MANAGEMENT PRINCIPLES for HEALTH CARE SERVICES

MANAGEMENT PRINCIPLES for HEALTH CARE SERVICES
Shortell and Kaluzny PROGRAM PASCA SARJANA IKM-FK UGM

LEARNING OBJECTIVES Memahami organisasi pelayanan kesehatan sebagai suatu sistem dan para manajer di dalamnya Memahami aspek manusia dalam melakukan perencanaan, pengorganisasian, pelaksanaan dan pengendalian upaya kesehatan; Memahami berbagai isu dalam pelaksanaan program. Memahami kebutuhan strategis agar lembaga pelayanan dapat hidup dan berkembang.

Memperbarui Organisasi Merencanakan Masa Depan
Organisasi dan Manajer -Teori Organisasi dan Manajemen Pelayanan Kesehatan (Bab 1) Peran Manajer (bab 2) Memotivasi dan Memimpin Orang serta Kelompok Menjalankan Sistem Teknis Memperbarui Organisasi Merencanakan Masa Depan Memenuhi Kebutuhan dan Nilai-nilai Individu Memotivasi Orang Lain (Bab 3) Memberi Arah Kepemimpinan: Sebuah kerangka kerja bagi pemikiran dan tindakan Mendorong Kerjasama Manajemen Konflik dan Negoisasi (Bab 5) Menentukan Kelompok Kerja dan Desain yang Tepat Kelompok dan tim dalam organisasi Pelayanan Kesehatan (Bab 6) Desain Kerja (Bab 7) Menetapkan Mekasnisme Komunikasi dan Koordinasi Koordinasi dan Komunikasi (Bab 8) Menggunakan Pengaruh Kekuatan dan Politik dalam Organisasi Pelayanan Kesehatan (Bab 9) Menentukan Desain Organisasi yang Tepat Desain organisasi (bab 10) Mendapatkan Sumber Daya dan Mengelola Lingkungan Mengelola Aliansi Strategis (Bab 11) Mengelola Perubahan dan Inovasi Inovasi, Perubahan dan Pembelajaran organisasi (Bab 12) Mencapai Sasaran Kinerja organisasi: Pengelolaan demi Efisiensi dan Efektifitas (Bab 13) Mengelola secara Strategis Penyusunan Strategi dalam Organisasi Perawatan Kesehatan (Bab 14) Mengantisipasi Masa Depan Menciptakan dan Mengelola Masa Depan (Bab 15)

CHAPTERS               

Organization Theory and Health Services Management
CHAPTER 1 Organization Theory and Health Services Management

Learning Objectives 1 : Identify the major forces affecting the delivery of health services. Understand how these major forces affect the role of the health service manager. Identify some of the commonalities and differences among major types of health services organizations. Identify and understand the basic processes that must be accomplished by any organization. Identify and understand the different units of analysis associated with studying organizations. Identify, understand, and apply the major perspectives on organizations to real problem facing health services organizations.

OVERVIEW Keadaan Ekonomi, Politik, Sosial dunia yang selalu berubah membawa Continuos Paradigm Shift terhadap sektor pelayanan kesehatan. Kompleksitas Pelayanan Kesehatan sendiri semakin menambah kebutuhan akan MANAJEMEN

Organisasi Dibutuhkan untuk membuat proses pelayanan kesehatan bekerja secara efektif dan efisien dengan cara membawa greatest value. Membawa kerangka berpikir baru dalam mensikapi perubahan dalam pelayanan kesehatan

Klasifikasi Organisasi Pelayanan Kesehatan
Health Maintenance Organizations Home Health Care Agencies Hospitals Pharmaceutical Companies

Health Services Organizations as a systems
Based on Process : Production Boundary Spanning Maintenance Adaptation Management Governance

Units of Analysis Environment E n v I r o m e t E n v I r o m e t
Inter organizational Organization Group / Department Individual Environment

Organizations Theory  Bureaucratic Theory  The Scientific Management School  Human Relations School  Contingency Theory  Resources Dependence Theory  Strategic Management Perspectives  Population Ecology Theory  Institutional Theory

Bureaucratic Theory Merupakan pendekatan Closed System Organizations dengan 5 Karakter dasar : Guided by explicit specific procedures for governing activities Activities distributed among officeholders Hierarchical Fashion Candidates selected by their technical competencies Impersonal Fashion

