continuing with an unwanted pregnancy and getting an abortion
done (she may morally be opposed to abortion.)

Approach – avoidance conflicts

It is a type of conflict that exists when one event or activity has

both attractive and attractive features. The result is continuing
oscillation between approach and avoidance creating a great deal
of emotional conflict and stress for example someone who wants
to have his wedding on the ocean yet he is afraid of the waves,
someone who wants to travel in the airplanes but he is afraid of
heights is in sort of this conflict.

Multiple approach – avoidance conflict

This conflict exists when a choice must be made between two or

more alternatives, each of which has both positive and negative
features. Such conflicts are the most difficult to resolve and to
make the right decision, the individual must analyse the
expected values of each course of action. For example, a person
may have an alternative of accepting any of the two jobs, of
which one may be boring but with very poor pay and other may
be interesting but with very poor pay. Either choice has a
positive and negative quality so which one does he chose? The
choice will be based on the person involved and his feelings
about the pay or work involved. When it is difficult to decide in
a double approach avoidance conflict people usually vacillate.
That’s they waver or go back and forth between the two choices.

Inter-personal conflict

It is the kind of conflict between person and person e.g.,

conflicts between children and parents, between employers and
employees, between two employers in the same department.
Intra-personal conflict This is the kind of conflict between a
person and his environment i.e., artificial acts and events which
people are powerless to prevent such as floods, drought,
earthquakes, fires, contagious diseases, ward, economic
depression and others, floods.

External and internal conflicts

External conflict is that kind of conflict that takes place outside
a person’s body. Internal conflict is the type of conflict that takes
place within a person, of motives, desires and impulses.
According to mental hygienists the internal conflict is more
dangerous than the external conflict. However, the internal
conflict can be further be divided into conscious conflict
(conflicts we are aware of its causes and sources) and
Unconscious conflict (conflicts that we are an unaware of its
causes and sources) The unconscious conflict is responsible for
many of our emotional disorders and mental illnesses.

Common causes of conflicts in organizations

Communication: infrequent or ineffective communication may

cause conflict for example, lack of feedback, misunderstandings,
lying, criticism etc

 Personal causes of conflict come from ego, personal biases,

and lack of empathy (for example, differing personalities,
perceived disrespect, past friction, differing backgrounds etc

 Process causes of conflict come from differing views about

what should be done or how it should be done for example
differing goals, differing approaches to a problem, differing
perspectives on an issue, and differing sources of information.

Preferred methods: Some people think that their way of doing

things is the right way and should therefore be used by others.

 Sharing or scarcity of resources: with limited resources,

most organizations share resources resulting in conflicts over
personnel, budgets, equipment, cars etc

 When the resources are limited, conflict is often unavoidable.

Priorities: Often people have and want others to share their

priorities.

 Personality style differences: People have different

personalities, Values, attitudes, Needs, expectations, perceptions
and social styles.

Power struggles: The need for control and power is at the root
of many conflicts in many workplaces for example whose office
is the most spacious? Whose opinion counts most in the final
decisions? Etc. These are all fertile grounds for conflict.
Values: People in the workplace judge their own behaviour as
well as those of others by what they believe should be done, by
the values that they hold

Levels of conflict

1. Intrapersonal

 Conflict occurs within us:

 When we are at not happy with ourselves

 For example, when we are torn between choices, we need to

make

 Or when we are frustrated with our goals or accomplishments.

 Conflict with us very often leads to conflict with others.

2. Interpersonal

 Conflict occurs between two or more individuals

 For example, an argument with a colleague etc

3. Intergroup

 Conflict occurs between groups in the work place

 For example, inter departmental conflicts Intergroup conflict

Conflict within a group

Indicators of conflict in a team

 Non-communication

 Poor meeting attendance

 Poor work performance

 Use of deviant language among members

 Dictatorship

The discovery of conflicts

 Grievance procedure-Employee-supervisor

 Direct observation

 Suggestion boxes

 Open-door policy (may follow grievance procedure, sounds

democratic, but hardly effective)

 Personnel Counselors

 Exit interviews

 The ombudsman/woman

Conflict outcomes
 Conflict is not always negative (destructive). Sometimes
conflict can be positive (constructive) depending on how it is
resolved. Constructive conflict is healthy for an organization.

 It can bring to light underlying issues

 It can force people to confront possible shortcomings in

solutions and choose a better one

 Better understanding of real interests, goals and needs of

individuals is enhanced and

 Communication around such issues is induced

Constructive conflict occurs

 When people change and grow personally from the conflict

 Involvement of the individuals affected by the conflict is

increased

 Cohesiveness is formed among team members and

 A solution to the problem is found.

However, if conflict is not managed properly, it can be

detrimental to an organization by threatening:

 Organizational unity
 Business partnerships

 Team relationships, and

 Interpersonal connection

Destructive conflict occurs

 When a decision has not been found and the problem remains.

 Energy is taken away from more important activities

 Morale of teams or individuals is destroyed

 Staff are stressed and lack focus and

 Groups of people or teams take sides

Stages of conflict

 Latent conflict.

 Conflict Emergency.

 Conflict Escalation

 Hurting/Stalemate.

 De-escalation

 Settlement/ Resolution

 Post conflict peace building and reconciliation.

Latent conflict: People have different ideas, values,
personalities and needs, which can create situations where others
agree with their thoughts or actions. This in itself is not a
problem, unless an event occurs to expose these differences

Conflict Emergency: At the emergence stage, conflict starts to

set in as the parties involved recognize that they have different
ideas and opinions on a given topic. The differences cause
discord and tension. The conflict may not become apparent until
a "triggering event" leads to the emergency (or beginning) of the
obvious conflict.

Conflict Escalation: If the parties involved in a conflict cannot

come to a resolution, the conflict may escalate. When a conflict
escalates, it may draw more people into the situation,
heightening any already existing tension. The escalation stage is
intense and during this stage people pick sides and view their
opponents as the enemy.

Stalemate (hurting): Stalemate is the most intense stage and

arises out of a conflict escalating. During the stalemate stage, the
conflict has spiralled out of control to a point where neither side
is in a position to agree to anything.

 The pain of continuing the conflict

exceeds that of maintaining the confrontation, and thus called
hurting stalemate.

 By this point, participants are not

willing to back down from their stances, and each side insists
that its beliefs are ultimately right.

 Even in a situation where a member of one side feels that

there may be merit in the other side’s stance, there’s an
unwillingness to admit it because of a need to protect interests.

De- Escalation: Even the most intense conflicts calm down at

some point, as one or more of the persons involved in the
conflict realize they are not likely to reach a conclusion if they
continue with their unwillingness to look at the conflict from all
sides. During this stage, parties begin to negotiate and consider
coming up with a solution.

Dispute settlement/Resolution: After hearing from all parties

involved in the conflict, participants are sometimes able to come
up with a resolution for the problem they are facing. As an
administrator, you may have to work with the involved parties to
settle the conflict very well by shifting the focus to what is really
important.

Post conflict/peace building: If the parties reach a solution, it’s

necessary to repair the relationships that may have been
damaged during the escalated conflict because it’s more likely
that the participants used harsh words or even fought while in
the midst of the conflict.

Approaches that can be used to address conflict situations

The organisational perspective

When faced with an interpersonal conflict, there are some of the

techniques to use to help resolve or mediate the conflict. These
include:

1. Discovery and exposure

2. Compensation - ask yourself if the behaviour you are seeing is

compensation for something else. Try to identify the root issue
and deal with that. The behaviour could reflect various issues.

3. Accept the person but you don't have to accept the behaviour.
Quote Organisational policies when necessary. This can take the
"burden" off you as the leader. Saying, "This is an organisational
policy and I am required to follow it as the person responsible."

 Know how much to push.

 Clarification of the goal and objectives

 Human resource management policies

 Avoidance

- Does not deal with issues at hand

- Lose-lose strategy

 Accommodation

- Agreement through yielding or conforming to the

positions of others

- Lose-win strategy

 Compromise

- Involves a search for a solution which is mutually

acceptable

- Lose-lose strategy
 Competition

- Offensive aggressive approach

- Win-Iose/lose-win strategy

 Collaboration

- Total-membership approach, generates creative

solution

- Win-win strategy

CONFLICT RESOLUTION

The good news is that by resolving conflict successfully, you

can solve many of the problems that it has brought to the
surface, as well as getting benefits that you might not at first
expect

 Increased understanding: The discussion needed to resolve

conflict expands people's awareness of the situation, giving them
an insight into how they can achieve their own goals without
undermining those of other people.
 Increased group cohesion: When conflict is resolved
effectively, team members can develop stronger mutual respect
and a renewed faith in their ability to work together

 Improved self-knowledge: Conflict pushes individuals to

examine their goals in close detail, helping them understand the
things that are most important to them, sharpening their focus,
and enhancing their effectiveness.

However, if conflict is not handled effectively, the results can be

damaging. Conflicting goals can quickly turn into personal
dislike. Teamwork breaks down. Talent is wasted as people
disengage from their work. And it's easy to end up in a vicious
downward spiral of negativity and recrimination. If you're to
keep your team or organization working effectively, you need to
stop this downward spiral as soon as you can. To do this, it helps
to understand two of the theories that lie behind effective
conflict resolution:

Conflict Resolution Styles

1. Competitive: People who tend towards a competitive style

take a firm stand, and know what they want. They usually
operate from a position of power, drawn from things like
position, rank, expertise, or persuasive ability. This style can be
useful when there is an emergency and a decision needs to be
made fast; when the decision is unpopular; or when defending
against someone who is trying to exploit the situation selfishly.
However, it can leave people feeling bruised, unsatisfied and
resentful when used in less urgent situations.

2. Collaborative: People tending towards a collaborative style

try to meet the needs of all people involved. These people can be
highly assertive but unlike the competitor, they cooperate
effectively and acknowledge that everyone is important. This
style is useful when you need to bring together a variety of
viewpoints to get the best solution; when there have been
previous conflicts in the group; or when the situation is too
important for a simple trade-off.

3. Compromising: People who prefer a compromising style try

to find a solution that will at least partially satisfy everyone.
Everyone is expected to give up something and the compromiser
him- or herself also expects to relinquish something.
Compromise is useful when the cost of conflict is higher than
the cost of losing ground, when equal strength opponents are at a
standstill and when there is a deadline looming.

4. Accommodating: This style indicates a willingness to meet

the needs of others at the expense of the person's own needs.
The accommodator often knows when to give in to others, but
can be persuaded to surrender a position even when it is not
warranted. This person is not assertive but is highly cooperative.
Accommodation is appropriate when the issues matter more to
the other party, when peace is more valuable than winning, or
when you want to be in a position to collect on this "favour" you
gave. However, people may not return favors, and overall, this
approach is unlikely to give the best outcomes.

5. Avoiding: People tending towards this style seek to evade the

conflict entirely. This style is typified by delegating
controversial decisions, accepting default decisions, and not
wanting to hurt anyone's feelings. It can be appropriate when
victory is impossible, when the controversy is trivial, or when
someone else is in a better position to solve the problem.
However, in many situations this is a weak and ineffective
approach to take.
Once you understand the different styles, you can use them to
think about the most appropriate approach (or mixture of
approaches) for the situation you're in. You can also think about
your own instinctive approach, and learn how you need to
change this if necessary.

Ideally you can adopt an approach that meets the situation,

resolves the problem, respects people's legitimate interests, and
mends damaged working relationships.

Approaches of conflict resolution.

The "Interest-Based Relational Approach" The second theory is

commonly referred to as the "Interest-Based Relational (IBR)
Approach". This type of conflict resolution respects individual
differences while helping people avoid becoming too entrenched
in a fixed position. In resolving conflict using this approach, you
follow these rules:

1. Make sure that good relationships are the first priority: As

far as possible, make sure that you treat the other calmly and
that you try to build mutual respect. Do your best to be
courteous to one-another and remain constructive under
pressure.
2. Keep people and problems separate: Recognize that in
many cases the other person is not just "being difficult" – real
and valid differences can lie behind conflictive positions. By
separating the problem from the person, real issues can be
debated without damaging working relationships.

3. Pay attention to the interests that are being presented: By

listening carefully you'll most-likely understand why the person
is adopting his or her position.

4. Listen first; talk second: To solve a problem effectively you

have to understand where the other person is coming from
before defending your own position.

5. Set out the "Facts": Agree and establish the objective,

observable elements that will have an impact on the decision.

6. Explore options together: Be open to the idea that a third

position may exist, and that you can get to this idea jointly.

By following these rules, you can often keep contentious

discussions positive and constructive. This helps to prevent the
antagonism and dislike which so-often causes conflict to spin
out of control.
Conflict Resolution Process Look at the circumstances, and
think about the style that may be appropriate. Then use the
process below to resolve the conflict:

Step One: Set the Scene

Make sure that people understand that the conflict may be a

mutual problem, which may be best resolved through discussion
and negotiation rather than through raw aggression. If you are
involved in the conflict, emphasize the fact that you are
presenting your perception of the problem. Use active listening
skills to ensure you hear and understand other's positions and
perceptions.

 Restate.

 Paraphrase.

 Summarize.

And make sure that when you talk, you're using an adult,
assertive approach rather than a submissive or aggressive style.

Step Two: Gather Information

Here you are trying to get to the underlying interests, needs, and
concerns. Ask for the other person's viewpoint and confirm that
you respect his or her opinion and need his or her cooperation to
solve the problem. Try to understand his or her motivations and
goals, and see how your actions may be affecting these. Also, try
to understand the conflict in objective terms: Is it affecting work
performance? damaging the delivery to the client? disrupting
team work? hampering decision-making? or so on. Be sure to
focus on work issues and leave personalities out of the
discussion.

 Listen with empathy and see the conflict from the other
person's point of view.

 Identify issues clearly and concisely

 Remain flexible.

 Clarify feelings.

Step Three: Agree the Problem

This sounds like an obvious step, but often different underlying

needs, interests and goals can cause people to perceive problems
very differently. You'll need to agree the problems that you are
trying to solve before you'll find a mutually acceptable solution.
Sometimes different people will see different but interlocking
problems – if you can't reach a common perception of the
problem, then at the very least, you need to understand what the
other person sees as the problem.

Step Four:

Brainstorm Possible Solutions If everyone is going to feel

satisfied with the resolution, it will help if everyone has had fair
input in generating solutions. Brainstorm possible solutions, and
be open to all ideas, including ones you never considered before.

Step Five: Negotiate a Solution

By this stage, the conflict may be resolved: Both sides may

better understand the position of the other, and a mutually
satisfactory solution may be clear to all. However, you may also
have uncovered real differences between your positions. This is
where a technique like win-win negotiation can be useful to find
a solution that, at least to some extent, satisfies everyone. NB:
There are three guiding principles here: Be Calm, Be Patient,
Have Respect.

Key Points Conflict in the workplace can be incredibly

destructive to good teamwork. Managed in the wrong way, real
and legitimate differences between people can quickly spiral out
of control, resulting in situations where co-operation breaks
down and the team's mission is threatened. This is particularly
the case where the wrong approaches to conflict resolution are
used. To calm these situations down, it helps to take a positive
approach to conflict resolution, where discussion is courteous
and non-confrontational, and the focus is on issues rather than
on individuals. If this is done, then, as long as people listen
carefully and explore facts, issues and possible solutions
properly, conflict can often be resolved effectively.

