HEALTH

SYSTEM
MANAGEMENT
1
 LEADERSHIP AND MANAGEMENT
OBJECTIVES
by end of lesson students should be able to:-
1. Define management and leadership
2. Explain difference between leadership and management
3. Explain functions of management
4. Explain levels of management
5. Explain neoclassical and classical theories of
management
What is management?
• Management is the art of getting things done
through people in order to achieve stated
organizational objectives.
• Management is also the systematic process
involving planning, organizing, staffing, directing
and controlling the efforts of organizational
members and using all other resources to achieve
stated organizational objectives.
•MANAGEMENT is a process
that utilizes organizational
resources in the most effective
and efficient manner, in order
to attain stated organizational
objectives.
•Efficiency in management refers to
optimal utilization of organization
resources with minimal wastage.

•It also refers to the ability to

accomplish something with the least
amount of wasted time, money and
effort.
•Effectiveness refers to attaining
specific organizational goals that
are timely and challenging.

•It is also the degree to which

something is successful in
producing a desired result.
What is leadership
The art of motivating a group of
people to act towards achieving
a common goal.
It is also the process
of persuading and influencing
others towards a goal.
There are six main resources in an
organization (6M)
1. Money
2. Manpower
3. Machines
4. Materials
5. Management (methods)
6. Minutes (time)
Who is a manager?

• This is an individual employed by an organization

who is responsible and accountable for
efficiently accomplishing the goals of the
organization.

• Managers focus on coordinating and integrating

resources using the functions of planning,
organizing, staffing, Directing and controlling.
1.Planning
•Planning is deciding in advance,
What to do, when to do and how to
do.
•It bridges the gap from where we are
and where we want to be.
2. Organizing
• It is the process of bringing together physical,
financial and human resources and developing
productive relationship amongst them for
achievement of organizational goals.
• According to Henry Fayol, “To organize a
business is to provide it with everything useful for
its functioning i.e. raw material, tools, capital and
personnel’s”.
The process of organizing
1.Identification of activities.
2. Classification or grouping of activities.
3. Assignment of duties.
4. Delegation of authority and creation of
responsibility.
5. Coordinating authority and responsibility
relationships.
3. Staffing
•The main purpose of staffing is
to put right man/woman on
right job i.e. square pegs in
square holes and round pegs in
round holes.
Staffing involves;
• Manpower Planning (estimating man power in
terms of searching, choose the person and giving
the right place).
• Recruitment, Selection & Placement.
• Training & Development.
• Remuneration.
• Performance Appraisal.
• Promotions & Transfer.
4. Directing
• Directing is that inter-personnel aspect of management which
deals directly with influencing, guiding, supervising,
motivating sub-ordinate for the achievement of
organizational goals.
• Direction has following elements:
1. Supervision
2. Motivation
3. Leadership
4. Communication
5. Controlling
•It implies measurement of accomplishment
against the standards and correction of
deviation if any to ensure achievement of
organizational goals.
•The purpose of controlling is to ensure that
everything occurs in conformities with the
standards.
Steps involved in controlling
•Establishment of standard performance.
•Measurement of actual performance.
•Comparison of actual performance with
the standards and finding out deviation if
any.
•Corrective action.
Characteristics of a manager
Managers have assigned positions within a
formal organization.
They have legitimate source of power due to
delegated authority that accompanies their
position.
They direct willing and unwilling
subordinates.
characteristics cont.……….
Since managers work in a formal organization,
they have a greater formal responsibility and
accountability for rationality and control than
leaders.
They are also expected to carry out specific
functions, and responsibilities.
Managers also manipulate people, the
environment, money, time, and other resources to
achieve organizational goals.
cont.
Managers work at various levels
in an organization. The number of
levels will depend on the size of
the organization. Generally three
levels of management are used.
Levels of management
Levels of management
1. First level management:
The first level managers are also referred as first line
managers and they are responsible for supervising the work
of non-managerial personnel and the day to day activities of
a specific work units or ward.
They are the lowest level.
In a hospital setting these would include, ward In-charge.
They are responsible for clinical practice, assigning staff to
patients, interfacing with the public, patient care delivery.
2. Middle level Management:
 The middle level managers supervise a number of first
level managers usually with related specialties or in a
given geographical area.
 They have a 24hr responsibility for their defined area.
 Typically middle level managers act as liaison between
upper management and first level managers.
 They are responsible for implementing the policies and
plans developed by top managers.
 A middle level manager maybe referred as a supervisor,
director or assistant director.
3. Upper level management (top
managers):
•This refers to top executives (such as Chief
Nurse) to whom the middle managers
report.
•They are responsible for establishing
organizational goals and strategic plans
for the entire organization and operating
policies for the entire division.
Managerial Skills
Different types of skills are required to
manage an organization effectively .
These skills have been classified into three
categories namely:
1. Technical
2. Human
3. Conceptual skills.
1.Technical skills:
Technical skills refer to the ability and
knowledge in using the equipment, technique,
and procedures involved in performing specific
tasks in a specialized field.

Technical skills are important in order to

accomplish or understand the specific kind of
work being done in the organization.
2. Interpersonal/human skills
•Human skills consist of the ability to
work effectively with other people both
as individuals and as members of a
group.

•These are required to win cooperation of

others and to build effective teams.
3. Conceptual skills:
This is the ability to see the organization as
a whole, to recognize significant elements
in a situation and to understand the
relationships among elements.

It is a cognitive ability to coordinate and

integrate all of an organization’s activities.
MANAGEMENT ROLES:

•Henry Mintzberg (1973) identified ten

management roles which he placed in
three categories:
1. Interpersonal role
2. Informational roles
3. Decisional roles.
1. Interpersonal roles:
1. Figurehead role: symbolizes the organization or
department and performs ceremonial duties.

2. Leader: determines the Mission and Objectives

of the organization and sees that they are
accomplished effectively. He hires, trains and
motivates employees and encourages them to do
better
• 3. Liaison
role: Involves
networking with outside
organizations, expanding
information sources, like
conferences, professional meetings
etc. Acts as a link between people,
groups or organizations within.
2. Informational role:
4. Monitor: (Get information useful to organization).
He/she tours of the organization and holds formal
and informal meetings to provide information about
the needs of the organization.
5.Disseminator: A manager is a link in the
organization chain of command. He shares
information from outside the organization and
between work units (sharing information improves
job satisfaction).
6. Spokes person: The manager
shares information with individuals
outside the organization, attends
meetings, offering continuing
education.
Decisional Roles:

The entrepreneur: The manager

• 7.

looks for profitable investments for

the organization to improve its
performance (start a school
of nursing).
8.Resource allocator; Managers schedule their
own time (work plan). They decide how
resources are distributed and with whom he
will work most closely with.
9. Negotiator; Enters into negotiation with other
parties e.g. to enter into a long term relationship
with a supplier.
10. Disturbance handler: Responds to
unforeseen circumstances eg. Replacement of a
sick staff, missing equipment, disease outbreaks
(shift staffs).
PRACTICE QUESTIONS
1. For effective management the manager should
possess a set of skills. Describe the three types of
skills that a manager should have. (6 marks)
2. A manager should be both efficient and effective.
Discuss efficiency and efficiency in management.(4
marks)
3. Mr Abdi is planning on opening a hospital within
Madogo area. State the six main resources that he
should consider. (3 marks)
 HISTORICAL DEVELOPMENT OF MANAGEMENT

Management has been developed

through the following periods:
i) The classical theories
ii) Neo classical theories
1. Classical theories:
• The exponents of classical theories were principally
concerned with the structure and mechanics of
organizations.
• They included the following
1. Henri Fayol (French Industrialist 1841-1925) –
Administrative theory.
2. Fredrick W. Taylor (1856-1915) – A Mechanical Engineer in
the USA (The Scientific Management Theory)
3. Max Weber (1864-1920) – A German Sociologist. The
Theory of Bureaucracy
1. Scientific Management Theory
was developed by Fredrick Taylor
(1900-1930) (A mechanical Engineer)
in 1911
• Taylor conducted research on methods of training
workers for increased productivity.
• He advocated that work be studied scientifically to
determine the one best way to perform each task.
• Taylor postulated that if workers could be taught the
“one best way to accomplish a task,” productivity would
increase. He came up with the basic principles of
scientific management:
•There should be
complete harmony
between
management and
workers
Principles of scientific management
1. Observing the workers’ performance through time and
motion study to determine the one best way to carry out each
task (develop a science for each element of man’s work to
maximize organization output).
2. Scientifically selecting the best worker to perform each job,
that is the person with characters and abilities needed to carry
out job tasks in the most efficient manner.
3. Training the selected worker to perform tasks in the most
efficient manner.
4.Paying the worker a differential piece rate
to motivate them to perform the tasks in
prescribed, efficient fashion.

5. Appointing a few highly skilled workers

to managerial positions and giving each
manager responsibility for planning tasks
for subordinate workers.
2. Administrative theory by HENRI FAYOL

• Administrative theory of management was

developed by (Henri Fayol 1841-1925)

• While the scientific management focused on the

tasks to be performed by the worker, administrative
management focused on the development of broad
administrative principles applicable to general and
higher managerial level.
14 Principles of management by Henri
Fayol
1. Specialization or division of labor;
 According to this principle one should work at activities in
which he/she has comparatively higher skills.
This helps the person to acquire an ability and accuracy
with which he/she can do more and better work with the
same effort.
Therefore the work of every person in the organization
should be limited as far as possible to the performance of a
single function
2. Authority and responsibility.

•Authority is the right to give orders and

the power to exact obedience.
•Each person should have an appropriate
authority to go with the given
responsibility.
3. Discipline
This is defined as respect or agreements
which are directed at achieving
obedience.
must prevail throughout the
organization as its essential for smooth
running of an enterprise.
4. Unity of command
 Every subordinate should receive orders
and be accountable to only one supervisor.
Dual or multiple commands is a perpetual
source of conflict.
Unity of command avoids conflicting
orders and ensures order stability in the
organization
5. Unity of direction

Teams with the same objective

should be working under the
direction of one manager,
using one plan.
 6. Subordination of Individual Interests to
general interests.
• When there is conflict between
individual interests and
organizations interests, the interests
of organization should prevail over
individual interests.
7. Remuneration of personnel.
•The amount of remuneration and
the methods of payment should be just
and fair and should provide
maximum possible satisfaction to both
employees and employers.
8. Centralization; Balancing centralized decision making
(from the top) with letting employees make decisions. Or as
Fayol wrote, "A place for everyone and everyone in his place."

9. Scalar Chain (line of authority). There should be a

clear line of authority ranging from top to down of
the organization. All upward and down ward
communication should flow through each position of
authority along the scalar chain.
10.Order. All materials and personnel have a prescribed
place, and they must remain there. The right man should
be in the right place
11.Equity. This means that employees
should be treated with justice and
kindness. Managers should be fair and
impartial in their dealings with
subordinates.

12. Stability of tenure of personnel.

Employees cannot work efficiently unless
job security is assured of them.
13. Initiative.
Initiative refers to the freedom to think for
oneself and use discretion in doing work. It
develops the interest of employees in their jobs
and provides job satisfaction to them.

14. Espirit de corps. This refers to harmony and

mutual understanding among members of the
organization. Unity among the staff is the
foundation of success in any organization
Espirit de corps
3. Theory of bureaucracy
• The theory was developed by Max Weber (1864-
1920).
• Weber’s rational bureaucracy states that employees
performing a large variety of tasks in an organization
must follow established rules and regulations in
order to ensure uniformity.
• There should be a clear line of authority.
• The following are the characteristics of an ideal
organization as described by Weber.
Characteristics of an ideal organization by Weber

I. Division of labour: Work should be

divided into small simple tasks.

II. Hierarchy of authority: Positions

should be organized in a hierarchical
manner resulting in scalar chain.
• III. Formal
selection: Employees
should be selected on the basis of
technical skill, formal examinations or
by education or training
•IV. Formal rules: There must be
formal rules and controls regarding the
conduct of official duties and
administrations
PRACTICE QUESTIONS
1. Henri Fayol is one of the classical theorists. He came up with the
14 principles of management. Discuss unity of command, unity
of direction, stability of tenure of personnel and subordination of
individual interests to general interests (10 marks)
2. Through the scientific theory of management, Frederick Taylor
advocated that work be studied scientifically to come up with
one best way of performing each task. Discuss the four main
principles he coined (8 marks)
3. There are several characteristics that an ideal organization
should possess. Discuss the various characteristics of an ideal
organization as described by max weber (6 marks)
2. Neoclassical theorist/ motivational theories

• Neoclassical theorists also referred as human

relation or motivational theorists were
concerned with the human factor at work place.
• They were concerned with motivation, group
relationships and leadership.
• They wanted to discover what it is that triggers
and sustains human behavior.
Neo-classical theories
1.Professor Elton Mayo (1880-1849
Hawthorne Studies
2.Maslow Hierarchy Of Needs (Theory Of
Motivation)
3.Herzberg’s Two Factor Theory
4.Mcgregor –Theory X And Theory Y
1. Professor Elton Mayo (1880-1849) Hawthorne studies

•He was concerned about studying people, in

terms of their social relationships at work.

•He carried out a study at the Hawthorne

plant of the Western Electric Company with
emphasis on the worker rather than the
work.
Conclusions from Hawthorne
Theory (Elton Mayo)
I. Individuals cannot be treated in isolation, but
must be members of a group.

II. The need to belong to a group and have status

within it is more important than monetary
incentives or good physical working conditions.

III. Informal (or unofficial) groups at work exercise

strong influence over the behavior of workers.
IV. Managers need to be aware of
these social needs and cater for
them if workers are to collaborate
with the official organization rather
than work against it.
2.MASLOW HIERARCHY OF NEEDS (Theory of
Motivation)

Maslow’s studies into human behavior

led him to propose a theory of needs
based on hierarchical model with the
basic needs at the bottom and higher
needs at the top.
 Maslow’s Hierarchy of needs

1. Physiological needs- These are the basic needs of air, water,

food, clothing and shelter. In other words, physiological needs
are the needs for basic amenities of life.
2. Safety needs- Safety needs include physical,
environmental and emotional safety and protection. For
instance- Job security, financial security, protection from
animals, family security, health security, etc.
3. Love and belonging- include the need for love, affection,
care, belongingness, and friendship.
4. Esteem needs- Esteem needs are of two types:
internal esteem needs(self esteem)(self- respect,
confidence, competence, achievement and freedom)
and external esteem needs(esteem from others)
(recognition, power, status, attention and admiration).

5. Self-actualization need- This include the urge to

become what you are capable of becoming / what you
have the potential to become. It includes the need for
growth and self-contentment.
Central points in Maslow’s hierarchy of
needs
• People tend to meet their needs
systematically, starting with physiological
needs then moving up the hierarchy.

•Until a particular group or needs is satisfied,

a person’s behavior will be dominated by it.
3. Herzberg’s two factor theory:

He concentrated on satisfaction at work.

From the study he came to conclude that certain
factors tend to lead to job satisfaction while
others frequently led to dissatisfaction.
Factors giving rise to satisfaction were called
motivators. Those leading to dissatisfaction were
called hygiene factors.
•Important motivators (satisfiers)
1. Achievement for performing a
task
2.Recognition and praise
3.Work itself
4.Responsibility for one’s work
5.Advancement: through promotion
Hygiene factors/dissatisfiers
(Extrinsic to the job)
I. Company policy and
administration
II. Supervision
III. Salary
V. Working conditions
•Unsatisfactory hygiene
factors lead to
dissatisfaction which lead to
increased absences,
grievances or increased
employee turnover.
 4. McGregor –theory X and theory Y

•McGregor –theory X and theory Y are

essentially sets of assumptions about behavior.
•He saw two different sets of assumptions made
by managers about their employees, one which
is negative ,theory X and the other positive,
theory Y.
Theory X assumptions
I. Human beings are lazy, dislike work and avoid it as
far as possible.
II. Since human beings dislike work they must be
coerced, controlled or threatened with punishment
to achieve goals.
III. Human beings will avoid responsibility, and want
to be directed whenever possible.
IV. Human beings will display little to no ambition.
 Theory y assumptions
I. Employees like work which is as natural.
II. People will exercise self-control and self-
direction if they are committed to objectives.
III. An average person can learn to accept
responsibility and want to be directed whenever
possible .
IV. The ability to make innovative decisions is
widely spread throughout the population.
LEADERSHIP
Definition of Leadership
• Leadership is the art of motivating a group of
people to act towards achieving a common
goal.

• A leader is anyone who uses interpersonal skills

to influence others to accomplish a specific goal
(good or bad)
There are two types of leadership
1. Formal leadership – Is practiced by a person with
legitimate authority conferred by the organization
and described in a job description who is a manager.

2. Informal leadership – Is exercised by a staff member

who does not have a specified management role.
Informal leadership depends on one’s knowledge, status
and personal skills in persuading and guiding others.
 Characteristics of a leader
Characteristics of a leader
I. Leaders often do not have delegated
authority but obtain their power through other
means, such as influence.

II. Leaders focus on group process,

information gathering, feedback, and
empowering others.
III. Leaders emphasize interpersonal
relationships.

