HEALTH SYSTEM MANAGEMENT • Knowledge

• Technique
WHAT IS MANAGEMENT? • Skills
• Getting the right things done, in the
right way, right time, right persons, Methods of Management
right amount of resources and • Organizational Design: to meet
effective use of resources health needs or demands
• Health system management • Personnel Management: right person
o purposeful and efficient use for the right job
of health system resources • Communications: sharing of
o Get health system members information between levels of
to work harmoniously, management
coordinated • Information system: Health
o Achieve common goals and information System
objectives • Management by objectives: Cost
effectiveness, good results for less
Why use Management in Health Systems? time, effort and money
• Integration of health programs and
departments Functions of Management
• Distribution of work, relieve
overload/underload
• Changing health needs and demands
• Apply modern management methods
and techniques to improve health
care delivery system

Targets<Objectives<Goals
• Goals: Ultimate Desired State ( To
combat HIV/AIDS)
• Objectives: Planned end point of a
health activity. Deals with the
problem in health activity (health Health System Management Functions
awareness program on HIV/STI, • Planning – course of action
condom use promotion, etc)
• Organizing – resources, structure,
• Targets: Discrete activity in a health job description
activity. Factors involved in the
• Staffing – recruitment, training,
problem (Increase condom use in at
supervision and monitoring
risk population
• Controlling- standards of
• Indicators: What you measure as
performance for quality control
output/progress in a health activity
• Directing and Decision Making –
orders and instructions
Health Resources
• Manpower
Health System Management Functions
• Money
• Coordinating – efforts and activities
• Materials of team and collaborating agencies
• Minute (time)
 • Reporting – to management,
stakeholders and collaborators Health Planning
• Budgeting – accounts and spending • Process of deciding on how the
• Innovation – out of the box, new future should be better than the
methods, novel ideas present
• Representation – participation of all • Define health problems, identifies
levels needs, inventory resources, establish
• Delegating – jobs at different levels goals and establish action to
to different personnel accomplish goals
• Proper utilization of resources
Skills of a good manager • Improvement of Health Services
• Effective communicator – listen,
express, emphasize What is a Plan?
• Good conceptual skills – Can see the • Template for action
forest but knows where the trees are • Components
• People Person - knows how to deal o Identification and
with all levels of the team prioritization of
• Team oriented – “We” not “I”. Trust, problems/issues
compatibility, esprit de corps, o Policy formulation
conducive work environment o Establish Objectives
o Budget
Skills of a good manager o Time Frame
• Effective technical skill – can use
new knowledge, methods, skills and Definitions
equipment • Health Policy: A guide for the health
• Effective Leadership skills – activities
empower, motivate team to work • Program: A sequence of activities
efficiently and effective • Schedule: Timeframe to complete the
o Competitive action
o Entrepreneurship • Procedure: A set of rules
o Innovativeness
o Order and rational thinking The Planning Cycle
Step 1. Analysis of the Health Situation
Concepts of Leadership • Collect, assess, interpret
information and demographic
data from surveillance
• Epidemiology of disease,
mortality and morbidity date
• Medical care facilities
technical manpower, training
facilities
• KAP of population about
disease prevention and cure
Step 2. Establish Objectives and Goals • A SOP for specific tasks and
• Reduce haphazard activity, roles
uneconomical use of funds, • Selection, training,
poor performance motivation, supervision and
• General Objectives at upper monitoring of the manpower
level, then more specific and • Proper management functions
detailed at lower levels is required here
• Resource are directed and
utilized properly taking into Step 7. Monitoring
nature of objectives (short • Following the activities
term vs long term) during the implementation
• Cost-Benefit Analysis (CBA) whether they are proceeding
and input-output analysis according to schedule
used to define goals, • Keeping tract of course of
objectives and targets activities
• Taking corrective action
Step 3. Assessment of Resources before failure
• Money, men, materials, time,
knowledge, technique and Step 8. Evaluation
skills • Assess the degree of
• Balance, what is required, achievements of the