DELEGATING AUTHORITY AND RESPONSIBILITY

To delegate is to give another person some of one’s authority or

in other words, to give another person the power to make
decisions. Authorities and responsibility may go together but are
not the same people use authority to get work done for which
they are responsible. Delegation is the use of personnel to
accomplish a desired objective through allocation of authority
and responsibility. Delegation is not merely distributing care. It
is a path to and a significant success factor for professional
practice. Delegation is a link that joins organizational concepts
with the management process; it is that which allows a manager
to manage. In the past, effective delegation has not been an
activity emphasized in nursing. As a result, many nurses do not
value this skill. Educational programme has emphasized primary
nursing as the dominant method of delivering nursing care
which focuses on the skill of individual nurse. As a nurse
manager it is essential to know about the principles, purpose,
steps, and concepts of delegation. It is also necessary to know
about the barriers of delegation and the effective measures to
overcome those barriers.

Definition

 Delegation: Delegation is transferring to a competent

individual the authority to perform a selected nursing task in a
selected situation. (The National Council of State Boards in
Nursing, 1995)
 Delegator: The delegator possesses the authority to delegate
by virtue of both positions in the agency  Delegate: The
delegate receives direction for what to do from the delegator.

The concept of delegation

The supervisor passes down to the subordinates a share of

his/her own responsibility together with the necessary authority
to discharge the tasks delegated.

 But the supervisor retains the ultimate responsibility. The

subordinate has immediate responsibility

 Hence the superior has the right to retract or withdraw the

authority delegated

 Because of the ultimate responsibility concept, the superior has

the duty to supervise the performance of the delegated authority.

 Hence delegation does not mean abdication

Purposes of delegation
 When work is spread over a large area, as in rural health work,
the health workers on the spot must be able to make decisions
according to circumstances

 Delegation of responsibility saves delays that occur when

awaiting decisions from a central office or other distant
authority.

 Health workers who are allowed to make decisions enjoy their

work more and become more knowledgeable and skilful.

 To achieve organizational goal

 Time and cost savings

 Professional growth of employees and it Mears imparting

training to them.

 Professional growth of the manager and decrease the burden of

tasks

 Helps the chief executive to devote more time in decision

making, policy formulation and planning

 Makes the organization to act efficiently and economically and

bring flexibility in it
 Helps in creation of managerial class and develops a sense of
responsibility in subordinate

 Delegation avoid delay and helps in succession

 To save time for other duties

 To train the subordinate

 Motivate staff

 Prepare future managers

 Allow yourself as a manager to learn from the subordinates

 Allow a person on the sport to make decisions

 Avoid resistance to change

Benefits of delegation

 Delegation can improve quality of work by allowing the

employees who have direct knowledge of products and services
to make decisions and complete tasks.

 Employees/delegates have more time to do their own jobs

when they assign tasks to others.
 Saves time for the accomplishment of a task since the sub
tasks have been delegated to other employees hence work is
done in shortest time possible.

 Development; when you delegate you will teach your team

members new skills and give them the opportunity to develop
themselves and achieve their goals.

 Raises employees’ self-esteem whereby when you give a

teammate a task, it shows that you have trust and confidence in
them. Having interesting and challenging work feels good, and
being trusted to complete the job raises self-esteem.

 Builds teamwork: Delegating new tasks to team members

allows them to build contacts with others whom they do not
normally work. This can lead to greater teamwork and
communication networking.

 Provides continuity of work: When a manager is on leave the

work is taken by subordinates and provides continuity in
functions.

Disadvantages
 If wrong decisions are made, the work may not be done or it
may be done less well.

 A leader may delegate all the work, leaving very little to do

 A leader may delegate decisions to people with insufficient

experience.

 Burden on Employees: Giving an employee too many tasks to

complete. If you place too much of a burden on your employee’s
shoulders, that employee may stop viewing himself as a trusted
employee and start viewing himself as an abused employee.

 Poor quality of the work done: If work is delegated to

wrong/unskilled personnel may yield poor results.

 Failures result in destroying worker confidence.

Principles of effective delegation

The dos and don'ts of delegation

 Clarify what you delegate

 Select the person you trust and have confidence in

 Inform all other stake holders of your delegate

 Do not interfere unnecessarily

 Be prepared for mistakes

 Give the needed authority, resources and support

 You can only delegate those tasks which according to the law
you can delegate

 A president cannot delegate his role as a commander-in-chief

 A delegate cannot also delegate

Rules of delegating authority and responsibility

 Be clear about what is delegated exactly.

 Select the person who you are sure can do the work

 Explain to others that you have delegated work and to whom.

 Do not interfere unless asked to and be prepared for mistakes.

 Give support as needed and follow-up the progress of work.

Three foundations for delegation

Delegation depends on a balance of responsibility,

accountability and authority
  Authority: is the power and right of a person to use and
allocate the resources efficiently, to take decisions and to give
orders so as to achieve the organizational objectives.

 Responsibility: is the duty of the person to complete the task

assigned to him. A person who is given the responsibility should
ensure that he accomplishes the tasks assigned to him.

 Accountability: means giving explanations for any variance

in the actual performance from the expectations set.
Accountability cannot be delegated.

Differences between Authority and Responsibility

Authority Responsibility
It is the legal right of a person It is the obligation of
or a superior to command his subordinate to perform the
subordinates. work assigned to him.
Authority is attached to the Responsibility arises out of
position of a superior in superior-subordinate
concern. relationship in which
 subordinate agrees to carry out
duty given to him.
Authority can be delegated by Responsibility cannot be
a superior to a subordinate shifted and is absolute
It flows from top to bottom. It flows from bottom to top.

Steps in delegation

 Plan ahead

 Identify needed skills and levels

 Select most capable personnel

 Communicate clearly

 Set deadlines and monitor the progress

 Empower the delegate

 Evaluate the job performance

 Reward accomplishments

Determine what you will delegate. Effective delegation begins

with defining your responsibilities. Write down all of your
activities and responsibilities. Review your master list and
categorize all of the items into two secondary lists: things you
alone must do and things that others could do or help you
complete. Anything that falls into the second list presents an
opportunity for delegation.

Choose the right/capable person to delegate the task to.

Andrew Carnegie said, "The secret to success lies not in doing
your own work, but in recognizing the right person to do it." The
key to finding the right person to delegate an assignment to is
matching skills and attitude to the task at hand.

Clarify the desired results. When the results are clear, it allows
the employee to use his or her own creativity and resources to
accomplish the task. An added benefit of effective delegation is
the individual may find a better and more effective way to
accomplish the task or achieve the desired results.

Clearly define the employee's responsibility and authority as

it relates to the delegated task. Clearly communicate the
expectation, responsibilities, and timeline (and set deadlines). Be
sure to ask the employee to share his or her understanding.

Establish a follow up meeting or touch points. The follow up

meetings should be focused on two things-monitoring progress
and determining the need for assistance. The number of follow
up meetings will vary based on the scope of the task or project
and whether the employee is new or a long-term member of the
department.

Reward accomplishments: appreciation of successful

accomplishments.

Kinds of delegations

 Full delegation

 Partial delegation

 Conditional delegation

 Formal delegation

 Informal delegation

Errors in delegation

 Under delegation: The manager may become over worked

and overwhelmed. This frequently comes from his/her
assumption that delegation may be interpreted as the lack of
ability on his/her part to do a correct or complete job. Another
frequent cause for under delegating is the manager desire to ‘do
the whole job by myself’ 76 because of the belief that he/she
needs experience or the belief that he/she can do it better and
faster than anyone else.

 Over delegation: Some managers over delegate as they are

poor monitors of time and spend most of their time just trying to
get organized. Others over delegate because they feel insecure in
their ability to perform a task.

 Improper delegation: It includes delegating at the wrong

time, wrong person for a wrong reason. It may include assigning
the task and responsibility that are beyond the capability of the
person

 Upward delegation: When the manager delegated a task to a

subordinate, the subordinate makes use of the manager to
complete the task

CONSTRAINTS TO EFFECTIVE DELEGATION

• Lack of confidence in the subordinates.

• Reluctance of the supervisor to delegate since he/she feels can
accomplish the task.

• Feeling of insecurity that is the subordinate may subsequently

take over her role.

• Lack of communication skills to make the delegate understand

her/his role/responsibilities.

• The delegate may lack technical skills required to accomplish

the task.

• Lack of willingness by the staff/subordinate to take up the

responsibility.

• Prestige and power consciousness by the manager

• Confidential nature of task

• Legal impediments associated with the way the task is

done/accomplished.

Factors that affect delegation

 Size of organization: usually small organizations have

limited role/activities to accomplish therefore delegation is
minimal yet in bigger organizations delegations is very
necessary.

 Importance of the duty or decision: important sensitive

organizational decisions need the involvement and control by
the top manager while less sensitive/important tasks can

 Task complexity: some tasks are better performed by the

managers because of their expertise and thus cannot be
delegated since the subordinates may lack enough expertise to
accomplish them. Whereas others may be performed by any
employee of the organization.

 Organizational culture: these are the norms, expectations and

values of the organization whereby some organizations always
prefer the manager to be the final decision maker in all
organizational activities hence do not opt/support delegation
which is opposite in other organizations.

 Qualities of subordinates: before delegating roles to

subordinates consideration of their abilities, strengths and
weaknesses should always be put at the back of the mind.

Obstacles in delegation
 Fear of being disliked

 Inability to give up any control of the situation

 Inability to prioritize using Maslow’s hierarchy of needs

 Lack of confidence to move beyond their level

 Tendency to isolate oneself and choosing to complete all tasks

alone

 Lack of confidence to delegate to staff who were previously

one’s peers

 Ineffective to communicate effectively and develop working

relationships with other team members.

 Thinking of oneself as the only one who can complete the task

 Lack of knowledge about staff’s capability

Barriers of delegation in different level

Organizational level

 Lack of established methods and procedures

 Lack of means of coordination and communication

 Unstable and changing nature of work

 Size and location of an organization

Managerial level

 Superiors are afraid that others will not make proper decisions
or carry them in a desired manner

 Fear that disloyal centres will develop among strong

subordinate

 In public administration political consideration often make

delegation difficult

 At time who desire to delegate do not know how to do it

 “I can do it better myself” fallacy

 Lack of ability to direct

 Lack of confident in staff

 Absence of control that warn of impending difficulties

 Aversion of taking risk

Subordinate level
 Easier to ask the boss

 Fear of criticism

 Lack of necessary information and resources

 Lack of self confident

 May have more work than the employee can do

 Positive incentive may be inadequate

 More work than once capacity to work

 Lack of resources and information to do a good job

Symptoms of poor delegation

 Long queue before boss room

 Boss is always busy

 Boss taking suitcase to home at evening

 Subordinate unhappy

 Disorganized resource

 Always delay in work

Symptoms of poor delegation

 Long queue before boss room

 Boss is always busy

 Boss taking suitcase to home at evening

 Subordinate unhappy

 Disorganized resource

 Always delay in work

Development of delegation process in patient care

 Know the patient

 Know the staff member

 Know the task delegated

 Explain the task and expected outcome

 Expect responsible action from the delegates

 Assess and supervise job performance

 Evaluate and follow

Delegation skills

 Create an environment of trust and co operation

 Create environment of teaching and learning

 Promote client satisfaction

 Communicate effectively

 Provide feedback and follow-up evaluation

Guidelines to effective delegation

 Defining the task clearly

 Outlining the scope of the task

 Assigning a deadline for follow up and task completion.

 Clear unity of command; each person in an organization

should report to one supervisor.

 Trust the delegate in terms of honest and confidence

 The duration of the delegated task should be specified to the

delegatee

 Explain to others that you have already delegated the work and
to whom

 Do not interfere unless asked to and be prepared for some

mistakes

 Members of the organization should know the proper flow of

authority and chain of command
CUSTOMER CARE Introduction Provision of quality health care is one of the top priorities in the National
Health Policy. While hospitals are performing a valuable service to the public, stakeholders, including the
public itself, are unsatisfied and complaining. Media reports always portray negative publicity and image
regarding health care providers This is because the services provided are not focused on the client’s
expectations and the services are not attractively presented to the clients. Surveys on customer
satisfaction done elsewhere found un-met non-health expectations such as dignity, basic human needs,
human rights, prompt attention in care, treatment, confidentiality, communication and autonomy are
contributing factors to customer blames and complains. For these reasons, BMC department of Nursing
conducted a min research to find out client’s satisfaction on the services we provide where findings
showed customer dissatisfaction in same non-health expectations. To address these problems the
department initiated customer care orientation classes to nurses, same sessions are conducted to newly
employed nurses/medical attendants during induction course. Out of 376 nurses have been oriented
(51.3%).

Definition

Customers to us are people who receive healthcare services. Every patient, family member, visitors,
cooperate representative and co-worker.

Quality: The Standard of something as measured against other things of a similar kind; the degree of
excellence

Quality health Care: Means doing the right thing, at the right time, in the right way for the right person
and having the best possible results.

Types of customers

They are two types:

 External Customers: Patients/Clients/Community receiving services

 Internal customers: Health workers within the Institution including administrators.

Why Quality Improvement To ensure the following:

 Safety – avoiding injuries to patients from the care that is intended to help them.

 Effective – Providing services based on scientific knowledge to all who could benefit and refraining
from providing services to those not likely.
  Patient-cantered – Providing services that is respectful of and responsive to individual patient
preferences, needs and values.

 Timely – reducing waits and sometimes delays for both those who receive and those who give care.

 Avoid unnecessarily long waits for registration, payments, consultations, lab results, surgery etc.
Eliminate processes that don’t add value to employees, patients or your workflow.

 Efficient – avoiding waste, including waste of equipment, supplies, ideas and energy. (Achieved
through 5S)

 Equitable – Providing care that does not vary in quality because of personal characteristics such as
gender, ethnicity, geographic location, and socio-economic.

Why customer satisfaction?

 Efforts to deliver customer-oriented services are a key to any quality care.

 Services that do not meet customer needs/expectations fail.

 To provide quality services we need to better understand our customer needs.

 Quality care provision is our promise to the public.

 We need to understand our customers so that we can anticipate their needs and expectations.

 A blame free environment leads to improved transparency, improved systems and, ultimately to better
results.

Methods of assessing customer satisfaction

 Complaint monitoring

 Interviews

 Focus groups

 Satisfaction surveys

 Quality indicators
 Internal audit

 Management review Basic needs of customers

 Need to feel in control

 Need to feel that their actions are directed toward their goals

 Want to be treated fairly and appropriately

 Want to know what is happening and why

 Want to feel safe and secure

 Want to feel important, recognized and appreciated

What matters most to Healthcare Customers

 Empathy

 Showing Compassion

 Courtesy and respect

 Dignity – privacy, confidentiality

 Responsiveness of hospital staff

 Learn to apologize in case of delayed services for whatever the reason.

 Good customer service- reception & communication

 Information

 Building trust

 Explanation in easy-to-understand terms from healthcare workers

 Pain relief

 Clean/Safe environment (5S&IPC)

Communicating effectively, we can achieve customer satisfaction by using the following communication
Tips:
 Establish rapport

 Listen attentively

 Ask questions to check understanding

 Answer the way you’re asked

 Reflecting

 Clarifying

 Using non-verbal

 Don’t judge

 Don’t use jargon

The importance for informed care

 Builds good interpersonal relationship

 Prepares patient/client psychologically and physically

 Eliminates complains

 Promotes patients’ satisfaction How do we know whether our customers are satisfied or not?

To provide services that are customer oriented we need to develop habit of gaining feedback from our
customers.

Feedback from customers can be gained through

 Survey Questionnaires

 Interview – exit

 Suggestion box

 Focus Group Discussion

 Community Forum

 Key Informants
 Community members of health committees

Why gain feedback from customers?

 Understand customer’ needs

 Feedback enhances customer loyalty and customers will recommend institution to others.

 Feedback can tell you things you may not know, including human factors such as staff behavior.

 Feedback can be used to analyse performance.

