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Chapter One Introduction to Health Management


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This chapter defines Health Management and takes a closer look at the different management theories that exist. It breaks down the concept of organisation management and explains how an organisation function.
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Fundamentals of Health Management
First Edition
Dr. Anthony Augustine Sandi, M.D, M.Sc
Jia Bainga Kangbai, MPH, DipTropMed
For staff and lecturers at various health institutions
Many professionals in various disciplines keep wondering why bother themselves about
management. The reason for this feeling is that, it is often assumed that anybody can
perform the role of a manager. In other words, they see no need for taking courses in
management as a discipline. Perhaps this is often because many senior administrative
officers got to their managerial positions through their duration or length of period at work
and through promotion. Although these assumptions may have some basis, yet the
perception is totally wrong. Nowadays, it is realized that prudent management of resources,
is the key to a successful organization and so the knowledge of management is very
fundamental as part of the training of every professional.
One of the most important and vital activity of man is managing. Man is a social being and
therefore the desire to form groups to accomplish his aims could not be achieved as
individual without management. In the process of achieving their aims as a group, they see
management as being essential to ensure the coordination of their efforts. Nowadays,
society has come to rely increasingly on group efforts, which has made the task of managers
to become large, complex and of course important. Everyone, including students and other
professionals who want to improve their understanding of the organization in which they
work, will benefit from this book. All managers undertake the same basic functions to obtain
their intended results. Managers obtained these results by a way of establishing their working
environment that is effective and efficient for their workers to perform and hence achieve the
organizational goals.
After reading this book one will gain: knowledge and skills to contribute to the health of
populations, communities and disadvantaged groups, the ability to apply the core disciplines
of management to the real world health problems, a deeper understanding of public health
issues and an academic qualification that will enhance your career development in health-
related fields.
This work would not have been possible without the support of some staff members of the
School of Community Health Sciences, Njala University in Sierra Leone. We are especially
indebted to members of the Department of Environmental Health Sciences and Nursing who
have been supportive of our career goals and who worked actively to provide us with the
protected academic time to pursue those goals. We are grateful to all these with whom we
have had the pleasure to work during this and other related projects. Each of these staff
members including Lawerence Babawo, Momodu Massaquoi, Angella George provided us
extensive personal and professional guidance and taught us a great deal about both
scientific research and life in general. We would especially like to thank Dr. Rashid
Ansumana, the Dean of the School of Community Health Sciences, Njala University in Sierra
Chapter One
Introduction to Health Management
Management is defined as the technique, practice or science of managing or
controlling an organization; the resourceful use of materials, time or the human
resources of an organization (Collins English Dictionary, 1981). In management, the
focus is on how to efficiently utilize the resources. The resources include materials,
time, infrastructures and personnel to carry out the process that will result into an
output i.e. the end result or products and services.
The following definitions of management can help us understand the nature of the
term and its significance.
1. Management is a process of designing and maintaining an environment in
which people, working together in groups, accomplish selected aims (Adeleke,
2. Management is the process of getting things done through people
(Follet, 1941).
3. Management is concerned with the process of planning, organizing,
controlling, leading and coordinating the efforts of organizational members and
the use of other resources to achieve given organizational goals. Management
in an organization means to coordinate the efforts of people to accomplish
goals and objectives using available resources efficiently and effectively.
Management comprises planning, organizing, staffing, leading or directing,
and controlling an organization or initiative to accomplish a goal.
Management as a discipline is not as easy as one may imagine. A very good surgeon
specialist for instance, who is promoted to a managerial level of a Medical
Superintendent of a hospital, will only rely on luck and providence if he has no basic
managerial background. His surgical skills and knowledge in anatomy or physiology
will be absolutely useless to him in his new assignment. Similarly, a good Geography
Teacher who is promoted to the post of a Head Teacher or Principal of a school but
has no managerial background, will equally only rely on luck and providence, since
his knowledge in geography will not help him manage the school well.
In effect, management could be considered as both an art and a science in its right.