The Scientific Management School
Has Characteristics : Span of Control Unity of Command Appropriate Delegation of authority Departmentalization Improving efficiency in work methods

Human Relations School
Focused on Individual, The Characteristics : Greater Autonomy Support with trainings to employee Problem Occurred : How to make Top and Middle Manager trust his employee to do the job Right

Contingency Theory Look an Organization as a Mechanic or Organic depends on the External Environment needs. A subunit in an Organization allowed to be managed differently (Mechanic or Organic)

Resource Dependence Theory
Focused on the Importance of Organization in securing needed resources in order to survive. Forming certain coalitions to pool resources and reduce transaction costs

Strategic Management Perspective
Focused on the importance of positioning organization relative to its environment in order to survive. This Perspective try to link environmental forces and internal organization design.

Population Ecology Theory
Focused on population of Organization. Organization can Achieve Success when they can build a relationship to population of competitors and overall environmental forces influencing the population.

Institutional Theory Organizations are faced with environments characterized by external norms, rules, requirements to which the organizations must conform in order to receive legitimacy and support

Discussion Questions 1 Bila Anda memiliki wewenang didalam program peningkatan kualitas Kaiser Permanente’s, Pendekatan teori organisasi yang mana yang paling cocok untuk itu ? Selama dekade terakhir ini, ada lebih dari 100 RS yang ditutup sementara beberapa ratus lainnya di reorganisasi. Cobalah diskusikan mengapa keadaan ini terjadi! (lihat debate time 1.1) Dengan melihat pendapat bahwa organisasi kesehatan sebagian besar hampir identik dengan organisasi lain, setujukah anda, diskusikanlah !

CHAPTER 2 THE MANAGERIAL ROLE

Learning Objectives 2 Understand historical perspectives on the managerial role and their underlying concepts. Recognize the managerial challenges posed by changes in the external environment and within health care organizations. Understand the changing roles of managers in providing vision and leadership, adapting the organization to its environment, and designing the organization to enact its mission and to achieve its objectives. Recognize changing skiklls and knowledge required by managers in light of environmental and organizational dynemics

Conceptions of Managers
Traditional Conception Political-Personal Conception Organizational Conception

Traditional Conception
Functional model Assumes that basic management function will be performed in any organizations, and they represent the key contribution of management. Human Relations Has its Central Theme the motivation of individuals to the achievement of organizational ends

Political-Personal Conception
Emphasizes the centrality of power and personal tactics in understanding the managerial role.

Organizational Conception
More Complex view, by taking into account factors both within the organization and its environment and considering their respective effects.

The New Managerial Challenges
Cost Efficiency Quality Improvement Greater Accountability in delivering services Turbulence environment Interorganizational Complexity

New Roles For Managers Leader Designer Strategist

Discussion Questions 2 Cobalah deskripsikan apa yang dilakukan oleh manajer dalam organisasi pelayanan kesehatan, dari fungsi, tugas, sasaran, dan pengetahuan serta keahlian yang dibutuhkan! Apakah hal-hal seperti mengadaptasikan lingkungan, menentukan visi, misi, merancang organisasi merupakan hal yang sama-sama perlu untuk dilakukan? Cobalah pikirkan kekuatan dan kelemahan anda! Seberapa pentingkah menurut anda bahwa manajer harus cukup menguasai semua aspek manajemen? Bagaimana menurut anda manajer harus bersikap menghadapi persaingan dimana dalam bidang itu dia tidak memiliki kapabilitas yang cukup

CHAPTER 3 MOTIVATING PEOPLE

Learning Objectives 3 Define Motivation and distinguish it from other factors that influence individual’s performance. Recognize popular but misleading myths about motivation Understand that motivation depends heavily on the situations in which individuals work Understand manager’s role in motivating people. Identify key characteristics of the content of people’s work that motivates them. Identify important processes involved in motivating people Asses and deal with motivational problems.