 Customers feel valued

 Promotes a sense of responsive customer service within the organization

 Promotes contact, communication and improve relationship with customers

Benefits of good customer care

 Increased Efficiency

 Employee Motivation

 Customer loyalty - Customers recommend services to others

 Enhance public image – and provides protection if there is a slip-up in customer service

 More effective workforce – satisfied customers create a positive working environment

 Staff who deliver good customer service receive their customers’ appreciation and are further
motivated to offer good customer service.

 Good customer care contributes to customer retention.

 Reduced Employee Turnover.

TRANSPORT MANAGEMENT

The role of transport in health care

Why Know Transport in Health Care

• Is a resource like any other

• Lack of transport prevents use of services

• Lack of transport affects provision of services

• Lack of transport is a frequent cause of non delivery of

services

• Better management of vehicles has a bigger impact on service

delivery than increase in vehicles

• Transport has high costs. Usually, third largest cost on District

Health Budget after staff and drugs

• Largest budget under control of District Health Manager

• Improved management frees more vehicle time for service

delivery

• Good use and maintenance save time and lives

• Important to have the correct vehicle mix and a sound

management system in place for good service delivery

• Management not prioritized-only use is

• Health managers think it's a matter for transport professionals

• Used by health workers hence should be managed by health
managers

Uses of transport in health care

 Health training

 Facilitators
 participants
 equipment
 study tours and equipment

 Data collection and feedback

 Service delivery

 Mobile care for example DOTS

 Outreach for example Immunization
 Mobilization
 Emergency response
 Environmental health
 Waste disposal
 School health
 Occupational health

 Meetings/support supervision
  MoH
 HSD
 LLHU
 Community
 Intersectoral (Participants should generate through group
work)

Forms of transport in Health Care

 Foot

 Animals (donkeys, camels, horses, cows, dogs)

 Bicycle, Motorcycles, Car, Train, Helicopter, Plane (Heavy

and Light)

Transport options in practice

 Owning and managing vehicles

 Owning vehicles managed by others (valet management)

 Owning and managing vehicles maintained by others

 Paying staff to use their own vehicles

 Co-ownership schemes with staff

 Contracting transport services from others and owning no

vehicles

 In all cases a Health Manager should be concerned with the

quality of service offered

The root of transport problems

The transport problems of a health unit may be the result of:

 Poor coordination of transport - different facilities and

authorities within a district having control of their own vehicles,
resulting in inefficient planning;

 A lack of vehicles - especially in rural areas where health

services are under resourced, the roads are bad and the
population is widely dispersed;

 Theft, indiscipline, drunk driving and the abuse of government

vehicles; and

 The poor maintenance and repair of vehicles.

Managing transport

Four aspects
 Having a transport policy

 Operational management

 Fleet management

 Transport management information

Health Transport Policy

Appropriate local transport policy is one of the keys to

successful transport management. A transport task team should
conduct situational analysis and develop rules and guidelines for
transport control and use. Policy areas should include:

 Determining who in the district/Health Unit is allowed to

request the use of vehicles, and who is responsible for signing
trip authorities

Operational management plan

Misuse and inappropriate use are the commonest causes of

transport shortage in the health sector. An operational
management plan is about how transport is used.

 identifies misuse and inappropriate use (during policy

making)
  prevents misuse and inappropriate use.

 Clarifying the roles, responsibilities and lines of accountability

of all those involved in transport management and use

 The mechanism and procedure for the issuing of vehicles;

 And what should happen to drivers and transport users who

continually return vehicles late, or who persistently fail to keep
to their schedules.

 Others (generate through group work)

Operational management plan

Misuse and inappropriate use are the commonest causes of

transport shortage in the health sector. An operational
management plan is about how transport is used.

 identifies misuse and inappropriate use (during policy

making)
 prevents misuse and inappropriate use.

Have three main activities

1. Planning and scheduling use

2. Controlling use
3. Appointing and training local Transport managers

Planning and scheduling transport

 Know the means of transport available

 Know your area

 Know the activities to be carried out

 Sort activities in order of priority

 Decide on appropriate means of transport for each service area

and for each activity

 Reserve reliable vehicles for priority areas

 May involve walking, sharing within the department, sharing

with other departments, use of public means, changing dates of
some activities

Controlling transport use Involves many activities

 Recording use: Trip record (Log) books

 Authorization of movement: Gate pass

 Destination

 Driving/riding the vehicle-Who?

 Minimum training and experience-permit

 Parking hours: When? Where?

 Disciplinary measures: Warning, dismissal etc.

Transport Managers

 May be trained or recruited

 Selected candidates should have the authority of the

management team

 Should preferably be a member of the management team

 May need transport assistants at lower levels (who also need

to be trained)

Fleet Management

Fleet management is the management of transport

resources Includes:

 Vehicle specification (deciding which type)

 Vehicle selection (choosing the vehicle)

 Vehicle procurement (purchase or renting)

 Repair and maintenance

 Replacement planning

 Vehicle disposal (by sale or other method)

Some of these aspects are too technical Require technical

personnel (mechanical engineers, procurement specialists etc)
May not be feasible to train such an expert at lower level

Usually contracted out to specialists or centralized at regional or

national level.

Transport Management Information System

Good quality information is the key to effective transport

management. The transport management system is based on
regularly filling out a number of forms for collecting this
information.

These forms include:

 The vehicle log sheet or logbook (which should be completed

by the driver for each trip taken)

 Vehicle issue and return forms which are completed when

vehicles are issued out by and returned to the transport officer
(recording the condition of the vehicle, quantity of fuel in the
tank, log book and petrol card numbers); and
 Monthly vehicle report forms which summarise the use and
performance of each vehicle for the preceding month, including
information related to accidents and maintenance, service or
repairs.

 In addition, a file should be opened for each vehicle. The file

should contain the vehicle registration document, the completed
monthly report forms, completed vehicle log sheets, and any
other correspondence relating to that vehicle.

Transport performance Indicators

 Distance travelled

 Fuel utilization

 Running cost per kilometre

 Vehicle availability for use

 Actual use

 Needs satisfaction

Some common problems with transport and management

strategies

1. Break down of vehicles

  Regular maintenance
 Log book
 Good relationship with local garages
 Temporary substitution
 User training
 Good drivers
 Stock spares
 Vehicle replacement
 others
2. Misuse of vehicles
 Good supervision
 Scheduling of use
 Restrict use to named individuals
 Log books
 Enact enforceable policies on private use
3. High transport costs
 Examine the need for transport
 Use low-cost means
 Use alternatives to travelling
 Good planning and scheduling
 Share journeys and transport costs
  Use public means
 Cost the journeys (for cost awareness)
 Standardize vehicles
 Get simple means

Health care drivers (recruitment and qualities) Driving patients

is very demanding. Most ambulance drivers work for long
hours, fast and under tension of losing lives. Recruitment of
Ambulance drivers should therefore be done carefully. Below
are some important qualities to consider when recruiting health
care drivers.

Attributes of a good health care driver

 Good psychomotor skills for example Can coordinate motor

functions, place the car exactly where its required on the road

 Good thinking that is Sees and recognizes potential hazards

before a manoeuvre is made, monitor hazard until they have
passed it.

 Good attitude that is willing to use their skill and knowledge.

Considerate of other road users
 In good health condition that is Alert, awake, rested, not in
pain, not anxious

 Able to check themselves that is Speed, use of lane, indicators,

distance between vehicles etc

 Willingness (and capability) to undergo some training in first

aid

 Have a sense of keeping people safe

 Good communication skills to deal with people under stress

and anxiety

 Good interpersonal skills for example Empathy

 Good reading and writing skills

 Work in small teams without supervision

TIME MANAGEMENT

You have had expressions such as time is money, time ships

away and time does not wait for the king. All those expressions
are true but whether time flies or drags for you depends on how
you manage it. Time management also make some managers say
“I don’t have time or have too many things to do ‘unfortunately
the amount of time available is strictly limited. Therefore, if you
are going to make the best use of it, you have to improve the
skills in time management. You are the person responsible for
managing yourself and your time is available to all of us
regardless of the type of job we do. However, if not properly
managed, time will be wasted and once it’s gone, you can’t get it
back. Managing yourself and your responsibility means
organizing your time and using it sensitively. It’s only after you
organize yourself that you can organize other people and other
resources when you waste your time, along chain of activities
are affected, e.g., if mother has brought her child for
immunization, she can’t go back to milk her cow in time
because she has been delayed for long hours at the health centre.
The milk truck that takes milk will leave the truck thus she will
lose her income for that day, will not be able to pay for her
child’s medical fee that day. Economists can quantify the
opportunity cost for such delays. Time is a non-renewable
resource and even can’t take place unless there is time for it.
Once wasted or abused time can’t be recovered, bought or
increased: Using time effectively is a management skill.
Techniques of time management

To be able to manage time and therefore organize yourself, it’s

important that you bear in mind the following important points.

 You must know what your responsibilities are. Are you doing
things which you could have delegated to someone else?

 Decide how to organize your activities. You have to plan how

best to use your time to produce maximum results.

 Develop a system which helps you reduce the time you spend
on unimportant tasks and increase the time you spend on
unimportant tasks.

Finding out how you spend your time

In managing health services, you have many responsibilities and

activities to carry out. It is important to find out how much time
is spent talking to staff health centre, meetings, supervising
activities, in rural health facilities training the health workers,
doing ward rounds or attending to financial and administrative
matters, visiting the administrative headquarters etc. You can
find out how much time you spend on these activities by
keeping a daily dairy for a few days 85 termed as an inventory
of your time. This is achieved by keeping track e.g., events and
the time. It takes great effort to carry this activity out. An
example is the form of a table shown below.

Some of the ways of managing time at work

 Administrative responsibilities: Time for correspondence and

necessary for health workers to provide proper. Co-ordination
and effective communication with other officials. The same time
is used to develop objectives for the work, write job-description,
and write reports.

 Caring for the patients: Time with patients should be

sufficient to take accurate history, diagnosis, treatment as well as
to give them health advice.

 Time for supervision: Time with staff is important to provide

support supervision (Staff development). This is the time used to
teach junior staff and students to assess achievement of the
objectives and give feedback to junior staff. The same time is
used to conduct staff meeting.

 Time with the community (Home visits): To promote

community participation hence health delivery. The health
worker meets with village health committees to identify health
problems, discuss ways of overcoming them, implement the
solutions and assess the success.

 Recreational time: For health mind and body the health

worker should plan time for recreation.

 Domestic activities: The main reason a health worker is

employed is to offer health services to the community or
individuals. This however, is influenced by the domestic
demands of the health workers. He/she should therefore plan
time for attending to his/her domestic affairs, preferably outside
working hours.

Types of time plans

Time tables

These should be made for routine daily work, weekly activities,

monthly activities and yearly activities. In addition, to the above
time labels, the health worker should on each morning make a
daily to do list, a lot of activities that should be done that day
i.e., duty allocation.
Assignment: List examples of time
wasters/Robbers/productivity killers.

Suggestions for saving time

After you have identified your weakness in managing time, try

these suggestions for having time.

Eliminate paper work.

Do not allow paper to accumulate and always, make a decision

or delegate or fill when action has been taken. Learn to make
decision, not to post-pone action.

Organize your desk

This helps you to know where to find everything, have as little

as possible on your desk and work on one paper at a time.
Things you use on regular basis should be within easy reach.
You must have a workable filling system.

Conduct regular meetings

It saves you time to communicate to many people at once

instead of talking to many people individually.

No interruption time.
Set aside a block of time which should not be interrupted and
use this time to complete a task. During this time no telephone
calls, visitors or other interruption of any king should be
permitted. Your secretary will take your telephone messages.

Open time

Let people know interruptions are alright schedule time for

people to drop in with their concerns, be strict

and stick to hours.

Learn to say No

Do not accept duties that are not your responsibilities or those

that you can’t handle at that time.

Plan for emergencies

You can predict when your work load increases e.g., you can
anticipate when reports must be submitted. For medical officers
may need to attend to court on perform post mortems.

Learn to complete your work

Avoid leaving your tasks unfinished, finish fully what is

initiated, and meet all the deadlines.
Take a break

This time helps you reduce stress. You should do task not work
related but task that you like, break tea, lunch. In addition to
enjoying your meal, you can have a short walk, say prayers or
read a novel/literature not related to work.

Pays offs from time management (Advantages)

These range from personal satisfaction to relationship with your

colleagues.

Greater Job satisfaction.

Working under intense time pressure can lead to stress and time
anxiety. Time anxiety can lead you down. If you can focus on
positive accomplishment your enthusiasm for your work will
increase. You will be able to meet more of your personal needs.
Great personal satisfaction will lead you to greater
achievements.

Increased productivity

Planning your time properly and eliminating time wasters, has

an impact on increased productivity. Highly motivated workers
can achieve more in less time than those who just put in their 8
hours.

Increased inter personal relationships

A health manager who is under pressure often has little patience

for communication or for working effectively with others.

On the other hand, a health manager, who has a reasonable time

schedule will relate more successfully with others.

Better future direction

A major who plans time properly has the ability to know the
direction in which he/she is moving both new and in future.

Reduced stress

A major source of stress for manger is a combination of heavy,

work load, time limitations. As result of the reduced time
anxiety, one may feel better mentally, physically and
emotionally.

A summary of tips that you can use to improve your time

management

 Take an inventory of how you spend your time

 Develop a system to help you use your time better

 Use tools such as a diary, a daily planner and a worker

schedule to plan and use your time most efficiently

 Set goals, prioritize your work

 Understand your productivity (energy cycle)

 Identify your time robbers and develop a plan to eliminate

them, develop a plan to eliminate them.

REPORT WRITING.

Meaning of report

 A report is a presentation of facts and findings, usually a basis

for recommendation, written for specific leadership and intended
to be kept as a record.

 It is a written or spoken account of an event.

 It is giving people information about what you have seen,

heard or done.

The purpose of report

 It is purely based on observation and analysis

 It gives an explanation of any circumstance

 It discusses a particular problem in details

 They are required for judging performance of an organization.

 A good report is impartial since it always finds facts not faults

Classification of reports

 Formal reports: it is prepared in a prescribed form and

presented according to an establish procedure to a prescribed
authority.

 Informal reports: person to person communication, it may

range from short, almost fragmentary statement of facts on a
single page to a more presentation taking several pages.

 Statutory reports: reports prepared and presented according to

the form and procedure laid down by law.

 Non statutory: these are formal reports not required under the
law but prepared to help management in framing polices.

 Routine reports: prepared and presented at regular prescribed

interval e.g., daily, weekly, annually, etc.

 Special reports: they are related to a single event or situation

e.g., report on a particular product.
 Informative reports: report present facts about certain given
activity in details without any notes or suggestions.

 Interpretative reports: it analyses facts, draws conclusions and

makes recommendation.

Advantages for report writing

 Solves current problems

 Updated information

 Discloses unknown information

 Internal communication

 Reliable permanent information

 Decision making and planning.

A good report

 Addresses intended audience

 Provides introductions and conclusions for internal sections as

well as the whole paper

 Provides transitions between sections

 Avoids “stream of consciousness” (rambling) writing

 Looks professional in style and appearance

 Recognizes that the document should be persuasive

Steps of report writing

 Investigating the source of information: it is done from the

beginning. Major sources of information are company files,
interviews, personal observations, etc.

 Take notes: keep taking note on anything that is related to the

subject during investigations.

 Analyse the data after taking notes.

 Making an outline: the problem is stated, facts recorded,

briefly analysed and the logical conclusion is arrived at.

 Writing the report: this is the last stage. It requires constant

shuttling between the outline and the notes.

Introduction

 It has four sections: purpose, background, method of

investigation and scope.

 Take note of language conversations and typical words and

phrases that are used
 Use present and past tense

 Format – numbered headings.

Purpose: State the purpose of the report Include what the report
will recommend e.g., the purpose of the report is to investigate
high cases of typhoid among people living in kawempe division.
The report will recommend preventive measures for typhoid in
kawempe area.

