Health Management-Dr Oyeniyi PDF

# HEALTH MANAGEMENT-PHS 405 - DR JOHNSON ADEGBOYEGA OYENIYI - MBBS,MPH,FWCP,Cert.Health Plan &Manag. # Background - The course is designed to acquaint student in the discipline of health science with management information and skill in matters relating to all aspect of national health care system...

# HEALTH MANAGEMENT-PHS 405 - DR JOHNSON ADEGBOYEGA OYENIYI - MBBS,MPH,FWCP,Cert.Health Plan &Manag. # Background - The course is designed to acquaint student in the discipline of health science with management information and skill in matters relating to all aspect of national health care system (the primary health care, the secondary health care and tertiary health Care). - The course gives an overview of national policy and the development of the national health system. - The role of government at each level and those of NGOs are highlighted. - Modern concepts and element of the management by objectives are review in the context of health planning, implementation and health programme monitoring and evaluation. - Modalities for leading health team and organising health care activities are as well highlighted methods and means of managing human and resources are also covered. - The course covers also various aspect of selected international health care system. # Outline of presentation. - Definition of management-Management could be define as: - a collection of person that formulate policy and generally direct the affairs of an organisation. Eg members of a Health Management Board. # Definition of management. - a set of functions eg planning, organising, staffing, directing and controlling so as to achieve the objective of the oranisation. - a process: rule,regulationand procedures by which goal are set and accomplished. - a profession, comparable with law,medicine, pharmacy which require spesific skill and knowledge. # Defination continues - Management is universal in the sense that all organisations, regardless of their objectives, types of work, geographical location or cultural environment, must be managed. - Management is very wide and it is an interdisplinary field, substantials contributions to the rich of management are obtained from such devise fields as philosophy, political science,engineeringeconomics, mathematics, sociology and anthropology. # Definition of Management - The health sector could be improved by judicious application of knowledge of management to health sector for effective and efficient use of scares resources-human, capital and material resources. # 1.2) Need for efficient management in health sector. - To achieve goals of National Health Policy. - To create administrative frame work in which a health service universal in scope and comprehensive in character can be achieved. - In planning for health services, regard had to be paid to the tradition, interest of established, functioning institution, and the professional specialist. - The management of health care organisations and services have evolve into extremely demanding for resources and difficult task. # Factor contributing to the complexity of health management - Increase demand for accountability by government, consumers and community. - Dwindling of government financial resources. - Public awareness that health is their right. - Increase need for material and such materials are very scarse, advance in health technology # Role of health manager in a health care organisation. - Determine community heath problem. - Setting priority among health problems with community members. - Assessing demographic characteristic and deciding which is the priority problem. - Selecting intervention programme directed at these health problem. - With community members set objectives for the intervention programmes. # Role of Health Manager - Implement needed programme with material resources. - Decided on the types and numbers of staff required to implement the programme. - Specify the activities to be carry out. - Training staff to carry out the activities. - Selecting indicators of achievement to evaluate intervention programme. # Management Theory - For Health Manager to succeed in his role: - Need a well defined program me of development. - Personality and style is important. It will affect how he communicate and react to response. - Management disposition, values and idiosyncrasies will affect and be affected by information he gives or - A good knowledge of the theories through formal training can enhance successful management since such theory serve as guidelines for managerial activities. # FUNCTION OF MANAGEMENT : - **Planning:** planning is necessary in all human business/work, including those of managing. It is a process of you look a head by which a course of action is consciously chosen out of alternative for the purpose of achieving desire result. - Forecasting is one of the prerequisite for planning. Health manager must be able to forecast the cost of material, availability of materials, the economic, social and political environment in which organization is working. - Planning is creative thinking and it is futuristic # TYPES OF PLANNING - 1)Strategic planning=long range planning for the entire Organisation by manager. - 2)Tactical (mediun) range planning at departmental level - 3) Operational planning- for day to day operation. # The need to planning - Due to changes in economy, business and organisation environment - As organisation become large and diversify, more factor will be taken into consideration for planning for future. - As there is increase in technical complexity of operation. - Existent of plan will assist to control process and subordinate. - As authomation machine price is high there is need to plan to make maximum use of those equipment. - Wage rate are increasing, workers has to justify their pay # Organising - **Organising:** - is a process of structuring activities, personnel and material to achieve assigned task. - Is a process by which a manager transform his work plan to action. - Organising make use