IV. Leaders direct willing followers.

V. Leaders have goals that may or may

not reflect those of the organization.
PRACTICE QUESTIONS
• State the 3 differences between theory X and theory Y.
(3 marks)
• State 4 main principles of scientific theory of
management. (4 Marks)
• Define the following terms;
Unity of command
Unity of direction
Subordination of individual interests to general
interests
Evolution of leadership theories

Leadership has evolved over period of

time as you are going to learn in the
following discussion;
The great man theory
• a. The Great man Theory (Trait Theories):
• These were basis of leadership research until
1940’s.
• The great man theory asserts that some people are
born to lead whereas others are born to be led.
• Trait theory assumes that some people have
certain characteristics or personality traits that
make them better leaders than others.
B) Behavioral Theories:
• During human relations era, many behavioral and
social scientists studying management also
studied leadership.
• Emphasis was on what the leader did or the
behaviors of leaders.
• The behavioral view of leadership, personal traits
only provide a foundation for leadership; effective
leaders acquire a pattern of learned behaviors.
The behavioral theories
•The behavioral theories includes;
1.The leadership styles
2.System 4 management
3.The managerial grid
4.The continuum of leadership
behavior.
1. Leadership styles:
•Lewin, Lippitt and White studied leadership
styles.
•They identified three leadership styles
which are
1. Authoritarian
2. Democratic
3. Leissez-faire
1.Authoritarian leader
•Authoritarian leader exhibits the
following behaviors
•i) Strong control is maintained over the
employees.
•ii) Others are motivated by coercion.
•iii) Others are directed with commands
Iv)Communication flows downwards.
v) Decision making does not involve
others.
vi) Emphasis is on difference in
status (“I” and “you”).
vii) Criticism is punitive (should be
constructive)
2. Democratic leader exhibits
the following behaviors
•I. Less control is maintained.
•II. Economic and ego awards
are used to motivate.
III. Othersare directed through
suggestions and guidance.
IV. Communication flows up and
down.
V. Decision making involves others.
VI. Emphasis is on “we” rather than “I”
and “you”.
VII. Criticism is constructive.
3. Leissez-faire leader is characterized by the
following behaviors
I. Is permissive with little or no control.
II. Motivate by support when requested by the group or
individual
III. Provides little or no direction.
IV. Uses upward and downward communication
V. Places emphasis on the group and does not criticize.
VI. Laissez-faire leadership is appropriate when problems are
poorly defined and brainstorming is needed to generate
alternative solutions.
2. System 4 management:
This theory was developed by Likert.
It is based on the premise that involving
employees in decisions about work is
central to effective leadership.
It has four dimensions based on
increasing levels of employee’s
involvement in decision making.
Systems 4 management
•I. Autocratic/ exploitative
authoritative leaders – have little trust in
employees and exclude them in decision
making.
•II. Benevolent authoritative leaders – Are
kind to employees but still do not involve
them in decision making.
III. Consultative
leaders – Seek employee’s
advice about some decisions but most
subordinates do not feel responsible for
organizational goals.

IV. Participative or democratic leaders –

they value employees involvement, team
work and team building. They also have high
levels of confidence and trust in employees
3. The managerial grid:
•Leadership model developed
by robert R. Blake and jane mouton.
• Five leadership styles are plotted in four quadrants
of a two dimensional grid.

• The grid depicts various degrees of leader concern

for production (structure) and concern for people.
1.Impoverished – Low concern for
both production and people.

2.Authority compliance – high

concern for production and low
concern for people.
3. Middle of the road – moderate concern for
production and people.

4. Country club management – High concern for

people and low concern for production.

5. Team management – High concern for both

production and people.
4. The leadership continuum theory
•Tannenbaum and Schmidt initially
proposed it in 1958 and updated it in
the year 1973.
• The leadership continuum theory places all leadership
styles along a continuum based on the balance of
authority and freedom that exists between the
leader and subordinates.

• Successful leaders will match their leadership style with

the needs of their team.
•This theory says there are
variations of leadership
practices along a continuum
that moves from an
autocratic leadership style
towards democratic..
C. SITUATIONAL AND CONTINGENCY THEORY:

This combines traits and situation.

 The contingency theories suggest that the most

effective leadership style is the one that best
compliments;
1. The organizational environment
2. The task to be accomplished
3. The personal characteristic of the people involved
in each situation.
Contemporary Theories of Leadership

Leadership theory has continued to evolve.

Contemporary approaches to leadership are

underpinned by the belief that information
that was previously restricted to the
professionals or managers is now available to
all.
•The contemporary leadership theories
includes
I. The quantum leadership:
•Burns (1978) suggested that both
leaders and followers have the ability
to raise each other to higher levels of
motivation and morality.
•He maintained that there are two types
of leaders in management.
I. The traditional manager, concerned with
the day to day operations was termed
as Transactional Leader.
II. The manager who is committed, has a
vision and is able to empower others with this
vision was termed as Transformational
leader.
1. Transactional leader
Transactional leaders are
often:
•direct
•less open to change
Transactional leadership
implementations generally:
•aim to follow rules precisely;
•encourage efficiency;
•favor structure over flexibility;
•focus on short-term goals;
•involve less personal connection; and
•use rewards and punishments.
2. Transformational leader
•Elements of a transformational leader
include;
1.Idealized influence
2.Intellectual stimulation
3.Inspirational motivation
4.Individualized consideration
1. Idealized influence
•Idealized influence involves
the transformational leader
serving as a role model to
followers by living by the
same principles that he or she
expects of their followers.
2. Intellectual stimulation
• Transformational leaders regularly challenge
assumptions, take risks and solicit team members’
input and ideas.
• They don’t fear failure, and instead foster an
environment where it’s safe to have conversations, be
creative and voice diverse perspectives.
• This empowers employees to ask questions, practice
a greater level of autonomy and ultimately determine
more effective ways to execute their tasks.
3. Inspirational motivation
• Transformational leaders are able to articulate
a unified vision that encourages team
members to exceed expectations.
• They understand that the most motivated
employees are the ones who have a strong
sense of purpose.
• These leaders are not afraid to challenge
employees.
4. Individualized consideration
• Transformational leaders listen to employees’
concerns and needs so they can provide
adequate support.
• They operate from the understanding that
what motivates one person may not motivate
someone else.
• As a result, they’re able to adapt their
management styles to accommodate various
individuals on their team.
1. Listening
• Although these are also important skills for the
servant leader, they need to be reinforced by a
deep commitment to listening intently to
others.
• He or she listens receptively to what is being
said and unsaid.
• Listening also encompasses hearing one’s
own inner voice. Listening, coupled with
periods of reflection, is essential to the growth
and well-being of the servant leader.
2. EMPATHY
•The most successful
servant leaders are
those who have
become skilled
empathetic listeners.
3.
•
HEALING
One of the great strengths of
servant leadership is the potential
for healing one’s self and one’s
relationship to others.
•Servant leaders recognize that they
have an opportunity to help make
whole those with whom they come
in contact.
4. AWARENESS
•General awareness, and
especially self-awareness,
strengthens the servant-
leader.
5. PERSUASION
•The servant leader
seeks to convince
others, rather than
coerce compliance.
6. FORESIGHT
• The ability to foresee the likely outcome
of a situation is hard to define, but easier
to identify.

• Foresight is a characteristic that enables the

servant leader to understand the lessons
from the past, the realities of the present,
and the likely consequence of a decision for
the future.
7. STEWARDSHIP
•Servant leadership, like
stewardship, assumes first
and foremost a
commitment to serving
the needs of others.
8. COMMITMENT TO THE GROWTH
OF PEOPLE
• The servant leader is deeply committed
to the growth of every individual
within his or her organization.
• The servant leader recognizes the
tremendous responsibility to do
everything in his or her power to
nurture the personal and professional
growth of employees and colleagues.
9. BUILDING COMMUNITY

•This awareness causes

the servant leader to
seek to identify some
means for building the
community around him.
10. CONCEPTUALIZATION
•The ability to look at a problem or
an organization from a
conceptualizing perspective
means that one must think
beyond day-to-day realities.
•This can go beyond thinking
“outside the box”.
LEADERSHIP FUNCTIONS
1. Supervision (overseeing)
• Supervision is another leadership behavior.
• It includes inspecting another’s work, evaluating
his/her performance and approving or correcting
performance.
• Good supervision is facilitative because a good
supervisor inspects work in progress and can remedy
inadequate performance before serious
consequences develop.
The following performance elements should be appraised
during supervision;

I. Quantity of work output

II. Quality of output
III. Time use
IV. Conservation of resources
V. Assistance to co-workers
2. Co-ordination
• Co-ordination ensures that everything that needs
to be done is done and that no two people are
doing the same thing (or duplication of activity).
• Coordinating means distributing authority,
providing channels of communication and
arranging work so that the right things are done,
at the right time, in the right place, in the right
way and by the right people.
 3. MOTIVATION

• Motivation describes the factors that initiate and

direct behavior.
• Therefore a manager’s most important leadership
task is to maximize subordinates work motivation
because employees bring to the organization
different needs and goals, the type and intensity of
motivators vary among employees.
 Therefore the manager must know which
needs the employee expects to satisfy
through employment and should be able to
predict, which needs will be satisfied
through the job duties and positions.
•Motivated employees are more likely to be
productive than non-motivated employees
and hence motivation is an important aspect
of enhancing employee performance.
Management
Functions
1. PLANNING
• DEF: Planning is deciding in
advance, What to do, when to
do and how to do.
TERMINOLOGIES USED
IN PLANNING
Mission
Mission - It is a broad general
statement of the organization
reason for existence.
MISSION of KMTC

•“To produce competent

health professionals through
training and research, and
provide consultancy
services”.
Mission of Kenyatta National
hospital
•The management and staff of Kenyatta
National Hospital are committed to optimize
patient experience through innovative
evidence-based specialized healthcare; facilitate
training and research, and participate in
national health policy formulation.
Vision
•Vision - A vision statement describes the goal
to which the organization aspires.

•Vision statements are future oriented

purposeful statements designed to identify the
desired future of an organization.
 Vision of KNH
•The Vision of Kenyatta National Hospital is;
'to be a world class referral hospital in the
provision of innovative specialized health
care'.
 VISION OF KMTC

To be a model institution
in the training and
development of competent
health professionals
•The goal: May be defined as the desired result
towards which effort are directed. This is a
specific aim or target that the unit wishes to
attain within a time span e.g. of 1 year.

•Objectives : An objective is the desired end

results of any activity. They specify what an
organization is meant to accomplish. AN
OBJECTIVE SHOULD BE SMART.
•Policy : Statements of conduct, principles
designed to influence decisions and actions.
They make managers take action in a certain
way.
•Procedure: A procedure is a series of steps for
the accomplishment of some specific project or
endeavor.
•Rules and Regulations : Rules describe
situations that allow only one choice of action.
Core values
•Core values are principles or
standards of behavior that
represent an organization’s
highest priorities, deeply held
beliefs, and fundamental
driving forces.
CORE VALUES OF KMTC
• Accountability.
• Integrity.
• Responsiveness.
• Equity.
• Teamwork.
• Professionalism.
• Creativity and innovation.
• Organizational structure in management
refers to the framework that defines the
hierarchy, roles, responsibilities, and
relationships within an organization.
• It outlines how tasks and activities are
organized, coordinated, and controlled to
achieve the organization's goals.
• The structure typically includes elements
such as reporting lines, communication
channels, and the distribution of authority
and decision-making.
TYPES OF PLANNING
1. Long period planning
• This normally covers a period of more than five
years though it can extend up to 20years or so.
• They are developed to guide the future efforts of an
organization.
• Long term planning is mainly the responsibility of
the top management.
2. Short period planning
•This refers to determination of courses of
action for the time period extending up
to one to three years.
•In short term planning the structure is fixed
and specific activities required to achieve
goals are developed.
•Its formulated by lower level
management.
3. Strategic planning
• Strategic planning is a process that is designed to
achieve goals in dynamic competitive
environment through the allocation of
resources.
• Drucker (1973) defines strategic planning as a
continuous systematic process of making risk-
taking decisions today with the greatest possible
knowledge of their effects on the future.
Steps in strategic planning process/planning cycle
1: Environmental scanning
• This involves assessment of the External an Internal-
environment .
• Carry out a SWOT analysis.
• The economic, demographic, technological, social, educational and
political factors are assessed in terms of their impact on
opportunities and threats within the environment.
• Internal environment assessment(Strengths and weaknesses)
includes review of the effectiveness of the structure size,
programmes, financial resources, human resources, information
system, research and development capabilities of the organization
2: Strategy formulation
• This includes the development of the mission,
specifying objectives, developing strategies and
setting policy guidelines.
• Mission: The development of the mission statement
provides a sense of direction and focus and draws the
organization together. The purpose of the mission
statement is to communicate what the organization
stands for and where it is heading.
• Mission statement answers the question, why do we
exist. Everyone should participate in deciding of the
mission statement.
•Goal Setting: Goals assist the managers to
focus attention on what is relevant and to
develop strategies and actions to achieve the
goal.
•Objectives: Objectives should be challenging,
measurable, consistent, achievable, reasonable
and clear. SMART – outcome oriented
•vision
3: Identification of strategies: Strategy determines HOW the
organization will go about attaining their vision i.e. how it
will exploit the external opportunities and internal strengths
and counter external threats and internal weaknesses.
This involves preparing a detailed plan of action, either
short-term and long-term objectives.
Formulation of annual departmental objectives, resource
allocation and preparation of budgets is also done at this
stage.
Strategies may include; retrenchment, expansion, recruitment
etc
4: Strategy Implementation
• This is the action stage.
• The specific plans for action are implemented in
order of priority.
• It entails open communication with staff in regard
to priorities and formulation of area and individual
objectives related to the plan.
• Resource allocation (human/non human allows for
strategy execution. Resources are allocated in order
of priority i.e. established by annual objectives.
5:Strategy Evaluation
•At set periods, the strategic plan is reviewed
at all levels to determine if the goals,
objectives and activities are on target.
• Monitors the results of formulation and
implementation of activities and includes
measuring individual and organizational
performance and taking corrective actions
when necessary.
PRACTICE QUESTIONS
1. Burns suggested that both leaders and followers have the
ability to raise each other to higher levels of motivation. He
stated that there are two types of leaders, Transformational
and transactional leader. Discuss the differences between
the two leaders.(6 marks)
2. For successful strategic planning, SWOT analysis must be
conducted. Discuss SWOT analysis. (8 marks)
3. Lewin, Lippitt and White studied leadership styles. Discuss
the leadership styles. (6 marks)
 TEAM LEADERSHIP
•A group is an aggregate of individual
who interact and mutually influence
each other.

•Both formal and informal groups

exist in an organization.
Types of groups
• Formal Groups: These are clusters of individuals
designated by an organization to perform specified
organizational tasks. These may include task forces
and committees.

• Informal Groups: These evolve naturally from social

interactions that are not defined by an organizational
structure e.g. People who take lunch together who
convene spontaneously to discuss a clinical dilemma.
Group and team processes
Groups whether formal or informal typically
occur through the following phases
1.Forming: This is the initial stage of group
development in which individual members
assemble into a well-defined cluster
( members get to know each other, and are
very cautious).
 Stage 2 : STORMING
• The second stage of group development where
members wrestle with roles and relationships.
• Conflict dissatisfaction and competition arise on
important issues related to procedures
and behavior.
• Members often compete for power and status
and informal leadership emerges.
STAGE 3: NORMING
• This is the third phase of Group development.
• The Group defines its goals and rules
of behavior.
• They also define acceptable and unacceptable
behaviors and attitudes.
• The group structures, roles and relationships
become clearer.
• Cohesiveness also developes.
 STAGE 4: PERFORMING
• This is the fourth stage.
• The group members agree on basic purposes and
activities.
• The group members perform the task at this phase.
• Cooperation improves and emotional issues subside.
• Members communicate effectively and interact in a
relaxed atmosphere of sharing.
 STAGE 5: ADJOURNING
•This is the final stage of
group development.
•The group dissolves after
achieving its objectives.
 c. Team building/team development
• This is a group development technique that focuses on task and
relationship aspects of group functioning in order to build team
cohesiveness.
Team building involves
a) Gathering data through individual interviews, questionnaires and or
group meetings about the team and its functioning.
b) Diagnosing the team strengths and assess need of development.
c) Holding semi- structured retreat sessions usually directed by an
experienced facilitator aimed at addressing priority team problem
 d. Characteristics of effective
teams
I. Clear objectives and agreed goals
II. Openness and confrontation
III. Support and trust
IV. Co-operation and conflict
V. Sound procedures
VI. Appropriate leadership
VII. Regular review
VIII. Individual development
IX. Sound intergroup relations
 Problem-solving
Problem solving is a systematic process that
focuses on analyzing a difficult situation.
Problem solving is also an active process that
starts with a problem and ends with a solution.
Problem solving always includes a decision-
making step.
Managers are constantly faced with problems to
solve in an organization.
b. Scientific Problem Solving
•Most problems are solved using step by
step problem solving process.
• Problem solving uses critical thinking to
gather and analyze data/information,
creative thinking to come up with
solutions and decision making at key
steps on the process.
 STEPS INVOLVED IN PROBLEM
SOLVING
Problem solving process has the following seven steps ;
1. DEFINE THE PROBLEM
2. GATHER INFORMATION
3. ANALYZE INFORMATION
4. DEVELOP SOLUTIONS
5. MAKE A DECISION
6. IMPLEMENT THE DECISION
7. EVALUATE THE SOLUTION
1. DEFINE THE PROBLEM, ISSUE OR
SITUATION
•The most common cause of failure
in problem solving is improper
identification of the problem.
• In work settings problems fall under
certain categories e.g. Manpower,
methods, machines and material.
 2. GATHER INFORMATION/DATA
•Collect the facts that can provide
the clues to the scope and solution of
the problem.
•Obtain relevant, valid, accurate and
detailed descriptions from appropriate
people or sources and put the
information in writing.
 3. ANALYZE THE INFORMATION
Categorize information in order
of reliability.
List information from most
important to least important and
set information into a time
sequence.
4. DEVELOP SOLUTIONS
•As the information is being analyzed
numerous solutions will come up and
should be written down and plans
made to immediately start developing
the best of them.
• Develop alternative solutions, in case the
first order solution proves impossible.
5. Make a Decision: Select one
solution that is most feasible and
satisfactory and has the fewest
consequences.
6. Implement the decision: The
manager implements the decision
after selecting the best cause of
action.
7. Evaluate the solution: Review the plan
instituted and compare the actual results
and benefits to those of the idealized
solutions.
The Manager should ask herself or himself:
Is the solution being implemented?, are the
results better or worse than expected and
how can he/she ensure that the solution
continues to be used and to work?
Problem Solving Principles
To be able to solve problems effectively it is important to
apply the following principles
I. Separate large problems from small ones, and rely on policy
for small problems while conserving managerial time for
solving major problems.
II. Delegate smaller problems to subordinates trained to
handle them.
III. Seek information for problem solving from internal and
external experts so that the solution will be based on current
knowledge.
IV. Approach problems in relaxed fashion
and avoid solving problems under stress.
V. After appropriate consideration, select
and implement the best solutions without
rumination. (do not agonize over selecting
a solution) it is impossible to expect 100%
accuracy in diagnosing and resolving
problems.
Decision making
Definition:
•Decision making is a complex, cognitive
process often defined as choosing a particular
course of action.
• “the process of making choices or reaching
conclusions
•Choice made from at least two alternatives
 Rational decision making
process
The primary steps of decision making process are similar to
those of problem solving.
I. Define the problem/issue and diagnose the problem.
II. Collect relevant data
III. Develop alternative solutions
IV. Assess consequences
V. Select optimum solution
VI. Implement solution
VII. Measure and monitor
CENTRALIZATION AND
DECENTRALIZATION
IN DECISION MAKING
INTRODUCTION

• Henri Fayol wrote, "A place for

everyone and everyone in his
place.“
•According to Henri Fayol,” Everything which
goes to increase the importance of a
subordinate’s role is decentralization,
everything that goes to reduce it is
centralization”.
CENTRALIZATION
• Centralization refers to the concentration of authority at the top
level of the organization.