Motivation and Management
A State of feeling in which one is energized or aroused to perform a task or engaged in a particular behavior

Myths about Motivation
Motivated workers are more productive Some people are just motivated while others aren’t Motivation can be mass produced Money makes the world go round

Manager’s Role Assessing motivation to their employee, periodically

Framework of employee motivation
Need Deficiency Determination of future needs and search or choice for satisfaction Search for ways to satisfy unmet needs Evaluation of need satisfaction after Implementing alternatives Choice of alternatives to satisfy unmet needs

Motivation Theories Content Perspectives Process Perspectives
Theory that focus on needs and need deficiencies Process Perspectives Focus based on Process involved in motivation

Content Perspectives Maslow’s Need Hierarchy ERG Theory
Two Factor Theory Learned Need Theory

Comparison of need theories of motivation
McClelland’s Model Herzberg’s Model Maslow ’S Model Alderfer’s Model Achievement Recognition Advancement The Work itself Possibility for personal growth REsposibility Self Actualization needs Achievement Growth Needs Motivation factors Ego and self esteem needs Power Relatedness Needs Social and belongingness needs Status Company policy & administration Quality of supervision Relations with supervisor Relations with peers Relations with subordinate Salary Job Security Personal Life Working Cond Affiliation Existence Needs Safety and security needs Hygiene Factors Physiological needs

Process Perspectives Equity Theory Expectancy Theory Reinforcement Theory Goal Setting

Motivational Problems & Solutions
Inadequate performance definition Impediments to employee performance Inadequate performance-reward linkages Solutions Behavior Modification Pay For Performance Enhanced Achievement Well Defined Performance Standard

Discussion Questions 3 Bagaimanakah Teori motivasi Content perspective dan process perspective dapat digabungkan didalam aplikasi organisasi? Bagaimanakah cara mendiagnosa masalah- masalah motivasi dari faktor-faktor lain yang mempengaruhi kinerja individu? Bagaimanakah teori motivasi dapat digunakan untuk memilih pemecahan terbaik dari kepentingan individu?

CHAPTER 4 Leadership

Learning Objectives 4 Better appreciate why leadership skills are so important. Understand what leadership is and what it is not. Understand the distinction between management and leadership. Understand the leadership role and how it is executed in health services organizations. Understand the major leadership perspectives as well as some emerging theories and concepts. Consider how different leadership perspectives can be combined into a more integrative framework. Appreciate several distinctive challenges of leading in health services organizations. Continue developing leadership knowledge and skills.

Overview Leadership is one of the most highly valued management abilities Leadership is the process through which an individual attempts to intentionally influence another individual or a group in order to accomplish a goal.

Leadership Core concepts
Is a Process, an action word, not a noun Locus of leadership is in a person Focus of leadership is other individuals and groups Influence is leadership’s center of gravity

Key points of Leadership
Leadership is Multidirectional. Although its multidirectional, Leadership focus on the downward. The focus is generally other managers; Managers lead other managers. Leadership depends on the power associated.

Leadership effectiveness and Success: What We know
Perspectives of Leadership : The Trait perspective The Behavioral perspective The Contingency Perspective

The Trait perspective The Nurture Argument The Situational Argument
The Nature Argument : Traits Leadership Effectiveness & Success The Nurture Argument Abilities and Behavior Leadership effectiveness & Success Traits The Situational Argument Traits Abilities and Behavior Situation Leadership effectiveness & Success

The Behavioral perspective
Low Initiating Structure, High consideration Style High Initiating Structure, High Consideration Style Consideration Low Initiating Structure, Low consideration Style High Initiating Structure, Low Consideration Style Initiating Structure

The Contingency Perspective
Leadership Match Model Path Goal Model LEAD Model Attribution Theory

Emerging Theories & Concepts
Transformational Leadership Concerned with changes than exchanges. Seeking to alter both the objective and nature of manager-follower interactions, lead by empowering. Charismatic Leadership Distinct social relationship between the leader and follower, in which the leader presents the revolutionary idea & Follower accepts the idea not by rationally, but by believes

High Performance leadership, Depends on :
Systems Thinking, Mastering a conceptual framework and associated set of analytical tools or technique which allow us to understand these patterns and how they can be changed. Visioning Effective managers lead by pulling, not pushing Facilitating learning Organizations and the environments in which they operate are not static. Changes tends to revolutionary than evolutionary

Distinctive aspect of leadership in health services organizations
Leading the Clinical Professionals Leadership and Gender in Health Services Organizations

Discussion Questions 4 Bagaimanakah menurut anda kepemimpinan itu? Dan apa sajakah faktor-faktor yang berpengaruh dalam efektivitas kepemmpinan? Ceritakanlah gaya kepemimpinan anda! Dan diskusikanlah itu dengan rekan-rekan anda. Menurut anda apakah karakteristik dari organisasi kesehatan yang membutuhkan peran kepemimpinan dari manajer? Setelah melihat data dari ACHE mengenai kaitan Gender dan kepemimpinan, bagaimana menurut pendapat anda? Bagaimana implikasi dari data ini ?