of scalar principle(chain of command) and span of control. - Span of control-= narrow span of control i.e few people report to manager. - Chain of command-pyramidal of authority in an organisation. # Staffing - **Staffing:** - Is the process of ensuring that competent person are employed, developed and rewarded for contributing to the to the achieving organization’s objectives. - Establish a working climate to employee so as to contribute his quota to the organization. - Human resource management need to do the following to employee: - Employment planning-forecasting staff need, their number, cadres to be recruited. - Recruitment-attract applicant with skill, knowledge and ability to achieve organization objectives. - Selection-screen applicant, so as to select the best candidate for the job. - Orientation-=new employee are introduced to their job. And environment, superior officer and their colleague. - Performance appraisal-a process by which the employee is assessed to determine how he is doing/ performing his job. You are not assessing his character. - Training-you are developing the staff skill,knowledge, and ability so as to increase his present and future performance. - Compensation-you are rewarding the staff for contributing to the achievement of the organisation. **Discipline**-action taken against employee for violating establishment rule and regulation. # DIRECTING - Directing mean telling the subordinate what to do and ensuring that they do it. - They are three parts to directing. - The director-telling subordinate what to do - Subordinate-the one accepting the responsibility - Directive-the task to be performed. - Success in directing requires effective leadership, adequate motivation of subordinate and the level of the difficulty of the task to be performed. - Closely tied up with directives are: Authority, Responsibility & Accountability. - **Authority**- mean the right to give order and the power to make decisions which consequently guide and direct the action of others. A right of power to influence action of other to achieve a given result. - **Responsibility**-it is an obligation to use authority to see that duties are performed. Responsibility is an obligation to his superior to see that duties/ assignment are performed. - The essence of responsibility is a person obligation to his superior in the efficient performance of assigned tasks and duties. - When responsibility are assign they must carry along commensurate authority so as to avoid dissatisfaction on the part of the superior. - **Accountability:** is an aspect of responsibility that implies liability for the proper discharge of duties by the subordinate. - Each person given authority and responsibility must recorgnise that his superior would judge him according to his performance. - Authority serve as the basis for responsibility and it is the backing force in any organisation.It should be noted that by accepting authority, it implies that responsibility and accountability are also accepted. - **Delegation**-is the process by which an individual or group transfer to others the authority to carry out some particular actions and at the same time take some decisions. - It means entrusting some aspect of work of a manager to subordinates. This will give the manager some ample time to attend to more important issues. - No one single person can carry all the tasks necessary to achieve all the objectives of a given organisation, as organisation grow he has to delegate to subordinate. - Delegation is a process where by managers determine: - Result expected from a performance of some tasks - Assign duties to subordinate. - Give adequate authority and resource available to the tasks to be done. - Create obligation on the part of subordinate for the satisfactory performance of duties. - **Advantages of delegation:** - It enhance training of subordinate. - It break an organisation objectives down to a achievable goals. - It motivate the subordinate. - It reduce work load of managers. - It give subordinate the feeling of involvement. - It save time. - It give the sense of acheivement. - **Disadvantages of delegation** . - Feeling of indispensability. - Feeling of omnipotence. - Lack of confidence on subordinate. - Fear that subordinate could take over from him. # CONTROLLING - Controlling-is the process of ensuring that objective are accomplished as planned. - It is a continuous process, but it could be broken into three steps. - Establish standarg- eg reduce absenteeism in a class to 3% per year. - In establishing a standards, one should avoid as much as possible, standard that are stated in qualitative terms.eg develop a more efficient work schedule - Compared measured performance with standards. - Effective manager will not wait till the end of the project/performance to determine if standard are being met. - They monitor regularly the intermediate performance indicators. - They could monitor on weekly or monthly basis. - 3 Reinforcing success and correcting shortcomings. When there is short coming, a manager should deal with most serious one first. Determine the nature and extent of difficulties involved, and what corrective actions are necessary. - By acting quickly, the manager can often influence the results. # METHOD OF CONTROLLING - Policies/procedure/rules - External/internal auditor - Budget - Performance appraisal report - Personal observation - Project control-Gantt Chart, quality control chart. # Group dynamic - To Manager need to know how to work through group dynamic. - He should know how group behave from time they are form and the time the group is disbanded. 5 stages - **Forming**- period of orientation and testing. Member exchange information and acquaintance is form. - **Storming**.