MCH 501 – HEALTH SERVICES MANAGEMENT

Principles of Management and

Total Quality Management
Prof. W. Odero
April 8, 2021

1
 Objectives
• Explain the definition, concepts and functions
of management
• Understand the levels of management in an
organization
• Explain the management roles and skills of
managers at each level
• Explain the definition and principles of Total
Quality Management

2
Management Concepts and Definitions
• Management – is the art of getting things done
through people, thus managers give direction to their
organizations, provide leadership, coordinate activities
and decide how to use organizational resources to
accomplish goals. It is the accomplishment of results
through the efforts of other people
• Management is the process of using organizational
resources to achieve the organization’s goals in an
effective and efficient manner, through planning,
organizing, leading, and controlling organizational
resources
• Organization: People working together and
coordinating their actions to achieve specific
goals
• Resources: are organizational assets and
include (4M):
– Man
– Machinery
– Materials
– Money
• Goal: is a desired future condition or status
that the organization seeks to achieve

• Efficiency: A measure of how well resources

are used to achieve a goal.

• Effectiveness: A measure of the degree to

which the goals are achieved
Purpose and Functions of Management

1. The purpose of management is to facilitate

attainment of organization goals in an
effective and efficient manner.
2. The Functions of management are:
― leading
― planning
― organizing
― controlling organization’s resources;
Management Functions
 Management Functions
• Planning - means deciding on the tasks and use of
resources needed to attain goals of the organization.
It is the determination of what is to be done, how and
where it is to be done, who is to do it, and how the
results are to be evaluated.
– The planning process involves:
• Establishing a set of organizational goals
• Developing strategies and plans to achieve the
stated goals
• Evaluating organizational resources
• Formulating a decision-making process
• Leading or Directing - is the use of influence to
guide and motivate employees to achieve
organizational goals 
– The leading function involves three components:
• Motivating employees
• Influencing employees
• Forming effective groups
– The leading process helps the organization move
toward goal attainment
– In directing, managers determine direction, state a
clear vision for employees to follow, and help
employees understand the role they play in attaining
goals.
• Organizing - means making sure there are available the
resources and logistics to carry out a plan. It is the
systematic arrangement of different aspects of the
organization’s operations to achieve the planned objectives
–  involves the assignment of tasks, the grouping of tasks into
departments, and the allocation of resources to departments
– Three elements are essential to organizing:
i. Developing the structure of the organization
ii. Staffing - acquiring and training human resources
iii. Establishing communication and coordination patterns,
and networks
– Determining the method of grouping these activities and
resources is the organizing process
• Controlling - means monitoring employees' activities,
determining whether the organization is on target
toward its goals, and making correction as necessary.
– Control function has three basic components :
• Elements of a control system of the organization
• Controlling financial, informational, physical and human
resources.
• Evaluating and rewarding employee performance
– In controlling, managers evaluate how well the organization is
achieving its goals and takes corrective action to improve
performance
– An affective control function determines whether the organization
is on target toward its goals and makes corrections as necessary.
• All management functions are necessary in organizations
and are interrelated
 Who is a Manager?
• A manager is someone who coordinates and
oversees the work of other people so that
organizational goals can be accomplished. A
manager’s job is not about personal
achievement — it’s about helping others do
their work.
• Managers can be classified in two ways:
– by their level within the organization, and
– by their roles and scope of their responsibilities.
 Classification of Managers by Level
within an organization
• There are THREE levels of managers:
1. Top managers
2. Mid-level managers
3. First-line managers

• The Levels can be illustrated in form of a

Pyramid in terms of the numbers of people
involved at each level
Vertical Management – practiced in most
organizations
 Three Levels of Management
1. Top managers are responsible for the overall
direction and operations of an organization.
They have such titles as chief executive officer
(CEO), managing director, president, etc.
2. Middle managers are responsible for business
units and major departments of the
organization. E.g., department/faculty/division
head, director of the clinical/ laboratory
services. They manage the work of first-line
managers
3. First-line/ operational managers: manage the
work of non-managerial employees who are
directly involved in producing the
organization’s products or servicing the
organization’s customers. They may be called
section head, office manager, shift manager,
line manager, foreman, supervisor, etc.
― Team leader- A team leader is a special kind of
manager who may be appointed to manage a
particular task or activity.  Once the task is
complete, the team leader position may be
eliminated and a new team may be formed to
complete a different task. The team leader
reports to a first-line or middle manager.