Conflict Management and Negotiation
Chapter 5 Conflict Management and Negotiation

Learning Objectives 5 Identify reasons that conflict is prevalent in health care organizations. Understand several different types of conflict management technique, based on various concerns of the disputants. Identify the basic concepts and dimensions of negotiation. Appreciate the importance of planning for a negotiation and know the key issues to consider when preparing to negotiate. Identify and understand special types of conflict management situations, such as multiparty negotiations and third-party intervention.

The Importance of Conflict Management
The Marketplace is growing increasingly global as firms face competition from foreign company. The epidemic of corporate restructuring experienced during the past decade produced the framework for the development of todays organized delivery systems Shift from manufacturing based to a service based

The Causes of Conflict The role of resource scarcity
Beneficial vs. Detrimental effects of conflict Jehn’s Typology of Conflict

Levels of Conflict Individual Level Group Level

Managing Conflict The Dual Concern Model
Models as typology of conflict management, focusing on four ways that people handle conflict: Accomodation Pressing Avoidance Negotiation

Dual Concern Model Assertive Pressing Collaborating Concern for Self
Negotiating Concern for Self Compromising Avoiding Accomodation Unassertive Uncooperative Concern for others Cooperative

Negotiation, the key points
Basic Concepts A Negotiator never has to negotiate; there always alternatives to reaching an agreement through a negotiation. The Distributive dimension of negotiation 1. Know your BATNA (Best Alternatives to a Negotiated agreement) 2. Determine your bottom line or reservation price 3. Set a Goal of aspiration level that is significanly better than your bottom line and optimistically realistic. 4. Think of what objective Standards might be acceptable to the other party. 5. Plan your opening. An initial offer should not be to extreme, but it should prevent the other party from anchoring the negotiation. 6. Develop reciprocity. Avoid making unilateral concessions

Negotiation, the key points (Con’t)
The integrative Dimension of Negotiation. The assumption is that one party can gain without the other party necessarily having to lose. The Mixed motive nature of negotiation. Simultaneously balance cooperative and competitive behavior The Role of information sharing Symmetric Information

Multiparty Negotiations
Difference between two and multiparty negotiations Two party negotiations is less complex than multi party negotiations

Fairness and Ethics in Negotiation
Fairness Norm : Equality Equity Need

Managing conflict through third party intervention
There are several types of intervention strategies Manager as Inquisitor as Arbitrator as Mediator

Discussion Questions 5 Jenis keahlian apakah yang dibutuhkan manajer dalam mengelola konflik yang ada? Apakah anda memilikinya? Bagaimana meningkatkan kelemahan anda dalam mengelola konflik ini? Setelah melihat debate time 5.1, apakah indikasi sebuah HSO memiliki konflik? Bagaimanakah sistem untuk memantau indikator itu. Strategi pihak ketiga apakah yang akan dijalankan oleh manajer sebagai pihak ketiga? Dalam menangani konflik antar-group, kelompok mana yang paling sering mengalami konflik? Jika anda dalam posisi James Grover di Chiefland memorial hospital tindakan apa yang harus anda ambil untuk meredakan konflik antara hoffman and Young? Jelaskan langkah-langkah anda!

Managing Groups and Teams
Chapter 6 Managing Groups and Teams

Learning Objectives 6 Describe the importance and types of groups and teams in health services organizations. Distinguish between different approaches to assesing work group performance Analyze the effect of a work group’s structure on group performance. Explain the relationship between work group norms and group productivity. Identify the key roles assumed by individuals in work groups. Describe key aspects of group process including communications structures, decision making, and stages of group development. Define major causes and consequences of intergroup conflict and identify alternative strategies for managing conflict.

Types of groups and teams in organizations
Reference Groups Friendship Groups Interest Groups Work Groups Management teams Temporary Groups or task forces Intermittent Groups Standing Committees

A Model of Work group Performance
Group Characteristics: Group composition and size Group norms Role relationships Group role clarity Group cohesiveness Status differences Group Process : Leadership Communication Decision Making Stages of group development Effectiveness : Performance or Productivity Member satisfaction Intergroup Conflict : Interdependence among groups. Group role and task ambiguity. Intergroup differences in work orientation. Intergroup goal incompatibility.