- intragroup conflict, inter personal differences, disagreement over procedures & competition for leadership position. Have difficulty in making decision. - **Norming**-real sense of cohesion is established. Resistance is overcome.procedure are agreed upon and role defined. Personal opinion are freely expressed. Group structure and harmony surface. - **performing**- increase cooperation problem solving. Decision are made with participation of every one. This is the most difficult for group to reach. - **Adjouning** = task is completed. Duties terminated. Wrapping thing up as group is disband. Regret and increase emotion. # Communication and interpersonal relation - The task of management is to get things done through people. This task might be so large that it is difficult for one individual to carry it out. - The management is thus faced with the choice to break down the task in to smaller unit. It is this smaller bit & pieces of the task that is now assign to an individual. - However, there is a responsibility to pull the task together again to form a whole. This is achieved through an organization structure. - The organization structure will depict the officially sanction relationship both horizontally and vertically with in the enterprise. - Horizontally, it depicts relationship between workers of the same level in the enterprise while vertically it shows superior- subordinate relationship. - Organization chart or organogram is the graphical presentation of the structural relationship with in the place of work. - Theoretically, the structure must be design to contribute from the members of the work group toward the attainment of the goal of the enterprise. # Basic form of department - As part of organization structure & design. There are basic form of creating the department. - Department by simple number. Structure are based on simple number eg in Army: Platon-100troops and batallion-1,000 troops. - By time-Where you group activities on basis of time. And each group under department do shift duties.eg 8.0am-2.0pm are group A while from 3.0pm-8.00pm belong to department B. So that any change in that department will affect coordination in the structure. When there is distruption you can apply for night or morning duty. - By enterprise function-The function categories in to: 1) production,2) Sales or marketing,3) finance & accounting, 4) personnel. - Advantages are: 1) It reflect the function that is performed and the people are tuned to the function of the department. 2) It simplify the type of trainning. - Disadvantage:1) It de-emphasis over all organization objective. The thinking is narrow to departmental objectives. - Departmental by territory or geographic spread. For organization that has wide geographical spread. We have North-Easth Manager, South-West Manager. - Customer type: This occur in bank industry. manager for cooperate Affairs, Manager for retail customer. - In hospital we have different corporate structure creation-amenity ward, female surgical ward - **Span of control:** That is how many people should be in a department. Span of control can not be fixed. It depend on several factors: - Nature of job-If it require intensive supervision the number of subordinate to be supervise will be very small. - Ability of subordinate-where the subordinate has good ability to perform the number of subordinate to be supervise will be more by the supervisor. - Ability of the superior. Ability of the superior to cope with many subordinate at a time will determine how much subordinate he can supervise or to be under his supervision. - How large or small the span of control is will determine whether the organogram is short or tall. - There is tendency to create many department but there is limit to this for efficiency to be achieved. - Beyond a point, creation of many department will not help in achieving the aim # Communication - Is a means by which we get information know by one person to attention of others people who should have the information usually quickly, correctly and consciencelly.to - In communication process we have : sender- medium- Receiver. And their must be a message to be sent back for the sender to know that receiver understood the message. - In communication, the concern is to ensure that it is intended meaning in the message that eventually get to the receiver. This is because the receiver is expected to behave in a particular way in relation to the communicated message. - We can only know if our message or communication is successful through a feed back we get from receiver. - Noise can be introduce during the communication process. Noise is any thing that disrupt the intended meaning of the message. - Noise can come from sender, medium or receiver. - Effective communication require that: - Communicator will clearly define the idea and or the message. - He must understand his audience and that will affect the choice of his words and the medium of communication. - He must specified the action expected from the communication. - This will enable him to know from the feed back whether the communication has achieved the purpose or not. - If the reaction is to communication is positive the communicator must reinforce the communication( reinforcement with nodding of head or positive comment). - From the sight of the audience the communication will be effective based on the ability of respondents to understand the message which can only be know if there is opportunity of response from the receiver. # Barrier to communication. - 1) Sematic or Diction or choice of words. Words may not mean the same thing to two people.eg use of technical terms. - 2) Difficulty in evaluation. we evaluate communication in the light of our experience. It is better to be open minded to allow him to communicate before we concluded. - 3) Heighten emotion-It is difficult for communication to get through emotion. - 4) Distance-Distance will affect the content of the message as it is pass from one person to another. - Types of communication: 1) written and 2) verbal. - Written- can not be denied and is well understood. Used in official business. - Verbal- Not well understood. used in private environment. It can be denied # Grape vine - It is informal communication that goes on in between enterprise to which no