Principles and Functions of Management

Prof (Col) Dr R N Basu

Adviser, Hospital Planning and Management MedicaSynergie, Kolkata
Formerly:
Prof & Head, Dept. of Hospital Administration Armed Forces Medical College, Pune And Prof & Head Dept. of Hospital Administration Kasturba Medical College, Manipal
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Management Process
Most important area of human activity Managers see that individuals can make their best contribution to group activity Why Group Activity?
People form group to accomplish aims they could not achieve as individuals Man has limitations These are physical, biological and psychic limitations Man found it necessary to cooperate with others Also, everyone wishes to accomplish personal goal satisfaction to maximum possible extent with least expenditure of resources This desire to accomplish goal satisfaction efficiently through cooperation applies to all group action be it business, military, religious, charitable, social or other objectives.

Management
Definitions The creation and maintenance of an internal environment in an enterprise where individuals working in groups can perform efficiently and effectively toward the attainment of group goal Functions Planning Organizing Staffing Directing Controlling
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Nature of Management
As managers, people carry out managerial functions Management applies to any kind of organization It applies to managers at all organizational levels The aim of all managers is the same: to create surplus Managing is concerned with productivity
This implies effectiveness and efficiency
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The Six Health Systems Building Blocks

Service Delivery

Information

Human Resources

Leadership and Governance

Financing

Medicine and Technology WHO

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Leadership and Management in Health System

WHO

Henry Fayol s 14 Principles of Management

Principles 1. Division of work Explanation 1. This is the specialization that economists consider necessary for efficiency 2. Authority should be commensurate with responsibility 3. Directed at achieving obedience, application, energy and the outward mark of respect 4. Employees should receive orders from one superior only
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2. Authority and Responsibility 3. Discipline

4. Unity of command

Contd .
5. Unity of direction 5. Each group of activities with the same objective must have one head and one plan 6. Subordination of 6. Self explanatory individual to general interest 7. Remuneration 7. Should be fare and afford the maximum possible satisfaction to employees and employers
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Contd .
8. Centralization 8. Individual circumstances will determine the degree that will give best overall yield 9. Scalar chain 9. Flow of authority from top to bottom. Should not be shortcircuited 10. Order 10.A place for everything and everyone 11. Equity 11.Loyalty and devotion should be elicited from personnel by a combination of kindness and justice

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Contd
12.Stability of Tenure 12.Unnecessary turnover is the cause and effect of bad management 13. Initiative 13. Thinking out and execution of a plan. It is one of the keenest satisfaction for an intelligent man 14. Esprit de corps 14. In union there is strength

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Planning
Most basic of all management functions All managers at all levels has planning responsibilities Planning is deciding in advance what to do, how to do it, when to do it, and who is to do it Nature of Planning Contribution to objective Primacy of planning Pervasiveness of planning Efficiency of plans

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Types of Plans
Objectives end towards which activities are aimed Policies which guides or channels thinking and actions in decision making Strategies It is the broad overall concept of an enterprise operation Procedures It is a customary method of handling future activities. Essentially, chronological sequence of required action Programmes A complex of goals, policies, rules, tasks, task assignments, steps to be taken necessary to carry out a given course of action Budgets Numerical plan
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Importance of Planning
To offset uncertainty and change To focus attention on objectives To gain economical operation To facilitate control Steps in Planning Being aware of opportunity Establishing objectives Premising Determining alternative courses Evaluating alternative courses Selecting a course Formulating derivative plans
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Organizing
Organizing is the grouping of activities necessary to attain objectives, the assignment of each group to a manager with authority to supervise it, and provision for coordination horizontally and vertically in the enterprise structure Span Structure of an organization basically depends on span of control. It means the number of subordinates a manager can effectively supervise
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Effective Span
Depends upon various factors:
Subordinates training Delegation of authority Planning Rate of change Use of objective standards Communication techniques Amount of personal contacts
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Basic Departmentation
Allows an enterprise to expand indefinitely Types
By simple number By time By enterprise function By territory By product Customer departmentation
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Staffing
The personnel function is especially concerned with the development of a highly motivated smoothly functioning workforce. Personnel management is a subsystem of the management system. To have well qualified motivated employees in adequate number available at the right time, careful advance planning is necessary. This is called MANPOWER PLANNING
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Components