To be an effective Manager, one needs skills as distinct as those of any other
profession. In other words, management, like all other disciplines, medicine, law,
engineering and others, is about doing things that reflect the realities of the situation,
which makes it as a practice, an art. And in order to do things that reflect the realities
of the situation, one needs some organized skills and knowledge and it is these
organized skills and knowledge underlying the practice that are referred to as a
science. In the context of management, science and art are not mutually exclusive
but complementary.
A manager, without the formal fundamentals of management as a discipline, thus
relying on luck and providence, is like a doctor without the advantage of the sciences,
who is little more than a witch doctor.
In effect, the main responsibility of a health manager is to facilitate the attainment of
organizational objectives. A health manager gives guidance and effective leadership
to his staff and controls their efforts towards achieving a common goal. An efficient
Manager is the one that delegates authority and follows it up with effective
supervision and monitoring. In other words, a Manager does not try to do all the work
himself. In management, time is considered an important resource that needs to be
managed well like all other resources.
Three Golden Rules of Management
As soon as you ask someone else to do something, rather than undertaking it
yourself, you become a Manager. We rely on people to perform the task in the way
we would do ourselves if we have the time, knowledge, skill and patience. At its
simplest, there are three fundamental rules, otherwise known as the golden rules of
Management to be followed when working through people.
The three golden rules are for managing people are:
1. Agree expectations.
2. Ensure skills and resources.
3. Feedback.
Rule 1: Agree Expectations
Unless people know what is expected of them, they are unlikely to achieve it. We
need to agree with people just what it is we expect them to achieve and how. If for
instance you intend to engage the services of a Cleaner either in your Office or
Home, you probably must tell him/her what exactly you would want him/her to do.
However very often, we employ people and without telling them exactly what is
expected of them, we rely on the professional tag they wear And when our notions of
what is ever professional tag may mean does not coincide with our expectations, we
blame them.
In recent time, job descriptions have greatly improved and as a result, they have
become a useful basis for a discussion of this kind. Reaching agreement requires
both parties to express their views. Often at work, talking together and meeting face-
to-face is really the only way to observe rule 1. What is more, it will be necessary to
have regular discussions to check that both parties are in agreement.
Rule 2: Ensure Skills and Resources
Once people know what we expect of them, we must ensure that both parties are
confident that they can achieve it, that they have the knowledge, skills and resources
required. Mind you, in observing rule 2, some people may give an over confident
assertion that they have the required skills, while some may feel unsure of their
To be able to diagnose properly if any of such situations apply, you will need to
spend time with your staff, observing the skills they use, the reasoning they employ
and the way they deploy their resources including their time. If for any reason you are
unable to assess their skills because they are technical and outside your own area of
expertise, then you will need to seek Specialist advice. But this of course must be
discussed with the Staff Member involved. Although management is about trust, yet
Managers who failed to assess their staff often don’t have trust but hope.
Rule 3: Feedback
Once people know what is expected of them and have the skills and resources to
achieve it, then there is need for them to receive regular feedback on whether they
are on the right track. This will enable them to increase their effort in one or more
areas if necessary. The importance of giving a feedback cannot be over emphasized'
it is about receiving a feedback, either expressed or observed, that people improve
their skills, develop and grow. We therefore owe a feedback to the people we are
working with, especially those we are managerially responsible for. A feedback must
be giving to them to enable them to progress.
However, it must be borne in mind that the way a feedback is given, makes the
difference. Criticism may be so wounding that instead of enabling the recipient to
change and grow, it robs him of the confidence to attempt any change and this
situation can often exacerbate the problem.
Organizational Management
Organizational Management is based on the concept of how organizations function
with reference to:
a) Organizational Structure.
b) The process of Leadership.
c) Change Management.
d) Team Work.
The structure of any organization consists of units and functions. These units and
functions contain positions in which job holders are accountable for achieving results.