Discussion Question 6 Direktur yang baru-baru ini bekerja, diserahkan tugas untuk memimpin rapat mingguan team manajemen. Team manajemen ini membutuhkan beberapa dokter, perawat, asisten dokter, dan petugas sosial. Apa kebijakan yang akan anda berikan pada direktur RS untuk membantu meningkatkan kerja team? Sebuah kelompok interorganisasional telah dibentuk untuk mengidentifikasi kendala-kendala dalam memberikan pelayanan kesehatan. Bagaimanakah anda mengelola organisasi dalam lingkup divisi dan global terjaga dengan manajemen yang baik. Dalam keadaan apa saja uncohesive group lebih produktif daripada cohesive groups? Strategi apa yang harus dibuat oleh pemimpin untuk membuat Cohesive group lebih produktif? Strategi apa yang digunakan pemimpin group untuk meningkatkan komitmen dari anggota group? Bagaimanakah pemimpin group dapat memantau apakah anak buahnya telah memiliki komitmen atau tidak?

Chapter 7 Work Design

Learning Objectives 7 Identify the range of approaches to work design, including the psychological and task inventory approaches. Understand the relationship between work design and individuals motivation and productivity. Discuss the differences between work and working. Identify components of work, their characteristics and their performance requirement. Analyze the interconnectedness of components of work among individuals and among work groups. Understand how to approach the design of individual jobs and work units.

Approaches to job design
Task Inventory approaches. Psychological approaches

Analysis of Work Work, Working
is objective and impersonal, it is energy directed at organizational goals, identifiable separately from the person who does it. Working it is a workers affective response to work. Is an individual personal and subjective reaction.

Types of Work Direct work
effort that directly contributes to the accomplishment of an organization’s goals Management Work Providing the resources and and context within which direct work can be perform. Support Work Does not directly result in achievement of an organizational goal, but it needed for effective accomplishment of other job

Key points in Designing Works
To evaluate works and working run properly, we need a more detailed analysis, which is : Determining components of work interconnectedness of work

Designing individual job
It is important to match people and their needs to jobs and their inherent work requirements. People evaluate courses of action for the purpose of choosing among them

Coordinating interconnected work within organizational units
Interconnected elements of work are best placed within an individual job. In this section, focus on how to achieve coordination. Van de Ven et al. Found variations in patterns of coordination among unit facing different level of task uncertainty. Charns et al extended the findings, Mintzberg suggest that work groups use a combination of six approaches to coordination and that the use of these approaches is related to the effectiveness of patient care. The Six approaches fall into two categories: programming methods and feedback methods.

Discussion Questions 7 Under what conditions does a job with a high motivating potential lead to high job holder motivation? What are the potential pitfallsin job redesign ? Give examples of highly motivated people who do not contribute greatly to organizational productivity? What is the relationship among individual motivation and satisfaction and an organization’s ability to coordinate work? Give examples of situations in which dependable role performance is required in a job but effort above minimum level is not. What happens when individuals in such jobs innovate? Give examples of jobs requiring cooperative behavior. What happens when people in such jobs are willing to give only dependable role performance?

Coordination and Communication
Chapter 8 Coordination and Communication

Learning Objectives Differentiate between pooled, sequential, and reciprocal interdependence. Differentiate between intraorganizational coordination and interorganizational coordination. Discuss a variety of coordination mechanisms used in intraorganizational settings. Consider the aplication of the intraorganizational coordinating mechanisms to a given situation using the contigency approach. Discuss the three major types of transactions used in interorganizational coordination. Discuss the management of interorganizational linkages. Describe the elements of effective communications Discuss the technical mechanism of communication. Discuss the barriers to communication Describe the flow of intraorganizational communication. Describe the flow of interorganizational communication Discuss the special case of communication between units of a system.