Background: Provide information on the problem or situation

that gave rise to the investigation. May refer to secondary data
e.g., data discovered by some else.

Method of investigation: State how investigation was carried

out e.g., using questionnaires (how many people and how long).
This is called primary data (data discovered by the writer). May
include references to secondary data. Example: questionnaires
were issued to 80 residents of Katanga village on January, 2018.
20 patients with typhoid were also interviewed to get more in-
depth information.
 The scope: State the area of investigation e.g., reasons,
consequences, etc. i.e., what information you need in order to
meet your purpose. First scope item is respondents’ profile.

There should be at least 3 other items. Example: Besides

respondents’ profile, the reports look into other reasons for the
high typhoid cases in kawempe such as low latrine coverage,
poor drainage systems, overcrowding and ignorance.

FINANCIAL MANAGEMENT

INTRODUCTION

Managing money in health services is complex and a

responsibility done by accounts finance officers. However,
sometimes the in charge of a Health centre may be asked to
record the spending of money (to keep accounts). Prior to
spending the money, managers are also required to make
budgets of what they need in line with the available funds. E.g.,
government may give a health centre an allocation of funds
500,000/= to withdraw drugs from GMS.

The health Centre will not get the money but will order for the
drugs equivalent to 500,000/= and is accountable for it. A
written accountability must be kept of each order or requisition
used against the allocation.

Visible money or cash

This is money that is seen and handled. It is advanced to the

health centre for health workers to spend for the work of the
health service. It is not safe to have a large amount of cash at the
health centre as it may be stolen. For this reason, visible money
is usually small in amount and is called “Petty cash”.

Keeping and allocations ledger (spending “invisible “money)

The allocated invisible money by government or any other
organization) is usually of a definite purchase and can only be
spent for that purpose e.g. drugs, equipment or transport.
Accurate records of how the allocation is spent must be kept in
an allocation ledger (accounts book). E.g., allocations ledger

Date

Description /purpose

Document reference (folio No.)

Order or requisition
 Filling in an allocation ledger Allocation of invisible money
may be monthly quarterly or annually. When granted the data,
the purpose and the amount are recorded in the allocation’s
ledger. The reference number of the document that confirms the
grant of the money is written in the column headed document
reference (folio number) in order that the original document can
be found again when necessary. When a purchase is made, the
date, the order (requisition) and amount are also recorded. The
number of the requisition form or order form is written in
“Document reference (folio number) column. From this number,
the order (requisition) can be found again in the files that hold
copies of the order forms or requisition.

At certain intervals, perhaps monthly or quarterly, the amount

paid out is totalled and deducted from the amount allocated. The
unused money is brought forward (BF) and added to the new
allocation for the next months and quarterly or yearly or
according to the interval chosen e.g using petty cash, imprest
system or spending visible money. Petty cash means small
money; this is forwarded to the health unit to be used
exclusively for certain authorized Health services e.g Postage
stamps, telegram, calls from public telephone calls, cleaning
materials, soap, and detergent, antiseptic, furniture polish and
office needs like paper, envelopes, glue, pins etc. Sundries,
matchboxes, paraffin and candles

The Imprest system

An imprest is an advance of cash given for a particular purpose

but can be replenished as necessary. It is spent as need arises.
Whatever the period the imprest is replenished provided the
money provided has been accounted by presentation of receipts,
this prevents misuse of function.

The Petty Cash Voucher

Each time money is spent for the petty cash it must be recorded,
numbered and is kept and filled in order. Each petty voucher
must have a receipt attached to it from the person who sold the
item. Vouchers must be kept carefully because the finance offer,
chief cashier or audities may need to look at them in their
supervisory roles.

Note: Keep the petty cash vouchers under lock and the way.

Managing Drugs
The use of drugs is only one aspect of health service but it is one
of the most important, thus we have 3 statements.

 Drugs are important

 Drugs are powerful

 Drugs are expensive

Management of drugs supply is one of the most important

responsible functions of a health worker. He/she should use
them with skill, knowledge and accuracy otherwise, they are
dangerous.

It is to use drugs wisely and avoid wastage, have enough for

patient’s needs.

The following ways are how money can be wasted in drugs;

 Using too many drugs on one patient (polypharmacy)

 Using expensive drugs when cheaper ones could be equally

effective and safe.

 Prescribing before diagnosis is made “just to try them”.

 Using a larger dose than necessary.

 Using drugs which patients have no faith in such that they may
forget to take them.

 Poor maintenance e.g., those kept in fridge if not well

maintained lose their potency become ineffective  Issuing too
much (from store) at one time so that they are used
extravagantly or even stolen.

The ward in charge has the responsibility of teaching, both staff

and patients about use of drugs with emphasis on drug
compliance, to the patients. Patients with TB and leprosy who
have to take drugs for a long period need special explanation
and encouragement. They must continue taking the tablets even
when they feel better otherwise, the disease will become active
again.

Preparing a standard drug list

Mostly health centres make a drug list of the commonly used

drugs thus; Maternity units have drugs like Ergometrine,
pethidine etc. peadiatric ward/ clinic drugs include; vaccines,
ORS, Vitamin A, Albendazole, X-pen etc. The list is usually
made by the in charge or medical officer. Such a list should be
selected from the list of essential drugs at this national level. The
nature of health worker and knowledge about diseases and
treatments are constantly changing as new drugs appear
therefore standard drug lists may be constantly changing as new
drugs appear therefore standard drug lists may be out dated and
or inadequate if continuous revision and changes are not made
not for the following reasons: -

 Diseases are treated which were not previously treated

 Patients who were admitted in the hospital are now treated as

outpatients

 New drugs have become available

 The budget for drugs is no longer sufficient to purchase all the

drugs and cheaper alternatives are needed. While changing a
drug list on must consider the following;

 What disease and health conditions are expected in the health

centre

 Which drugs are available and could be used for these diseases
are health problems.

 The comparative effectiveness, convenience, toxicity and cost

of alternative drugs.
How to decide between alternative drugs

Procedure for modifying a standard drug list

 Find out the conditions treated for the last 6 months. If there is
any condition for which no drug is available include the drug on
the list

 Look at the list of drugs; if there is any duplicate (drugs of

same action) e.g., Aspirin sodium and paracetamol, choose one
drug for each purpose and remove the rest/others

 Find out if there is any absolute drugs never used for quite a
long time e.g. caster oil that stay in shelves for long time,
remove them from the list.

Choosing appropriate drugs

When many patients are being treated for a certain disease in an

endemic area, choose the least expensive drugs, when fever
patients are being treated for a disease, an expensive drug may
be chosen.

Estimating drug requirements – (Ordering and storing

drugs)
 Calculating drug, requirements It’s essential to estimate
appropriately how much drug is needed to avoid wastage or
shortage. This can be done basing on the previous experience or
by calculating.

Formula

Total dose of average course of drug X usual no. of patients

treated with the drug with the purchasing interval. e.g.,
supposing an average no. of patients are prescribed Panadol the
average course of Panadol is 2 x 3 days, purchasing interval is 3
months. Then it means 6 tabs x 10 x 90 = 5400 tabs, 5 tins of
1000 tab tin and 400 tabs should be ordered every 3 months.
There is need to use clinic records and registers.

Ordering for drugs

The same procedure must be followed as for ordering

equipment, using a modified standard list, the exact type and
quantity. Only brand name drugs are ordered. When satisfied
that they are effective and safe, they are generally clean. They
quantity, dosage, form, strength should be stated and a cost
estimate made when an order form is completed. While ordering
drugs one should consider the brand names and if generic names
are used one has to be careful because in developing countries,
there are large numbers of spurious (false) useless and even
dangerous drugs (genetic preparations). WHO has instituted a
certification scheme on the quality of pharmaceutical products
which the countries may purchase. In these countries, the
authority that controls importation of drugs will know which
genetic preparations are safe for use.

Stocking Drugs

 Orderly stocking is an essential part of drug management

 Drug received should be recorded in a stock card or stock

ledger as for any other equipment

Storing drugs

 Most drugs must be kept dry, cool and away from light in
cupboard i.e., best for these conditions

 Keep tablets in air light containers and have each bottle/tine

labelled.
 A red star should be placed on the tins that have expiry date in
the current year, in that they are used first.

 Dangerous drugs must be kept in double locked cupboards,

with special registers.

Stock card system

 The stock card is sometimes used instead of ledger. It is used

the same way as for ledger when balancing equipment

 Each drug is put on a separate card as each item is put on a

separate page on the ledger.

 The card relating to each particular drug is preferably pinned

to the shelf next to the drug stock to which it refers.

Issuing and controlling the use of drugs

Drugs are issued from a locked store cupboard, by the person in

charge of the drug or section using the drug. Drugs are issued
regularly and are known quantities and this permits monitoring
and control of drug usage. Infrequently used drugs may be
issued like every 6 months and frequently used drugs may be
issued weekly or monthly. Drugs on the dangerous drug list are
controlled by special laws and are issued only on prescription.
Each issue of a drug is recorded on the appropriate stock card,
calculating the balance and checking against stock in the shelf.
This monitoring helps the health worker to: -

 Notice when stocks need re-ordering

 Check drug against patient treatment

 Become rapidly aware of discrepancies

 Check changes in drug use in different sections of the health

unit.

NB.  Discrepancies should be and the necessary remedies taken

 Controlling the overuse of drugs is solved by educating the

staff in the proper use of drugs.

A/B or Double – shelf system of drug stock control

The A/B or double shelf stock control system can be used either
for all drugs or only for important and life-saving drugs. When a
new drug stock is received, it should be divided into two parts
that can be labelled A and B and placed separately on two
shelves. Part B should be sealed in a plastic bag or otherwise
wrapped and placed on the bottom shelf. As a reminder, it
should be labelled “Not to be used” until new order is sent”.
When part A is finished, the order for the new stock should be
sent. Part B should then be used which by the time it is finished
should have been delivered.

Controlling life-saving drugs

Sometimes, a patient condition is so acute, severe or critical that

only the immediate use of certain drugs can save his life. It is of
vital importance that such drugs are always in stock as their
absence in an emergency may result inpatient’s death,
unnecessary tragedy and a failure of health service management.
To avoid this, it is essential to: -

 Make a list of life saving drugs

 Place them together on the same shelf

 Check the shelf frequently

 Order new stocks whenever stocks are depleted by half.

Examples of emergency drugs are adrenaline and oxygen N.B:

The emergency drugs should be placed on a tray in certain
corner/placed accessible to every staff. It should be checked
every day and handled over between shifts.
REVENUE AND EXPENDITURE MANAGEMENT

Introduction

Definitions

Revenue Is money coming in from

1. Patients

2. Donors

3. Government

4. Project

Expenditure

Money going out for:

1. Drugs

2. Salaries
3. Supplies

4. Allowances

5. Utilities (water and electricity)

Importance of proper management of Health Facility

Revenue and expenditure

1. To ensure money is available for high priority purchases for

example drugs and supplies

2. To ensure the health unit does not run out of money

3. For the health unit to know how much it is spending on

certain items

4. For the Health Unit to determine how much money it has at a

given time

5. To ensure the health unit follows approved budget in

spending

Process of managing revenue

Six steps involved

1. Collect money and issue receipts

2. Record exemptions and debtors

3. Keep money at the bank or at the unit

4. Record in the cashbook and bankbook, money deposited in

the bank and received at hand

5. Verify bank statements and bank book

6. Ensure money recorded in health unit registers equals the

amount in receipts, debtors and exemption books

Managing expenditures

 Some health units have decided that some expenditure needs

approval for example by Chairperson of Health management
committee, Treasurer, Health unit in charge etc.

 Obtain approval for large purchases

1. To prevent one person from making sole decisions in

procurement

2. To ensure agreement that the purchase is reasonable

3. To ensure consistence with H/U budget

Key financial records in the management of revenues and

expenditures Documents

Use the following documents in managing expenditure

1. Cash and bank books

2. Budget

3. Cheques

4. Requisition forms

5. Vote books

Steps in managing expenditure

 Determine if money is available

 Record expenditure in the cash and bankbook

 Record expenditure in vote book

 Write a cheque

 Make requisition for large purchases

The impress system

An officer should not use his/her personal money to buy

goods/services for official use although there is a possibility of
this money being refunded
 Impress system is an official system of advancing money to a
public officer to use on official duties and for purchase of
official goods and services

 He/she should there after account for it according to impress

regulations

 It is the accounting officer who appoints impress holders and

normally gives this permission in writing by preparing an
impress warrant.

 The impress holder then submits accountability to the

Accounting Officer.

 Authority to run impress lasts only one year

BUDGETING AND BUDGET CONTROL

Definition of the term budget

A budget is a financial statement which contains estimates of

revenue and expenditure of an organization for a certain period
of time (usually one year) in order to achieve pre-determined
Objectives
Others refer to the budget as:

 A short-term plan of action

 A method of predicting the future

 A translation of needs into a financial outlay Importance of

budgeting

Why budget?

Budgeting assists in:

 Planning and policy making

 Evaluating performance

 Determining sources of resources

 Determining expenditure

 Authorizing future expenditure

 Coordinating activities of an organisation

 Regulating and controlling the income and expenditure

 Determining the affordability of programs

Qualities of a good budget

 Realistic
 Balanced

 Plan based

 Understood by users

 Include all sources of revenue

 Reflect team work and consultative effort

The budgeting process and techniques

 Zero-Based Budgeting (ZBB)

 Program budgeting:

 Incremental budgeting:

Incremental budgeting:

It considers the entire previous year's budget and only increases

or reduces by a small margin, also giving allowance for changes
in price levels

Advantages:

 It's cheap

 Requires not highly skilled manpower

 Easy to understand
 Takes shorter time

 Reduces conflict since changes are few

 Suitable for maintaining long term goals of the organization

Disadvantages of incremental budgeting

 Deficiencies of previous year are carried forward

 Does not question the previous level of spending

 Does not question previous areas of spending

 Current expenditure could be inflated or padded

 A disincentive to innovation/generation of new ideas

Program budgeting:

 This considers fundamental objectives of an organization and

evaluates costs and benefits of each alternative relating them to
programs

 It tries to group activities into program categories and program

elements and therefore also groups resources Advantages of
program budgeting
 It's a rational framework for decision making

 Cuts across lines of responsibility

 Exposes contradictory or overlapping programs

 Concentrates on long term effects

 Gives information on the likely impacts of alternatives

 Enables a rational choice based on cost-benefit analysis

Disadvantages of programme Budgeting

 A complicated process

 Required information will not be readily available

 A lot of work required

 Needs a pyramidal structure for decisions to be taken at the

top, hence ignores decentralization o has failed everywhere at all
times

Zero-Based Budgeting (ZBB)

Also called "clean sheet budgeting", ZBB means preparation of

operating budgets from a zero base. ZBB does not consider
previous year's budget
Advantages

 Eliminates the traditional approach of just taking whatever was

in the previous budget

 Focuses on output in relation to value for money

 Is more realistic to the current needs

 Is bottom-up involving the lower cadres of staff

 Encourages creativity of lower staff

Disadvantages of ZBB

 Time consuming

 Is very costly to do

 Lower-level cadres find it hard to understand it

 Requires highly skilled personnel who are scarce

 Very theoretical and difficult to apply

The budgeting cycles

1. Identification of objectives

2. Determination of resource needs

3. Pricing of the requirements

4. Identification of revenue sources

5. Negotiation of budget allocation with superiors

6. Prioritizing the needs

7. Coordination and consolidation into master budget

8. Approval

9. On-going review

Main points on budgets

 Income and expenditure should be equal. The budget should

balance

 If the expected income is higher than expected expenditure,

then a category called 'savings' or projects can be created under
expenditure to balance the budget

 The expenditure should not be allowed to exceed the expected

income

 The budget and actual expenditure of the previous year should

be taken as a starting point.