• It is the systematic and consistent reservation of authority at the

central points within an organization.

• In a centralized organization, managers at the lower level have a

limited role in decision-making.

• They just have to execute the orders and decisions of the top level.
DECENTRALIZATION
• It is the distribution of authority
throughout the organization.
•In a decentralized organization, the
authority of major decisions is vested
with the top management and balance
authority is delegated to the middle and
lower levels.
Factors determining the degree of
decentralization
1.Significance of the decision
Decisions which are costly either in terms of
money, goodwill of the company and other such
decisions which are significant to the organization
are centralized at the top-levels of the organization.
Therefore, even in a decentralized organization,
these decisions are made in a centralized manner.
2. Size of the organization
• The size of the organization is an important factor
which determines the degree of decentralization. A
larger firm needs more decisions. Also, a large-sized
company has numerous departments and levels.

• Coordinating all of them and consulting several

specialists and executives can take a lot of time,
delaying the decision.
3. The attitude of the management

•The attitude of senior management plays

an important role in the extent and mode
of authority dispersal.
•Usually, senior executives with a
traditional mindset are a little skeptical
about decentralizing authority.
CENTRALIZATION DECENTRALIZATION

The concentration of The evenly and

authority at the top level systematic
is known as distribution of
Centralization.
authority at all levels
is known as
Decentralization.
There is no delegation of There is a systematic
authority as all the authority
for making decisions is
delegation of
vested in the hands of top- authority at all levels.
level management.
There is no freedom of There is freedom of
decision-making at decision-making at all
 HUMAN RESOURCE FOR HEALTH
MANAGEMENT

Introduction
• The greatest asset of health care organizations is the collective
and individual knowledge and intelligence of their employees.
• Nurses are among the health care providers called “
Knowledge workers” because the services they provide is
based on specialized expertise and complex decision making
hence the importance of investing in human resource.
 HUMAN RESOURCE MANAGEMENT CONCEPTS

Human Resource Management

• Human resource management (HRM) is the strategic and
coherent approach to the management of an organization's
most valued assets - the people working there who
individually and collectively contribute to the achievement of
the objectives
Human Resource: This is any individual employed by the
organization
• performance management: is the continuous
process of improving performance
by setting individual and team goals
which are aligned to the strategic
goals of the organization.
• Staff development It’s the process of orientation, in-
service education, and continuing education to promote
the development of personnel within any employment
setting consistent with the goals and responsibility of the
employer ( Refers to both professional and non-
professional staff
• Orientation: Introducing new staff members to the
philosophy goals, policies, procedures role expectations,
physical facilities, and special services in a work setting
• In-service education: Learning of experiences provided in
the work setting to assist staff in performing their assigned
functions
• Continuing education: Educational programmes that
consists the concepts, principles, research or theories related
to profession that build on previously acquired knowledge,
skills and attitudes.
•Strategic Human Resource Management:
This is the linking of HRM and strategic goals
and objectives in order to improve business
strategy.
•That strategy then provides the framework that
guides the design of specific HR activities such
as recruiting and training
 • HUMAN RESOURCE MANAGEMENT PROCESS

• The following are the techniques required for Human

Resource Management
• 1. Conducting a Job analysis determining the nature of
each employees Job
• 2. Planning labor needs (HR Planning) and recruiting Job
candidates
• 3. Selecting Job candidates
4. Orienting and training new employees
5. Managing wages and salaries ( compensating
employees)
6. Providing incentives and benefits
7. Appraising performance
8. Communicating ( interviewing, counseling,
disciplining)
9. Training and development
HUMAN RESOURCE PLANNING; In the
organization, the objective of human resource planning
is to ensure that the organization will always have the
right people in the right places to do the work required
by the organization.
It consists of forecasting human resource needs,
forecasting the availability of human resources and
matching supply and demand for personnel
 In planning, consideration must be given to:
I. The type of patient care management used
II. The education and knowledge level of staff to be
recruited
III. Budget constraints
IV. The diversity of the client population to be served
 Principles of effective human resource plan
I. The plan should be as detailed as possible
II. Plans should not extend too far into the future,
as accurate prediction of the distant future is not
always possible
III. All alternative courses of action should be
considered
V. Instructions to individuals and departments
must be incorporated into the plans
VI. Plans should be concise and easy to understand
 Recruitment process
1:Defining requirements:
Categories and number of people required should be specified in
the recruitment programme derived from human resource plan.
The department in which the recruit will work must draft or revise
a comprehensive job specification and job description (from job
analysis) for the vacant position, outlining its major and minor
responsibilities; the skills, experience and qualifications needed;
grade and level of pay and particulars of any special conditions
attached to the job (temporary, permanent, contract, shift duty).
2. Attracting candidates: After defining
requirements then the job is advertised. This
involves reviewing and evaluating alternative
sources of applicants inside and outside the
company. First consideration should be given to
internal candidates, then advertising and
outsourcing.
•3. Selection of candidates: This is the
assessment of candidates and choice of the one
who best meets the criteria for the available
position. It involves matching job requirements
with the attributes of the candidates. Normally
involves the following steps;
a) Short listing: List applications on a control sheet and
comparing the applications with the key criterion in the
job specification and sort them into three categories.
i) Possible
ii) Marginal
iii) Unsuitable
Scrutinize the possible again to draw up a short –list for
interview. Ideally should be 4-8 candidates per position
b) Interviewing; An interview may be defined as a verbal
interaction between individuals for a particular purpose. The
goals of the selection interview are;
 The interviewer seeks to obtain enough information to
determine the applicant’s suitability for the available position
The applicant obtains adequate information to make an
intelligent decision about accepting the job should it be
offered
The interviewer seeks to conduct the interview in such a
manner that, regardless of the interview’s results, the applicant
will continue to have respect for and good will towards the
organization.
Types of interviews
• There are many types of interviews and formats for
conducting them.
The unstructured interview
• The interviewer asks whatever seems appropriate
and adapts the discussion to the response. This
requires little planning because the goals for hiring
may be unclear, questions are not prepared in
advance, and often the interviewer does more
talking than the applicant.
Semi structured interview
• Only the major questions to be asked are prepared in
advance and the interviewer may ask other questions
that open up areas of discussion during the interview
session.
• They require some planning since the flow is focused
and directed at major topic areas although there is
flexibility in the approach.
structured interview
• The interviewer uses a prepared list of questions and does
not deviate from them.
• This type of interview requires greater planning time
because questions must be developed in advance that
address the specific job requirements.
• Information must be offered about the skills and qualities
being sought, examples of the applicant’s experience must
be received, and the willingness or motivation of the
applicant to do the job must be determined. The
interviewer who uses a structured format would ask the
same essential questions of all applicants
• Other formats of conducting interviews
Individual interviews
Interviewing panels
Selection boards
4. References: This is to obtain in confidence factual
information about a prospective employee and opinions
about his or her character and suitability for a job
5. Physical examination: The examination determines if
the applicant can meet the requirements for a specific job
and provides a record of the physical condition of the
applicants at the time of hire. Also helps to identify
applicants who will potentially have unfavorable
attendance records or may file excessive future claims
against the organization’s health insurance
6. Confirming the offer
• Confirm offer of appointment after satisfactory references have
been made and applicants have passed medical exam. Contracts
of employment should be written. Applicants offered a position
should confirm their acceptance in writing
• After the employee has been given the appointment and have
reported to work they have to understand the work environment
and adjust effectively to the job. This is done through the
indoctrination process
 PRACTICE QUESTIONS
1. For recruitment process to be successful a series of
steps should be incorporated. Discuss the
recruitment process. (10 marks)
2. Discuss job analysis (6 marks)
3. Discuss centralization and decentralization in
decision making (6 marks)
Indoctrination Process
•As a management function, this refers to the
planned, guided adjustment of an employee
to the organization and the work
environment.
•The process includes;
1. Induction
2. orientation
3. socialization.
1. Induction:
• This includes all activities that educate the new
employee about the organization and employment
and personnel policies and procedures.
• This takes place before the employee starts
performing the job.
• A handbook can be given and a form signed to
verify that it was given.
• The form should be placed in the employee’s
personal file.
2. Orientation:
• Induction provides the employee with general
information about the organization whereas
orientation activities are more specific to the
position.
• Orientation is the process of assisting new
employees to adjust to new roles and responsibilities
within the organization.
• It is the process of introducing new employees to the
organization and to their superior, their juniors,
3. Socialization:
• Socialization involves introducing new employees to
the expectations and behaviors of the organization.
• This is sharing of the values and attitudes of the
organization by the use of role models, myths and
legends.
• The leader introduces the employees to unit values and
culture and molds them to fit in the unit by introducing
them to norms of the group.
• Role models, preceptors and mentors can be used to
clarify role expectations.
1. Role models are examples of experienced, competent
employees. The employee sees the role models are skilled
and tries to emulate them.
2. A preceptor is an experienced nurse who provides
emotional support and is a strong clinical role model to the
new nurse. (Preceptors are usually assigned and have a
short relationship with the person assigned while a
mentor has a long term relationship with the mentee)
3. Mentoring is a supportive and nurturing relationship
between an expert and a novice. The mentor makes a
conscious decision to assist the mentee in his or her career
development
 PERFORMANCE APPRAISAL

• Managing the performance of people is a fundamental

organizational strategy to gain competitive advantage
through mobilization of human resources.

• An important part of a manager’s job is to define

performance in advance and to state desired
results.
Definition of performance appraisal

• Performance appraisal means evaluating an employee’s

current performance relative to the performance
standards.
• Also known as employee appraisal, it is a method by which
the job performance of an employee is evaluated (generally
in terms of quality, quantity, cost and time).
• Performance appraisal is a part of career development.
• They begin when an employee is hired and stops when he/she
leaves
 Purpose of performance appraisal are;

I. To identify an individual’s current job performance

and give feedback on performance to employees.
II. Identify the strength and weaknesses of the
employees
III. Identify employee training and development needs
IV. To motivate the employee.
V. Document criteria used to allocate organizational
rewards.
vI. Form a basis for personnel decisions:
salary increases, promotions, transfers,
disciplinary actions, etc.
VII. Provide the opportunity for
organizational diagnosis and development.
VIII. Facilitate communication between
employee and administration
X. Provide information for succession
planning
The appraisal process
I. The management needs define the appraisal: This involves
establishing the performance
standards/objectives/expectations and Communicating the
expectations to the employee
II. Allow the employees some period to work
III. Appraisal: Assess and measure the actual performance of the
work
IV. Compare actual with the expected performance
V. Complete the appraisal
Appraisal problems

1. Unclear standards:
This is where the
performance standards have
not been clearly defined
2: Halo and horns effect:
• The halo effect occurs when the appraiser lets one or
two positive aspects of the assessment or behavior of
the employee unduly influence all other aspects of the
employee’s performance.

• The horns effect occurs when the appraiser allows

some negative aspects of the employee’s performance
to influence the assessment to such an extent that other
levels of job performance are not accurately recorded.
3. Central tendency: This is where the
appraisers stick to the middle when filling
rating scales by avoiding high or very low
marks and hence cannot be used for
promotions or salary increase since everybody
is average.
4.Leniency or strictness: This is where rating
an appraiser rates employees consistently high
(leniency) or low (strictness)
5.Personal bias: The tendency to allow
individual differences such as age, race,
culture and sex affect performance appraisal
ratings employees receive.

6.Recency and primacy effects: This occurs

when a superior (appraiser) places to much
weight on factors that occurred recently
(recency) or in the beginning (primacy).
• 7.Matthew effect:
• The Matthew Effect is said to occur
when employees receive the same appraisal
results, year after year.
• Those who performed well early in their
employment are likely to do well. Those who
struggled will continue to struggle.
• The Matthew Effect suggests that no matter how
hard an employee strives, their past appraisal records
will prejudice their future attempts to improve.
 Matthew effect
• The term was coined by sociologist
Robert Merton in 1968. The name
Matthew Effect comes from the Gospel
book of Matthew in the Bible, verse
25:29, "For whosoever hath, to him
shall be given, and he shall have more
abundance: but whosoever hath not,
from him shall be taken away even
what he hath."
2. STAFF COACHING
 This is the day today process of helping
employees improve performance.
 Coaching also should be used when performance
meets the standards but improvement can still be
obtained.
 The goal of the meeting is to eliminate or
improve performance problems.
Performance Deficiency Coaching
•Performance deficiency coaching is another
strategy that the manager can use to create a
disciplined work environment.
• This type of coaching may be ongoing or
problem-centered.
•Problem-centered coaching is less
spontaneous and requires more managerial
planning than ongoing coaching
•In performance deficiency coaching, the
manager actively brings areas of
unacceptable behavior or performance to the
attention of the employee and works with him
or her to establish a plan to correct
deficiencies.
•Because the role of a coach is less threatening
than that of an enforcer, the manager becomes
a supporter and helper.
 3. STAFF MOTIVATION
• Motivation describes the factors that initiate and direct
behavior.
• HRM most important leadership task is to maximize
subordinates work motivation because employees bring to the
organization different needs and goals, the type and intensity of
motivators vary among employees.
• Therefore the HRM must know which needs the employee
expects to satisfy through employment and should be able to
predict, which needs will be satisfied through the job duties of
each employee position.
4. SUPPORTIVE SUPERVISION

• Supportive Supervision refers to an activity of

more experienced or higher positioned personnel
whereby they support the work of their juniors
so that it meets set standards.

• It means assisting health workers in achieving

work outcomes, finding out work problems and
challenges and together finding solutions to the
problems.
Human resource management functions
1. STAFF DISCIPLINE
• Discipline is the action taken when a regulation has
been violated.
• Discipline can be defined as the process by which an
employee brings her or his behavior into
disagreement with the agency’s official behavior
codes.
• It can also be a managerial action to enforce employee
compliance with agency rules and regulations.
•Purpose of discipline
•The purpose of discipline is to encourage
employees to behave sensibly at work or
adhere to rules and regulations.
•Discipline is called for when rules and
regulations are violated.
•The purpose of rules is to inform employees
ahead of time what is and is not acceptable
behavior
The disciplinary process
•The purpose of a disciplinary action should be
to correct rather than to punish a wayward
employee.
•Discipline should be administered promptly,
privately, thoughtfully and consistently.
•Discipline should also be progressive and
preceded by counseling.
THE DISCIPLINARY PROCESS

1.Identification of Misconduct:
The first step involves identifying and
documenting the employee's misconduct
or violation.
This may be discovered through
performance reviews, reports from
colleagues or supervisors, or direct
observation.
2. Investigation:
Once misconduct is identified, an investigation may
be conducted to gather all relevant information.
This may involve interviews with the employee,
witnesses, and a review of any relevant
documentation.
3. Informal Counseling:
In some cases, a manager may choose to address
minor infractions through informal counseling.
This involves a one-on-one discussion with the
employee to communicate expectations, provide
feedback, and encourage corrective action.
4. Verbal Warning:
If the misconduct persists or is more serious, the next
step may involve issuing a verbal warning.
This is a formal communication outlining the specific
issue, the expected behavior, and the consequences if
the behavior continues.
5. Written Warning:
If the employee does not correct their behavior
following a verbal warning, a written warning may be
issued.
This is a more formal document outlining the details
of the misconduct, the corrective action required,
and the consequences of further violations.
6. Suspension:
In cases of severe or repeated misconduct, a suspension may
be imposed.
This involves a temporary removal from work with or without
pay, depending on the severity of the situation.
Allow the employee to return to work with written stipulation regarding
problem behavior