(a) Projection of future needs

(b) Job Analysis (c) Recruitment (d) Selection (e) Training and development (f) Promotion (g) Transfer (h) Retirement
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Job Analysis Uses

(a) To know how to recruit and whom to hire

(b) To know how much to pay employees on one job, relative to another. (c) To design a promotional ladder (d) To set a sensible work load. (e) To evaluate the effectiveness of selection and training programmes (f) To meet government fair employment requirements.
Elements:

Job Description
It can be defined as a written record of the duties, responsibilities, working conditions and reporting relationships.
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Components of Job Analysis

(a) Job title, work location, salary range (b) Skill, Experience, training or education requirement (c) Length of additional training required after hiring. (d) Previous jobs within the organization which are likely to qualify employees for the job. (e) Jobs for which successful completion of this job qualifies an employee. (f) Analytical, technical & behavioral requirement (g) Working conditions such as cleanliness, noise, stress, travel, safety. (h) Performance standards - specify frequency of use and expertise required. (j) Role relations: Who evaluates? Who orders? Who gives information?

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Problems of Job Analysis

To resolve the problems of job analysis it should go beyond simply recording existing job practices. The following needs analysis: (a) Person versus job (b) Breadth of job (c) Excessive high job standard (d) Inconclusiveness of descriptions (e) Craft Consciousness Can be avoided by : - By developing broad job description - By defining jobs - By avoiding dead end jobs
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Recruitment
The process of acquiring employees begins with recruitment Aspects that needs to be considered Labor market boundaries It is the geographical area in which forces of demand and supply interact, effecting price of labor. Available skills Undifferentiated labor is rarely hired. .
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Contd ..
Requirement of a large number of highly trained labors often creates severe recruitment problem.
Organizations attractiveness
A well known organization offering attractive salary and perks will have no recruitment problem

Economic condition
In economic depression labor supply is large
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Training
All employees periodically need some training. The scope and intensity varies. Training is an ongoing and continuous process.

Types of training
Induction Training Aspects a) Opportunity for familiarization with task. b) Provides information about policies and rules.

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Contd .
a) Introduces to fellow employees. b) Relationship of their job and overall operation. c) Helps overcoming fear and anxiety. d) Best time to train - employees are receptive. e) Shapes future work attitudes.

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Learning new techniques and concepts

(

Remedial training.

( Aiding displaced employees. ( Training for advancement ( Apprenticeship

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Grievances
Grievance means any dissatisfaction arising out of any activity, policy, supervision or service connected with the organization. Grievance needs to be handled promptly. Delay gives rise to dissatisfaction. More often grievance is based on emotion. Unresolved grievances may snowball into conflicts. Organization should have well laid out grievance procedure. Handling of grievance is basically a responsibility of line managers.
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Grievance Procedures
It is a mutually agreed upon formal step by step method to deal with grievance.

Aspects (a) Person to whom the grievance is to be referred. (b) Set time limits. (c) Indicates procedure of filing grievance at each stage.

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DISCIPLINE ( Best discipline is self discipline ( Normally people will live up to the rule ( Possibility of discipline will stimulate individuals to win over
their lazier self

( If employees perceive rules as reasonable and just, compliance is

automatic
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AVOIDING DISCIPLINE

( If possible it should be avoided. ( It should be the last step.

WAYS TO MINIMIZE NEED OF DISCIPLINE

( Avoid too many rules ( Rules should be fair - Employers need to be convinced. ( Avoid poor job assignment ( Explain clearly what the job requires.
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THE RED HOT STOVE RULE

1. While disciplining employee the manager is

always in a dilemma.
For resentment of employees. For their future cooperation. For employees future need of help.

2. These can be overcome by Douglas McGregor's "Red-Hot-Stove-Rule 3.When a red hot stove is touched the discipline is Immediate
With warning Consistent Impersonal
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Contd .
4. Advance Warning
To accept without resentment discipline should be:
With clear warning Clear warning for quantum of penalty for a given offence.