Deviations should be based on the lessons learned or justified

changes.
Approaches for budgetary control

It means monitoring the budget on a regular basis to make sure

implementation is done as planned.

Budget monitoring is done:

 To control expenditure

 Avoid wastage

 Identify the variance between the approved and actual

expenditure

 Compare activities with value for money

 Ensure no planned activity is forgotten or left undone

 How to monitor budget

1. Look at policy decisions and priorities

2. Study the approved estimates

3. Check the budget codes

4. Identify and notify the departmental heads of any possible

errors in the figures or the codes
 Continuously follow-up the expenditure patterns

 Assess the likely overspending and make sure vehement is

sought for in time

 Assess variations from the approved allocations and reasons

why

Role of management team

The management team is responsible for the control and

management of funds and resources. They should ensure that:

1. All revenues due are collected, received and safeguarded

2. Preparation of the draft annual estimates

3. Submission to the hospital Board

4. Maintenance of adequate and efficient systems of budgetary

control.

5. Ensure expenditures keeps within approved levels

6. Responsible for budget implementation and running of the

hospital/HU

7. Preparation of supplementary budget if and where necessary

8. Operate a system of budgetary control and ensure value for
money while implementing the budget.

LOGISTICS MANAGEMENT

Definition of Logistic It refers to material equipment that is used

on the day-to-day activities by health workers. It involves
supply, distribution and replacement of material

Types of material equipment (Logistics)

There are two: -

 Expendable termed as consumable

 Non expendable termed as capital

Expendable equipment: - It is the equipment that is used for

short time e.g Matchbox, cotton wood, lab stains, disposable
syringes, gloves etc.

Non- expendable equipment: Is that equipment that last for

several years and needs care and maintenance e.g weighing
scale, tables, beds, microscope, vehicles, bed, pans, trolleys,
trays, etc.

Procedures of managing equipments

These are four procedures of management of equipment.

 Ordering

 Storing

 Issuing

 Controlling /maintaining

ORDERING

Ordering of equipment is usually done by the senior staff in

charge, who has authority. When ordering, the in charge should
make sure that there is still a balance on stock which will be
used before a new stock is delivered (head time consideration).
The ordering staff must have the skills to do it which includes: -

 Listing the relevant equipment

 Balancing the requirements with available resources and

making cost estimates

 Use the catalogue

 Purchasing

 Balancing quantity with demand (to avoid shortages and

surplus)
 Completions of the order forms or requisition forms

 Listing equipments needed with specifications of the type of

each item and the quantity required.

Using a catalogue, A catalogue is a book that contains a list of

articles for purchase from a certain place. It is a communication
tool the manufacturer supplier uses to enable the customer make
a final decision of what is to be bought (also termed as
preformer invoice). It is used whenever things are ordered at a
distance. Therefore, while ordering; one needs to note the exact
item, number, description and price.

Purchase of new equipment Before purchasing new equipment,

several factors should be considered which means asking
yourself and your colleagues a number of questions which
include the following

Uniformity

 Does the equipment you are proposing to buy match with

equipment which is already being used locally.

 Nationally, is it proved to be good?

Sustainability
 How expensive are replacement’s spares and consumables?

 Will replacement parts be available for a reasonable price in

the future?

 Does a local agent supply them?

Training / Complexity

 How easy is the equipment to maintain?

 Is special test equipment needed?

 Can hospital staff be trained to maintain equipment or need

outside experts?

 Are special tools required to carry-out maintenance or

adjustment?

 Does it have any accessories which are expensive that will do

the job just as well?

Safety

 What risks or challenges are associated with the piece of

equipment?
 Will costly building alterations or services be required to
accommodate the equipment?

 Will there be need for special protective clothing for users?

Durability and Robustness

 Will the equipment withstand the local conditions (temp,

humidity, drought, dust)?

 Manufacturers should be able to supply relevant records if

requested to do so.

Cost

 Do not buy cheapest just because it is cheap. The most

expensive design or makeup may be cheaper in the longer term.

 Buy equipment best suited to your hospital needs.

Specifications

If requested to do so, the world health organization (WHO) will

confirm whether or not the equipment you are proposing to buy
meets their standards.

Balancing quantity and demand.

While making an order, the in charge should ensure the quantity
matches with demand. However, it’s therefore not easy thus a
need for unpredictable demand forecasting will be used without
definite information. There should be a method of estimating the
quantity of them to be ordered.

Thus, call for eliminating very expensive items which are rarely
used to be purchased at the time they are needed or have just a
few for emergency handling while critical needed items must be
in place all the time.

Completing an ordering form (requisition form)

An order form or requisition form is usually supplied together

with the catalogue. Different suppliers, stores or films have their
own particular order forms.

STORING

Equipment is stored in two places

 A main or reserve store where stocks are kept but not used

 Place of use after issue

To store equipment, the following skills are necessary

 Recording the receipt of new articles and the issue of articles

 Keeping the stock book as ledger on balance

Activities in storing

 Recording

 Labelling

 Holding equipment in a stock or store room

Skills are required

 Recording the receipt of new articles and the issue of articles.

Compare with invoice (A statement of the cost of the article) or
the delivery note.

 Keeping a stock- book or ledger in balance.

 Use separate page for each item stocked

 the date in which the item was received

 The reference number of the item (from the catalogue) and the
place of purchase

 Every time an item is delivered, the quantity received is added

to the total sore; each time an item is issued, the quantity is
subtracted from the total stock.
Perceiving New Items of Equipments into Store

This involves checking of the equipment whether new or 2nd

hand. Equipment should be accepted in hospital if only after
specific checks and tests have been carried out and found
satisfactory. The equipment should be received in the presence
of purchasing officer, maintenance engineering officer;
maintenance staff; maintenance staff member and user
representative.

This team together should: -

 Undertake a site inspection to confirm that necessary services

(water supply, drainage, electricity supply) are available

 Check the delivery note

 Keep all packaging materials in case the equipment needs to

the transported again

 Check the contents against the delivery note, ensure reports

are there and manufactures instructions are provided

 Check if the serial number of the package matches with that on

the equipment

 Check equipment damage

 Report any omissions or damages to the supplier as soon as
possible, register the guarantee, if appropriate.

 If the equipment is to be connected to the electricity check the

plugs, switches and everything

 Include the equipment register, giving it a serial number

 Carry out test runs of equipment

 Organize staff training for performance and users of the

equipment

Apart from equipment checking, on receiving new equipment

item, some documents are delivered with items like delivery
note should be checked and signed keeping a copy of each from
the supplier who also gets a copy. Invoices and delivery notes
must be kept in separate files which are labelled.

Each item is recorded on a separate page in the stock book or

ledger, noting the following: -

 Date on which the item has been delivered

 Reference number of the items from catalogue and places of

purchase
 Invoice number of statement account

 The quantity of items

Keeping ledger balance

Each item is recorded, on a separate page every time a similar

item is bought and added to the total stock. Each time the item is
issued, it is subtracted from the total stock, thus the balance on
stock.

ISSUING EQUIPMENT

A health centre has several sections/departments e.g., medical,

surgical, treatment room, maternity, lab, etc and each department
is responsible for the equipment in its section. After equipment
has been received and recorded in the stock book, it is stored
and later issued for use as it is needed. Three papers work
procedures are involved in issuing (writing the issue in stock
ledger, issue of voucher which must be signed and inventory
record of the section receiving and issuing the equipment.

Ledger record
When an issue is entered in the stock ledger, the balance of
items remaining in stock is accumulated by adding.

Activities in issuing equipments

 Giving out

 Recording the issue

 The balance of remaining stock

 Receiving a signed issue voucher to the appropriate

department.

Three steps in issuing equipments:

 A ledger record (writing the issue in the stock ledger) - to

make balance, to order new below a certain level

 Issue of a voucher which must be signed (date, what, how

much, page in the ledger, to which department, by whom,
signature).
 An inventory record of the section receiving and using the
equipment.

CONTROLLING AND MAINTENANCE

Expendable equipment must be maintained to avoid wastage on

expendables and kept in good working condition. To control and
maintain equipment, the following skills are needed: _

 Convincing staff that equipment must be cleaned, inspected

and kept in good working order

 Reporting any defects- immediately and returned to its correct

place after use

 Using an inspection check list and inspection schedule

 Detecting the discrepancies (discrepancy is a difference

between what is reported and what is found out)

The value of use of equipment records

Good management takes care of equipment by:

 Introducing and motivating staff to feel responsible for the

equipment they use

 Ordering supplies when needed

 Storing supplies safely

 Controlling the use of supplies

There are several reasons for keeping equipment records,

requisition forms, stock cards/ledgers, issue vouchers,
inventories, etc.

 Previous order records make subsequent orders quicker or

easier. They should have supplies address, item reference
numbers, normal quantities required.

 The balance in the ledgers shows when to order for more

supplies thus avoids items to be out of stock which improves
effectiveness of health services

 Issue vouchers encourage workers to take responsibility of

equipment and can indicate who is responsible for loss or
breakages.

In summary accurate records save time and contribute to the

economy, efficiency and smooth functioning of the health
service.
HEALTH MANAGEMENT INFORMATION SYSTEM
(HMIS)

Health Information system is a vital tool in health services

management. It plays an import role at every level/stage of
health services management e.g. planning, implementation,
control and monitoring/evaluation of health services. HMIS
involves collection, complication, analysis, interpretation,
utilization and dissemination of data on health. The information
can be used for planning, implementation and evaluation of
health activities.

Introduction Data and information

Although these 2 words are used interchangeably as one, there

are significant differences between them. Data consists of facts
and figures e.g. number of patients attended to, number of
children immunized and number of staff just recorded in the
files. This is not information. It is only after these fats are
analysed for facilitating decisions that they become information.
Collection of data Source of data In Uganda, data can be
collected from various sources. Routine collection of health data
is from;

The health facilities e.g.,

 Morbidity and Mortality

 Special investigations

 Quarterly and annual reports

The community: Through surveillance reports e.g., survey,

census, and epidemic reports and on spot observation.

Other sectors

 Agriculture e.g., food production

 Education e.g., literacy levels, student involvement

 Administration e.g., manpower, finance supplies

 Media (Newspapers, magazines, radios and TV)

Types of his forms used to collect data in the health care setting
Health data is routinely collected through a set of his registers
and forms

 Outpatient register
 Outpatient card MF5 (>5 years) 101

 Outpatient tally sheet

 Child health care card MF5 (< 5 years)

 ANC tally sheet MF 454

 ANC card

 Maternity return/discharge register MF49

 Monthly summary report MF77

 Inpatient return /discharge register MF 74

 Lab registers

 Lab tally sheet MF 1999 A

 Environmental health tally sheet and special investigation

forms namely

 EDP sheet

 Surveillance forms for special health problem e.g.,

AIDS/T. B etc.

Analysis of data
The first step in analysing the data is to determine the various
types of information obtained from the HMIS forms. Each and
every form seeks particular information about the patient or
client e.g.,

Outpatient card MF5 Record of an individual’s health status.

The information which can be obtained on this card includes
Diagnosis, Treatment, weight record, immunization of under 5
years.

Inpatient return discharge register can also give information

on case morbidity patterns, case fertility rates as well as, major
causes of admissions age specific mortality rates.

Maternity return/discharge register MF49 can indicate

 No. of mothers delivered

 Still births

 Maternal death rates

 Complication of deliveries

Antenatal tally sheet MF 49A provide information on:

 Utilization of services
  Complication of pregnancy

 Proportion by trimester tendency

Child health tally sheet MF 45A can indicate: -

 Incidence and prevalence rate of malnutrition

 Utilization of vaccines

Lab tally sheet MF199 shows:

 Rate, work load utilization of reagents

 Common investigations done

Environmental tally sheet:

This gives information on access to safe water, housing

indicators, mortality rates, access to PHC workers. Information
can also come from reports, usually from the health-related
sources e.g., Administrator reports provide information for
managerial purposes on manpower, finances and supplies.
Censuses and surveys can provide information on population
(demographic) and other specific finding respectively.

Presentation of information
To make use of various types of information, the information
should be presented in a logical and understandable way by
using 2 methods.

 Numerical presentation i.e., Percentages and rates

 Pictorial presentation i.e., maps and graphs, histograms, pie

charts etc.

Utilization health information service

This is a useful management tool even for the operational level

of the health worker. Operational health workers can use it in the
following respects, planning, Supervision check list,
accountability, monitoring and evaluation.

Heath Information System data (HIS) management

The data generated by an HIS has to be managed correctly and

efficiently to yield the desired information. This management is
at the micro (collection point) level and macro (District, national
among others levels). Data management involves collation,
checking on accuracy and completeness, storage, processing,
analysis, report generation and information communication.
Computers are useful tools for data management at all levels of
an HIS.

Desirable characteristics of an HIS

The key desirable characteristics of an HIS are that it should be:

 Covering, and used by, all levels of the health system

 Affordable and manageable

 Flexible, functional, useful, reliable and relevant

Decision-making process based on health information

The decision-making process follows the following steps:

 Identification of issues

 Examination of relevant information for allocating

priorities to the problems;

 Setting of goals;

 Selection of possible solutions to the problems;

 Decision-making on which solutions to implement;

 Implementation of the chosen solutions;

 Assessment of the results.

Relevant sources of data (Health Information Sub-Systems) HIS
may be divided into five different sub-systems;

a) Disease surveillance

b) Service reporting

c) Specific health programmes

d) Administration

e) Vital registration and census

Various types of HIS may exist in the same country, the national
(public) system, the private sector information systems and
others. In any of the systems, there are often several levels, from
the community level, the small health units, through the district,
regional or provincial levels to the national level. The system
relies on feedback procedures to continuously improve the
quality of data and the information.

Types of Health data collection system

Health data are either collected routinely or obtained through ad

hoc exercises. Normally, data are collected from all the health
reporting units. However, in certain circumstances, sentinel
reporting units can be established to provide special or
additional information for the HIS.

a) Regular or routine data collection systems

A regular or routine data collection system usually consists of

established procedures for collecting data as they become
available. Some systems are national with legal backing or are
demanded by international regulations, yet others are sub-
national or even institution specific.

b) Ad hoc data collection systems Ad hoc data collection is

usually in the form of a survey for information not
available on a regular basis. This may include special
investigative studies or merely additional information on
routinely collected data. One advantage of the ad hoc
system is that it provides more accurate and reliable data on
specific needs of the user. But the logistics and expenses
involved in its execution are some demerits of this system.
The various levels of a health informationon system.

Procedures for data collection

a) Regular or routine system

The procedure for regular data collection is usually along
the following lines (but not necessarily in the stated order):

 Decision on items of data to be collected according to the

demands of the Health Information System (for example,
health programme monitoring, management of the health
system, etc.). 103  Establishment of rules and regulations
instituting the system, giving it legal backing, especially if
it is to be a nationwide system. These rules and regulations
are enacted by a competent authority.  Physical
establishment of office facilities, recruitment of personnel,
and dissemination of appropriate information to the public.

 Design of forms and registers to be used for recording

information.

 Specification of the recording procedure: who supplies

the information, when the information has to be registered,
among others

 Specification and design of registration receipts: these are

tokens given to the person registering an event to indicate
compliance. on system
Examples are: hospital registration cards, birth and death
registration certificates.

b) Ad hoc system

The steps involved in the organization of data collection on

an ad hoc basis are:

 Definition or statement of the objectives of the collection

exercise, indicating what type of information is needed and
the data to be collected, and how the information is to be
used.

 Definition of the population for which information is

required (the reference or target population)

 Decision on whether information will be collected from

all or some of the units in the reference population.