– Non- managerial employees - these are the

workers who are directly involved in the
production of goods and provision of services
 Management Roles
• Managerial roles refers to specific actions or
behaviors expected of and exhibited by a
manager.
• To do their jobs, all managers assume three
different roles: leadership (or interpersonal),
informational, and decision making.
• No manager stays in any one role all of the
time, but shifts back and forth the three roles.
Management Roles
1. Leadership / Interpersonal Roles:
• Leadership is the ability to communicate a
vision and inspire people to embrace that
vision.
• Interpersonal roles are ones that involve
people (subordinates and persons outside the
organization), and other duties that are
ceremonial and symbolic in nature.
– Top managers are often required to fulfill
leadership role. They are the figurehead and public
face of the management team, and represent the
organization in legal, economic, and social forums. 
– Middle managers are also leaders, although their
focus is more on interpersonal skills, such as
motivating employees and encouraging innovation
and creativity.
– First-line managers lead by example, when they
actively participate in implementation of the tasks
assigned to their workers, and by modeling the
policies and work ethics of the organization.
2. Informational Roles
• Informational roles involve collecting,
receiving, and disseminating information
—whether as a spokesperson, a mentor,
a trainer, or an administrator.
– A top manager is the voice of the
organization and has to monitor,
disseminate information, and act as the
spokesman.
– Middle managers must skillfully determine what
information from top management should be
shared with others, how it should be interpreted,
and how it should be presented.

– The informational role for first-line managers is

primarily one of disseminating what they have
been given and helping the employees to see how
their own contributions further organizational
goals. They have a responsibility to see that the
employees understand what they need to be
successful in their jobs.
3. Decision Making Roles - entail making
decisions or choices. All managers are
required to make decisions, but managers
at different levels make different kinds of
decisions. There are four types of
management decision roles:
i. Entrepreneur. The entrepreneurs in an
organization are usually top-level managers. They
identify economic opportunities, lead the
initiative for change, and make product decisions.
ii. Disturbance handler. Top and middle managers will
react to disturbances/unexpected events in the
organization—whether internal or external. They will
decide what corrective actions should be taken to
resolve the problems.
iii. Resource allocator. All levels of management will
make resource allocation decisions, depending upon
whether the decision affects the entire organization, a
single department, or a particular task or activity.
iv. Negotiator. Most negotiations are done by top and
middle-level managers. Top managers will handle
negotiations that affect the entire organization, such
as union contracts or trade agreements. Middle-level
managers negotiate most salary and hiring decisions.
 Management Skills
• Managerial skills refer to the ability to make business
decisions and lead subordinates within an organization.
• Regardless of their level of authority, managers need to
have 5 critical skills: conceptual, human, technical,
diagnostic, and political