available and what needs to objectives and targets
be utilized • Assess adequacy, efficiency,
effectiveness of final
Step 4. Fixing Priorities outcome of a health activity
• Prioritize objectives or • Important for feedback,
activities in order of opportunity for correction of
importance or magnitude deficiency and gaps during
• PAPA (Plan well, Analyze phase of implementation
critically, Prioritize Activity,
Act timely, promptly and Management methods (Qualitative, based
decisively) on principles of behavioral sciences)
• Alternate plans ( think 2 steps • Organizational design
ahead) • Personnel Management
• Communications
Step 5. Writing of Formulated Plan • Information systems (HIMS)
• Preparation of detailed plans • Management by Objectives (MBO)
• Working guidance to all those
responsible for execution of Management methods (Quantitative,
plan (health care team) based on principles of economics,
budgeting and Operational Research)
Step 6. Programming and • Cost-Benefit Analysis
Implementation • Cost-Effective Analysis
• Effective organization like • Cost-Accounting
staffing, coordination, • Input-Output Analysis
communication
 o To analyze cost control
Management methods (Quantitative, operating in each
based on principles of economics, activity/department/service
budgeting and Operational Research) o Detect and reduce wasteful
• System Analysis expenditures by proper
• Network Analysis planning and allocation of
• Planning-Programming-Budgeting resources
System o Calculate and accumulate
• Work Sampling data like cost of
• Decision Making hospitalization, cost of work
and production, cost of
Cost Benefit Analysis pricing, cost of
• Cost: A factor of production. reimbursement
Monetary valuation of an
expenditure to obtain an asset/service Input-Output Analysis
• The benefits are expressed in • Economic Technique
monetary terms only. A benefit-to- • Input: every type of resource utilized
cost ratio >1 is acceptable • Output: results like number of cases
• Rarely used to assess health seen at the ER/OPD/ Follow up
programs because in health care, the clinincs, number of surgeries done,
benefits are in terms of births/deaths, immunizations conducted, etc
illness prevented, etc)
• A form of economic evaluation System or Organization Analysis
• Measures “value for money” to • A formal analysis
community o Purpose
o Problems within
Cost Effectiveness Analysis o Cost effectiveness
o Risks
• Most widely used in health
programs/services • Examples of system
o Hospital supply system
• Similar to CBA but benefits
o Hospital management
expressed in terms of
information system
results/outcomes/improvements in
o Community health system
health status
• Measures relative cost to achieving
Network Analysis
objectives and targets
• Graphic Representation and analysis
• Benefits in terms of effectiveness (
of activities
improve health conditions, reduced
• Interpretations in the form of
disease and deaths, injuries
diagrams, flow charts
prevented
Program Evaluation and Review
Cost Accounting
Technique (PERT)
• Set of procedures used to determine
• Example of network analysis
the cost structure of various services
and activities in a health program • Used for control of Time and Cost in
complex programs or projects
• Listing of activities and tasks
 • Presented in a form of a network
with sequential relationships
between them

Planning-Programming-Budgeting
System
• Economic Framework
• Helps decision makers to prioritize
expenses, allocate resources and
Critical Path Method (CPM) minimize opportunity cost
• Example of network analysis • Helps t o group activities related to
• Control of time and cost in a each objective
complex program or project
• Program is broken into component Work Sampling
parts • Systematic Observation and
• Each part analyzed in isolation and recording of one or more persons
in relationship to others • Carried out at Predetermined
• Longest path with greatest time /random time
constraint is determined • Major parameter is Time
• The critical path is that step that has • Hospitals – nurses, doctors,
“zero slack” – no delay can be pharmacists, lab technicians
tolerated • Analyzes appropriateness of current
• Any delay in the start or activity in staff, job descriptions and
that step will delay entire program standardizes practice
• Sum of durations for critical • Determines manpower needs
activities represent the “shortest
possible time” to complete a project Decision Making
• Path with longest time duration • Best decisions are not always made
determines the shortest possible time at the top
for completion of a project/program • Complete data = better decisions
• Analyze and pick out the best
decision
• Apply consensus building to making
a decision