7. Termination:
If the employee fails to rectify their behavior despite previous
warnings or if the misconduct is severe, termination may be
the final step in the disciplinary process.
This involves ending the employment relationship due to the
employee's failure to comply with company policies.
CONFLICTS(23-sept 12-
march)
Introduction
• Conflicts are generally defined as the internal or external disorder
that results from differences in ideas, values, or feelings between
two or more people.
• Because managers have interpersonal relationships with people
having a variety of different values beliefs and backgrounds and
goals conflict is an expected outcome.
• The Managers role is to create a work environment where conflict
may be used as a consult for growth, innovation and productivity
Types of conflict
1. Individual conflict
 common type is role conflict occurs due to
incompatibility between one or more role expectations
When you are uncertain about what is expected or
wanted or have a sense of being inadequate to perform a
task.
2. Interpersonal conflict
Occurs between two people due to differences in
personalities or competition.
3. Intergroup conflicts –
conflict occurs between
groups e.g. different wards,
unit service team ,health care
professional
groups ,agencies.
THOMAS KILLMAN CONFLICT
MANAGEMENT MODEL
• In 1974, a pair of researchers – the
Kenneth W. Thomas and Ralph H. Kilmann –
studied workers and their routine conflicts in
the workplace.
• Over time, they were able to observe a pattern
of ways in which people resolved conflict; most
methods could be distilled down to five core
methods.
• These five options formed the basis of the
Thomas Kilmann Conflict Resolution Model.
•The model has two
approaches, also
known as
“dimensions”:
assertiveness and
cooperation.
1. Assertiveness
• Assertiveness is the extent to which an
individual attempts to satisfy THEIR concerns.
• This strategy is useful in the following situations:
Results are needed fast
Ethics or morality is in question
You know you are correct and need to push
forward
Other attempts to resolve conflict are fruitless
Your power and influence are significant.
2. Co-operation
• Cooperation is the degree to which people are
willing to work together to accomplish a goal.
• It’s all about teamwork and weighing different
points of view, much like a democracy.
• Here are situations where cooperation may be
superior to assertiveness:
There is no clear-cut best way to handle the situation
Your way may not be the right way.
Your opponent/rival is cooperative.
Helps lower threat levels in the workplace and
minimize your number of enemies.
THE FIVE MODES OF THOMAS
KILLMANN
• The Thomas Kilmann Conflict mode
instrument has 5 modes:
1. Competing
2. Avoiding
3. Accommodating
4. Collaborating
5. compromising.
I. AVOIDING
• At the low assertiveness and low
cooperative corner is the “avoiding” mode.
• As it sounds like, this involves avoiding
conflict entirely.
• The person will watch the situation play
itself out organically and try to avoid getting
directly involved.
• A business would fail if everyone avoided
conflict – that’s just common sense!
2. ACCOMMODATING
• Also at the low assertiveness end, but with a
higher degree of co-operation baked within,
is the accommodating option.
• This, as it sounds, involves giving in to the
rival/other individual.
• Sometimes we must “take the loss” and accept
that we should change our ways or yield to the
other parties.
• Unlike avoiding, this mode acknowledges
the conflict and puts an end to any tension.
•NB: Parties that
consistently ignore feelings
and give in can end up
feeling frustrated or used
and may be less willing to
co-operate in future.
3. COMPETING
• High assertiveness and low co-operation is
the classic mode of competition.
• The workplace is full of competitive people,
sure, but in the context of conflict resolution,
competing means people openly dissent
against the other party and directly try to
prove that YOUR way is right.
• This is the classic debate or argumentative
stance: “my way or the highway,” so to
speak.
4. COLLABORATING
• The collaborating mode allows one to acknowledge
the rival’s points and take the time to agree.
• High level of assertiveness, High level of co-
operation
• This is indeed very time-consuming and resource-
intensive, but it can be a great way to handle an
issue if both sides have good points and there’s no
clear-cut winner in the conflict.
• A lot of great things come out of collaborating, but it
can be a strain on resources and slow everything down.
5. COMPROMISING
• Here’s the center of everything on the
Thomas Kilmann Conflict Model.
• Compromising is all about being
somewhat assertive and cooperative –
giving up a lot of ground and gaining a
little bit.
• The saying “A Good Compromise Leaves
Nobody Fully Satisfied” is true, but it’s
often better than the alternative.
 Grievances
• Grievance Process = When a union member (employee) believes that
management has failed to meet the terms of the contract or labor
agreement and communicates this to management. This process is
called grievance!
The grievance process steps
1. The employee informs the employer about the nature of the
grievance
2. The employer arranges for a formal meeting to be held without
unreasonable delay after a grievance is received
3. The meeting is held and the employee should be accompanied
at the meeting by a union rep. Following the meeting a decision
is made on what action if any to take. Decision should be
communicated to the employee in writing without unreasonable
delay.
4. The employee is allowed to take the grievance further (appeal)
if not resolved)
5. The appeal should be dealt with in a just manner
6. The outcome of the appeal should be communicated to the
employee in writing without unreasonable delay
NB: Grievance procedures differ from union to union.
 EMOTIONAL
INTELLIGENCE
IN
MANAGEMENT
 INTRODUCTION
•Emotional intelligence is defined as the
ability to understand and manage your
emotions, as well as recognize and
influence the emotions of those
around you.
COMPONENTS OF EMOTIONAL
INTELLIGENCE
Emotional intelligence is typically broken
down into four core components:
Self-awareness
Self-management
Social awareness
Relationship management
1. SELF AWARENESS
A key part of emotional intelligence is a
level of recognizing and understanding of
a person's own emotions.

An individual with high EI is not only

aware of what emotions they are feeling
but can put words to their feelings.
2. SELF MANAGEMENT
• Self-management refers to the ability to manage
your emotions, particularly in stressful
situations, and maintain a positive outlook
despite setbacks.

• Leaders who lack self-management tend to react

and have a harder time keeping their impulses in
check.
3. SOCIAL AWARENESS
• While it’s important to understand and manage your own
emotions, you also need to know how to read a room.
• Social awareness describes your ability to recognize others’
emotions and the dynamics in play within your organization.
• Leaders who excel in social awareness practice empathy.
• They strive to understand their colleagues’ feelings and
perspectives, which enables them to communicate and
collaborate more effectively with their peers.
4. RELATIONSHIP MANAGEMENT
• Relationship management refers to your ability to
influence, coach, and mentor others, and resolve
conflict effectively.
• Some prefer to avoid conflict, but it’s important to
properly address issues as they arise.
• Research shows that every unaddressed conflict can
waste about eight hours of company time in gossip and
other unproductive activities, putting a drain on
resources and morale.
 DISASTER
MANAGEME
NT
DISASTERS
• 1945
• 1998
• 2001
• 2007/2008
• 2013
• 2015
• 2023
 Course outline.
• Terms and definitions
• Types of disasters
• Manmade disasters
• Natural disasters
• Phases of disasters
• Effects of disasters
• Factors likely to affect disasters.
• Disaster mitigation.
• Disaster preparedness.
Disaster

A disaster is a serious disruption of the normal way of life.

Disaster events are always described by the need for

external assistance

 Thus we can say a disaster is a serious disruption such

that the local people are unable to cope with their
normal way of life and hence they require external
assistance.
.
Disaster management
• Is the discipline of dealing with and avoiding risks.
• It is a discipline that involves preparing for disaster
before it occurs.
• In general, Disaster management can be termed as any
Emergency management which is the continuous
process by which all individuals, groups, and
communities manage hazards in an effort to avoid
impact resulting from the hazards
 Impacts
•The consequences or effects of the
disaster
•Impacts can either be direct or indirect
depending on their effects.
 Types of disasters.
•There are basically two types of disasters
which we normally have.
• Natural Disasters/Calamities
• Man made/caused disasters
Natural Disasters / calamities
•A natural disaster is the consequence of a
natural hazard (e.g. volcanic eruption, earth
quake or tsunami) which affects human
activities.
•Human vulnerability, exacerbated by the lack
of planning leads to financial, environmental
or human losses.
Natural Disasters / calamities

•These types of disasters are usually

caused by the effects of nature and
can be classified in various ways.
1. Meteorological disasters

•These are disasters resulting

from weather / climatic
conditions. They are climate /
weather related.
 Examples of meteorological
disasters

• Floods
• Hurricane
• Cyclones
• Drought
• Heat waves
• Cold spells
• Lighting
• Tornado
• Storms
• Blizzard
• Tidal waves
• Hail storms.
 2. Topological disasters
• These kind of disasters originate from the surface of
the earth and they impact on the earth’s surface.
• They include;
• Landslides
• Avalanches
• Rock falls.
3. Tectonic disasters
• They originate from the earth’s crust or from within
where there is a movement or a shift of tectonic plates.
• They include;
• Earth quakes
An Earthquake is a sudden shaking or vibration of the earth's
crust. The vibrations may vary in magnitude. The
earthquake has point of origin underground called the
"focus".
• Tsunami
• Volcanic erruptions.
 4. Biological disasters
These are those that are caused by pathogens.
They include epidemics and communicable
diseases examples are;
H.I.V
Cholera
Typhoid
Ebola
Rift valley fever
Natural Disasters summary
• The natural disasters can be further classified
in to either rapid onset and slow onset types.
• The rapid onset types are those that occur
rapidly or suddenly like Volcanic eruptions,
earthquakes, tsunamis, typhoons, and
epidemics.
• The disruptions usually occur within a short
time.
Man made / caused Disasters
• These are those disaster that are caused by human
being.
• They include;
• Civil disturbances i.e. when the population is restless.
• Warfare. Nuclear war effect has very serious impacts both on the environment
and on human beings.
• A major possible impact of warfare is upcoming of refugee camp.
These cause other problems like
• unplanned settlements,
• Improper waste disposal
• Diseases and epidemics.
• Bioterrorism
• A bioterrorism attack is the deliberate release of
viruses, bacteria, or other germs (agents) used to
cause illness or death in people, animals, or
plants.
• These agents are typically found in nature, but it is
possible that they could be changed to increase
their ability to cause disease, make them
resistant to current medicines, or to increase
their ability to be spread into the environment.
• Chemical warfare.
• This is the use of chemicals for lethal purposes
or as a weapon for killing people, plants e.t.c a
good example is mustard gas.

• Terrorism
• Creating terror. The terrorist detonate or cause
bomb blast, destruction of infrastructure and
causing deaths like what happened in the US
the Sept attack and in Kenya august Bomb.
 IMPACTS OF EXPLOSIONS
• Things like explosions will cause;
• Blindness due to the bright light.
• Deafness which might be caused by the explosion
noise
• Deaths from the fire
• Buildings collapse hence endangering human life.
• Radiations
• Bush fires
• etc
 Phases of disasters
• A phase is a step or a stage.
• Disasters also has got phases i.e.
1. Warning phase
2. Impact phase
3. Rescue phase
4. Relieve phase.
5. Rehabilitation phase
1. Warning phase
•This is the first phase of a disaster.
•This is when the warnings of the
calamity are given or sent sometimes it
is referred to as early warning systems.
They are usually told to people in
advance.
•Use of sophisticated equipment may be
necessary to foresee a possible disaster in a
certain area example satellites, professional
network international bodies like world
meteorological organization, international
red cross organization etc have always been
able to predict meteorological disasters
like hurricane, tsunami , e.t.c.
Warning phase cont…
• Some of the information gotten from the
organizations are given to the government and relief
agencies.
• Most disasters are preceded by a kind of warning but
the time allowed for excessive action may vary from
seconds to months or even years, for example earth
quakes may give seconds of warning while things like
volcanoes may first release things like dark clouds and
therefore give more time for evacuation.
Phase 2. Impact phase
• This is the time when the disaster actually strikes and when
there is little done to lessen the effects of the victim.
• The period may last seconds in earth quakes, days or months
in situations like floods and droughts or epidemics.
• The possible impacts are
• Loss of
• Habitat degradation
• Species fragmentation
• Pollution where chemicals are used,
Phase 3.Response/Rescue phase
• This always starts after the impact and continues until the
entire place has been recovered / restored.
• Survivors here always assist the victims by giving them first
aid and other necessary requirements.
• The response phase includes the mobilization of the
necessary emergency services and first responders in the
disaster area.
• This is likely to include a first wave of core emergency
services, such as fire fighters, police and ambulance crews.
• Evacuation takes place and also removal of the dead bodies
.e.t.c
Phase 4. Relief phase
 experts of the voluntary organization starts
arriving.
actions take place like provision of alternative
shelter for the homeless, relocations are done
and relief supplies are received and continue
being distributed to victims.
Medical and food supplies are therefore given
out.
Phase 5. Rehabilitation/Recovery phase.
• To rehabilitate is to bring back to the original form
or state.
• This is also called the recovery phase.
• The aim of the recovery phase is to restore the
affected area to its previous state.
• Recovery efforts are primarily concerned with actions
that involve rebuilding destroyed property, re-
employment, and the repair of other essential
infrastructure.
 Effects of a disaster
• The magnitude of a disaster can be assessed by the effects
on a particular community or the whole country at large.
• They can be both tangible and non tangible.
Tangible impacts
• These impacts are usually easy to assess and they include
• The size of the damaged area
• The number of people affected
• Number of infrastructure damaged
•Non tangible impacts
• These are those impacts that are difficult
to assess. They include things like;
• Health impact
• Economic impacts
• Psychological impacts.
•Man made disasters like wars cause long
term and serious psychological impacts than
many other disasters.
 Factors likely to affect disasters
•Factors that are likely to contribute to
the magnitude of disasters include;
• High population
• Unplanned settlements (urbanization)
• High concentration of equipment
• Technology advancement e.g. nuclear plants
• etc
DISASTER MANAGEMENT
• Is the discipline of dealing
with and avoiding risks.
• It is a discipline that
involves preparing
for disaster before
it occurs.
DISASTER MANAGEMENT
• As per Disaster Management Act, 2005, “disaster
management” means a continuous and integrated
process of planning, organising, coordinating and
implementing measures which are necessary for:
(i) Prevention of danger or threat of any
disaster;
(ii) Mitigation or reduction of risk of any
disaster or its severity or consequences;
(iii) Capacity-building;
(iv) Preparedness to deal with any disaster;
(v) Prompt response to any threatening
disaster situation;
(vi) Assessing the severity or magnitude of
effects of any disaster; evacuation, rescue
and relief;
(vii) Rehabilitation and reconstruction;
 Key Phases of Disaster Management
There are three key phases of activity within
disaster management:
• 1. Pre – Disaster: Before a disaster to
reduce the potential for human, material or
environmental losses caused by hazards and
to ensure that these losses are minimized
when the disaster actually strikes.
2. During Disaster: It is to ensure
that the needs and provisions of
victims are met to alleviate and
minimize suffering.
3. Post Disaster: After a disaster to
achieve rapid and durable recovery.
DISASTER
MANAGEMENT
CYCLE
 Pre – Disaster Phase
1.Prevention and Mitigation
Mitigation is the ongoing
efforts to lessen the impact
that disasters have on people
and property.
• Mitigation embraces all measures
taken to reduce both the effects of
the hazard itself and the vulnerable
conditions to it in order to reduce the
scale of a future disaster.
2. Preparedness
This brings us to the all-important issue
of disaster preparedness.
The process embraces measures that
enables governments, communities and
individuals to respond rapidly to
disaster situations to cope with them
effectively.
• Preparedness includes for example;
the formulation of viable emergency
plans
the development of warning systems
public awareness and education
the training of personnel.
 search and rescue measures
DURING DISASTER PHASE
3. Response
• This refers to the first stage response to any calamity, which
include for examples such as;
putting the contingency plan in action
issue warning
action for evacuation
taking people to safer areas
rendering medical aid to the needy etc.,
simultaneously rendering relief to the homeless, food, drinking
water, clothing etc. to the needy,
 THE POST- DISASTER PHASE

4. Recovery: Recovery is used to describe the

activities that encompass the three overlapping

phases of emergency

rehabilitation ,reconstruction and development.

• A) Rehabilitation:
Rehabilitation includes the
provision of temporary public
utilities and housing as
measures to assist long-term
recovery.
B) Reconstruction: Reconstruction attempts to

return communities to improved pre-disaster

functioning. It includes such as the

replacement of buildings.
4. Development: Long-term prevention/disaster
reduction measures for examples like construction of
embankments against flooding, irrigation facilities as
drought proofing measures, increasing plant cover to
reduce the occurrences of landslides, land use
planning, construction of houses capable of
withstanding the onslaught of heavy rain.
 QUESTION

•How are patients triaged in a

mass accident?
TAKE ACTION NOW

Questions
?
PRACTICE QUESTION
•Disaster management focuses on
predicting the occurrence of a disaster
before it occurs in order to reduce its
impact. Discuss the phases of a
disaster,phases of disaster management
and the disaster management cycle.
• Nairobi hospital is planning its budget for the upcoming year. The hospital
leadership team is tasked with determining how to allocate resources to ensure
that patients receive the best possible care while also keeping costs under
control.
• To begin the budgeting process, the team reviews the hospital current financial
situation, including REVENUE STREAMS and EXPENSES. They identify areas where
costs can be reduced, by negotiating better prices for medical supplies.
• The team also considers investments that will improve patient care, such as
hiring additional staff or purchasing new medical equipment. They weigh the
costs of these investments against the potential benefits to patients and
determine which initiatives are most important.
• Once the team has identified its priorities, they develop a budget that allocates
resources accordingly.
 What is a budget?
•Budgeting is a systematic approach, that
predicts revenues and expenditures of an
individual, family, group, business entity, or
government.
•A realistic report helps businesses trace
their financial performance. This is crucial
for decision-making.
•Budgeting projects anticipated revenue
and expenditures for a future period
based on prevailing internal and external
factors.

•A detailed statement of projected

financial result is prepared by considering
inputs from various levels.
•It is a health check for the organization—it is
essential for avoiding cash crunch or losses.

•Budgeting is done by top-level management in

the top-down approach; other levels
implement it.

•In the bottom-up approach, inputs from

various levels are sent to top management.
•It can be approached top-down or bottom-up.

•In the top-down approach, top-level

management estimates costs and gradually
moves down levels.

•Ultimately, the top management prepares the

breakdown of spending and passes it down for
implementation.
•In contrast, in the bottom-
up approach, managers prepare
department-wise reports based on
team inputs and past experiences.

•They then send it to

top management for approval.
THE 50-30-20 BUDGET RULE
•The “50-30-20 budget rule
recommends spending 50% of
earnings (after-tax) on needs. Of the
remainder, the rule recommends
spending 30% on wants and 20% on
savings.
Types of budgeting
1. Personal Budget: An individual or
family plans their monthly
earnings and expenses to ensure
that they don’t run out of cash
before the next paycheck.
2. Corporate Budget:
is a comprehensive estimation
of what a business' expenses
and revenues will be for a given
financial year.
3. Government Budget: A financial plan
prepared by the federal government
accounts for the estimated national
revenue for a particular financial year and
the expected expenditure.
The revenue comes from taxes, fees, and
grants.
•4. Master Budget: It is a
culmination of various lower-
level budgets prepared for
different areas of
business operations. It is a
consolidated business plan.
5. Operating Budget: It is
created at the beginning
of a given period. It
reflects the
profit and loss accounting.
6. Static Budget:
It is mostly formulated by the government
and non-profit organizations.
It is rigid and does not allow variations
depending on the activity of the institution.
It is a prediction of revenue and expenses—
based on anticipated values.
7. Flexible Budget:
 It is a realistic approach adopted by businesses.
A flexible plan considers changes in expenses
and costs over the period and adjusts
accordingly.
8. Financial Budget:
It incorporates assets, liabilities.
It charts a company’s short-term and long-term
financial goals.
9. Cash Budget:
It is simply a cash flow prepared in advance.
It documents anticipated payables and
receivables for an upcoming period.
It is prepared to ensure that the business
has enough money to run the organization
effortlessly.
10. Labor Budget:
It is tailor-made for
labor-intensive firms.
Businesses that are heavily
reliant on employees need a
systematic plan
balancing revenue and wages.
BUDGETING METHODS
•#1 – Incremental Budgeting
• It is a traditional method; the manager takes the
previous period’s budget as a benchmark.
Further, the anticipated percentage change is
either summed up or deducted to formulate the
current budget.
#2 – Zero-based Budgeting (ZBB)
• In this method, all the figures are reset to
zero, and the manager begins with a fresh
interpretation of all the items.
• The manager has to justify every new number
with reasoning, in contrast to using figures
from the previous accounting period.
• ZBB eradicates traditional expenditures that
are no longer required.
•#3 – Activity-based
Budgeting
•Operations or activities that
generate cost to the business are
identified.
•Ways of reducing costs are
strategized.
#4 – Participative
Budgeting
•It is a bottom-up approach.
•Top-level executives often take the
help of the managers and workers of
different departments in designing
the financial plan.
#5 – Negotiated Budgeting
•It has both top-down and bottom-
up traits.
•Managers and employees together
frame the financial plan, keeping in
mind goals and targets—set by top-
level management.
•#6 – Value Proposition
Budgeting
•As the name suggests, every cost
is re-evaluated and justified
based on its impact. Unnecessary
expenses are eliminated.
BUDGETING PROCESS
1. First, ascertain the goal of financial
planning.
2. Next, interpret and compare historical
data of revenues and expenses.
3. Then, devise a rough budget to direct
the actions towards the objective.
4. Further, refine the findings to chalk
down a final budget.
5. Prepare and submit a budget report.
6. Review the financial plan from time to
time—detect loopholes.
7. Track the performance, taking the
necessary corrective measures if
required.
REPORTS
REPORTS
• At the end of a 12 hour shift, a nurse is responsible for providing
comprehensive report to the incoming nurse who will be taking over care
for their patients.
• This report includes;
 information about each patient’s medical history
current condition and any changes that occurred during the previous
shift.
This may include vital signs, medication administration, lab results
any interventions or procedures performed.
may also include information about any pending orders or tests that
need to be completed during the next shift. This ensures that the
incoming nurse is aware of any outstanding tasks and can prioritize their
INTRODUCTION
• Nursing reports is a critical component of
nursing care, that helps promote
patient safety and continuity of
care.