individual or group is clamming or prove responsibility to own up. - How importance is grape vine? Management can use it to find reaction of members of staff and take a decision # QUALITY ASSURANCE OR CONTINOUS QUALITY IMPROVEMENT IN HEALTH SERVICES - Quality can be define as the degree of worth or the degree of excellence or fitness for the purpose or conformance to specification. - The British Standard Institute define quality as the totality of features and characteristic of a product or service that bear on its ability to satisfying stated or implied need. - It is a degree of excellences which reflect on measurement on product or service in term of departure from the ideal and it demonstrate fitness for purpose relating to ability to meet stated needs. - Doing the right thing in the right way. - There are dimension of quality which has been identified as follows: - **Technical competence**-professional competence: It refer to technical, interpersonal and managerial capability. - And performance of health care providers, managers and support staff. This dimension focuses both on clinical services, diagnosis, treatment and non-clinical services. - Contact with the hospital start with gate-man that need to give warm reception. - 2) Client satisfaction- This is usually from perception of client to the response of health services to his felt needs and generally clients opinion will be based on the care of health, amenity of care, interpersonal relationship with workers and outcome of health care.eg clients need laboratory investigation, if he has to stay for hours before he receive the result that will give negative impression about that health facility. Trainings in interpersonal relation is very good for the staff even when clients need can not be meet. Explain to them in a pleasant way that will be pleasant to them. - 3) Acceptability= Access to health facility mean freedom from a variety of barrier such as geographical barrier, economic barrier(ability to pay), social, cultural, time, organization barrier, language barrier, - 4) Effectiveness-Does the procedure, programme, treatment when correctly carried out lead to desired outcome. Does the procedure, programme the most appropriate for the setting where it is carried out. - 5) Efficiency-Are the service produced efficiently. Do we have optimum care given per available resources. - 6) Continuity of services-are services provided in continuous way. How sustainability is the programme. - NB: Quality assurance will be the client focused scientific approach which relies on them work toward error prevention, rather than error detection and correction. # (a)Where do we start quality assurance programme - 1) Focus on high volume activity . where a lot of people are involved. - 2) activity that cause problem for staff - 3)Risky activity for the staff - (b) What kind of quality assurance will be undertaken-is it training on methodology. - Advocacy or dissemination of information - © Institutionalize advocacy # Stages of implementation of quality assurance - 1) Pre-concept stage-stage we say we are doing this - 2) Stage of awareness-can we improve on this - 3) Education-Let us learn how to do it. - 4) Partial implementation-let start pilot study in pharmacy or medical record. - 5) Full implementation-taking place in all the department. - 6) Build in to the culture of the organization - 7) Finally- continuous quality improvement so as to achieve world standard. # Standard - Standard is a statement of quality expected by every one. This lead us to develop practical guideline. Standard will be set by party concern and external consultant,professional organization, teaching institution. - Administrative procedure-based on some guideline. - Performance standard. # Health management information system - HIMS- a collection of personnel, procedures, instruments and data- base organised to develop and utilized information to facilitate decision making. - HMIS are made operational by indicators. - An indicator is a measure of performance which enables the assessment of progress towards the attainment of defined obiectives - Computation of indicators require the collection of data - PHC MIS: - Six operational levels: - Home, - Community, - Health facility, - LGA Department, - State - Federal level. # 2. Home-based record : - PHC Child Health Card < 5years - Personal Health Card >5 years - Community-Based Records: - Voluntary Health Workers/TBA Record of work- a pictorial tally sheet. - Community demographic profile. - Community pregnancy profile - VHW monthly family planning activities. # 3. Health Facility Records- - Health activities tally sheets. Compile daily, monthly and annually for 8 activities. - Immunization. - maternal care, - family planning, - Nutrition & Growth monitoring. - In-Patient admission. - Out-Patient attendance - Health facility - District HQ-LGA PHC Department. # 4 .LGA PHC Department. - Collation, analysis & dissemination to : SMOH,FMOH-PHC ZONAL OFFICE, FMOH - PHC Dept..... FMOH data bank(DPRS),.....National Data Bank. - Major constraints against efficient MIS: - Lack of skill man power, - Lack of finance - Lack of time - Lack of finance - Lack of motivation - lack of feed back - cultural factor. # PHC INDICATORS - 1. Immunization-% of children fully immunized with potent vaccine at 1 year. - 2. Maternal health-% of pregnant female fully immunised with potent TT by 8months. - 3. Maternal health- % of new born weighing <2.500 gram. - 4. Nutrition- % of children with weight for age less than 3rd percentile. - 5. Maternal Health- % of delivery attended to by trained health workers. - 6. Family planning- % of women in reproductive age group who are using modern family plan. - 7. Care of common ailment.- % of population living with in 5km or 1 hour of travel time to a health centre. - 8. Water supply- % of population with in 200 meter of standing water pipe or other source of portable water. - 9. Sewage disposal-% of population living with in 50 meter of a pit latrine or toilet.