i. Conceptual skills: are the skills managers use to think and

to conceptualize about abstract and complex situations. They
are the cognitive ability to see the organization as a whole
and the relationship among its parts.
ii. Human skills: involve the ability to work well with other
people both individually and in a group. Include the ability to
communicate with, understand, and motivate both
individuals and groups.
iii. Technical skills - are the job-specific knowledge and
techniques needed to proficiently perform work tasks.
They are skills necessary to accomplish specialized
activities - (e.g., engineering, medical, nursing,
accounting, etc.)
iv. Diagnostic skills: is the ability to determine, by analysis
and examination, the nature of a particular condition.
v. Political skills: is the ability to acquire the power
necessary to reach objectives and to prevent others
from taking power. Political skill can be used for the
good of the organization and also for self-interest.
• The extent to which managers need different
kinds of skills moves from lower management
to upper management.
• Most low-level managers use technical skills
extensively. At higher levels technical skills
become less important while the need for
conceptual skills grows.
• Human skills are very important to all
managers.
 Total Quality Management
• Total Quality Management (TQM) - is a management
approach to long-term success of an organization
through customer satisfaction.
– TQM aims to hold all parties involved in the production
process accountable for the overall quality of the final
product or service
– It uses strategy, data, and effective communications to
integrate the quality discipline into the culture and activities
of the organization.
– In a TQM effort, all members of an organization participate
in improving processes, products, services, and the culture in
which they work
 Principles of TQM
There are EIGHT Principles to TQM:
1. Customer-focused: The customer ultimately determines
the level of quality. No matter what an organization
does to foster quality improvement, the customer
determines whether the efforts were worthwhile.
2. Total employee involvement: All employees participate
in working toward common goals.
― Total employee commitment
― empowerment of employees, formation of self-managed work teams 
― Provision of proper environment.
― Continuous improvement efforts
― .
4. Process-centered: A process is a series of steps that take
inputs from suppliers and transforms them into outputs
that are delivered to customers.
― The steps required to carry out the process are defined, and
performance measures are continuously monitored in order to
detect unexpected variation
5. Integrated system: Focuses on the horizontal processes
interconnecting functions of different vertical
units/departments.
― Everyone must understand the vision, mission, and guiding
principles as well as the quality policies, objectives, and
critical processes of the organization.
6. Strategic and systematic approach: involves strategic
planning or strategic management, and includes the
formulation of a strategic plan that integrates quality as a
core component.
6. Continual improvement: A large aspect of TQM is
continual process improvement.
― Continual improvement drives an organization to be both
analytical and creative in finding ways to become more
competitive and more effective at meeting stakeholder
expectations.
7. Evidence-based decision making: In order to know how
well an organization is performing, data on performance
measures are necessary
― TQM requires that an organization continually collect and analyze
data in order to improve decision making accuracy, achieve
consensus, and allow projections based on past performance.
8. Communications: Communications involve strategies,
method and timeliness.
― Effective communication plays a large part in maintaining morale
and in motivating employees at all levels.
• These elements are considered so essential
to TQM that many organizations define them
as a set of core values and quality assurance
principles on which the organization is to
operate.
– See Maseno University Quality Assurance Policy

• Since TQM often represents a large cultural

shift, these principles may need to be
implemented in phases to lessen the impact.
 STRATEGIC MANAGEMENT
Objectives
• Explain the definitions, concepts, theories and
uses of strategic management
 What is Strategic Management?
• Strategic Management consists of two
words:
– Strategy
– Management
• What is strategy?
– Greek verb ‘strategos’ means to plan the destruction of one’s
enemies through effective use of resources; the skill of employing
forces to overcome opposition
– A means of achieving organizational purpose
– A means to develop organizational core competencies to create
sustainable competitive advantage
– An expression of strategic interest
– A long-term plan, a policy…
– Is the creation of the company’s future which is the result of
collective social activity,…
– Strategy is associated with a long range planning, a structured system
of objectives and goals, and a selected way of creating a fit between
external environment, internal resources and capabilities
 Despite the obvious importance of
strategy, there is little agreement on
what a strategy really is.
 There is no one single, widely accepted
definition of the strategy!
 Strategy: 5 P’s about the strategy
• A strategy is viewed as a:
– Plan – strategy is an integrated plan and outcome of a
deliberate process
– Play – strategy as a manoeuvre to overcome your
opponents or competitors
– Pattern – strategy as a pattern in decisions and actions
– Position – strategy as a mediator between internal and
external environments
– Perspective – strategy as an internal view on the
organisation’s future
Strategic Management Concepts
Strategic management answers three
questions :
– “where do you want your business to go” (goals),
– “how is your business going to get there”
(strategy), and
– “how will you know when you get there”
(evaluation)
 Strategic Management Concepts:
1. Goal setting : setting specific targets to be met
by the organization; deciding what is important
for the long-range success of your business and
focusing on it.
– Employees would know what they have to do or what
are they doing to reach their goals. Also a manager
would know what he has to do to meet the
organization's goal
– Organizations could plan what they will do to meet
their goal by strategic decisions such as what they will
prepare for advertisement or what kind of policy they
will formulate to improve their business
2. SWOT Analysis: organization has to do some
analysis about environment of the organization
• SWOT analysis of an organization consists of the
following aspects:
– Strengths (what is the organization's power, advantage),
– Weakness (what is lacking in the organization i.e. skills,
resources, systems or something else),
– Opportunities (while leading the way in strategic
management what kind of chances the organization will
have or miss),
– Threats (what kind of risks the organization might have
while leading the way in strategic management).
3. Strategic Planning:
― Planning is done to turn theoretical works into
practical implementation, e.g., what kind of
resources organization will use, how many
employees will be needed, etc.
4. Forecasting:
― Refers to awareness and predicting that
something may happen during the process, or
face some problems or other opportunities
necessitating a change in your strategy by making
another plan or some changes in the plan
5. Strategy Formation:
― An organization seeks to find ways of maximizing
profitability and maintaining a competitive advantage by
making decisions based on statistics, data analysis and
information.
6. Strategy Implementation:
― This is a key component of the management process, it
involves putting the strategy into practice to achieve
organization’s goals.
7. Strategy Monitoring:
― This is the last step in circular strategic management
process. Monitoring enables the organization to change its
strategy in order to achieve its goals
8. Matching business resources to market
opportunities