• Effective communication between nurses

during shift changes is essential for
ensuring that patients receive high-
quality care around the clock.
•Reporting is the verbal or written
communication of data regarding the
clients health status needs,
treatments, outcomes and responses.

•Reporting facilitates clinical

decision making, continuity of care
and co-ordination among health
team members.
THE BENEFITS OF A HEALTHCARE
REPORT
•Reports have many
benefits to the
healthcare system.
This include;
1.IMPROVED MANAGEMENT AND DECISION
MAKING
• The first benefit, and arguably one of the
most important ones, is improved facility
management and decision-making process.

• Hospital managers can make informed

decisions to ensure better clinical
performance and correspondingly better
outcomes.
2. PREVENTETIVE
MANAGEMENT
•One of the most striking
elements is the ability to
harness the power of
historical and current data to
spot potentially fatal medical
issues before they occur.
 3. DISEASE MONITORING
• The predictive analytics and insights found
in reports related to health can also help in
placing surveillance on potentially large-
scale disease outbreaks.

• This would ensure that the correct course of

action or preventative measures is taken to
control or contain the situation.
4. PATIENT WELLBEING
• A healthcare report can assist hospitals
in offering information on an individual
patient basis.
• By doing so, an institution can give
individuals tailored advice on how they
can maintain a healthy lifestyle based
on their medical data and biometric
vitals.
6. NURSES PERFORMANCE
•Reports can shed unbiased
light on how your nurses are
performing – an essential
point on how management
reporting can help improve the
operation of the hospital.
•With healthcare reports, it’s
possible to accurately
evaluate the
performance, efficiency,
and effectiveness of staff
at the point of delivery.
7. ENHANCED COMMUNICATION
• More than any other organization, a care
facility employs many people who cover
different functions.
• From attendings, residents, interns,
nurses, and physical therapists, to rapid
response teams and more, all of them
need to stay connected to ensure the
ultimate goal is achieved: excellent care
for patients.
TYPES OF REPORTS
•The reports used in hospital setting
usually are :

1. change - of - shift reports

2. Transfer reports.
3. Incident reports.
4. Telephone reports
1. CHANGE OF SHIFT REPORTS/HAND
OVER REPORTS
• These may be given orally in person, by audio taping,
recording or during rounds at clients bedside.

• Change-of-shift report is the time when

responsibility and accountability for the care of a
patient is transferred from one nurse to another.

• some of the points to be kept in mind while giving such

reports are as follows:
POINTS TO CONSIDER WHEN GIVING
CHANGE OF SHIFT REPORTS
Provide only essential background
information about client but do not review
all routine care procedures or tasks.

Identify clients nursing diagnosis or health

care problems and other related causes but
do not review all biographical information.
Describe objective measurements
about client condition and response to
health problems.

Don’t engage in idle gossip.

Evaluate results of nursing or medical

care measures. Do not simply describe
results as good or poor. Be specific.
•Be clear on priorities to
which in coming staff
must attend.
•Do not force incoming
staff to guess what to
do first.
2. Transfer reports
• Patient will frequently be transferred from one unit to
another to receive different levels of care. When giving
transfer request, the nurse should include the following
information.
Clients name, age, primary doctor and medical diagnosis.
Summary of medical progress upto the time of transfer.
Current health status - physical and psycho-social.
Current nursing diagnosis or problems and care plans.
Any critical assessment or interventions to be completed
shortly.
Needs for any special equipment etc.
Key points to consider in incident
reporting
The nurse who witnessed the incident or
who found the client at the time of
incidence should file the report.

The nurse describes in concise form what

happens specially objective terms.

The nurse does not interpret or attempt to

explain the cause of the incidence.
• The nurse describes objectively the
clients conditions when the incident was
discovered.
• Any measures taken by the nurse, other
nurses or doctors at the time of the
incident are reported.
• No nurse is blamed in an incident report.
• The report is submitted as soon as
possible to the appropriate authority.
4. Telephone reports
• Health professionals frequently report about a patient
by telephone.
• A registered nurse makes a telephone report when
significant events or changes in a patient’s condition
have occurred.
• The nurse receiving the telephone report should
document the date and time, the name of the person
giving the information and the subject of the
information received and sign the notation.
For example;
•At 20/09/2023, 10am, MR
Mohamed the laboratory
technician reported by
telephone that Mrs Fatuma’s
haemoglobin level was 5.5g/dl,
sign at the end.
• The person receiving the information should
repeat it back to the sender to ensure accuracy.
• It is important that the nurse be coincise and
accurate.
• Telephone reports usually include the client’s
name and medical diagnosis, changes in nursing
assessment, vital signs, significant laboratory data
and related nursing interventions.
• After reporting, the nurse should document the
date, time and content of the call.
Common formats used in reporting
•Common formats used to document
patient care include;
charting by exception
focused DAR notes
narrative notes
SOAPIE progress notes
SBAR
1. Charting by exemption
• Charting by exemption was designed to
decrease the amount of time required to
document care.
• CBE contains a list of normal findings.
• After performing an assessment, nurses
confirm normal findings on the list
found on assessment and write only
brief progress notes for abnormal
findings.
2. Focused DAR notes
• Focused DAR notes are a type of progress
note that are commonly used in combination
with charting by exception documentation.

• DAR stands for Data, Action,

and Response. Focused DAR notes are
brief. Each note is focused on one patient
problem for efficiency in documenting and
reading.
1. Data:
This section contains
information collected during the
patient assessment, including
vital signs and physical
examination findings found
during the “Assessment” phase
of the nursing process.
2. Action:
This section contains the nursing
actions that are planned and
implemented for the patient’s focused
problem.
This section correlates to the
“Planning” and “Implementation”
phases of the nursing process
3. Response:
This section contains information
about the patient’s response to the
nursing actions and evaluates if the
planned care was effective.

This section correlates to the

“Evaluation” phase of the nursing
process
3. NARRATIVE NOTES
•Narrative notes are a type of
progress note that chronicles
assessment findings and
nursing activities for the
patient that occurred
throughout the entire shift or
visit.
4. SOAPIE NOTES
•is a mnemonic for a type of progress
note that is organized by six
categories: Subjective, Objective,
Assessment, Plan, Interventions,
and Evaluation.
•SOAPIE progress notes are written by
nurses, as well as other members of
the health care team.
1.Subjective: This
section includes what
the patient said, such
as, “I have a headache.
2. Objective:
This section contains the
observable and measurable data
collected during a patient
assessment, such as;
the vital signs
physical examination findings,
lab/diagnostic test results.
3. Assessment:
This section contains the
interpretation of what was noted in
the Subjective and Objective
sections, such as a nursing
diagnosis in a nursing progress note
or the medical diagnosis in a
progress note written by a health
care provider.
4. Plan: This section outlines the plan of
care based on the Assessment section,
including goals and planned interventions.

5. Interventions: This section describes

the actions implemented

6. Evaluation: This section describes the

patient response to interventions and if the
planned outcomes were met.
5. SBAR REPORT
1. PRECISION
•In a good report, the report
writer is very clear about the
exact and definite purpose of
writing the report.
•The precision of a report provides
unity to the report and makes it a
valuable document for best usage.
2. ACCURACY OF FACTS
•Information contained in a
report must be based on
accurate facts.
• Since decisions are based on
report information, inaccurate
information or statistics will lead
to a wrong decision.
3. RELEVANCE
•The facts presented in a report
should be accurate and
relevant.
•Irrelevant facts make a report
confusing and likely to be
misleading.
4. SIMPLICITY
• Simplicity is the best for anything.
• It is just another essential feature of a good report.
• A good report is written in simple language,
avoiding vague and unclear words.
• The message of a good report should be self-
explanatory.
• A good reporter should use simple sentences
instead of complex sentences in the narration of
facts.
5. GRAMMATICAL
•A good report is free from
errors.
•Any faulty construction of a
sentence may change its
meaning in the reader’s mind
and potentially make it
confusing or ambiguous.
Time
Management
 What is Time Management ?

•Time management refers to;

Managing time effectively, so that the right
time is allocated to the right activity.
• Making the best use of time, as time is always
limited.
TIME MANAGEMENT STYLES

1.Time Martyr
• Your own tasks feel like too much responsibility,
so you jump at the chance to take on anything
else - you gain validation from others, but
neglect the tasks that would bring you self-
validation.
• Issues: multitasking, missed deadlines,
ineffective scheduling, skipping breaks
•2.Procrastinator
• Time Martyrs at least tackle other people's tasks
— Procrastinators delay work on everything
remotely important to anyone. Some claim they
work better under pressure, but the results they
get are often dampened by the stress and anxiety
this practice brings.
• Issues: missed deadlines, ineffective scheduling,
multitasking
 3. DISTRACTOR
 Your heart's in the right place, but you're
easily distracted.
 A random request from a colleague is as
likely to catch your fleeting attention as is a
20-minute phone call from your proprietor.
 Issues: multitasking, missed deadlines,
ineffective scheduling
 4.
UNDERESTIMATOR
•You estimate that handling a task
will take you much less than it
actually does — you rarely live up to
your optimistic deadlines.
•Issues: missed deadlines, ineffective
scheduling
 5. FIREFIGHTER
• You try to tackle everything on your own, you're
constantly putting out "fires" left and right, and
don't feel fulfilled unless you're working on 10
tasks at once, and feeling "busy". Once you're
done with that, you simply ask: "What's next?"
— which is a practice that will lead you to
burnout.
• Issues: missed deadlines, skipping breaks,
ineffective scheduling
 6.
•
PERFECTIONIST
Similar to the procrastinator and distractor, but your
inability to finish a task at least has a noble cause — you
want everything to be perfect. You'll work overtime, and
invest all your efforts into delivering a high-quality
project — but you often don't know how to quit while
you're ahead, so you may miss your deadlines and risk
burnout.
• Issues: missed deadlines, skipping breaks
 Time Management
Includes:
1.Effective Planning
2.Setting goals and objectives
3.Setting deadlines
4.Delegation of responsibilities
5.Prioritizing activities as per their importance
6.Spending the right time on the right activity
 1- Effective
Planning
 Plan your day well in advance.
1. Prepare a To Do List or a “TASK PLAN”.
2. Order activities according to
their priority.
3. Allocate suitable time to each activity.
 Complete pending tasks one by one.
– Do not begin fresh work unless you have
finished your previous task.
 Tick the ones you have already
completed.
 Ensure you finish tasks withinthe stipulated
time frame.
 2- Setting Goals and
Objectives
Working without goals and
targets in an organization
would be similar to a situation
where the captain of the ship
loses his way in the sea.
Set targets for yourself and
make sure they are realistic
and achievable.
3- Setting Deadlines
 Ask “how much time
needs
yourself to be devoted to
a particular task?”
 Set deadlines for every task, and
be committed to.
– Do not wait for your superiors to
ask you every time.
– Learn to be self driven.
 4- Delegation of
Responsibilities
 Don’t do everything on your own,
there are other people as well.
 Roles and responsibilities should be
delegated to employees according to their
interest and specialization to ensure they
would finish within deadlines.
 An employee who does not have
enough knowledge needs more time than
someone who knows the work well.
5- Prioritizing
Tasks
Prioritize tasks as per their
importance and urgency.
– Know the difference
between
important and urgent work.
Identify which tasks should
be done along the day, and
during the month.
6- Spending the Right Time on
Right
Develop Activity
the habit of doing the
right thing at the right time.
Work done at the wrong time is
not of much use.
Keep some time separate for
your personal calls or checking
updates on Face book or Twitter.
– After all human being is not a
machine.
 Characters of Good Time
1.Manager:
Organized
 Avoid keepingstacks of file and heaps of
paper at your workstation.
– Throw what all you don’t need.
 Put important documents in folders.
– Keep the files in their respective
drawers with labels on top of each file.
– It saves time which goes on
unnecessary searching.
 Cont. …
2. Don’t misuse time
 Concentrate and finish assignments on time.
– Don’t wait till the last moment.
 Do not kill time by loitering or gossiping
around.
 Remember your organization is not paying you
for playing games on computer or peeping
into other’s cubicles.
 First complete your work and then do
whatever you feel like doing.
Cont. …

3. Be Focused
 Develop the of using
habit
planners, organizers, tables
calendars for better time
management.
 Set reminders on phones
or your personal computers.
Time Management
Techniques
1.POMODORO
TheTECHNIQUE
pomodoro Technique is a time management method
based on 25-minute stretches of focused work broken by
five-minute breaks.

Longer breaks, typically 15 to 30 minutes, are taken after

four consecutive work intervals. Each work interval is
called a pomodoro, the Italian word for tomato
2. The eisenhower
decision matrix
The Eisenhower decision matrix is a
way to categorize and prioritize
items on your to-do list according to
their urgency and importance.

It's a box with four quadrants.

 3. Eat that frog
technique
•This technique is named after a Mark Twain
quote: “Eat a live frog the first thing in the
morning and nothing worse will happen to
you the rest of the day.”

•Start your day by doing the most onerous

tasks first and getting them out of the way.
 4. The pareto
•analysis(
The 80/20 rule80/20 rule)
is a technique created by
the Italian economist Vilfredo Pareto.
•It’s the idea that 20% of actions are
responsible for 80% of outcomes. The
goal of Pareto analysis is to help you
prioritize tasks that are most effective at
solving problems.
 5. Pickle jar theory
• The theory helps you figure out what is useful and what is not useful in an
organization. It allows you to plan tasks with time to spare and set priorities
for your day.
• How it works:
• Imagine a pickle jar full of sand, pebbles, and rocks. The sand is at the
bottom and the rocks sit at the top.
The sand: This represents disrupting elements of your day, such as phone
calls, text messages, emails, social media, etc.
The pebbles: This represents tasks that need to be completed, but can be
done on another day or by someone else.
The rocks: These are the most important tasks that need to get done today.
OTHER TIME
MANAGEMENT
TECHNIQUES
1- Set Your Priorities
 Prepare a “TO DO” List or a “Task
Plan” to jot down tasks you need
to complete against the time slot
assigned to each activity.
 High priority tasks must be written
on top followed by tasks which can
be done a little later.
 Make sure you stick to your task
list.
2- Finish Your Assignments
on Time

 Tick the tasks you have already

finished.
3- Differentiate Between Urgent
and Important
 Important “ … of great significance or
value”
 Urgent “ …. requiring
immediate action or attention”
First, finish off what all is urgent and
important.

 Do not begin your day with

something which is not so important
and can be done a little later.
 Do not wait for your Boss’s
reminders.
4- Stay Focused
 While doing an urgent job, do
not leave your work station.
 Going for strolls in the middle
of an urgent work breaks
continuity and makes you
loose focus.
 5- Add Life to Work
 In your daily schedule, you should
include time for:
– Tea breaks
– Net surfing
– Personal calls
 Human being is not a machine who
can work at a stretch for eight to
nine hours.
 Assign 30:45 minutes to check
updates on social networking sites,
call your friends or family or go for
6- Set Realistic
Targets
Know what you need to achieve
and in what duration?
Do not lie to yourself.
Assigning one hour to a task which
you yourself know would require
much more time does not make
sense.
 7- Don’t Overload
Yourself
 Say a firm “no” to your boss if
you feel you would not be able to
complete a certain assignment
within the assigned deadline.
 Don’t worry, he will not feel bad.
 Probably he can assign the same to
any of your fellow workers.
 Accept tasks which you are really
confident about.
8- Be Disciplined and
Punctual
Avoid taking unnecessary
leaves from work.
Reach work on time as it
helps you to plan your
day better.
9- Be organized
Keep things at their proper places.
–Files must be kept at their respective drawers.
–Staple important documents and put them in
a proper folder.
–Learn to be a little more organized, this will
save your time which goes on unnecessary
searching.
Ideal Task
Plan
Ideal Task Plan
 Date -………………
 Day -………………
 9 AM - Day Begins.
 9.15 - 10 AM - Reply urgent emails.
 10 AM - 12 noon - Work on client A’s proposal, prepare
reports and necessary data. (Most Urgent). Also work on
comparative analysis of competitors. (Urgent)
 12 Noon - 12.30 PM - Sit and discuss with team members on
pending issues (Have to clear all pending work by end of the
day).
Cont. …

 12.30 - 1.30 PM - Lunch Break (Enjoy with fellow workers).

 1.30 - 1.40 PM - Call up spouse.
 1.40 - 3 PM - Work on Client B’s Proposal (Still have two
days).
3 PM - 4 PM - Sit with Boss for approvals and other
critical issues.
 4 PM - 5 PM - Call up existing and potential clients.
 5 PM - 5.15 PM - Check personal mails.
5.15 - 6 PM - Collate reports and send to immediate
reporting Boss.
 6 PM - 6.15 PM - Organize Work Station.
 Day Ends
NURSING CARE
MODALITIES
 NURSING CARE MODALITIES
•This refers to the manner in which
nursing care is organized and provided.
•It depends on the philosophy of the
organization, nurse staffing and client
population.
1. Case method/ Total patient care
•In case method, the nurse cares for one
patient whom the nurse cares for
exclusively.
•The Case Method evolved into what we
now call private duty nursing. It was the
first type of nursing care delivery
system.
•Total Patient Care, is a nursing model
where one nurse provides total care to a
single patient or a group of patients during
his/her shift.
•During that shift, all the patient needs are
addressed by the nurse, and in some cases,
the nurse issues care until the end of the
patient's medical needs.
 ADVANTAGES
•Consistency in carrying out the nursing
care plan
•Patient needs are quickly met as high
number of RN hours are spent on the
patient
•Relationship based on trust is developed
between the RN and the patient’s family
DISADVANTAGES

•It can be very costly

 2. FUNCTIONAL NURSING
•It is a task-oriented method wherein a
particular nursing function is assigned to
each staff member.