Interdependence Pooled interdependence Sequential interdependence
Reciprocal interdependence

Skills needed by Managers
Within the Hospital Coordination & Communication Managers Coordination & Communication With Other Organizations

Coordination As a means of effectively linking together the various part of an organization or of linking together organizations and dealing with interdependence. Intraorganizational Coordination Interorganizational

Intraorganizational Coordination
Since the activities of health professionals are seen as being complex, uncertain, and of great social importance, three distinctive structural arrangements has evolved to support the autonomy of these professions. Autonomous arrangement, present when an organization delegates to a professional group goal setting, implementation, and evaluation of performance and the administration manages the support staff. Heteronomous arrangement, Professionals are subordinated to the administrative structure with specific responsibilities delegated to various professional groups. Conjoint arrangement, Professionals and administration are equal in power.

Intraorganizational Mechanisms of Coordination
Hierarchical coordination, The various activities are linked by placing them under a central authority. Administrative system, emphasizing formal procedures, provides a second mechanism for coordinating activities. Voluntary Action, inw hich individuals or group see a need for coordination, develop a method, and implement it.

Mintzberg’s Five Coordinating Mechanism
M Manager M Manager Analyst A Analyst A O O O O Mutual Adjusment Direct Supervision M A Standardization Outputs Worker Skills O O

Interorganizational Coordination
Typology : Market Transactions, Involve the focal organization and other organizations entering into relationships in order to obtain operational resources or product markets. Voluntary interorganizational relationship transactions, Distinguished by the voluntary dimension of the transactions. Involuntary Interorganizational Transactions, lead to unique ways of managing interdependence.

Managing Interorganizational linkages
It is important for a manager to use a contigency approach when establishing and maintaining relationships with interdependent organizations

Communication Provides information people need to make decisions. Communications from the Managers perspective, has: Intraorganizational Communication, depends on formal establishment of channels and networks within the organizations. Interorganizational Dimensions, occurs between organizations or between organizations and constituencies outside them.

Elements of Effective Communication
Reinforcement Desire to Communicate Effective Communication: Being Understood Making meaning, not agreement Understanding How others Learn Perceive and Process information Analytic vs Intuitive Abstract vs Concrete,etc Purpose Information Cues Eliciting Cues Decision Cues Content Importance Complexity Sender Ascribed Credibility Achieved Time Frame Long vs Short

Barriers to Communication
Environmental Barriers Personal Barriers

Flows of intraorganizational Communications
Downward Flow Upward Flow Horizontal and Diagonal Flows Communication Networks Communication networks Chain Networks Y Pattern Wheel Pattern Circle Pattern All-Channels Network

Communication Flows in Health care Organizations
Upward Communication Problems & Exceptions Suggestions for improvement Performance reports Grievances and disputes Financial and Accounting information Downward Communication Implementation of goals, Strategies, Objectives Job Instructions and rationale Procedures and practices Performance feedback Indoctrination Influence Interpret COORDINATE HORIZONTAL AND DIAGONAL COMMUNICATION Intradepartmental problem solving Interdepartmental coordination Staff advice to the departments

Discussion Questions Diskusikan perbedaan koordinasi intra dan inter organisasional. Apa sajakah cara-cara yang dapat digunakan oleh manajer untuk mencapai koorinasi tipe tertentu? Jelaskan model komunikasi dan gambarkan model komunikasinya! Anda baru saja diangkat menjadi manajer sebuah proyek bersama antara RS tempat anda bekerja dengan beberapa staff medis untuk mengoperasikan fasilitas bedah. Program yang anda pentingkan adalah untuk menjalin kerjasama yang efektif dengan RS. Buatlah rencana proyek ini berdasarkan materi pada bab ini! Bayangkan Organisasi pelayanan kesehatan anda menerima sebuah pemberitaan yang buruk. Bagaimanakah organisasi anda akan bereaksi?

Power And Politics in Health Services Organizations
Chapter 9 Power And Politics in Health Services Organizations

Learning Objectives 9 Distinguish between rational and political models of organization of their appropriateness to health services organizations. Know the practical, managerial implications of the effective use of power in health services organizations. Identify the conditions that promote the use of power, politics, and informal Influences in health services organizations. Understand the range of political strategies and tactics employed by members of health services organizations Understand the sources of power in health services organizations. Know the key approaches for consolidating and developing power by managers, physicians, and other groups in health services organizations.

Power, Influences and Politics, definitions
Power, has been a notoriously elusive term to define and identify within organizations. Influence, indicate actions that, either directly or indirectly, cause a change in the behavior or attitudes of another individual or group. Politics, domain activity in which participants attempt to influences organizational decisions and activities in ways that are not sanctioned by either the formal authority system of the organization, its accepted ideology, or certified expertise.