In between these positions, relationships exist which require the exercise of an
authority and an exchange of information. There is what is generally referred to as a
“chain of command” which starts from the top defining a hierarchy of positions,
indicating who is accountable to whom and for what.
How Simple is Management
Management is not, by any stretch of imagination, as simple as may be imagined.
Imagine for instance, that you are not a Medical Doctor and you are put in charge of
a critically skilled based health facility. How likely is it that you could manage that
facility effectively? Keeping in mind of the fact that you are managing highly skilled
professionals of whose professional skills you have little or no experience of.
Mind you, effective management practices can transform an inefficient organization
into a more productive one while bad management practices can transform a
productive organization into an inefficient one. A bad Manager, who lacks the
fundamentals of management as a discipline, will be going the wrong direction and
doing so efficiently. Good management is vital if an organization is to be successful
and effective. Management is one big advantage any organization can have. It is not
just a matter of seniority but a matter of acquiring skills and “practicalizing” those
Today, there are many different views about management. Many technical schools
and universities now provide courses for planners and managers. As a result, there
are increasing numbers of planning professionals; many of whom are Doctors,
Nurses and even Public Health Specialists. However, although these courses help to
develop skills in the technical aspects, such as cost benefit analysis, yet they do not
always help such planners to understand how professionals and beneficiaries think
and relate to each other.
Theory of Management
It is quite appropriate to know what a theory is, before you can confidently discuss its
processes and the other important issues relating to it. In this respect therefore, it is
thus prudent that one knows what a theory is before we go on to look at the actual
processes involved. Homans, an outstanding scholar of management, defined theory
as a systematic grouping of interdependent concepts and principles that give a
framework to or tie together a significant area of knowledge. A theory according to
Homans “is a set of pigeon holes or a filing cabinet, in which facts are accumulated
and nothing is more lost, than a loose fact.” One must realize however, that naturally,
theories reflect the thinking and attitudes of their time but at any rate, they still tend to
have a lot of influence on today’s organizational methods and ideas.
Management theories can be classified into three distinct categories, as follows:
1. Scientific or Classical Management Theory
2. Human Relations Management
3. Open Systems Approach
Scientific Approach
According to Frederick Winslow Taylor, it was proposed that Scientific Approach or
Classical Management Theory focuses on fundamental principles, which he thought
were the underlying facts that could be appropriately applied to any organization.
The main principle of Taylor’s Classical or Scientific Theory was the replacement of
custom and the rule of thumb by the application of scientific methods, which could
yield productivity without the expenditure of more human energy and effort. Taylor
believed that with division of labour, that is dividing a piece of work into its actual
constituent parts, productivity can be increased and there will be a rise in the pay of
the workers as well.
Taylor’s aim was to increase the efficiency of production methods, not just to lower
organizational cost and increase production but also to enable the workers to
increase their earning wages. It can conclusively be said that the scientific approach
to management focused more on organizational structure.
Human Relation Approach
According to Emile Durkheim, a French Sociologist (1825-1917), further propounded
by Elton Mayo (1880-1949), the Human Relations Approach focused more on the
people doing the work in the organization. Human Relations was about the social
needs of the people, their motivation and behaviour. The point made in this approach
was that workers could become highly motivated by being part of a social working
group and by being consulted by management about changes in work practices.
Open System Approach
This approach does not focus only on one aspect of an organization, like the
scientific or human relations approaches. The systems approach is focused on the
organization as one complete entity that is the people, structure, environment and
technology. The organization is seen as a collection of interrelated and interacting
part, which is viewed as a whole. The Open Systems theory dictates that all
organizational elements, people, structure, environment and technology have to be
considered as a cohesive whole and not as separate items. It can either be opened
or closed. Open system interacts with its external environments, while a closed
system is regarded as self-supporting from within. Management implies organizing
workers into groups in order to work together towards common goals. Various
management theories and how they have developed over the years, from the one-
dimensional scientific approach, through to the multi-dimensional systems approach
are thinly discussed. Now we are to look at crucial management processes, which
together constitute management as a discipline.
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