•The medication nurse, treatment nurse and

bedside nurse are all products of this system.
• For efficiency, nursing was essentially
divided into tasks, a model that proved
very beneficial when staffing was poor.

• The key idea was for nurses to be assigned to

tasks, not to patients
 ADVANTAGES
•A very efficient way to deliver care.
•Could accomplish a lot of tasks in a small
amount of time
•Staff members do only what they are
capable of doing
•Least costly as fewer RNs are required
 DISADVANTAGES
• Care of patients become fragmented and
depersonalized
• Patients do not have one identifiable nurse
• Very narrow scope of practice for RNs
• Leads to patient and nurse dissatisfaction
 3. TEAM NURSING
•This is the most commonly used model
and is still in use today.
• It was developed in the 1950’s inorder
to somewhat ameliorate the
fragmentation that was inherent in the
functional model.
•The goal of team nursing is
for a team to
work democratically.
•In the ideal team, an RN is
assigned as a Team Leader for
a group of patients.
•The Team Leader has a core of staff
reporting to her, and together they work to
disseminate the care activities.

•The team member possessing

the skill needed by the individual patient is
assigned to that patient, but the Team
Leader still has accountability for all of the
care.
 ADVANTAGES
•Each member’s capabilities are maximized so
job satisfaction should be high

•Patients have one nurse (the Team Leader)

with immediate access to other
health providers
 DISADVANTAGES

• Requires a team spirit and commitment to

succeed
• RN may be the Team Leader one day and a
team member the next, thus continuity
of patient care may suffer.
 4. PRIMARY NURSING
• The hallmark of this modality is that one nurse
cares for one group of patients with a 24-
hour accountability for planning their care.
• In other words, a Primary Nurse (PN) cares for
her primary patients every time she works and
for as long as the patient remains on her unit.
• An Associate Nurse cares for the
patient in the primary nurse absence
and follows the Primary nurse
individualized plan of care.

•This is a decentralized delivery model:

more responsibility and authority
is placed with each staff nurse
 ADVANTAGES

•Increased satisfaction for

patients and nurses
•More professional system:
Nurse plans and communicates
with all healthcare members.
•RNs are seen as more knowledgeable
and responsible.

•RNs more satisfied because they

continue to learn as part of the in-
depth care they are required to
deliver to their patients.
 Disadvantages
•Only confines a nurse’s talents to a
limited number of patients, so other
patients cannot benefit if the RN is
competitive
•Can be intimidating for RNs who are
less skilled and knowledgeable
 5. PROGRESSIVE PATIENT CARE

•PPC is a system of nursing care in

which patients are placed in units on
the basis of their needs for care as
determined by the degree of illness
rather than on the basis of a medical
specialty.
• Progressive patient care is the systematic grouping of
patients according to their degree of illness and
dependency on the nurse rather than by classification
of disease and sex.

• It is a method of planning the hospital facilities, both

staff and equipment, to meet the individual
requirements of the patient.
 ELEMENTS OF PPC

• Intensive care units for critically ill patient

• Intermediate care units for those patients not
requiring to be housed in either of the
foregoing, and who would constitute
approximately 60%, of all patients in hospital.
• Self-care units for convalescent patients
or those requiring investigation.
MONEY AS A
RESOURCE
SOURCES OF FINANCE
1.The government
provides finance to companies in cash grants
and other forms of direct assistance, as part of
its policy of helping to develop the national
economy, especially in high technology
industries and in areas of high unemployment.
2. Donor funding is expected to be an
increased direct source of funding
which is factored either in investing or
financing activities of the organization.
•3. A revolving fund is a fund or account that
remains available to finance an organization's
continuing operations.
• The organization replenishes the fund by repaying
money used from the account. Revolving
funds have been used to support both government
and non-profit operations.
4. CDFS
The CDF program has facilitated the putting up of new
health facilities in all parts of the country, including
remote areas that were usually overlooked during
funds allocation in national budgets.
 HEALTHCARE FINANCING
• Refers to the means by which healthcare services are
paid for.
• It encompasses the various sources of funding that
support the provision of healthcare services, including
public and private insurance programs, government
susbsidies, out of pocket payments and philanthropic
contributions.
COMMODITY AND SUPPLIES MANAGEMENT
Commodity management is a set
of activities and procedures
that ensure that health
commodities are available,
accessible and of high quality.
Importance of commodity management
•This is to ensure consistent availability of and
access to medicines, laboratory reagents and
other medical supplies.
•Some of the supplies also have a short shelf-life
and are costly and hence needs to be
managed effectively.
•The other importance is to improve quality of life
of patients and to increase the consumer
confidence in the healthcare system
Commodity management cycle
• Commodity management can be described as a
cycle made up of various components. These
components are;
product selection
Procurement
inventory management (with storage &
distribution)
use
1.PRODUCT SELECTION
• is the process of identifying which commodity should be
made available as per the national guidelines.

• Appropriate selection ensures that the effective medicines

and related commodities for are selected.

• It also ensures that right dose, dosage form, preparation are

selected and the most affordable commodities are made
available.
 2. PROCUREMENT
•This is the process of obtaining
the required medicines and
supplies through purchase,
donations or manufacturing.
KEY COMPONENTS OF
PROCUREMENT
Quantification which is the need to
know how much to buy.
Supplier selection; who to buy from
and how to buy is identified.
Quality assurance in order to
ensure quality of the products you buy
3. DISTRIBUTION
• This is transferring commodities from a
storage facility/supplier to a point of use or from one
point of use to another, including appropriate storage
and inventory control.
• It involves moving stocks from national stores, to
district stores or central sites.
• It also includes distribution from District stores or
central sites to facilities and finally from the facility
store to user points.
4. USE
•Refers to practices that include
dispensing the prescribed medicines
to patients, patient adherence and
follow up and also issuing other
commodities to points of use.
FEFO & FIFO
•Use FEFO (first expiry first out)
when arranging and issuing drugs

•for drugs with the same expiry date

use FIFO (first in first out)
TYPES OF RECORDS USED IN
COMMODITY MANAGEMENT
• Stock keeping cards: These keep information about
commodities in storage at the facility
• Transaction records: Keep information about
commodities being moved from one facility to
another or within a facility.
• Consumption records: Keep information about
quantities of each commodity dispensed on daily basis
to patients
THE PROCUREMENT
•Public Procurement means
procuring by public funds.
•Procurement also means
acquiring affordable commodities of
good quality, either by purchase or
from donations.
 PROCUREMENT METHODS
• In Kenya, procurement in the public sector is governed
by the Public Procurement Act. Let us briefly look at the
methods used in procuring health commodities:
1. Open tender
2. Closed tender
3. Direct purchasing
4. Competitive negotiation
 1.OPEN TENDER
• This is a formal procurement process in which local
or international suppliers (or their representatives)
are invited to submit bids for the supply of
commodities under the terms and
conditions stipulated in the tender.
• This method allows for the widest selection of
potential suppliers.
• However it is a time-consuming and bureaucratic
method
2. CLOSED/RESTRICTED TENDER
• Similar to open tender but here the bidding is limited
to suppliers meeting certain conditions, e.g. suppliers
of a certain financial capacity, suppliers producing
drugs of certified quality, gender.
• These suppliers are short-listed using a pre-
qualification procedure.
• It assists by reducing the potentially large number of
suppliers who may bid, as compared to the open
tender.
 3. COMPETITIVE NEGOTIATION

•Here, the buyer selects a small

number of suppliers and negotiates
prices with them directly.
•It is useful for bulk procurements or
for emergency supplies.
 4. DIRECT PURCHASE
•The product is purchased directly from
one supplier.
•This is the simplest method but usually
very expensive since the buyer does not seek
better value by checking out other suppliers.
•It’s useful for small procurements or for
emergency supplies.
Ethical and legal implications in commodity
and supplies management
• Public procurement in Kenya should be based on core
principles and pillars. Some of these principles
include:
1. Transparency and Accountability: Procuring
entities should ensure there is openness and clarity
on procurement policy and its delivery.
2. Efficiency: This encompasses the performance of
the procurement process as cost effectively as
possible and in a timely manner.
3. Consistency: The application of the
procurement process should be the
same across all procuring entities.
4. Open and Effective Competition:
Provision of ample and
equal opportunities for participation
by interested and qualified suppliers
of goods, works or services.
5. Ethics and Fair Dealing: Under the
Public Officers and Ethics Act (2003), it is
an offence for the buyer in their official
capacity to accept any gift or
consideration as an incentive or reward
for acting in a manner showing favor or
disfavor for any person or entity.
PUBLIC PROCUREMENT AND
DISPOSAL ACT, 2005
What is the purpose of the public procurement and
Disposal Act 2005?
• to promote competition and ensure that competitors are
treated fairly
• to promote the integrity and fairness of those procedures
• to increase transparency and accountability in those
procedures
• to increase public confidence in those procedures.
QUALITY ASSURANCE
•It is defined as a continual
striving for excellence and
conforming to specific
approaches or guidelines.
•It is the extent of
resemblance between
the purpose of
healthcare and the truly
granted care.
•It is the promise or
guarantee that certain
standards of excellence
are being met in the
delivery of care.
QUALITY ASSURANCE TRIANGLE
•The Quality Assurance (QA)
approach to addressing quality of
care issues incorporates three core
quality assurance functions:
1.defining quality
2.measuring quality
3.improving quality
Quality assurance programs
Standards of practice (SOP)
Advances in technology
Changes in practical environment
Continuing competences
Continous quality improvement
Goal of quality assurance programs

•To ensure the delivery of

quality patient care
Approaches to quality
assurance programs
General approaches
1. Accreditation
2. Licensure
3. Certification
4. Recognition
Specific approaches
1. Nursing audit
2. Utilization review
3. Risk management committee
4. Professional review
organizations
5. Client satisfaction
GENERAL APPROACHES
•It involves large governing of
official body evaluation of a
person or agency ability to
meet standards at a given
time.
General approaches
1.licensure
It is the contract between
the profession and the
state.
2. ACCREDITATION
It is the voluntary approach to quality control used for
institutions.
Accreditation is a form of external quality
assurance process.
Institutions are evaluated by an external
body (accrediting agency eg; KENAS) to
determine if applicable standards are met.
Accreditation is both a status and a process.
3. Certification
Educational achievements, experience and
performance on an examination determines a
person's qualifications for functioning in an
identified specialized area.
4. Recognition
It is a process whereby one agency accepts the
credentialing status of and the credentials
conferred by another.
 Specific approaches
1. Nursing audit
Is the exercise conducted to
find out whether good nursing
practices are followed.
Purposes of
nursing audit
Evaluating nursing care given
Achieves deserved and feasible quality of
nursing care
Stimulant to better records
Focuses on care provided and not on care
provider
Contributes to research
 Types of nursing audit

1.Retrospective view
This refers to an in depth
assessment of the quality after
the patient has been discharged.
2. The concurrent review
• This refers to the evaluations conducted on
behalf of the patients who are still undergoing
care.
• It includes;
Assessing the patient at the bedside in relation
to predetermined criteria.
Interviewing the staff responsible for this care.
Reviewing the patients record and care plan.
Clinical audit cycle
• The main stages of the clinical audit cycle are:
1) Selecting a topic.
2) Agreeing standards of best practice (audit criteria).
3) Collecting data.
4) Analysing data against standards.
5) Feedback results.
6) Discussing possible changes.
7) Implementing agreed changes.
8) Allowing time for changes to be
implemented, before re-auditing.
9) Collecting a second set of data.
10) Analysing the re-audit data.
11) Feeding back the re-audit results.
12) Discussing whether practice has
improved.
Advantages of nursing audit
• It can be used as a method of measurement in all
areas of nursing.
• Scoring system is fairly simple.
• Results easily understood.
• Assesses the work of all those involved in recording
care.
• May be a useful tool as part of a quality assurance
program in areas where accurate records are kept.
Disadvantages of nursing audit
•Appraises the outcomes of
the nursing process, so it is
not useful in areas where the
nursing process has not been
implemented.
•Time consuming
•Requires a team of trained
auditors
•Only evaluates record keeping. It
only serves to improve
documentation, not nursing care.
2. Utilization review
•It is to ensure that
care is needed and
the cost is
appropriate.
3 types of utilization review

•Prospective review
•Concurrent review
•Retrospective review
Advantages of utilization review
•It is designed to assist clients to avoid
unnecessary care.
•It may serve to encourage the consideration
of care options by providers such as home
healthcare rather than hospitalization.
•It provides a measure of
agency accountability to the customer.
3. Risk management committee
•It reviews clients and
personnel safety policies and
procedures and determines
whether personnel are
following rules.
4. Professional review
organizations
•They monitor
access to care and
cost of care.
5. Client satisfaction
•It is used to
measure quality
of care.
Elements of QAM
1. ETHICS
It is a discipline concerned with good or bad in any
situation. These can be organizational or individual
ethics. AUTONOMY, BENEFICENCE,JUSTICE, NON-
MALEFICENCE
2. INTEGRITY
Integrity implies honesty, morals, values, fairness and
adherence to the facts and sincerity.
• 3. TRUST
• It is the by product of integrity and ethical
conduct. Trust allows decision making at
appropriate levels in the organization
• 4. TRAINING
• Training of the employees includes interpersonal
skills, the ability to function within teams,
problem solving, decision making, job
management performance analysis.
5. TEAMWORK
• Teams provides more permanent improvement
in processes and operations.
6. LEADERSHIP
• Leadership in total quality
management provides an inspiring vision,
makes strategic directions that are
understood by all and to instill values that
guide subordinates.
7. COMMUNICATION
It acts as a vital link between all
elements of quality management.
It can be vertical communication or
horizontal communication.
QUALITY EVALUATION MODEL

•DONABEDINA MODEL
This triad is also known as
the Donabedian model
named after Avedis
Donabedian, the physician
who developed it.
 DONABEDINA MODEL
•It is a conceptual model that provides
a framework for examining health
services and evaluating quality of health care.
•According to the model, information
about quality of care can be drawn from
three categories: “structure,” “process,”
and “outcomes."
 Structure, Process and outcomes
• Structure describes the context in which care is delivered,
including hospital buildings, staff, financing and
equipment.

• Process denotes the transactions between patients and

providers throughout the delivery of healthcare.

• Outcomes refers to the effects of healthcare on the health

status of patients and populations.
FACTORS AFFECTING QUALITY
ASSURANCE
•Lack of resources
•Personnel problem
•Improper maintainance
•Unreasonable patients and attendants
•Absence of accreditation laws
What is Monitoring
• Monitoring is a process of observing and
tracking activities and progress.
• It is a critical component of any successful
project, intervention, public policy or program.
• Monitoring is an ongoing, continuous process.
• It requires the collection of data at
multiple points throughout the program
or project cycle, including at the beginning
to provide a baseline.
N/B
• In monitoring, we keep a
close eye on a project or
program to ensure that
everything is going
according to plan and there
are no unexpected surprises.
MONITORING QUESTIONS EXAMPLES;
1.What progress has been made towards
achieving the project goals and objectives?
2.What activities have been completed since
the last monitoring visit?
3.What challenges have been encountered
during implementation, and how have they
been addressed?
4.How effective have the project activities
been in achieving the intended outcomes?
What is evaluation
•Evaluation involves the
examination of the
relevance, effectiveness,
efficiency and impact of
activities in the light of
specified objectives.
• In broad terms, monitoring is carried out in order
to track progress and performance as a basis for
decision-making at various steps in the process of
an initiative or project.

• Evaluation, on the other hand is a more

generalised assessment of data or experience to
establish to what extent the initiative has
achieved its goals or objectives.
Purposes of M & E
•Monitoring systems provide managers and
other stakeholders with regular information
on progress relative to targets and outcomes.
•This enables the early identification of
problems so that solutions can be proposed.
•It is considered to be a critical part of good
management.
Key reasons for performing M &
E
1. For accountability:
•demonstrating to donors, taxpayers,
beneficiaries and implementing partners that
expenditure, actions and results are as agreed
or can reasonably be expected in the
situation.
 2. FOR OPERATIONAL
MANAGEMENT
•Provision of the information needed to
co-ordinate the human, financial and
physical resources committed to the
project or programme, and to improve
performance
3. FOR STRATEGIC MANAGEMENT

•Provision of information to
inform setting and
adjustment of objectives
and strategies.
TYPES OF MONITORING
1. PROCESS MONITORING
This is often referred to as ‘activity
monitoring.
Process monitoring is implemented
during the initial stages of a
project as its sole purpose is to
track the use of resources, along
with examining how outputs are
delivered.
2. COMPLIANCE MONITORING
• The purpose of compliance monitoring is to
ensure compliance with;
Donor regulations
Grant
Contract requirements
Local governmental regulations and laws
Ethical standards
Compliance with the expected results of the
project.
3. CONTEXT MONITORING
often called ‘situation monitoring.’
 It tracks the overall setting in which the project
operates.
Context monitoring helps us identify and
measure risks or any unexpected
situations that may arise within the
institutional, political, financial, and policy
context at any point during the project.
5. FINANCIAL MONITORING
• The main purpose of financial monitoring is to
measure financial efficiency within a
project.
• It tracks the real expenditure involved in a
project in comparison to the allocated budget
• Helps the project team to form strategies to
maximize outputs with minimal inputs.
• is crucial for accountability and reporting
purposes.
TYPES OF EVALUATION
1.FORMATIVE EVALUATION
This is generally conducted before the
project implementation phase.
But depending on the nature of the project,
it may also continue through the
implementation stage.
Its main purpose is to generate baseline
data to investigate the need for the
project.
2. SUMMATIVE EVALUATION
• This occurs immediately after project conclusion
to assess project efficacy and the instant changes
manifested by its interventions.
• Summative evaluation compares the actual
outcome data with baseline data to determine
whether the project was successful in producing the
intended outcomes
• It provides evidence of project success or failure to
the stakeholders and donors.
3. PROCESS EVALUATION
•It is conducted as soon as the
project implementation stage
begins.
•It assesses whether the project
activities have been executed as
intended and resulted in certain
outputs.
4. OUTCOME EVALUATION
•This type of evaluation is conducted
once the project activities have been
implemented.
•It measures the immediate effects or
outcomes of the activities in the
target population and helps to make
improvements to increase the
effectiveness of the project.
5. IMPACT EVALUATION
•Impact evaluation assesses
the long term impact or
behavioral changes as a
result of a project and its
interventions on the target
community or population.
6. REAL TIME EVALUATION
It is often conducted during
emergency scenarios, where
immediate feedback for
modifications is required to
improve ongoing
implementation.
7. PARTICIPATORY EVALUATION
• This type of evaluation is conducted
collaboratively with the beneficiaries,
key stakeholders and partners to
improve the project implementation.