Rational vs political perspectives on management
Organizational management is influenced by two models : Rational models imply that the managers are orchestrating the activities of a team whose members all subscribe to a common set of goals and objectives. Political Perspectives acknowledge the existence of power and influence other than that vested in formal authority system or professional expertise.

Sources of power Access to resources Access to information
Formal Authority Skill in dealing with uncertainty

Mintzbergs Political Games
Games to resist authority Games to counter the resistance to authority. Games to build power bases. Games to defeat rivals Games to Effect Organizational change

Power Strategies and Tactics
The use of power is to implement decisions. Power is most effectively used when it is employed unobtrusively as possible. Effective attempts to influence is in an aura of legitimacy and rational purpose. Coalition Building

Power, Politics, and Organizational Performance
In an organizations, the use of power is to maintain the importance of a decision has been made. Such Strategies for reducing the level of influence are available for manager who simply do not feel comfortable for using power.

Chapter 10 Organization Design

Learning Objectives Understand the principles of organization design
Have an awareness of the evolution of organization design. Use a framework for understanding organization design considerations. Analyze common organization designs in terms of their applicability, Strengths, and limitations. Consider guidelines for changing organization designs.

What is Organization Design
OD is the way of building blocks of organization which, authority, responsibility, accountability, information and reward are arranged or rearranged to improve effectiveness and adaptive capacity.

Management role in OD Management primary task is to maintain and improve performance in the organization. In designing OD managers should consider input from employee. OD must be design bottom-up not Top down.

Organization design in relation to other management activities.
Statement Of Organizational Mission Strategy Development & Implementation Feed Back OD Information Needs Rewards Performance Evaluation

Levels of OD Position Work Group Cluster of Work Group
Total Organization Network System

Things to consider before design
The Mission Environmental Assessment Organizational Assessment Human Resources Assessment Political Process Assessment

Variety Designs of HSO Classic Design : Functional Design
Divisional Design Matrix Design New Evolving Design : Parallel Design Product Line or Program Design

Influences on the future OD
The Mission Future Environment Organization Human Resources Political Process Organizations in transition

MANAGING STRATEGIC ALLIANCES
Chapter 11 MANAGING STRATEGIC ALLIANCES

Learning Objectives Understand why strategic alliances are increasing in use, particularly among health care organizations. Distinguish between different types or forms of strategic alliances, using number of dimensions. Classify an alliance both in terms of what it looks like and what it is meant to do. Understand how alliance motivation is often related to alliance structure and outcomes. Identify whethet your motivations for a strategic alliance are compatible with those of your alliance partner. Think about strategic alliances in terms of the likely stages of development that alliances often experience and the critical issues that you may face at each stage. Distinguish between an alliance problem and an alliances symptom and recognize the different implications for managerial intervention. Understand both the pros and cons of alliances.

Alliances in health care industries
Strategic alliances dalam organisasi selalu diibaratkan dengan orang yang sedang membina hubungan pacaran, dimana ada kemungkinan hubungan yang harmonis dengan kekuatan yang sinergis atau konflik yang menghancurkan.

Types and forms of alliances
Ownership and control Number of members Governance Structure Mandated vs Voluntary Participation

What are Alliances meant to do
Pooling vs Trading Alliances Cost reduction vs Revenue Enhancement Quality, innovation, and learning Power enhancement, uncertainty reduction, and risk sharing.

The Alliance Process : A Multistage Analysis
Emergence : Finding Partners Transition Maturity Critical Crossroads

Frameworks for analyzing alliance problems
Locating the problem Separating the root from the symptom.

Organizational Innovation and Change
Chapter 12 Organizational Innovation and Change

Learning Objectives Describe the change process that occurs within health services organizations and identify factors which facilitate or inhibit that process. Identify and understand the types of changes associated with technical operations and the methods to manage such changes. Identify and understand the types of changes and methods associated with identify \ing and introducing new services. Describe the types of changes involving administrative, structural, or strategy mechanisms and the approaches that affect such change processes. Describe human resource changes and identify methods for managing such changes.

The Change Process Awareness Identification Implementation
Both changes and innovation involve a number of distinct stages : Awareness Identification Implementation Institutionalization

Types of Changes Technical Changes Product or service changes
Administrative, structural, or strategy changes. Human resources changes.