9. Using a strategic plan to identify and

assess alternative business strategies

10. A strategic plan is a “living” document

that changes as your goals and resources
evolve
 Strategic Management: 7 Key Stages
1. Goal Setting: setting specific targets to meet, such as to
protect current profit, to increase profit, to be leader in
the market, or to protect current situation in the market
2. SWOT analysis: making comprehensive analysis helps to
understand environment clearly at the beginning
3. Forecasting: predicting that something could happen
that may need change in the strategy to other
possibilities
4. Strategic Planning: is the core of strategic management;
all organizations and their managers need a plan to
understand their strategic management process
5. Strategy Formation: seeking ways of maximizing
profitability and maintaining a competitive
advantage of the organization by considering
statistics and analysis of information
6. Strategy Implementation: is putting the strategy
into practice to achieve organization’s goals
7. Strategy Monitoring: assessment of progress of
the organization’s plan and whether there might
be need to some changes in the plan
Fundamental issues in strategic management

• How firms achieve and sustain competitive

advantage?
• How and why certain firms build competitive
advantage?
Purpose of Strategic Management
An organization employs strategic
management in order to:

1) Pursue and fulfill its mission and goals

2) Satisfy and reward its stakeholders (funders/
sponsors, customers/clients)
3) Attain and survive in a competitive business
environment (sustainability)
Importance of Strategic Management
– Development of ‘theme’ /goal for the organization
– Provides opportunity for long-term
thinking/planning
– Facilitates more effective resource allocation
– Allows integration of diverse administrative
activities
– Increases managerial effectiveness
– Helps to deal with environmental complexity
– Improves employee motivation and performance
– Addresses stakeholder concerns
 Levels of Strategy
Strategy Level Actor/Manager
1. Strategic: Top Management
Corporate/Organizational-wide (CEO, MD)

2. Business/Competitive Head/Director Strategic

strategy: Product or Service-line Business Unit SBUs make up the
Strategic Business Units have parent corporation’s portfolio
their strategic Plans
3. Operational strategy: routine Mid-level managers/supervisors
operations of departments
4. Tactical strategy/ current Lower level /frontline/ junior
operations managers
 MCH 501:
HEALTH SERVICES MANAGEMENT