 Decision on how many respondents (those from whom

information will be collected that is sample size) are to be
included in the study

 Decision on how these respondents will be selected

 Design of the instruments (forms, etc.) to be used for

data recording
  Selection and training of personnel to collect the data

 Mode of data collection (personal interview, self-

administered questionnaire, telephone etc.)

 Identification of selected units and data collection

HMIS as a planning tool

As a planning tool HMIS achieves the following;

 Assessment of the work load at the Health Unit

 Resource requirement for specific activity in a specific

period e.g., drugs personnel, stationary, other logistic or
materials

 For casting and reviewing disease and mortality patterns

over seasons or periods.

Use of HMIS as superiority checklist

 To determine performance of workers

 To access training needs

 To faster distribution of facilities/resources

 To keep inventory check

 To determine travel plans

 To identify priority attention items.

HMIS use in accountability The coverage and utilization rates

of a service do commonly explain the utilization of materials or
funds availed for the specific activity. The resources supplied
should be reflected by the activity. The resources supplied
should be reflected by the services provided by the community
or target groups.

HMIS use in monitoring and evaluation The services

provided can be accessed through continuous collection of
information to determine coverage, accessibility and utilization
of such services. The morbidity and mortality patterns may
reflect effectiveness of services.

Maintenance of HMIS The Health worker should first and

foremost appreciate that HMIS or the data is more useful to the
DHO or the health planning unit for the better utilization.
Therefore, the health workers should ensure that the health data
he collects or submits to high authorities is;
  Complete data

 Accurate and accurately recorded

 Regularly recorded

 Collected and compiled by the H/staff with good

knowledge and skills in HMIS

 Well stored and easy to retrieve

 Copied to relevant activities

The collection, compilation and analysis of health data should be

done within the limited resources available to the health worker.
He should be very familiar with types and resources of various
forms being used and the quantities required over a specified
period. The ordering should be based on set targets, facilities
available or previous coverage. There should be proper custody
and /or security of record. As a method of motivation, HMIS
reporting should be a two-way system to ensure feedback can
reach the one who collects the information and the subsequent
user at a higher level.
The health data /information should be kept in a summarized
form for as long as it is still wanted.

Flow of health information

The health worker in charge of health unit should collect all the
information from the various health services preferably from all
health programmes such as EPI, ANC, MCH, General OPD and
others to summarize the monthly forms. He must use HMIS
information for his own day to day running of the health facility
as well as for long term planning purposes. It is also necessary
that health workers send a copy of the summary monthly report
to the DHO’s office. Urban H/Units send it through the
municipal council to the DHO’s office. At the DHO’s office, all
summary monthly reports of various health facilities including
hospitals are compiled into a monthly summary report for the
district which is sent to the HMIS unit of MOH in Entebbe.

After the analysis of the data from all Health Units, important
information should be sent back through the DHO’s office to the
respective Health Units. The information sent back should
consist of queries, advice or a comparison with other units or the
districts. Another flow of information is from the DHO’s office
through the Chief Administrative Officer (CAO) who reports to
the ministry of local government. This information is mainly
administrative e.g., salaries, personal, general problems in the
health facilities, etc. Note. Since some of this information is also
health related, the ministry of local government will discuss the
reports with the ministry of health and give feed-back
accordingly.

Health service management records

Meaning of records

Records consist of information kept in the health unit about the

work of the unit, health conditions in the community and
individual patients as well as information on administrative
matters such as staff, equipment and supplies. Records are
written information kept in notebooks; they may also be kept on
tapes or be computerized. Records are administrative “memory”
an important tool in controlling and assessing work. Note:
Failure to keep patients records accurately will lead to mis-
diagnosis, miss management and difficulties in follow up of
patients /clients.

Types of records kept in health unit

 Inventory

 Drugs

 Registration book

 Admission/discharge books

 Monthly returns

 Report books

 Notification form

 Birth/death certificates

 Patient’s record

Inventory

Inventory is a list of items that are found in a certain place/unit

(including those in use and storage). Each section of a health
centre/unit keeps an inventory of its non-expendable equipment
i.e., equipment that is used for several years e.g., 105 furniture,
trolleys, drip stands, weighing scales, etc. Expendables are those
used in a short time e.g., match box, cotton wool, disposable
syringes and needles etc. New equipment issued to the unit must
be added to the inventory.
Advantages of Inventory taking

 Any loss is easily identified and prompt report is made

 Any shortage is easily identified and new order made

 It helps in identifying equipments that need repair or

replacement Interval of Inventory taking It is important to have a
careful physical checking of all equipment at frequent intervals:

Monthly: Checks should be made/carried out by a nursing

officer incharge. However, the staff does it on daily basis as they
handle and take over in their different shifts (even students).
Sign for the equipment and report any loss to the incharge.

Three Monthly: Checks are carried out by the Principal Nursing

Officer (PNO) or inchargeof the Health Unit. In other times, the
inventory is carried out when a new incharge is taking over a
unit/hospital.

During handing over and taking over and signs for the
equipment he/she finds on that unit. Points of Importance

 Involve all the staff

 Identify any loss

 Mark all equipment

 Keep the books safely

Importance of Records

 Source of information that keeps the patients identified

 Assist the hospital discharge its obligation to the patients and

community

 Assists physician to give logical services to the patient

 Protects the physician in case of legal suits

 An indispensable tool for teaching and research

 Legal document for claims e.g., Insurance and compensation

 Basic element for vital health statistics

 Donors use records to compare alternative methods of Health

care delivery and to assess progress with effectiveness and
efficiency.

 Records give information which is a vital resource for health

planning, implementation and evaluation

 Records help in handing over and taking over between Health

workers of all categories by giving a written report.
Methods of keeping records

Filling Alphabetical filling

Files are arranged in an alphabetical order according to the 1st

letters of the main name of staff member or patient. This method
is when there are large numbers of papers on a single subject. In
Health services, it is useful for each staff member to have an
individual file. In it, there are personal particulars, employment
and salary details, leave dates, implemental dates and any other
correspondence relating to personal problems.

Numerical filling

Filling by subject is the most useful system by general purposes

in small health units, all papers, documents; letters that do not
belong to any existing file should be listed. A file should then be
established for each subject category e.g. correspondence about
patients. E.g., Copies of referral papers, correspondence with
supervisor/administrator like from district regional office at a
higher level, then Health Unit and all other correspondences
e.g., funds and financerequisition papers. Correspondence with
supervisors/administration e.g., district regional office at higher
level, then health units and all other correspondences e.g., funds,
and finance- requisition forms, receipts, issue vouchers, petty
cash voucher.

Geographical filling

There should be a file for each village. It contains names of

leaders, dates of markets, special problems, travelling times and
distance’s e.g., bus services. Modified unit filling system 106 Is
a method used in filling, the unit number is called modified unit
filling system. The numbers indicated are the 2 last numerical
numbers of the case file. All cases files ending in the number
indicated are filed together. It means therefore that each file has
6 digits i.e., 00-00-00’ are last indicating the filling area while
the next last number indicate position of the file.

Filling by subject: At the end of the reports.

Coding and indexing

This is a system on which diseases classified in accordance to

etiology and manifestation nature as indicated in international
classification of diseases (ICD). This is WHO classification
which is up –to-dated every 10 years. A code number is provided
for each type of disease/injuries and ill-defined conditions. Each
code specifying a type of condition is allocated to what is
referred to as a disease diagnostic card. The card indicates the
patient number, resistance, and age, and sex, discharge, alive or
dead. It’s from these cards that the compilation or mortality and
morbidity data is done. The system allows comparison on
specific disease among different countries.

Cataloging

It’s arranged in order like a list of names, places, goods, and this
special order helps the user to get out what he wants at any time.
Staff files, files for support staff, offices e.g., finance, patients
etc.

Retrieving information,

It means looking up for information/records. Records can be

found out by using the following system.

Tracer system

This is a method of tracing of files during the filing period i.e.,

finding out where the file is and who took the file. The types of
tracer systems are:
 Common tracer: It is used for any records. It indicates the
number of the file, when it is taken, where it is taken, and
expected return date. Its advantage is that it can be used for
many different records.

Also, when the record is taken, the common tracer stays.

 Personal tracer: When a file is initiated, a tracer is created. It

has details of the record. The file and tracer are kept together.
When the file is to be taken out, remove the tracer, write
particulars indicating where the file is taken and keep the tracer
record. Its advantage is that it tells you how, who moved the file
in other departments. Its disadvantage is that it is inactive.

 Library tracer: small cards are kept within the book. When
the book is borrowed, records are done on that tracer card; it’s
removed and kept in another place. There it will be put back on
return of the book.

 Requisition holder: It is used particularly in stores. It has

ordered items and quantity when issued of tick; indicate who has
issued and who has taken.
  Master index: A system used to get patient’s records over
when he can’t remember the number. It’s a key to the numerical
filed records and it contains name, address and other particulars
contained in the identification. It’s a small card as the one
indicated below.

Hosp No……………………………………………………….

Name……………………………………………………………

Othername………………………………………………………

D.O.D……………………………………………………………

Address…………………………………………………………

Age………………………………………………………………

Sex………………………………………………………………

ORGANISING HEALTH –TEAM ACTIVITIES

Learning objectives

 Design job descriptions and use them in managing a team

 Coordinate activities of the team

The distribution of tasks among the members of a health team is
one of the manager’s most important functions. Unfair
distribution of work causes dissatisfaction and sometimes
quarrelling. Work should be arranged in such as way that team
members use their individual skills and talents. Distribution
should ensure no ‘over work’ or under work. Health tasks are
varied and this variation in tasks makes organization in health
work a challenge to the team leader. Job descriptions are the
means of helping to distribute tasks among the health team

JOB DESCRIPTIONS

A job description state:

 The objectives, activities and programmes of the holder of the

post concerned

 The authority of a health worker i.e., the decisions that the

health workers is expected to make and has a right make.

 The responsibility of a health worker, i.e., the expected degree

of achievement of tasks and functions. The purpose of the job
descriptions is to define exactly for the holders of different
posts, their fellow workers and their supervisors.
 What the holders of the posts are expected to do

 What standards they are expected to reach

 To whom they are responsible

 Whose work they supervise

Uses of detailed job description

 Job descriptions are a valuable tool for the organization of

work

 A job description clearly states what each health worker must

do and is expected to achieve.

 A job description helps prevent arguments between people

about who should do what. They help also into the distribution
of the equipment needed to do the work.

 A job description helps to prevent gaps and overlaps. If often

happens that certain tasks are not done because nobody accepts
responsibility for them.

 A job description can show the need for training, for instance
if it includes a duty for which the health worker has not been
trained nor needs further training
 Job descriptions are useful as a basis of evaluating team
members’ performance. However, they should be interpreted
flexibly, as guidelines, rather than too strictly or literally.

Content of a job description Job title:

This is the standard title for the person doing the work or jobs
e.g nurse/midwife/clinical officer.

Date: The date is included because a job description is not

final. People and roles change, and job description should be
received and if necessary, revised at least once a year.

Job summary: This is a summary of the main responsibilities of

the job.

Duties: This is the control and most important part of the job
description. Each duty should be an identifiable entity, a
recognizable part of the job holder’s work. Each duty should
correspond to one or more programme objectives, which should
be listed. The health worker can then see how his or her duties
contribute to the improvement of the health of the community.

Relations: These are simple statements concerning:

 The title of the person to whom the job holder is accountable.
For a particular task, one person can be responsible to only one
superior. However, one person can hold more than one job and
for different jobs may be responsible to different superiors.

 The titles of people supervised by the job-holder.

Qualifications: A section on qualification describes the basic

training and level of experience required for the job.

Training and Development: Every job description should be

accompanied by a programme for further training and
development of the person holding the job. This may be for
example, a regular programme for reading or of in–service 108
training, and opportunities to attend professional meetings. Like
every other element of the job description, this should be
discussed in full and worked out with the job-holder

Review and Appraisal: This is a statement describing the

process for review and appraisal of the performance of the job
holder. Normally the supervisor is expected to carry out such a
review periodically. The review and appraisal statement should
state clearly who has this responsibility. The appraisal may take
the form of an annual confidential report written by the
supervisor, simple statements that work is satisfactory, or a
recommendation for a change in the duties, or the promotion, of
the job-holder

NB. Job descriptions help to guide work organization.

Example of a job description

Job title: Medical Clinical Officer

Date: 21st September 2011 Job

Summary: A clinical officer is a health worker who provides

Promotive, preventive, curative and rehabilitative Services
within the health facility and the Catchment area.

Duties:

Management: The clinical officer manages Resources in the

health facility and the health services given in his catchment
area.

Community health: The clinical officer carries out the

following tasks.

 Carries out community diagnosis

 Plans, organizes and conducts integrated PHC in the area

 Promotes school health activities

 Evaluates health services in the community

 Institutes correct treatment including health education,

counselling, rehabilitation and the conducts operational research.

Clinical care:

The clinical officer carries out the following

 Diagnosis and management of common health conditions at

the health facility.

 He/she identifies emergences and gives appropriate treatment

 Conducts normal deliveries

 Carries out minor procedures/surgical operations

 Provides nursing care to patients

 Identifies and refers patients that cannot be managed at that

level

 Identifies and reports notifiable diseases

 Identifies some medical- legal conditions and takes appropriate
action e.g., rape, assault, defilement.

Career development; opportunities and avenues

The following opportunities are available for career

development.

 Ophthalmology

 Psychiatry

 Anaesthesia

 Medical education (Tutorship)

 Paediatrics

 Public Health

 Ear, Nose, Throat (ENT)

 Medicine and Surgery

 Health service management

 Health promotion and education

Eligibility for the above courses will be that a clinical officer

should have been confirmed and served for a minimum of two
years. After a post basic training, a clinical officer is eligible for
a salary increment. For tutorship, a clinical officer should have
served for a minimum of three years and after this course, a
clinical officer goes to U4

PLANNING HEALTH ACTIVITIES

Planning is a process of thinking and using its results to do

something. It is a forecast planning is one of the management
functions. It requires a well-developed sense of the future and
makes one to think of what could happen if certain steps are
taken. Planning as a management function involves setting goals
for future organizational performance. Goals are defined as
activities and needed resources to be used. Lack of planning or
poor planning can hurt organizational performance.

Planning includes the following

Identification of health problems, finding means and ways of

solving these problems.

In management, all resources including man power need

planning and organization so that a good plan make clear tasks
to be performed as well as considering other resources to be
involved in terms of money, material and time.

Effective planning addresses it’ self to the following questions

 Where is the community now?

 Where does the community want to go?

 How will the community get there?

 How much does it cost to reach there?

 How will the community know that they have reached?

Where is the community now?

This question seeks information regarding the health status of

the community, common diseases in it, existing health services
and facilities, as well as the resources available. Information
got/collected shows existing problems of the community. Some
of these problems may be related to health, agriculture and other
social services.

The health worker in collaboration with the community and

other government and NGOs must attend to these problems in
order to improve the health and well-being of the community. In
management, this task is called situation analysis.

Where does the community want to go?

After identifying the various problems (gaps) facing the

community, the health worker lists the problems in order of
significance, their severity, popular demand of the community
etc. then the community decides of how they will solve these
problems and what to handle first.

How will the community get there?

This is an attempt to find and use fairways and means of solving

identified problems or rather achieve the set objectives. These
ways and means are called activities. They are action the
H/worker takes to solve the identified problems.

How will the community know that they have reached there?

This means how the community knows they have achieved the
set objectives. To do this the H/worker together with the
community will determine where the community is in relation to
the set objectives. This is called evaluation. It shows the success,
failures, obstacles encountered strength and weakness of
H/services (SWOT).