Organizational Performance
Chapter 13 Organizational Performance

Learning Objectives Understand the importance of assesing organizational performance. Define performance measures for organizations. Understand the important issues in defining, measuring, and using performance measures. Evaluate professional work. Compare management models based on quality assurance and quality improvement. Manage for quality improvement in health care. Understand management roles to create high performance organizations.

Overview of performance
The terms widely used in assessing health service is Efficacy, capability of a health service under ideal conditions and applied to the right problems. Appropriateness, focuses on whether an efficacious treatment was apllied to the right patient at the right time. Effectiveness involves ascertaining the quality in which a service is carried out.

Issues in assesing effective performance
Fundamental perspectives about organizations. Domain of activity Different levels of analysis

Technical issues in assessment
Classes of measures Structural measures Process measures Outcome measures Factors associated with effective performance : Quality of professional staff High standart experience with other cases more professional staffs with high capability in managing conflict. Participative organization cultures emphasizing team approaches. Timely and accurate performance feedback. Active management of environmantal forces.

Two models for changing performance
Quality Assurance Quality Improvement

Cause and effect diagram for continous improvement
Environmental Characteristics Patient Characteristics Unit Characteristics Outcomes of care Provider Characteristics Organizational Characteristics Interorganizational Characteristics

Managers role in creating high performance Health care Organizations
Problem in measuring performance are a challenging factor in HCO. The task of defining, measuring, and influencing performance is so difficult that management can play a key role.

Managing Trade-offs Need a paradigm shift from mechanical model to a new model of commitment, and a cycle of continous improvement Each department determines who are the customer and what are they really want.

Leadership strategies for high performance HCO
Stretching Maximizing learning Take risks Exhibit transformational leadership incline toward action. Create chemistry Manage uncertainty Remain loosely coordinated Possess a strong culture signify meaningful values

Chapter 14 Strategy making in HCO

Learning Objectives Define the concepts of strategic management.
Undewrstand the major school of thought in strategic management and how the relevance of each might be dependent upon the degree of turbulence in the environment. Understand the major sources of competitive advantage, some major examples, of these sources, and why they are important in the design of strategy. Understand how multiorganizational structures can facilitate implementation of health care strategies. Identify the major structural features of markets and be able to apply them in the analysis of health care strategies. Identify the major force of threat in the porter framework and be able to use them in conducting strategic analyses. Understand the relationship between strategy and market structure and be able to apply this understanding to the analysis of health care markets.

Strategic Management Goal formulation Environmental analysis
Strategy Formulation Strategy Evaluation Strategy implementation Strategic control.

Schools of thought School Strategy Formulation as Prescriptive School
Design Planning Positioning Descriptive Schols Entrepreneurial Cognitive Learning Political Cultural Environment Configuration Strategy Formulation as A Conceptual process A formal Process an analytical process A Visionary Process A Mental Process An Emergent Process a Power Process an ideological process a passive process an episodic process

Strategy Positioning a business to maximize the value of the capabilities that distinguish it from its competitors Strategy is an integrating set of ideas and concepts that guide an organization in its attempts to achieve competitive advantage over rivals.

Strategic comfort zones for shifting pace
Prospector Analyzer Defender Reactor

Five forces Michael Porter
Potential Entrants Supplier Competitors Buyers Substitutes

Creating and Managing the Future
Chapter 15 Creating and Managing the Future

Learning Objectives Identify the major trends likely to affect the delivery of health care. Understand the changing role of physicians, nurses, and other allied health care providers within health services. Understand the changing role of management and the competencies required to function in the managerial role.

The organization and the environment
Changing social norms and expectations Demographic composition and epidemiology Technology Development Organizational arrangements Financing Social experimentation

The Worlds is changing Changing Role of Physician
Changing Role of Nurse Expanding role of allied health professionals

Health Services Policy
Dalam menetapkan kebijakan sangat dipengaruhi oleh keadaan masa depan. Untuk meramalkan masa depan perlu melakukan riset Kadangkala Manajer tidak memiliki waktu dalam melakukan riset sehingga diperlukan kerjasama dengan para peneliti.

The Managerial Role Role performance and emerging challenges Preparing future managers

MANAGEMENT PRINCIPLES for HEALTH CARE SERVICES

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MANAGEMENT PRINCIPLES for HEALTH CARE SERVICES

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