• Participatory evaluation can be empowering

for everyone involved as it builds capacity,
consensus, ownership, credibility and joint
support.
8. META
EVALUATION
• This is used to assess the evaluation
process itself.
• Meta-evaluations could be useful to
make a selection of future evaluation
types, check compliance with evaluation
policy and good practices, assess how
well evaluations are utilized for
organizational learning and change, etc.
MONITORING TOOLS
• Monitoring tools allow you to track
progress, identify challenges, and assess
the implementation of a program or
project.
• These tools can include;
1.key performance indicators (KPIs)
2.Dashboards
3.Checklists
1. KEY PERFORMANCE INDICATORS
(KPIs)
• KPIs are quantitative measures used to
track progress and assess the
performance of a program or project.
• Examples of KPIs include;
Budget spent
Number of participants
Number of training sessions
Number of products sold.
2. DASHBOARDS
•Dashboards are interactive
visualizations that provide a quick
overview of critical data and
performance metrics.

•Identify trends in real-time and can be

accessed from anywhere with internet
access.
3. CHECKLIST
•Checklists are simple lists
of tasks or activities that
must be completed to ensure
that a program or project is
being implemented correctly.
EVALUATION
TOOLS
• Evaluation tools allow you to collect and
analyze data to assess a program or
project’s;

Effectiveness
Efficiency
Impact
Relevance.
EVALUATION TOOLS
• These tools can include;
1.Surveys
2.Questionnaires
3.Interviews
4.focus groups
5.case studies
6.observational techniques.
1. SURVEYS
Surveys are evaluation tools that
can be used to gather a large amount
of data from a number of people.
Surveys can be conducted online, by
phone, or in person and can include
questions on various topics, including
attitudes, behaviors, and opinions.
2. INTERVIEWS
 Interviews are a qualitative
evaluation tool that allows for
in-depth topic exploration.
 Interviews can be
conducted with individuals or
groups and structured or
unstructured.
3. FOCUS GROUPS
•Evaluation method involving
bringing a small group of
people together to discuss a
specific topic.
•Focus groups can be useful for
gaining a more in-depth
understanding of a particular issue
or perspective.
4. CASE STUDIES
• Case studies are a form of
qualitative evaluation that involves
an in-depth examination of a specific
individual, group, or program.
•Case studies are useful in exploring a
particular issue, program, or
intervention.
5. OBSERVATIONAL TECHNIQUE
•Observational techniques are a form
of qualitative evaluation that involve
observing people in their natural
setting.
•This can include direct observation,
video recording, or participant
observation.
Change and change management
 Change is fundamental in order to guarantee
long term success in the organization.

Some organizations change in response to

external circumstances (reactive change) and
others change because they have decided to
change (proactive change).
• a. Definition of change -To change something
implies altering it, varying or modifying it in
some way.
• It is also the process of moving from one system
to another.
• It is also the process of making
something different from what it was.
• Also change is any shift in status from
an undesirable current status to a desirable
future status.
b.Types
Typesofofchange
change
• Planned change (pro-active change): Results from
deliberative, collaborative effort to improve system
operations and facilitate acceptance of the
improvement by involved parties
• Unplanned /accidental change (reactive
change): Unplanned change is defined as a necessary
action following unexpected events. An unplanned change
cannot be predicted but can be dealt with by effective change
management.
c. The change process (planned change)
Change is a continual unfolding process
rather than an event.
The process begins with the present state,
moves through a transition period then
comes to a desired state once the desired state
has been reached the process begins again.
The change process is very similar to the
problem solving process and involves :-
The change process
1.Assessment
At this stage, problem or opportunity for
change is identified.
Data about change is collected from both
internal and external sources and then analyzed.
Data analysis should support both the need for
change and the potential action selected
2. Planning:
During planning the change agent (WHO, WHEN,
HOW) determines who will be affected by change and
when change will occur.

Also all potential actions are examined which should

include how change will be implemented.

An evaluation tool to assess if the change met the

organizational goals is also constructed.
• 3. Implement the change:
• The plans are put into motion.

• Interventions are designed to gain the necessary

compliance.

• The change agent creates a supportive climate,

obtains and provides feedback and overcomes
resistance to change.
4. Evaluation:
Determine whether change is effective based on
outcomes (goals) identified during assessment and
using the evaluation method established during
planning.
The change agent determines whether presumed
benefits were achieved from a financial as well as
qualitative perspective
5. Stabilization:

•This is achieved by using policies

or procedures to make change the norm
rather than the innovation.

•Should occur as soon as possible to

complete the change process.
 d. Change theories
There are several theories that have been developed concerning
the change process. These theories are
I. Kurt Lewin force field theory
II. Lippitt’s phases of change
III. Rogers diffusions of innovations
IV. Bridges’ model of managing transitions
1.Kurt Lewin force field
theory
•Lewin provides a social psychological
view of the change process.

•He sees behavior as a dynamic balance of

forces working in opposing directions
within a field (e.g. an organization).
• He suggested that there is need to do an analysis
of change situations (which he referred as force
field analysis).
• This includes identifying the following
(i) Driving forces (behaviors’ that facilitate change
because they push participants in the desired
direction)
(ii) Restraining forces (behaviors that impede
change by discouraging participants from making
specified changes
•Therefore for change to be effective driving
forces must exceed restraining forces.

•To plan change one must analyze these forces

and shift the balance in the direction of change
through the following three step process:-
• Steps of change according to Lewin
1. Unfreezing the existing equilibrium:
Refers to the awareness of an opportunity,
need or problem for which some action is
necessary.

To unfreeze a status quo, a change agent

must increase driving forces or decreases
restraining forces in the situation.
•According to Lewin it involves motivating the
participants by getting them ready for
change, building trust and recognition for the
need to change.

•To actively involve the participants

in identifying problems and generating
solutions.
2.Move the target system to a new level
of equilibrium (moving):
This is done by getting the participants
to agree that the status quo is not
beneficial to them, encouraging them to
view the problem from a new perspective
and helping them scan the environment to
search for relevant information.

•3. Refreeze the system at the new level of
equilibrium:
•This involves reinforcing the new patterns of
behavior (e.g. rewarding for desired behavior).

•Reinforcement can also be done through formal

and informal mechanism (e.g. formulating
policies, establishing communication channels.
BRIDGES MODEL OF MANAGING TRANSITIONS

•The Bridges transition

model was developed by
William Bridges.
• Transition is the internal process that people
go through to adapt to the change, such as
letting go of the old, exploring the unknown,
and committing to the new.
•The Bridges transition model identifies three
stages of transition:
• 1. Ending, losing, and letting go
•2. The neutral zone
•3. The new beginning.
Bridges' Transition Stage 1: Ending,
Losing, and Letting Go
•People enter this initial stage of transition
when you first present them with change.

•This stage is often marked with resistance and

emotional upheaval, because people are
being forced to let go of something that they
are comfortable with or value highly.
STAGE 2: NEUTRAL ZONE
•It is the very core of the transition process.
•This is the time between the old reality and
the new one.
•People are creating new processes and
learning what their new roles will be.
•They may feel confusion and distress.
STAGE 3: NEW BEGINNINGS
•Beginnings are marked by a release of energy
in a new direction – they are an expression of
a fresh identity.
•Well-managed transitions allow people to
establish new roles with an understanding of
their purpose, the part they play, and how to
contribute and participate most effectively.
LIPPITT'S PHASES OF CHANGE
•Ronald Lippitt was a student and
later a colleague of, Kurt Lewin.
•There is the CLIENT
(ORGANIZATION) and the
CHANGE AGENT.
 Phase 1: Diagnosing the problem
•The creation of problem awareness and a
strong feeling in the client for a need for
change.

•The creation of at least some confidence

within the client that their situation can move
to a more desirable state.
Phase 2: Assessing motivation and capacity for change

•HOW MOTIVATED ARE THE

EMPLOYEES TO THE CHANGE?

•WHAT IS THEIR CAPACITY TO

CHANGE?
Phase 3: Diagnosing the
client system’s problem
•In this phase, the manager often
needs to cope with a broader and
more involved diagnosis of the
problem according to Lippitt.
Phase 4: Establishing alternative routes

• The client starts translating ‘the diagnosis’ into

possible routes forward. Alternative routes
forward are discussed between client and the
change agent.

• Motivation is important in choosing alternative

solutions and making a decision as to which one
would be best.
Phase 5: Transforming
intentions into actual efforts
to change
•So far, success is measured by
the extent to which plans and
intentions are translated into
actual action for change or
achievements.
 Phase 6: Stabilising
change
•Lippit rightly claims that one
critical factor in the
stabilization of change is
ensuring employees adapt the
change.
Phase 7: Terminal relationship

•The relationship
between the manager
and the change agent is
terminated.
•READ AND MAKE NOTES ON
ROGERS DIFFUSSION OF
INNOVATIONS & LIPPITT’S
PHASES OF CHANGE
e. Resistance to change
•Response to change varies from ready
acceptance to full blown resistance.
•Forces that oppose change are labelled
resistance.
•Resistance is anything that leads to delay or
additional costs to a change Programme. This
could be an extreme delay (non-starter) or
mild (a few months)
Reasons why people resist change

I. Fear of unknown: This is where the participants

wants the status quo because they are not sure of
what will happen when change has occurred.

II. When people do not know what is expected of

them either during the change process or
after change has occurred.
III. Parochial self-interests: This is
where people resist change because
of personal interest in expense of
organizational interests. May be they
fear that they might loose their
position if change occurs.
•IV. lack of information about what the
change entails and the implication of
change.

•V. Mistrust: This occurs especially when

people don’t trust the leaders. They might
assume that their leaders could be having
a hidden agenda e.g. layoff of employees.
 f. Measures of dealing with
resistance to change
I. Communication with employees; Speak in
person and privately with those who oppose the
change. Get to the root of their reasons for the
opposition.
II. Educate the people; emphasize the goals of
change and how the individual or groups will
benefit. Clarify information and provide accurate
feedback.
•III. Facilitation: This can be done by
providing the resources required. The change
agent should also maintain a climate of
support and confidence.

•IV. Involve people affected by change: The

change agent should be open to suggestions but
clear about the overall purpose and goals. Do
not compromise on the intended outcome.
V. Negotiation; It is also important to discuss the
consequences of resistance e.g. compromised patient care
or closure of the organization so that the participants can
see the importance of change.

VI. Manipulation: This method can be used by

rewarding those who have accepted change so that
those who are resisting can see there are some benefits
and comply.
VII. Coercion: This by threatening people who resist
change and therefore they comply out of fear.
DELEGATI
ON
DELEGATION
•It is the process by which responsibility and
authority for performing a task is transferred
to another individual who accepts that
authority and responsibility.
•The delegator remains accountable and
responsible for the tasks.
PRINCIPLES FOR EFFECTIVE DELEGATION

I. Grant proper amount of authority: Authority should

not be less than responsibility delegated.
II. Define the results expected: Delegator must define
results expected (don’t give ambiguous instructions).
III. Consider the capabilities of the subordinates:
While delegating consider the background, experience,
intelligence, training and the limitations of the delegate
IV. Make sure authority is clearly stated:
Everyone must know who is in charge and
where authority rests.

V. Modify authority whenever necessary:

Authority is always revocable or subject to
modification and can be increased or decreased or
even withdrawn altogether (depending on
situations and also environment).
• VII. Develop a willingness to delegate:
Managers lack confidence in their staff, fear
to loose control. Let go and let others make
mistakes if delegation is to work.

• VIII. Create a supportive climate. Give moral

and material support. Provide advice and
encouragement continuously
• IX. Develop effective communication system. There
should be free flow of communication between
superior and subordinates for subordinates to seek
clarification and guidance from superior.

• XI. Appropriate incentives: Suitable financial and

non-financial incentives should be provided to reward
subordinates for successful assumption of authority
and completion of responsibility
Steps involved in delegation
process
STEP 1: Decide what to delegate:
•Delegate only an aspect of your work for
which you have responsibility and
authority. You need to define the nature
of the task.
• In defining the nature of the work you need
to ask yourself the following questions
a) Does it involve technical skills or
special knowledge
b) Are specific qualifications necessary?
c) Is the delegation of this task restricted by
scope of practice, standards or
job descriptions?
•d) How complex is the task.
•e) Is training or education required?
•f) Is the task required to be done in a
particular way or is there
room for creativity.
•g) Would a change in circumstance
affect who could perform the task.
STEP 2: DECIDE ON THE DELEGATEE
• Match tasks to the individual.
• Analyze the person’s abilities to perform various
tasks to be delegated and determine.
• Delegate to the person next in the hierarchy who
has the requisite capabilities and who is legally
allowed to do the task and also by organizational
policy.
STEP 3:DEFINE THE
TASK/COMMUNICATE
• Clearly define your expectations to the delegatee.
• Plan your meeting with the delegatee .
• Provide enough time to describe the task and your
expectations and to entertain questions.
• Communication should be clear and complete.
STEP 4: REACH AN AGREEMENT

•After outlining your expectation

you must be sure that the
delegatee agrees to accept
responsibility and authority for
the task.
STEP 5: MONITOR PERFORMANCE
AND PROVIDE FEEDBACK
•Monitoring performance provides
mechanism for feedback and control
that ensures that delegated tasks are
carried out as agreed.
BENEFITS OF DELEGATION
• To the delegator
üdevote more time to these tasks that cannot be delegated.
With more time,
üdevelop more skills and abilities facilitating the opportunity
for career advancement.
üImprove interpersonal relationship with subordinates,
üProvides continuity of work in the delegator’s absence and
offers ready replacement.
BENEFITS OF DELEGATION
•To the delegatee,
ügains new skills and abilities that can
facilitate upward mobility.
üDelegation also brings trust and support
thereby building self-esteem and confidence.
üJob satisfaction and motivation are also
enhanced as individuals feel stimulated by
new challenges.
üMorale improves a sense of pride, develops
greater awareness of responsibility and
individuals feel more appreciated and
learn to appreciate the roles and
responsibilities of others
BENEFITS OF DELEGATION
• To the Organization:
üorganization is able to achieve its goals more
efficiently due to team work,
üovertime and absences decrease and productivity
increases and at the same time organization’s financial
position may improve.
üAs delegation increases efficiency, the quality of care
improves and hence patient’s satisfaction
 HEALTH
INFORMATIO
N SYSTEM
INTRODUCTION
• Health information refers to data related
to individuals' medical history, diagnoses,
treatments, and outcomes.

• It includes information gathered from

healthcare providers, insurance
companies, public health agencies, and
patients themselves.
 Sources of health information
• Healthcare Facilities: Hospitals, clinics, pharmacies,
and laboratories.
• Health Professionals: Physicians, nurses,
pharmacists, and other healthcare providers.
• Patients: Self-reported data, including symptoms,
medical history, and lifestyle factors.
• Insurance Companies: Claims data, billing records,
and coverage information.
• Public Health Agencies: Surveillance data,
epidemiological studies, and health surveys
 Types of health information
• Clinical Data: Patient health records, including
diagnoses, treatments, medications, and laboratory
results.
• Administrative Data: Billing records, insurance
claims, and demographic information.
• Population Health Data: Epidemiological data,
public health surveillance, and health behavior
surveys.
• Research Data: Data collected for clinical trials,
observational studies, and health outcomes research.
Types of Health Information
Systems
1.Electronic Health Record
(EHR)/Electronic Medical Record (EMR):
These systems store individual patient
health information digitally, including
medical history, diagnoses, medications,
treatment plans, immunization dates,
allergies, radiology images, and laboratory
test results.
2. Hospital Information System (HIS):
This system manages
administrative, financial, and clinical
aspects within a hospital or
healthcare facility.
It includes patient registration,
appointment scheduling, billing,
inventory management, and clinical
documentation.
3. Public Health Information System:
Focused on population health management,
these systems collect and analyze data related
to disease surveillance, epidemiology,
immunization records, and health promotion
activities.

4. Health Information Exchange (HIE):

HIE facilitates the electronic sharing of health-
related information among different healthcare
organizations, enabling seamless exchange of
patient data across systems and providers.
 Data collection methods
• Electronic Data Capture: Direct entry of data into electronic
systems such as EHRs and surveys.
• Health Surveys: Questionnaires administered to individuals or
populations to gather health-related information.
• Clinical Assessments: Physical examinations, laboratory
tests, and diagnostic procedures conducted by healthcare
professionals.
• Claims and Billing Data: Information collected during
healthcare billing processes, including diagnoses, procedures,
and costs.
• Wearable Devices and Sensors: Devices such as fitness
trackers and medical sensors that collect data on activity
levels, vital signs, and other health metrics.
PREPARATION
FOR
EMPLOYMENT
PREPARATION FOR EMPLOYMENT;

1.Writing a cover letter

2.Writing a curriculum vitae
3.Preparation for an
interview
COVER
LETTER
• The first paragraph of your cover letter is to
make the employer feel special.

• Writing, “I’m applying to this position because I

saw it” is a lot like approaching somebody with
a line of,

• “You’re single, I’m single and both live in

the same city. We should go out on a date.”
• How bad does that sound?
•To catch somebody’s interest, you should
hook them with a line that makes them
feel unique.

•The goal here is to tell the employer

you have eyes on them specifically
and they are not simply another fish in
the job posting sea.
What is a cover letter?
•A cover letter is also known as an
application letter
•It is a three- to four-paragraph
memo to employers explaining your
interest in the job and company
and your fitness for the role.
•It's typically submitted along with your
CV in a job application .
•Its purpose is to introduce
you and briefly summarize
your professional background.

