HEALTH SERVICE MANAGEMENT

Table of Contents

Health service management is a profession that provides leadership and direction to organizations that deliver personal health services.

It involves managing divisions, departments, units, or services within these organizations.

The goal of teaching health services management (HSM) is to equip students with the skills necessary to effectively manage health services. Management involves getting things done by working with and through people to achieve organizational goals and objectives.

Health Service Management involves getting people to work together harmoniously, utilizing resources effectively to deliver health services to individuals and the community they serve.

Definition of Terms

Management:

Management is the process of influencing others with the specific intention of getting them to perform effectively and contribute to meeting organizational goals. (Drucker, 1967)
Management is the process of making efficient use of resources and getting people to work harmoniously together to achieve organizational objectives/goals.
The process of getting work done through other people.

Leadership:

The process of influencing others to work towards a common goal. (Bennie and Nanas, 1985)

Leader:

An influential person who has the ability to lead a group or department without necessarily holding a formal position.

Manager:

A formally and officially responsible individual for the work of a specific group or unit. For example, a ward in charge or a school principal is officially accountable for ensuring that their respective units accomplish their tasks effectively.

Authority:

Refers to the legitimate right granted to a manager or leader by an organization to direct and command subordinates. It empowers them to act in the best interests of the organization to achieve its goals.

Power:

The ability to influence others to act or behave in a certain way. It can be derived from various sources, such as rewards or coercion.

Nursing Management:

Nursing management is the process of working through nursing personnel to promote and maintain health, prevent illness, and alleviate suffering.
The role of a nurse manager is to plan, organize, direct, and control available resources to provide effective and efficient care to groups of clients.

MANAGEMENT

Management has been applied since the beginning of civilization. In communities, people have always worked together to grow crops, build temples, etc.

The manager who is stiff causes “a red tape” i.e. a breakdown in organization. In proper management, information should flow from subordinates to the supervisors and vice-versa.

In management, there is control of resources including human resources. Resources including human resources are considered under 4m’s i.e.

Manpower
Material
Money
Movement

Manpower resources cannot be bought from shelves like any other resources. This means manpower is not always available particularly in the right kind.

Management enhances teamwork as opposed to work in isolation. This therefore requires a manager to be flexible in order to succeed.

Health Service Management means getting people to work together harmoniously using resources effectively to deliver health services to the individuals and the community they serve.

DIFFERENCES BETWEEN THE LEADER AND THE MANAGER.

Leader	Manager
May or may not have an official appointment.	Appointed officially to the position.
Has the power and authority to enforce decisions as long as followers are willing to be led.	Has power and authority to enforce decisions.
Influences others either formally or informally.	Carries out predetermined policies, rules, and regulations.
Has a variety of roles beyond that of a manager.	Carries out specific functions, duties, and responsibilities.
Manipulates resources (people, money, etc.) to achieve organizational goals.	Strives to obtain results by making rules, remaining in control, and reacting to situations.
Achieves power through influence and charisma.	Achieves power by virtue of his/her position.
Focuses on group process, information gathering, feedback, and empowering others.	Performs all five functions of management.
Chooses to achieve goals through passion, heart, and charisma.	Is accountable for self and subordinates’ behavior and performance.
Has individuals who believe in what they say, known as followers.	Has subordinates who follow their rules.
Influences people to work willingly for group objectives.	People follow them on a voluntary basis.
Has no well-defined accountability.	Manager is accountable for self and subordinates’ behavior and performance.

Concepts of Management.

These are the most important concepts in health care management;

Effectiveness
Efficiency
Equity

Effectiveness:

Effectiveness refers to the extent to which an organization or individual achieves their goals and objectives. OR It is a measure of how well an organization or a person is meeting his or her goals e.g if the goal of the hospital is to provide high quality health care and it succeeds in doing so then it’s working effectively.
It focuses on the outcomes and results of actions taken. In management, effectiveness is measured by assessing whether the desired outcomes have been achieved and if the organization is fulfilling its purpose. This can include factors such as meeting targets, satisfying customer needs, and achieving desired outcomes.

Efficiency:

Efficiency is concerned with maximizing output or achieving the desired results with the least amount of resources, time, or effort. OR It’s a measure of how well an organization or individual is using its resources to achieve its goals. If money and materials have been used well and less wastage then the organization is working efficiently. If costs are too high or materials are being wasted then the activity is inefficient. Efficiency means doing things right, using resources wisely and with a minimum of wastage.
It focuses on optimizing processes and minimizing waste. In management, efficiency is measured by evaluating the ratio of inputs to outputs. This can involve streamlining operations, reducing costs, improving productivity, and eliminating unnecessary steps or activities .