PLANNING CYCLE

1. Situation analysis

2. Setting the priorities

3. Identification of Strategies and Activities

4. Implementation

5. Evaluation Activities

Situation analysis Summaries the profile of the catchment area

of the population which includes the geographical and
administrative features including;

 Demographic profile

 Socio-economic set up

 The main health problems in the area

 The life style of the people

 Beliefs and attitudes to health seeking behaviours

 Infrastructure
 Human and other resources available

 Health existing data in terms of HMIS. (Health management

information systems)

 Community based management information system

Types of plans

There are 2 types of plans:

These are: -

 Standing plans

 Single use plans

Standing plans

Are those plans that remain roughly the same for long period of
time used in organizations e.g. policy, roles, procedures.

Single use plans

This includes programs, budget, work plans, projects etc. These

focus relatively in unique situations with an organization and
may be used only once. Plans can also be termed as long term,
short and intermediate plans.
Steps used in planning

The following are guidelines/steps applied a planning: -

 Looking at the situation

 Recognizing problems

 Setting objectives

 Reviewing obstacles

 Scheduling the activities

Points to consider when planning

Performance review:

It reflects on the previous performance in the priority areas and

puts emphasis on achievements against set targets. Areas of poor
performance, reasons for achievement made and reasons of
areas of failure to perform as planned. Planning activities of
management of the next financial year. Uganda uses philosophy
of health support supervision programme (HSSP, PHC and
minimum health care package, MCHC. During the planning
process, there are 3 different financial years you consider: -
Current, the previous and next financial year. One crucial aspect
of this planning component is target setting. Targets are defined
as specific objectives that are quantified and are meant to be
achieved over a period of time. These targets should be set in the
next financial year fitting in the overall context of the national
and district targets. The availability of targets provides the
implementers /Health workers/community with something to
work towards i.e., have an objective to achieve.

Objectives have characteristics

The following are characteristics of an objective.

S - Specific

M - Measurable

A - Achievable/ attainable

R - Realistic /relevant

T - Time bound

 Specific: An objective should be in writing not ambiguous or

confusing but rather clear to all Health workers.

 Measurable/ Observable: General objectives are difficult to

interpret or to measure. There should be an indication for the
achievement e.g., state in figure like to reduce malnutrition by
10%.

 Attainable /Achievable: An objective should be feasible i.e.;

resources should be available and it should be possible to
overcome the obstacles.

 Realistic: Overly optimistic put unrealistic objective serve as

moral deflators and are not effective but also an objective should
not be easily achieved for an easily achievable objective is less
challenging.

 Relevant: It should easily fit in the general health policy or

relate to the problem to the solved or reduced.  Time bound:
Time /period should be indicated in which the objective intended
to be accomplished otherwise, there will be a tendency of
postponing activities that will cause delay to implement e.g., to
reduce the no of measles by 10% (in the year specified) e.g.,
2010compared to 2008.

Other points to consider during planning

Mutually supportive: One objective should not be achieved at
the expense of the other objective. Objectives should be
prioritized so that those with top priority are achieved.

Cross cutting inputs for the activities: These are inputs

required for implementation of activities across the board e.g.
infrastructure, human resources, drugs, equipment and other
logistics. Balancing resources in different departments according
to need.

Budget: This is the costing and financing of the inputs for

health. Use agreed standard unit cost as much as possible as
provided by ministries of health, financing, planning and
economic development, local government and the district.
Modification of these standards has to be justified.

Note: Supervision, monitoring and evaluation activities should

be planned for because these are continuous throughout. In
planning, also the incharge of the health facility makes a work
plan that helps schedule activities that are intended to be done
including materials and responsible personnel.

IMPLEMENTATION OF HEALTH SERVICES

Implementation means putting activities planned in action or in
practice. It is the operation stage i.e., without implementation,
plans remain theoretic. It is during implementation that
inputs/resources are used to achieve organization goals. In
implementation management is considered with achievements
and performance.

Four main types of decision making that have to be considered

during implementation.

 The 1st type consists of all those that ensure the programmed
activities are executed as planned and services delivered as
intended.

 The 2nd type is concerned with deployment of personnel in

the places to perform these activities.

 The 3rd involves allocation of other resources in terms of

money, material and time.

 The 4th type is concerned with information needed it’s

processing and it’s common in support of previously agreed
decision and of evaluation.

Thus, these decisions can be summarized as

 Coordination of activities

 Allocation of resources

 Provision of information

COORDINATION OF ACTIVITIES

Suppose there is a programme of retraining about TB

management due to take place next week. There will be
proceeding activities as:-

 Selection of candidates for training

 Preparation for planning materials

 Assignment of the responsible trainers

 Arrangement of training venue

Deployment of personnel Management that deals with

deployment of work force to carry out unplanned activity may
be grouped into the following

 Organizing

 Directing

 Supervising
NB: Job description, standard operating procedures and duty
rosters are the tools used by organizing manager to the
organized work. Organizing, directing and supervision are not
entirely separate management functions.

Allocation of resources

At the implementation stage allocation of resources depends on

the type of resources. Resources may be physical e.g., supplies
including drugs, instruments, time, space and infrastructure.
Information is dealt with separately in Health management
information system. The allocation of resources includes
monitoring and control of resources. This means watching for
the availability consumption and use of supplies, quality control
and quantity control as well as appropriate recording. The non-
expendable equipments are usually ordered through the PDA,
once out of function and beyond repair (PDAprocurement
disposal authority). Time is a non- newable resource. Similarly,
it’s subjected to the monitoring and controlling so that it is used
efficiently.

Most physical resources also imply the logical decision i.e.,

procurement, clearance, storage, forwarding and distribution,
replacement on replenishing of goods both consumable and non
consumable e.g., drugs, vehicles, beds etc.

Accounting

As are renewable resources, money is subjected to accounting,

the purpose of which is to keep tract of money and compare
receipts and expenditure and ensure that funds are
used/expended only on the purpose they are allocated.
Organization is another element found in resource allocation.
Some resources like work space and records need organizational
decision. It is generally necessary for physical resources in
regard to storage.

Procurement

Getting items to use by whatever means (donations, loans etc).

Processing of information

The key decisions concerning information are as follows.

Indications for answer the following.

 Have you got the debt needed for each indication

 Have set priorities for the needed information collected first

What (Information Audit)

This is the way you decide on what information you need in the
country. There is a lot of information so it is better to decide on
the relevant data. The criteria that information must support and
satisfy the need/decision making are relevance, validity,
reliability, timely and cheaper.

From where?

Once the nature of information is identified, management

should decide from which services, particular information
should be obtained e.g. government offices, village registers,
household registers, community surveys, interviews and
observations.

How?

The question of processing information then arises i.e. raw

information (Data) should be collected, analysed recorded and
reported. Processing information may be undertaken in different
places by different people.

To whom?
Depending on the degree of specificity of the decision for when
information is needed, it should be easy to decide to whom the
information should be communicated. The information that goes
into a planned activity schedule often needs updating of the
implementation process.

NB: Information processing provides no equitable health care

increasing services for those in great need. It allows raising
criteria e.g., seriousness of disease, the disease feasibility of
control and community acceptance. Summary Implementation
function of management is concerned with day-to-day decision
about the time of execution of activities within the organization.

EVALUATION OF HEALTH ACTIVITIES

Definition To evaluate means “to put value” to something e.g.,

an object or an activity in terms of money and /or input. Its
purposes are to check that corrective actions are taken
immediately. In his/her evaluation role, the health worker has to
judge whether the outcome of health activities are really what he
desired when he started planning to address the needs of the
community. Generally, the term evaluation is used to include the
whole process of examination/measurement and ultimate
judgment of the value of health care. It can also be defined as
the periodic assessment of the change in the targeted results that
can be attributed to as intervention. In this context, the term
assessment sometimes is used as synonym for evaluation in
relation to observation of performance of students as they
demonstrate skills or competences in carrying out a health out a
health care task.

The term appraisal is normally used instead of evaluation. In

evaluation the health worker asks himself three questions.

 What has been achieved as a result of the health activities?

 Were the resources for those activities used efficiently?

 If necessary, are other activities required to improve the

results?

The effectiveness of the health activities and the efficient use of

resources, especially money, personal and materials judged by a
set of indicators. The extent to which their indicators (When
questions) are fulfilled determines the success of the activities.
E.g., in a certain area UNEPI has set a target of 75%
immunization coverage for all children under 5 years, the set
target is the indicator of success. If they reach 81%, they will
have done very well if they only reach 60% coverage, Health
workers have to find reasons how it went wrong and how they
can improve it to reach 75%.

Evaluation of health services

Definition: Evaluation is a process that assesses an achievement

against preset criteria i.e., it is a systematic process that
determines the extent to which service needs and results have
been or are being achieved and analyse the reasons for any
discrepancy. Monitoring is a planned, systematic process of
observation that closely follows a course of activities and
compares what is happening with what is expected to happen.

MONITORING OF HEALTH ACTIVITIES

Health activities occur at the same time and health team needs to
watch and monitor the work.

Definition:

Monitoring is the process of observing whether the activity or

service is occurring as planned during implementation. It is a
systematic continuous collection and analysis of selected
indicators to enable managers know whether the activities were
being carried out as planned and yielding the intended results on
the targeted population.

The monitoring system is a set of procedures through which

information flows within the organization at different
management levels needs to support decision making.

Monitoring is gathering information to know whether the

previous agreed course is being maintained, resources are wisely
spent and staff utilized effectively. It is the complication of work
and collecting indicators. It enables management to: -

 Know of activities that are being implemented or planed

 Have feed-back to improve operation

 Take corrective action

Monitoring and continuous changes to the programme are more

effective than major changes when the situation is serious.
Besides keeping update, monitoring has an added advantage that
new opportunities are exploited as they arise before they get out
of hand.

Reasons for monitoring

 Track progress of implementation of health activities

 Identify problems and correct them in time

 Identify over and underfunded areas

 Facilitate re-adjustment

 Ensure accountability for action by implementers

 Indicate if project is on course

 It is a basic and universal management factor, identifying

strength and weakness

 Identify whether the material and financial resources are

efficient whether people in charge have necessary technology
and personal qualifications

 Monitoring of inputs/resources ensures that work progresses

according to the schedule.

 Resources consumption is within the planned limits.

Monitoring inputs is concerned with use of resources, progress

of activities and the way they are being carried. It ensures the
expected functional activities are performed according to set
norms procedures.
 Work standards are made

 Meetings are held as needed

 Communication occurs as necessary

Monitoring outputs

 It ensures that products meet specialization services are

delivered as planned e.g. training results in new skills or her
level of skills.

 Decisions are timely and appropriate

 Records are reliable and reports are used

 Conflicts are resolved

 The community is satisfied

Steps in health activity monitoring

 Planning

 Implementation

 Assessment of planned objectives

 Decide of the scope

 Select indicators and standards

 Choose data sources to develop

 Corrective procedure

Implementation (carrying out/monitoring)

 Collect data, tabulate and analyse data present the findings

 Take appropriate action

 Identifying the problem

 Identifying the cause

 Get data to find unknown cause

 Implement the solution

 Monitor results of action

Principles of monitoring This helps to make the process more

structured standardized and improved.

 Determine what you want to monitor and what interval

 Determine how to monitor, develop a checklist

 Monitor as planned

 State any problems identified and describe each problem

 Identify causes of each problem

 Identify and implement solution

 Provide feedback to the health worker

Methods of monitoring health activities

1. Reports: Written or verbal reports concerning particular

aspects of work, any special problems. Written reports should be
briefly kept with specified headings. The managers /supervisors
should give immediate feedback to the one reporting.

2. Visits: Are particularly important because they add to human

touch. Besides, 1st hand information, knowledge is obtained.
They help to boost morale of communities and health staff.

3. Check list: Ensure that all aspects have been inquired into as
there may be over sight or other pressing problems may be
present on the check list, observe performance and recognizes
differences in procedures, standards and output.

4. Meetings: Are important to review other local targets,

discussing reports and future planning. It enables discussion of
progress difficulties with staff and the communities.

5. Complaints: In all human interactions, there are bound to

disaffect people. In general complaints are good indicators that
there is something wrong. Complaints are a one way of
identifying problems at an early stage.

Summary

Monitoring means watching the progress, achievement and

standard of work of the programme It can be done by every staff
member with the help of a check list, by studying records and
reports. It can result in program redirected and it’s a tool that
promotes quality health care.

SUPERVISION OF HEALTH SERVICES

All health services are expected to provide some managerial or

administrative supervision or appraisal of workers below them
or even of the work they themselves are doing.

Definitions

 Inspection: Is a process of identifying faults committed by a

subordinate with an intention of punishing.  Supervision:
Refers to the overall range of activities carried out by a manager
to ensure that an organization achieves its objectives
 Support supervision: A process of helping, guiding, teaching
and learning from staff at their places of work and helping them
to improve performance in a joint problem-solving manner

When is it necessary It’s always necessary.

It aims at accessing performance of the workers under your care

for quality of work/service they are doing with the aim to
improve it. The following should be looked into:

 Quality and quantity of services being offered

 Availability and conditions of resources or facilities used to do

work e.g., inventory, checklists, personnel and facility.

 Community’s need for the services

 Constraints faced by workers that may necessarily hinge on

work resources or those that may be outside their scope.

 Items/activities that require priority attention.

Requirements

 Supervisory check list to ensure that ideas (items) or activities

that need priority attention are attended to and no activities are
left out/forgotten
 Regular and frequency of supervision.

 Adequate interaction with supervises to all cordial discussions

for better learning from each other

 Problem solving and alleviating the supervisor anxiety by

providing some solution to his/her problem/corresponding
activities.

Qualities of good supervision

 Good leadership and do not take over the work of those you
are supervising

 Give clear and good guidelines to enable the supervised

achieve the set goals and objectives

 He is the team leader who is tasteful and motivating

 He is an effective communicator, links those under him with

higher authorities through report making.

 Servant of workers he is supervising and in competent enough

to guide them
 A good trainer who gives support supervision to enable them
attain knowledge, promotion, outlets, ability to plan and execute
the work.

 Ability to supervise others as well.

SUPPORT SUPERVISION

Support supervision: A process of helping, guiding, teaching

and learning from staff at their places of work and helping them
to improve performance in a joint problem-solving manner
Types of support supervision 1. Integrated support supervision

2. Technical support supervision

3. Emergency support supervision

Integrated support supervision

 Aims at covering a wide range of services at the same time

 Includes a multidisciplinary team with a mix of required skills

that is mgt, clinical, public health skills etc.  From HSD to
units, at least six months and within hospitals, monthly.

 What are the advantages of integrated Support supervision?

  Integrated support supervision allows sharing of scarce
resources

 A wide range of services are supervised at the same time

 Supervisors get a broad awareness of different programs

 Supervisors share information for meaningful discussion

 Makes priority setting easier

Technical support supervision

 Provides technical support in a specific specialty area

 Enables specialists to work with supervisees and integrated

teams to address particular specialized services

For Health Sub Districts at least monthly except when there is to

be integrated support supervision.