•On average, your cover letter

should be from 250 to 400
words long.
•A well-written cover letter has the
potential to impress employers and
set you apart from other applicants.

•You should conduct in-depth

research on the company and role for
which you're applying to before writing
your cover letter.
What to consider before writing a
cover letter
1. Think about your experiences
and how you would like to relate
these experiences to a hiring
employer.
What talents, skills or
accomplishments would you like the
company to know?
For example;
•Communication.
•Community service.
•Teamwork.
•Leadership.
•Problem-solving.
•Time management.
•Adaptability.
2. Think about how you learned
about the job opportunity.
If it's a personal contact, jot down
the person's name and title.
If it was an advertisement, write
down where and when you saw it
and list any specific instructions
noted in the job description.
3. Think about the company you're
writing to and what drew you to it.
Do you admire its culture or brand?
Are its reviews positive or negative?
Research the company to see if you
agree with its mission statement and
vision.
4. Think about who you are
writing to.
If it's a specific person, address
them by name and title.
If not, consider addressing the
cover letter to "Dear Hiring
Manager" or "Dear Human
Resources."
N/B
• Your cover letter is your chance to share
your story, personality and strengths.
• Don't forego a cover letter in your rush to
submit an application.
• Taking time to write a cover letter is an
indication that you're interested in the
position and organization and are willing to
go above and beyond for a great
opportunity.
Cover letter format
1.Header with date and contact
information
2.Salutation or greeting
3.Opening paragraph
4.Middle paragraph(s)
5.Closing paragraph
6.Letter ending and signature
1. START WITH THE HEADER
•As with any
standard business letter header, you
should include a few pieces of
personal and role-specific
information at the top of your cover
letter to make it easier for a hiring
manager or recruiter to follow up with
you.
Header contains;
Your name
Your phone number
Your email address
Date
Name of recipient
Title of recipient
Company name
Company address
2. Include a greeting
•In your research, try to find the name
of the person reviewing applications
for the job.
• Address your letter to this person with
a common business greeting, such
as "Dear [first and last name]" or "Dear
[position title]." Avoid using "To whom it
may concern."
Greetings example;
•Dear Hiring Manager,
•Dear Tyler Wallace,
3. Write an opening paragraph
In the first paragraph, BE DIRECT; mention
the job title you're applying for and where you
saw the position posting.
Explain your interest in the role and company
to show you've done your research.
The first section of your cover letter is also
the first impression the reader will have of
you, so it's important to appeal to that
person quickly.
Tip #1; Show passion and
commitment
•Showing the hiring manager
that you’re passionate about
the job will instantly boost your
chances of getting hired. It’s not
a secret that committed
employees are more engaged
and, therefore, more productive.
Opening paragraph with passion
• I am writing to express my deep enthusiasm for the
Registered Nurse position at [Hospital/Clinic Name]
as advertised. Nursing isn't just a profession for
me; it's a calling that fuels my passion for providing
compassionate care to those in need. From a young
age, I've felt a profound sense of purpose in
helping others navigate their health journeys, and
I've dedicated my career to honing my skills and
knowledge to make a meaningful difference in
patients' lives.
Without passion
•I am writing to apply for the
Registered Nurse position at
[Hospital/Clinic Name] that I saw
advertised. I have recently completed
my nursing course and am keen to
start my career in a reputable
healthcare facility like yours.
TIP #2 ; MENTION A MUTUAL CONTACT
• If someone referred you to the position, the
opening paragraph of your cover letter is a
great place to mention that.
• Referrals are key to securing an interview, so
take the opportunity to let the recruiter know
at the start of your cover letter.
• The idea is that if someone the hiring manager
knows recommended you for the position, your
skills and qualifications immediately become
more credible.
TIP #3; PROVE THAT YOU HAVE
RESEARCHED THE COMPANY
The recruiter reading your cover letter wants to
know that you’re excited to be applying for that
particular company, and you’re not just applying
to dozens of jobs randomly, hoping that one will
stick.
• As such, it’s very important to do some research
about the company you’re applying for, and in
the cover letter, mention why you’re a good
culture fit.
TIP #4; LEAD WITH AN
ACHIEVEMENT
•There’s no better way to grab
attention than to lead with an
achievement.
•It immediately gives you
credibility and makes the hiring
manager curious to read more
about you.
Tip #5; Be direct
•Oftentimes, beating around the bush
gets you nowhere. So, a great
strategy to follow when you start
writing your cover letter is to just be
direct about the position you’re
applying for and the reasons you
believe make you the perfect fit
for the job.
4. ADD A SECOND PARAGRAPH
• Your second paragraph should be a brief
overview of your background as it relates to
the position.
• Include key achievements, skills and
specialties that make you particularly suited
to the position.
• Focus on one or two and provide specific
details about your success, including
measurable impacts you made.
 5. Finish with a closing
•
paragraph
Thank the recipient for
considering you for the position.
•State that you would appreciate
an interview for the opportunity
and to discuss how you could
benefit the company.
Example ;
• "Thank you for your time and consideration. I look
forward to learning more about the sales position
and TradeLot. Growth is essential to my continued
success, and I'm excited for the chance to be a part
of TradeLot's industry-leading team. My proven
track record and TradeLot's quality products are a
winning combination for increasing the company's
market share.
• Sincerely,
Malik Rabb
1 ST
PARAGRAPH
• First Paragraph:
Indicate your reason for writing.
Name the position you are applying for and how
you found it.
Introduce how you think you will be a good fit
based on your skills and experience.
The goal for the cover letter is to compel the
reader to look at your resume.
 2 nd
PARAGRAPH
• Second Paragraph:
Elaborate on your skills, experience,
achievements, and traits that this specific
employer is looking for in a candidate for this
specific position.
Use key words from the listed job analysis that
you meet and give examples. Don’t repeat your
resume.
3 RD
PARAGRAPH
•Third Paragraph:
Thank the recipient for considering you for
the position.
State that you would appreciate an interview
for the opportunity and to discuss how you
could benefit the company.
Regards (or Sincerely), (signature) Your name
N/B : Proof read before you submit
• Reread your cover letter several times before
submitting it and keep an eye out for spelling, grammar
or punctuation errors.

• Reading it aloud can help you pick out awkward phrasing

or too-long sentences. We all tend to gloss over errors, so
do a slow, deliberate reading that examines each word.

• If your salutation includes the hiring manager's name,

triple-check the spelling.
CURRICUL
UM VITAE
DEFINITION
•A CV—short for the Latin
“curriculum vitae,” meaning
“course of life”—is a detailed
document highlighting your
professional and academic
history.
SECTIONS CONTAINED IN A CV
Contact information
Personal statement
Work experience
Educational history
Skills
Other optional sections, including languages,
projects, volunteering experience etc
1. CONTACT INFORMATION

1.Name
2.Professional job title
3.Email address
4.Phone number
5.Location
Professional-tip
•Use a professional email
address, something like [first
name]+[last name]@gmail.com.

•Avoid silly nicknames, gamer

tags, or whatever else in your
email address.
2. PERSONAL STATEMENT
•Your personal statement is
a short, 50-100 word pitch
of your professional and
educational career, and it
goes right on top of your
CV:
•The personal statement can be
written in 2 ways:
As a CV Summary - Focused more
on your work experience and
achievements.
As a CV Objective - Focused on
your aspirations, goals, skills, and
educational background (instead of
work experience or achievements).
•If you have any practical work
experience, you’d go for a CV
summary, as your experience sells
you better as a candidate than your
education or goals.

•You’d only pick a CV objective if you

either don’t have any work experience
or if you are switching industries or
professions.
3. WORK EXPERIENCE
• Format your CV work experience section as follows:
Start with your most recent job, and work your way
back.
For each work experience entry, start with the position
title.
Under the title, list out the following: name of the
company, dates worked.
Finally, mention 4-6 responsibilities or achievements for
each position.
• We recommend sticking to 3-4 of your last positions
(and not your entire career history).
PRO-TIP
• When it comes to work experience, we
recommend focusing on achievements instead
of responsibilities.

• The recruiter knows exactly what your

responsibilities were - they’re hiring for the
role, after all. What’s going to make you stand
out in their book are your achievements (or,
how you stood out from the rest of your
peers).
4. EDUCATIONAL HISTORY
•Format your educational
history in the following order:
Course name.
College name.
Study timeframe.
Courses taken (optional)
Pro-tip
•If you have any work experience,
put your work experience
section on top of education.
•If you’re a recent graduate,
though, do it the other way
around.
5. SKILLS
•Listing your skills on a CV
is relatively
straightforward - just
create a section named
“Skills,” and list them out.
1. Hard skills
• Hard skills are the discrete, measurable skills you
possess.
• With nursing, hard skills come into play for much of
your nursing school education.
• You have learned all about the patient care skills
like;
assessing patients
giving medications
treating injuries
Using nursing care plan
N/B
•Including your hard skills in
patient care shows employers
that you have mastered your
core nursing skills, which
makes your resume
impressive.
2. Soft skills
•It may seem like hard skills are the
most important for keeping your
patients safe, but possessing soft
skills is also vital for comforting and
caring for them.
•Furthermore, these soft skills ensure
you work well within a hospital team.
6. OTHER OPTIONAL
SECTIONS
• The optional sections you can include on your resume
include:
Awards & Honors
Projects
Certificates
Extracurricular Activities
Hobbies & Interests
Professional Organizations
Languages
Volunteering Experience
Teaching Experience
Pro-tip
•More often than not,
the first 5 essential
sections are enough
to make a convincing
CV.
HOW TO PREPARE FOR A JOB
INTERVIEW
•The job interview is probably the
most important step you will take
in your job search journey - it’s
your best chance to show the
hiring manager or
recruitment company that you’re
the best person for their job.
Knowing how to prepare for a job interview begins
with the following:

1.Reviewing the job description

2.Thoroughly researching the company
3.Thinking about what you will wear
4.Planning your journey to the interview
5.Preparing for questions you will be asked
6.Preparing your own questions for the em
ployer
1. REVIEWING THE JOB DESCRIPTION
•The first step in the preparation
process should be to go back and
review the JOB DESCRIPTION AND
JOB SPECIFICATON;
Job title/Department
Duties and tasks
Skills required
Experience
•Read and review the job
description very thoroughly and be
sure to align your competencies
with the skills required for the job.
•You will consequently ready
yourself for questions around your
previous experiences, performing
similar duties in other
organizations.
2. RESEARCH THE COMPANY
• Organizations look to hire people with similar
values to those of the company culture.
• Researching the company before an
interview will give you an insight into the
organisation's future goals and plans,
mission and vision statements and being
able to discuss these points will make you
seem like a long-term investment to your
future employer.
3. WHAT TO WEAR TO A JOB INTERVIEW
• When it comes to a job interview, first
impressions count and being able to
dress to impress will go a long way to
help secure your dream job.
• Although it might seem quite natural to
put on your best suit, skirt or dress for
the interview as though you already
work there, there are more elements to
take into consideration.
•You want to look ready to step into the
role you’re seeking.
•Being able to answer questions and
concentrate during an interview is
important, so wear an outfit you feel
comfortable in.
•Be sure to check the weather the night
before and have a couple of outfits
ready just in case the day looks like it
might be hot or cold.
What women should wear to a job
interview
1. Clothing:
Make sure you wear a professional and
clean shirt or blouse without a deep
neckline.
If you wear a skirt, be sure that the skirt is
no shorter than two inches above the knee.
Don’t forget to put on tights or stockings
under your skirt. Alternatively, wear a pair
of trousers.
2. Colours:
 If you’re going for an interview with a
very corporate company, more muted
tones would be better suited to the
formal environment.
Black and dark blue are the ideal
business colours, grey or brown are also
good options.
But don’t combine more than three
colors and two patterns.
3. Shoes:
Open shoes like flip-flops or sandals
are a no-go for a job interview.
4. Jewellery:
Stay away from too much jewellery
such as large necklaces and bangles,
as too much clanging can cause
unnecessary distraction. Be sure to
only wear subtle earrings.
5. Make-up: Don’t overdo the
make-up, keep it conservative
and natural looking and just a
light touch of perfume.

6. Tattoos and piercings: Cover

your tattoos and remove facial
piercings.
WHAT MEN SHOULD WEAR TO A JOB
INTERVIEW
1.Clothing:
Put on a clean crisp suit. Wear
a clean, long-sleeved white
shirt and clean jacket. Be sure
to have freshly pressed pants.
2. Tie:
Accessorise with a modest tie.
Make sure your belt is matched to the colour of
your shoes and the buckle is not too prominent.
3. Colours:
Wear a business shirt of a solid colour, preferably
white.
Complete the outfit with a dark blue, black or
charcoal two or three-piece suit.
Make sure your tie is subtle in colour and design.
4. Shoes: Wear shoes that have been polished and
make sure they are clean. Try to match the colour
of your socks to your suit.

5. Accessories: Wear a conservative belt and tie.

When it comes to perfume and aftershave, less is
best. The last thing you want is to be remembered
for your cologne and not your answers.

6. Tattoos and piercings: Be sure to cover your

tattoos and remove facial piercings.
4. PLANNING YOUR JOURNEY TO THE
JOB INTERVIEW
• When preparing for a job interview one of
the most important things to consider is how
you are going to get there.
• A failure to plan is a plan to fail.
• If you are planning on driving to the
interview, make sure you fill your car with
fuel the night before. You don’t want to be
filling up on the way dressed in your suit.
•Make sure you arrive on time, or
better yet, at least 15 minutes
early.
•Ensure this by knowing the
address and if you can, have a trial
run a couple of days before.
•Go to bed early the night before
and wake up early to give yourself
plenty of time.
5. HOW TO ACT IN AN INTERVIEW

•It's not just what

you do, it's also
what you say, and
how you say it.
COMMON INTERVIEW QUESTIONS
AND ANSWER
• The most important part of preparing for an
interview is practicing how to answer
interview questions you might be asked on
that day.

• Knowing the most common types of job

interview questions is an advantage - that
way, you can craft your answers well in
COMMONLY ASKED INTERVIEW
QUESTIONS
•Tell us about yourself
•How did you hear about this position?
•Why do you want to work here?
•Why did you decide to apply for this position?
•What are your strengths and weaknesses?
•What do you know about this company/organization?
•Why should we hire you?
•What is your greatest accomplishment?
•What are your salary requirements?
•Do you have any questions for us?
Tell us about yourself
•Briefly introduce yourself: What’s
your name? How long have you been
working as [profession]?
•What do you love about your job?
•What are your top 2-3 achievements
that are relevant to the job you’re
applying for?
6. HOW TO FOLLOW UP ON AN
INTERVIEW
 The next part of the process is just as

important, if not more so.

In today's competitive job market it's

imperative you
follow up your initial job interview with
a thank-you email to reiterate your
interest in the role.
DELEGATI
ON
DELEGATION
•It is the process by which responsibility and
authority for performing a task is transferred
to another individual who accepts that
authority and responsibility.
•The delegator remains accountable and
responsible for the tasks.
PRINCIPLES FOR EFFECTIVE DELEGATION

I. Grant proper amount of authority: Authority should

not be less than responsibility delegated.
II. Define the results expected: Delegator must define
results expected (don’t give ambiguous instructions).
III. Consider the capabilities of the subordinates:
While delegating consider the background, experience,
intelligence, training and the limitations of the delegate
IV. Make sure authority is clearly stated:
Everyone must know who is in charge and
where authority rests.

V. Modify authority whenever necessary:

Authority is always revocable or subject to
modification and can be increased or decreased or
even withdrawn altogether (depending on
situations and also environment).
• VII. Develop a willingness to delegate:
Managers lack confidence in their staff, fear
to loose control. Let go and let others make
mistakes if delegation is to work.

• VIII. Create a supportive climate. Give moral

and material support. Provide advice and
encouragement continuously
• IX. Develop effective communication system. There
should be free flow of communication between
superior and subordinates for subordinates to seek
clarification and guidance from superior.

• XI. Appropriate incentives: Suitable financial and

non-financial incentives should be provided to reward
subordinates for successful assumption of authority
and completion of responsibility
Steps involved in delegation
process
STEP 1: Decide what to delegate:
•Delegate only an aspect of your work for
which you have responsibility and
authority. You need to define the nature
of the task.
• In defining the nature of the work you need
to ask yourself the following questions
a) Does it involve technical skills or
special knowledge
b) Are specific qualifications necessary?
c) Is the delegation of this task restricted by
scope of practice, standards or
job descriptions?
•d) How complex is the task.
•e) Is training or education required?
•f) Is the task required to be done in a
particular way or is there
room for creativity.
•g) Would a change in circumstance
affect who could perform the task.
STEP 2: DECIDE ON THE DELEGATEE
• Match tasks to the individual.
• Analyze the person’s abilities to perform various
tasks to be delegated and determine.
• Delegate to the person next in the hierarchy who
has the requisite capabilities and who is legally
allowed to do the task and also by organizational
policy.
STEP 3:DEFINE THE
TASK/COMMUNICATE
• Clearly define your expectations to the delegatee.
• Plan your meeting with the delegatee .
• Provide enough time to describe the task and your
expectations and to entertain questions.
• Communication should be clear and complete.
STEP 4: REACH AN AGREEMENT

•After outlining your expectation

you must be sure that the
delegatee agrees to accept
responsibility and authority for
the task.
STEP 5: MONITOR PERFORMANCE
AND PROVIDE FEEDBACK
•Monitoring performance provides
mechanism for feedback and control
that ensures that delegated tasks are
carried out as agreed.
BENEFITS OF DELEGATION
• To the delegator
üdevote more time to these tasks that cannot be delegated.
With more time,
üdevelop more skills and abilities facilitating the opportunity
for career advancement.
üImprove interpersonal relationship with subordinates,
üProvides continuity of work in the delegator’s absence and
offers ready replacement.
BENEFITS OF DELEGATION
•To the delegatee,
ügains new skills and abilities that can
facilitate upward mobility.
üDelegation also brings trust and support
thereby building self-esteem and confidence.
üJob satisfaction and motivation are also
enhanced as individuals feel stimulated by
new challenges.
üMorale improves a sense of pride, develops
greater awareness of responsibility and
individuals feel more appreciated and
learn to appreciate the roles and
responsibilities of others
BENEFITS OF DELEGATION
• To the Organization:
üorganization is able to achieve its goals more
efficiently due to team work,
üovertime and absences decrease and productivity
increases and at the same time organization’s financial
position may improve.
üAs delegation increases efficiency, the quality of care
improves and hence patient’s satisfaction