Organization Behaviour and

Structure
Prof. W. Odero
April 2021
 Objectives
• Understand the definition and characteristics of
an organization
• Understand the definition and goals of
organization behaviour
• Describe organization of health services in Kenya
 Organization
• Definition:
– An organization - is a collection of people who
work together to achieve individual and
organizational goals
– An organization is an entity, such as an institution,
agency or an association, that has a collective goal
and is linked to an external environment
 Features of an organization
• Definitions of an organization usually contain 5
common features:
– Composition: individuals and groups of individuals
– Orientation: towards achievement of a common
goal
– Functions: defined differential functions
– Coordination: rational coordination of functions
– Continuity: continuity through time
 Organization Behaviour (OB)
• Definition:
–is the study and application of knowledge about how people
- as individuals and a groups - act within organization
–is the study of what people do in an organization and how
their behaviour affect the performance of the organizations
• OB is both a scientific study (in which a number of
studies and conceptual developments are taking place),
and applied science - where information about
effective practices in one organization is being extended
to many others.
 Goals of OB
• To describe how people behave under a variety of
conditions in the organization.
• To understand  why people behave as they do.
• To predict  future employee behavior.
• To control and develop some human activity at work,
to enable managers to:
– improve employee behavior, skill development, team
effort and productivity.
– improve the results through their own and
their employee’s actions.
 Importance of Organization Behaviour
• OB helps an individual to understand himself and
others better, i.e., improves interpersonal
relationships in the organization
• OB helps the manager understand the basis of
motivation and what he should do to motivate his
subordinates.
• OB helps to maintain cordial industrial relations
• OB enables a manager to motivate his subordinates
towards higher productivity and better results.
 Organization Structure
• The structure of an organization is the manner in which
various sub-units are arranged and inter-related
• It is the typically hierarchical arrangement of lines of
authority, communications, rights and duties in an
 organization. 
• Is the institutional arrangements and mechanisms for
mobilizing human, physical, financial and information
resources at all levels of the system.
• It defines how activities such as task allocation,
coordination and supervision are directed toward the
achievement of organizational goals
• The classical organizational structure includes:
– The simple centralized design - suited for smaller
organizations, where power, decision making
authority and responsibility for goal setting are
vested in one or two persons.
– The bureaucratic structure - suited for larger
organizations where standard methods and
procedures are employed for ensuring work
performance.
– The divisionalized organization refers to a
multiproduct or service design.
 Principles of Organization Structure
Modern Organizational structures have the following basic
principles:

• Specialization: - facilitates division of work into units for efficient

performance. Work can be specialized both horizontally (e.g
departments/units) and vertically (chain of command)
• Coordination: -refers to integrating the objectives and activities of
specialized departments to realize broad strategic objectives of the
organization.
• Departmentalization: - is a process of horizontal clustering of
different types of functions and activities on any one level of the
hierarchy. It is conventionally based on purpose, product, process,
function, personal things and place
• De-centralization and Centralization:
– De-centralization refers to decision making at lower levels in the
hierarchy of authority.
– In contrast, decision making in a centralized type of organizational
structure is at higher levels.
– Every organizational structure contains both centralization and de-
centralization, but to varying degrees.
• Line (Professional) and Staff (Administrative) Relationships:
Line authority refers to the chain of command, or to the
superior-subordinate linkages, that extend throughout the
hierarchy. It is an important aid to communication and
coordination.
– Line and staff personnel have different functions, goals, cultures and
backgrounds.
 University Governance Structure
UNIVERSITY COUNCIL
UNIVERSITY SENATE
MANAGEMENT

ADMINISTRATION, ACADEMIC & PARTNERSHIPS, RESEARCH

FINANCE & STUDENT & INNOVATIONS
ADMINISTRATION AFFAIRS

ADMINISTRATION FINANCE PARTNERS RESEA INNOVA

HIPS RCH TIONS

STUDENT WELFARE SERVICES LIBRARY

LIBRARY ACADEMIC AFFAIRS
SCHOOLS & INSTITUTES
DEPARTMENTS
Organization of Health Services in Kenya
Health Sector and the Constitution
• The new Constitution 2010 provides a major milestone
for improvement of health standards
• Article 43 states that every citizen has right to life, right
to the highest attainable standard of health including:
– reproductive health
– emergency treatment,
– right to be free from hunger and to have food of acceptable
quality,
– right to clean, safe and adequate water and reasonable
standards of sanitation, and
– the right to a clean healthy environment.
 Kenya Health Policy

• Policy Goal: - attainment of the highest possible

health standards in a manner responsive to the
population needs, through:
– supporting provision of equitable, affordable and quality
health and related services at the highest attainable
standards to all Kenyans.