Within hospitals, at least weekly for example in form of major

ward rounds

Emergency support supervision

 This provides support to a specific emergency problem such as

a strike, an epidemic outbreak or any disaster

 It should be provided where necessary

 Note that it is neither desirable nor possible to supervise
everything during a single visit

 Main issues should be singled out and addressed and others

left for the next visit

Qualities of a support supervisor

 Knowledge

 Patience

 Ability to listen

 Ability to motivate

 Attitude to learn

 Ability to teach and demonstrate

 Planning skills

 Ability to mobilize

Skills of a support supervisor

 Conceptual skills

 Communication skills

 Human relations skills

 Demonstration skills

 Problem solving skills

 Technical skills

 Listening skills

 Leadership skills

The process of support supervision

1. Planning

2. Conducting a supervision exercise

3. Giving the feedback

4. Making a follow-up

Planning

 Develop a supervision plan & schedule (for a year)

 Make a budget

 Set supervision objectives for a year and for each visit

 Communicate the program

 Review records for example previous reports, HMIS returns

etc.
 Constitute teams depending on the tasks at hand

 Prepare logistics for example vehicle, fuel, stationary,

allowances

 Adopt supervision tools for example checklists

 Brief teams on the objectives of the visit and crucial areas to

cover, send them

Conducting a supervision exercise

 Explain the purpose of the visit

 Discuss the general state of health services at the unit

 Follow up the issues from previous visit

 Produce tools you want to use, emphasizing they are for

facilitation, not fault finding

 Let the staff go back to their work places and you begin

 Identify the strengths, weaknesses and establish the causes of

weaknesses

Giving the feedback

 Appreciate the participation of everybody

 Begin with the strong points

 Discuss the weak points

 Accept staff comments

 Demonstrate where possible

 Have return demonstration if need be

 Write a group report and leave a copy at the unit or a

summary in their support supervision book

Making a follow-up

 Revisit the actions agreed upon

 Consult members responsible, if possible, or the unit in-charge

 Identify actions not implemented

 Get reasons for not implementing those actions

 Give and request for accountability at the next visit

 Support supervision will not be complete until this has been

done

Importance of support supervision

 Monitoring service delivery

 Collecting data for planning

 Providing on-the-job training

 Identification of training needs

 A tool for performance management

 Improving staff motivation

 Assessing the impact of training

 An opportunity of inducting new employees

 A basis for designing quality intervention programs

 A basis for resource allocation

Constraints to support supervision

 Logistical problems

 Organizational problems

 Failure to follow scheduled programs

 Incapacity by supervisors

 Lack of interest by both teams

 Lack of coordination among different actors

 Lack of cooperation by supervised staff

 Failure to take action by those concerned

 Tendency to perceive and implement sis as a routine activity

 Too much expectation from both sides

QUALITY ASSURANCE

Definition: These are activities and programmes intended to

assure or improve the quality of care

The concept includes the assessment or evaluation on quality of

care, identification of problem or short comings to overcome
these deficiencies and following up monitoring to ensure
effectiveness of corrective steps.

Quality health care

Providing quality care means doing the right thing.

WHO definition of quality health care consists of standards of

intervention that are known to be safe, affordable to the society
in question and hence ability to produce an impact on mortality,
morbidity, disability and malnutrition.

Other definitions
All health care should be safe, timely, effective efficient
equitable and patient cantered.

Quality health care in family medicine is the achievement of

optimal physical and mental health through accessible safe, cost-
effective care that is based on best feasible response to the need
and preferences of patient, family, personal values and beliefs
(American academy of family physicians 2006).

Generally look at the way things are done and key emphasis is
on ensuring that;

 Right action has been done in right way and

 At right time

Perspectives on Quality Health Care

Different stake holders have different perspectives on what

constitutes good quality health. Client /patients, service
providers, mangers, policy makers and donors all have different
perspectives e.g.

 Perspective of quality

 Addressing client’s concerns

 Waiting time and privacy

 Accessibility

 Customer belief

 Respect

 Good relations

Health care and Administration management perspective

 Logistic management

 Support supervision

 Appropriate standards and guidelines

 Infrastructure

 Balance of cost and quality

 Innovative training

 Education of community

Provider perspective (Health Care provider)

Historically quality has meant clinical quality of care offering

technically competent effective, safe care that contributes to an
individual well-being.
Programme manager

Recognize that support services e.g. logistic and record keeping

are important to the quality service delivery.

Donor’s perspective

Additionally key elements of quality include cost, efficiency and

outcomes for population as a whole.

The provider perspective quality of care would include.

 Clear job description

 Clear and performance feedback

 Motivation to perform as expected.

 Knowledge and skills-job based on formal and technical

competences.

 Organization- support- strategic direction, job roles and

responsibilities support supervision.

 Environmental –adequate and proper tools, supplies and work

place.

Effectiveness’s: achieving intended results i.e., degree to which

desired results are achieved.
Efficiency of service: The ratio of the output of service to the
associated cost of service.

Safety: The extent to which risks of injury, infection, other

harmful side effects are minimized.

This implies reduction of risks to patient, provider and

community.

MANAGEMENT OF HEALTH FACILITY RESOURCES

Learning objectives

 Management of;

 Space

 Time

 Finance

 Material & Medicines

 Transport

 Infrastructure

SPACE AND WORK FLOW MANAGEMENT

Introduction Workspace may not always be enough or adequate.
It’s important to make use of limited available space. The major
features may include: -

 Shortage of rooms

 Small rooms.

Rooms can have double functions if they are carried out at

different times. Two related rooms can be combined in one
room. This applies to shortage of rooms e.g., can have a
morning immunization session and then after noon adolescent
and reproductive health programme. Different integrated
activities can be carried out under one roof. To small rooms: -
The available space, should be used more efficiently where
people are few. Small rooms can be used if unnecessary people
and furniture are removed from the room plus an efficient
storage for files.

Rationale

 Space is a resource: rent for example Multiplex

 It is scarce

 Required for many purposes, hence competition

 Receives little attention during training and health planning

 Allocation not always a smooth process

 Conflict arises out of space management for example

 Ethiopia and Eritrea: Not yet solved

 Palestine and Israel: will (probably) never be solved

Common space problems in health facilities

 Shortage

 Inefficient use

 Congestion

 Non-transparent management

 Unplanned development.

What space?

 Land

 Compound

 Parking
 Accommodation

 Office

 Desk

 Notice board

 Computer

Institutional spacing allocation

 Before attempting space allocation

 Conduct a space inventory

 Determine the space needs

 Space needs analysis: ask what is needed

 Space audit: check whether what is available is adequate for

actual needs based on standards

 Create a space database (who is where?) Who needs how

much? Where is the shortage? Etc
 Create a space allocation committee of experienced (not
senior) staff

 Set up procedures for space allocation

 Requisition
  Allocation criteria
 Eligibility and entitlement criteria
 Vocation criteria
 Re-allocation criteria
 Sharing criteria
 Allocation duration limit

Doing a space survey

 Interviews with knowledgeable departmental personnel to

prepare

 Summary room list

 Draw a floor plan
 Fill the room survey form
 Group the usage into categories of functional usage
 Make an employee list

Doing a space inventory Knowledgeable departmental

employees have:

 Firsthand knowledge of how the space is used

 An understanding of the activities performed in the rooms

 Information on funding sources related to the activities for the

space (grants, contracts, departmental funds etc)

 Access to the space and occupants of the space

 Knowledge on local departmental sensitivities about space

Criteria for space allocation

 Institutional goals and priorities

 Master plan for development

 Long term plans

 Program for which space is allocated

 Activity for which space is allocated

 Level of activity: performance and traffic

Principles of space allocation and use

Managing office and workspace

5 key principles

 Compartmentalise: Have space for each activity

 Declutlerise: use file boxes and bins

 Categorize: file inactive documents

 Utilise all space, even upwards

 Minimise time wasted by quick filing

Institutional space

 Have a master plan

 Label the buildings

 Label the paths/roads

 Indicate directions to major destinations

 Have notice boards

 Establish space management regulations

 Have space management committees Inside the buildings

 Label departments

 Give directions to and fro

 Label rooms

 Use notice boards/bulletin boards

 Ensure labels are maintained and up to date

Notice boards

 Be

 Placed in strategic points, likely to be seen by the target

audience

 Well maintained

 Of good or appropriate size

 Allocate specific parts of board for certain notices

 Colour coding may be used for different types of

announcements for easy notice

 Remove notices when they become irrelevant

 Avoid pinning over other notices

 Have sections for official and non-official notices

 May need to screen off part of notice board with lockable glass
window

Car parking

 Allocate specific space for car parking

 Use way-finding posters to direct to parking lot

 Perimeter (outside) parking encouraged

 Park and ride also encouraged

 Metered parking (20-25 min) may be used

 Parking fees discourage use of vehicles

 Valet parking helps to reduce on poor parking

 Educate on and enforce parking regulations

 Demarcate parking space

 Label vehicle according to parking area

 Promote and prioritise ride-sharing

 Create space for motorcycles and bicycles

Access

 Access is a major concern to new visitors, the unfamiliar and

the distracted

 Needed in many places: hospitals, universities etc

 In health facilities, life can be lost if access is not well

managed

Access functions
 Traffic and circulation

 Public and alternative transport

 Parking

 Entrances

 Emergency activities

 Loading and unloading

Access management involves:

 Planning

 Implementing

 Integrating and

 Managing access-related functions

Regular access audit is required, to keep improving the access

function

Access to final destination is an important component of

perceived quality for example

 Finding parking space

 Finding the main entrance or desired door

 Obtaining direction (from signs or staff)

 Finding way to final destination

Access audit

 Regular users should also be guided because their activities

may affect access to suppliers, vendors and volunteers

 Assess access functions

Work flow management in the health unit Work flow is an

arrangement in which a series of work functions are coordinated
in space and time so that delays are minimal.

 The greatest obstacle to the organization of work flow is one of

attitude.

 Prevent congestion and queues- they are not indicators of how

busy and hard working you are.

 It is essential to examine the whole process- removing a queue

from one stage may result only in creating a queue at another
(for example if the position at the examination room is
improved, patients may have to wait at the pharmacy for their
drugs).
 Avoid delays (provide service with only a very short waiting
time). Example in a health care facility: -

 Label every door

 Separate rooms for new and repeat visitors. Give
identification numbers usable during return. Simplified
filing system ...
 Establish a brief assessment room for preliminary
treatment, and resorting of patients. Daily returning
patients should go directly. Appointments with busy
officials should be made carefully.
 In the pharmacy pre-package routine courses of drugs.
Keep a stock of written instructions to patients on how to
take routine course of drugs

MANAGEMENT OF TRANSPORT

Most Health Units have some means of transport at the Health

Unit level. These include: - bicycles, motorcycles and vehicles
depend on level of Health facility. For such transport means to
be useful for the intended results, some minimal management
procedures or instructions need to be instituted these include: -
 Keeping an update inventory record of various types of
vehicles, under your care as regards make up or type,
registration number and other identification marks brought in
and what conditions and who uses (responsible officer)

 Servicing and maintenance This entails careful handling to

prevent break down or routine maintenance, work on the vehicle
should strictly be followed. Early inspection before departure for
long distance should be done ensuring adequate fuel and oiling.
All vehicles should have a programme travel specifying when,
why, by whom and of what purpose.

For each vehicle should be maintained so as to avoid fuel

wastage and unnecessary movement or unauthorized journey,
with a proper working speedometer to show mile age reading on
departure, on arrival and total distance covered. This should be
followed to achieve intended purpose.

Training use of vehicle: - vehicles should be handled by

properly trained driver/personal who are well composed and of
good integrity.
MANAGEMENT OF PERSONNEL

People are the most important resources of any country and as

such should be managed properly.

It’s important to manage staff properly because 80% of health

budgets is spent on salaries and staff benefits, the personnel are
crucial assets. Secondary, managing staff is more complex than
managing other resources. The field concerning personnel
administration has subsequently changed names to management,
manpower management; human resources management.

All means the same i.e., the organizational function concerned

with the management of employees. When personnel are well
damaged can make the best use of the available resources.
Health staff management involves several approaches and sub
functions which include the following functions: -

 Planning, organization, directing and controlling all the

human activities of the organization.
 It is concerned with the people at work and their relationships
within the organization

 It strives to bring together and develop into an effective

organization people who make up an organization as well as the
well-being of individuals and working groups so as to make the
best contribution to the organization’s success.

MANAGEMENT RESPONSIBILITIES OF AN IN-

CHARGE OF A HEALTH UNIT

The incharge is responsible for proper operation and

management of a health unit ultimately the incharge is
responsible for:

 Monitoring the staff in terms of the quantity of work, quantity

of the work they do and punctuality

 Determining the allocation of staff on different duties

 Accounting for revenue and ensuring efficient and honest use

of it

 Ensuring constant availability of drugs and other supplies

 Ensuring timely reporting, keeping the files updated and in

good order (filling)
 Plan and follow up activities, ensuring that they are executed
as expected.

 Equally, the in –charge is expected create a strong bond

between the Health Unit and the communities in the services
which in his catchment area.

 The in –charge is entrusted to improve the coverage of

preventive services e.g., Immunization notification of diseases
etc.

 The in –charge is also entrusted to every patient (client)

MANAGING PAPER WORK

Definition of an office

An office is a place where paper work is done, documents and

letters are stored. It is not always a whole room. It may be a desk
or table or a corner of a room. Paper work mainly
correspondences and maintenance and use of records, is an
essential part of management of a health service and almost all
health activities involve paper work. Its quantity and efficiency
play a large role in the effectiveness of health care activities and
programmes. Without a well-arranged record’s system, neither
clinical care nor community health work can be monitored or
controlled. Paper work is the communicator, (correspondence,
the information system (reports) and the memory system
(records and registers) of a health service. We shall deal writing
referral letter and other official letters, plus organization of
record system. Down is the functions of an office and the
corresponding paper work.

HOW TO WRITE A REFERRAL LETTER

When a patient is being referred to a health centre or hospital at

a higher level for advice and treatment a letter containing
accurate details should be sent. The information will help the
medical officer who sees the patient to understand the history
and background of the patients’ conditions and treatment to date.
The following rules are a guide to referral letter writing.

 Use the customary format for official letter writing or full in

the official provided referral form. In place of the subject
heading write the name of the patient and age.

 Stage the exact date when the patient was first seen
(examined). Do not use statements such as a week ago, which
may lead to confusion.
 State the approximate date, week month when the patient first
became ill.

 Give a summary of the main complaints (history) and clinical

findings.

 Give the results of any lab investigation

 Most important, give details of all treatment to date including

doses of drugs

 Include a polite request for advice or treatment

 Sign the letter/form with the names and your title e.g Nurse,
incharge, Nursing officer etc as the person referring the patient.

 Write the patient’s address, name and address of the nearest

relative at the bottom of the letter.

Examples of the referral letters

Date month year

THE CONSULTANT OBSTETRICIAN

DISTRICT HOSPITAL P.O.BOX……………………

Dear Doctor, Mrs.………………………………….

Age………………………………… I saw the above-mentioned
patient who carries this letter for the first time today; it was her
first visit to the health centre although she is about 38 weeks
pregnant. She does remember her LNMP (first date). She
complains of swelling of the feet for the last 2 weeks, she has no
other complaints. On examination, I found albumen in urine and
the B.P is 140/110 mmhg. She seems to have pre- eclampsia and
needs hospital admission. I have sedated her with
phenorbarbitone 50 mg for the journey. We send her kindly
requesting you for further advice and treatment. Thank you.

Name and Title

Signature

Patient’s address

Relative’s name and address.

NB. All the time the office/table should be organized.

Do not allow papers to accumulate and use filling system to

keep important documents that will make it easy to retrieve
information whenever needed.

PLANNING TIME ARRANGEMENTS

 Events are arranged in daily, weekly, monthly or yearly time
periods, depending on their frequency or regularity. Time
planners are written in various common forms as timetables.
Forms are used in the following ways Time table

For daily or weekly regularly recurring events Schedule For

intermittent irregular or variable events including details of
where the events take place. Roster

 For duties planned for different staff members for different

times

 For long arrangements of several different events or activities

Plans in health service

As well managed health unit may need the following time plans.

 Weekly timetable showing the time of the week when certain

irregular events always occur e.g., staff meeting

 Several schedules showing the detailed dates on which

intermittent events occur and where they occur e.g., visits to
peripheral health centres or mobile clinics.

 Several duty rosters for different sections of the work e.g.,

night call out patient duties
 A programme of any special health activity e.g., nutritional
campaign. An annual over view of events

 Sometimes the timetable, schedule and roster may be

combined.

 Health centre weekly activities and time table.