Equity:

Equity refers to fairness and justice in the distribution of resources, opportunities, and outcomes.
It emphasizes equal treatment and consideration of all stakeholders. In management, equity involves ensuring that decisions and actions are unbiased and that everyone has equal access to resources, benefits, and opportunities. This can include promoting diversity and inclusion, addressing discrimination, and creating a supportive and inclusive work environment
Access to basic health care is a right to all people, however this does not happen in real life for many reasons. Health inequality is a result of unfair distribution of health services and may be associated with low economic status, poor geographical location, and other factors.

NURSING MANAGEMENT

Nursing management is the body of knowledge related to performing the functions of planning, staffing, directing, organizing and controlling (evaluating) the activities of nursing.

Nursing management is the field of nursing that focuses on leadership and overseeing of nurses.

Nurse manager is a person responsible for translating the administrative reasons into operational plans and acting in the middle and first line level of hierarchy.

Roles of an effective Nursing Manager.

A nurse manager works along four main dimensions.The dimensions are geared towards her own development and offering quality and clinical standards.

Enhancing the patients experience by;

Inspiring patients’ confidence.
Develops a culture of person centered care in their area of responsibility.
Is approachable, identifiable and accessible.

2. Promoting safe and effective clinical practice.

Offers clinical leadership and teamwork.
Provides evidence based and clinical effective practice.
Develops a culture of continuous quality improvement.
Focuses on patient safety.

3. Manages and develops performance of a team.

Role modelling.
Facilitates learning and development i.e create a learning environment.
Ensures effective and efficient use of resources.

4. Contributes to delivery of organizational objectives.

Creates political and strategic awareness.
Contributes to service development.
Recognizes the links with national initiatives and advocates on behalf of patients.
Empowered clinical leader.
Inspires and motivates the team.
Has proper recognition of their role.

Roles of Nursing Managers in Healthcare Facilities

The American Organization of Nurse Executives (AONE) outlines six primary roles and functions of nurse managers:

Clinical Practice Excellence: Nurse managers are responsible for ensuring the delivery of high-quality patient care and maintaining clinical practice standards within their assigned units or areas.
Resource Management: They are accountable for managing human, fiscal, and material resources to support clinical nursing practice. This includes optimizing personnel, equipment, and supplies while considering cost-effectiveness.
Staff Development: Nurse managers facilitate the professional growth and development of their staff. They ensure that competency levels are maintained and that new skills are acquired to meet patient needs. They also provide support and guidance to students in nursing and other healthcare professions.
Compliance Assurance: Nurse managers are responsible for ensuring that their units and the healthcare facility comply with professional, regulatory, and government standards of care. They interpret and implement these standards and ensure that staff is aware of and adheres to them.
Strategic Planning: Nurse managers participate in strategic planning at the unit, department, and organizational levels. They develop and implement plans that support the overall goals of the healthcare facility and respond to changes in the healthcare environment.
Interdisciplinary Collaboration: Nurse managers promote cooperative relationships among different disciplines and departments to ensure effective nursing care delivery. They promote companionship, mutual respect, and support to strengthen teamwork and communication.

Additional Roles of Nurse Managers

In addition to the AONE roles, nurse managers at various levels may also:

Lead and motivate staff to achieve optimal performance
Implement evidence-based practices to improve patient outcomes
Manage budgets and allocate resources effectively
Advocate for patients and their families
Participate in quality improvement initiatives
Collaborate with other healthcare professionals to provide comprehensive care

Challenges for Nurse Managers

Nurse managers face numerous challenges in today’s healthcare environment, including:

Managing in a constantly changing system: The healthcare system is constantly changing, with new technologies, regulations, and patient care processes emerging all the time. Nurse managers must be able to adapt to these changes quickly and effectively to ensure that their units and staff are providing the best possible care.
Delivering quality care within cost constraints: Healthcare costs are rising, and nurse managers are under pressure to deliver high-quality care while also managing costs. This can be a difficult balancing act, but it is essential to ensure that patients receive the care they need without breaking the bank.
Adapting to new technologies and practices: New technologies and practices are constantly being introduced into healthcare, and nurse managers must be able to evaluate and implement these new technologies and practices in a way that benefits patients and staff. This can be a challenge, especially for nurse managers who are not familiar with new technologies.
Managing diverse teams of professionals: Nurse managers often oversee teams of professionals from a variety of backgrounds and disciplines. This can be a challenge, as each profession has its own unique culture and set of expectations. Nurse managers must be able to create an inclusive team environment where everyone feels valued and respected.
Addressing staff shortages and burnout: Nurse shortages are a major problem in many parts of the country, and this can make it difficult for nurse managers to staff their units adequately. Nurse managers must also be aware of the signs and symptoms of burnout in their staff and take steps to prevent and address it.
Ensuring compliance with regulatory requirements: Nurse managers are responsible for ensuring that their units and staff comply with all applicable regulatory requirements. This can be a complex and time-consuming task, but it is essential to ensure that patients are receiving safe and quality care.