• The target of the policy is to attain a level and

distribution of health at a level commensurate with
that of a middle income country (Vision 2030)
 KHP Objectives
Six policy objectives have been defined to
facilitate realization of the policy goal, each
with specific strategies:
1. Provide essential health care
2. Eliminate communicable diseases
3. Halt, and reverse the rising burden of non
communicable diseases
4. Reduce the burden of violence and injuries
5. Minimize exposure to health risk factors
6. Strengthen collaboration with health related
sectors
THE KENYA ESSENTIAL PACKAGE FOR HEALTH (KEPH)

• KEPH highlighted in the National Health Sector

Strategic Plan (NHSSP) emphasizes integration
of all health programmes into a single package
that focuses its interventions towards the
improvement of health at different phases of
the human development cycle, at the different
levels of the health care delivery system
 KEPH Levels
The KEPH defines 4 levels of care:

Level 1 - Community level: provides non-facility based health

services
Level 2 - Primary care level: The first physical level of the health
system, comprising all dispensaries, health centres, maternity /
nursing homes.
Level 3 - County level: The first level hospitals, whose services
complement the primary care level to allow for a more
comprehensive care to client services
Level 4 - National level: The tertiary level hospitals, whose services
are highly specialized and complete the set of care available in Kenya
 KEPH Cohorts
• KEPH interventions are aligned to the phases
(cohorts) of the human development cycle as follows:
– Pregnancy and the newborn (up to 28 days)
– Childhood (29 days – 59 months): The health services
specific to early childhood period (<5 years)
– Children and Youth (5 – 19 years): The time of life between
childhood, and maturity.
– Adulthood (20 – 59 years): The economically productive
period of life
– Elderly (60 years and above): The post – economically
productive period of life
 Devolution of Healthcare

• In the devolved system, healthcare is

organised in a four-tiered system defined in
the KEPH
• The counties are responsible for three levels
of care: community health services, primary
care services and county referral services.
• The national government has responsibility for
national referral services.
ORGANIZATION OF HEALTH DELIVERY SERVICES

NATIONAL HOSPITALS

COUNTY REFERRAL HOSPITALS

PRIMARY CARE FACILITIES

COMMUNITY CARE

HOUSEHOLDS
 Organizational Structure - MOH

• National Level
– Cabinet Secretary
– Principal Secretary
– DMS
– Heads of Departments and Divisions
• County Level
– County Executive Committee (CEC) for Health
– Chief Officer for Health
– County Director of Health
– Heads of Departments
Responsibilities of the National Government

 Health policy
 Financing
 National referral hospitals
 Quality assurance and standards
 Health information, communication and technology
 National public health laboratories
 Public-private partnerships
 Monitoring and evaluation
 Planning and budgeting for national health services
 Services provided by KEMSA, NHIF, KMTC and KEMRI
 Ports, borders and trans-boundary areas
 Major disease control
Responsibilities of the County Governments
• County health facilities and pharmacies
• Ambulance services
• Promotion of primary health care
• Licensing and control of agencies that sell food to the
• Public
• Disease surveillance and response
• Veterinary services (excluding regulation of veterinary
• professionals)
• Cemeteries, funeral homes, crematoria, refuse dumps,
• solid waste disposal
• Control of drugs of abuse and pornography
• Disaster management
• Public health and sanitation
 County Health Departments
• County Health Management Teams (CHMTs)
have been established to provide
“professional and technical management
structures” in each county, and to coordinate
the delivery of health services through health
facilities available in each county
• Key References
1. Basic Strategy Concepts (Chapter 1): Jones & Bartlett
Publishers
2. Strategy and Strategic Management Concepts: Are they
recognized by management students? Business
Administration and Management. Emerson Wagner
Mainardes, et al.; 2014
3. Kenya Health System Description. Derived from the
NHSSP II, 2005 – 2010
4. Devolution of Healthcare Services in Kenya. KPMG
5. Kiambu County Health Services Act, 2014