Additional Challenges

In addition to the challenges listed above, nurse managers may also face the following challenges:

Managing patient expectations
Dealing with difficult patients and families
Resolving conflicts between staff members
Advocating for patients and staff
Staying up-to-date on the latest clinical research and best practices.

Solutions to the Challenges faced by Nurse Managers

Challenge: Managing in a constantly changing system

Solution: Nurse managers must be able to adapt to change quickly and effectively. They must be able to identify and assess the impact of changes on their units and staff, and develop and implement strategies to address these changes. Nurse managers must also be able to communicate changes to staff and patients in a clear and concise manner.

Challenge: Delivering quality care within cost constraints

Solution: Nurse managers must be able to identify and implement cost-effective strategies to deliver high-quality care. This may involve negotiating with vendors for lower prices, implementing new technologies that can improve efficiency, or redesigning care processes to reduce waste. Nurse managers must also be able to track and monitor costs to ensure that they are staying within budget.

Challenge: Adapting to new technologies and practices

Solution: Nurse managers must be willing to embrace new technologies and practices that can improve patient care. They must be able to evaluate new technologies and practices to determine their potential benefits and risks, and develop and implement strategies to implement these new technologies and practices in a way that benefits patients and staff. Nurse managers must also be able to provide training and support to staff on new technologies and practices.

Challenge: Managing diverse teams of professionals

Solution: Nurse managers must be able to create a cohesive team environment where everyone feels valued and respected. They must be able to communicate effectively with staff from a variety of backgrounds and disciplines, and resolve conflicts between staff members. Nurse managers must also be able to provide support and guidance to staff, and help them to develop their skills and knowledge.

Challenge: Addressing staff shortages and burnout

Solution: Nurse managers must be able to identify and address the causes of staff shortages and burnout. This may involve implementing strategies to improve working conditions, such as providing more flexible scheduling or offering tuition reimbursement. Nurse managers must also be able to provide support and resources to staff who are experiencing burnout, such as counseling or stress management programs.

Challenge: Ensuring compliance with regulatory requirements

Solution: Nurse managers must be familiar with all applicable regulatory requirements and develop and implement strategies to ensure that their units and staff are in compliance. This may involve creating policies and procedures, providing training to staff, and conducting regular audits to ensure compliance.

Additional Challenges and Solutions

Challenge: Managing patient expectations

Solution: Nurse managers must be able to communicate effectively with patients and families to manage their expectations. They must be able to explain the realities of the healthcare system and the limitations of care. Nurse managers must also be able to provide support and guidance to patients and families as they navigate the healthcare system.

Challenge: Dealing with difficult patients and families

Solution: Nurse managers must be able to deal with difficult patients and families in a professional and compassionate manner. They must be able to identify the underlying causes of difficult behavior and develop strategies to address these behaviors. Nurse managers must also be able to provide support and guidance to staff who are dealing with difficult patients and families.

Challenge: Resolving conflicts between staff members

Solution: Nurse managers must be able to resolve conflicts between staff members in a fair and impartial manner. They must be able to identify the underlying causes of conflict and develop strategies to address these causes. Nurse managers must also be able to provide support and guidance to staff who are involved in conflicts.

Challenge: Advocating for patients and staff

Solution: Nurse managers must be able to advocate for their patients and staff. They must be able to speak up for their patients’ needs and ensure that they receive the best possible care. Nurse managers must also be able to advocate for their staff’s needs and ensure that they have the resources and support they need to provide quality care.

Challenge: Staying up-to-date on the latest clinical research and best practices

Solution: Nurse managers must be able to stay up-to-date on the latest clinical research and best practices. They must be able to identify and evaluate new research findings and determine their potential impact on patient care. Nurse managers must also be able to implement new best practices into their units and staff.

Management Theories and Styles

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