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Retention of Nurses (Nurse-Friendly Hospital Criteria)

1. Control of nursing practice
Activities are structured to facilitate nursing standards of care and are evidence-based practice.

2. Safety of the work environment

Facility demonstrates a concern for the health and safety of nurses.

3. Systems exist to address patient care concerns

Systems exist to evaluate and resolve issues related to nursing practice and quality of care.

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Contd
4. Nurse orientation
Orientation program is competency-based and considers the education, experience, and strengths/weaknesses of nurses.

5. Chief nursing officer

Activities of CNO in management of nursing services are supported by hospital administration.

6. Professional development
Professional development program exists to facilitate ongoing educational needs to maintain and/or further develop professional expertise.
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Contd .
7. Competitive wages
Nursing salaries are competitive, are market adjusted, and recognize outstanding performance and professional commitment.

8. Nurse recognition
Individual nurse merit and excellence are recognized.

9. Balanced lifestyle
Facility recognizes the need of nurses to balance their work and non-work life.
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Contd .
10.Zero tolerance policy for nurse abuse
Physician abuse of nurses is not tolerated.

11.Middle management accountability

Facilitation of leadership competency among direct-care supervisors and middle management occurs through a delineated leadership program.

12.Quality initiatives
Commitment to evidence-based practice is evident.
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Leading
To direct subordinates effectively, a manager is concerned with motivation, communication, and leadership Definition Directing is the interpersonal aspect of managing by which subordinates are led to understand and contribute effectively and efficiently to the attainment of enterprise objectives This is a difficult function as manager is dealing with a complex of forces about which not enough is known and over many of which he has no control

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Leadership
Definition It is the process of Directing and influencing the task related activities of group members Power Bases of Managers
Reward Power Coercive Power Referent Power Expert Power

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Approaches to Leadership
Leadership traits Effective leadership behaviour Situational perspective of leadership Traits
It was commonly held earlier that leaders are:

Braver More aggressive More decisive and More articulate

Researchers failed to uncover any traits that clearly and consistently distinguish leaders from followers
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Leadership Function and Styles

Two major functions:
Task related or problem solving Group maintenance or social function

Two leadership styles:

Task oriented
These managers direct and closely supervise subordinates to ensure that the task is performed to their satisfaction

Employee oriented
These managers try to motivate rather than control subordinates They encourage group members to perform tasks by allowing them to participate in decisions that affect them and by forming friendly, trusting and respectful relationships with group members
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Some studies
Ohio state and Michigan Studies Managerial grid and System 4 Management Managerial grid (Black and Mouton)

Expressed as a continuum on a scale of I to 9 Style 1,1 is impoverished management. Sometimes called laissez-fair management.

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Some studies
Style 1,9 management is country club management Style 9,1 is task or authoritative management Style 5,5 is middle of the road management Style 9,9 is democratic management. Argued as most ideal
Rensis Likert devised a four-level model of management effectiveness. System 1 managers make all the work related decision and order their 44 subordinates to carry them out

Contingency Approach
Situational perspective identified various factors that can influence leadership behaviour Paul Hersey and Kenneth Blanchard developed life cycle theory of leadership
Leader has to vary his style as the employees move through four phases of maturity.
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MOTIVATION
Human motives are based on needs, whether consciously or subconsciously felt Some are primary needs, such as physiological requirements Some needs are secondary like self esteem, status, affiliation with others Needs vary in intensity and over time among different individuals

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Motivation
This is a general term applying to the entire class of drives, desires, needs, wishes and similar forces Motivating means satisfying these drives and desires and induce subordinates to act in a desired manner with zeal and enthusiasm
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Complexity of Motivation
At any given time, an individuals motives may be quite complex and often conflicting Motivators

These are things that induce an individual to perform Motivation reflect wants Motivators are identified rewards, or incentives

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Complexity of Motivation
Motivators sharpen the drive to satisfy these wants These are also the means by which conflicting needs may be reconciled or one need heightened A manager can do much to sharpen motives by establishing an environment favourable to certain drives A motivator influences individual s behaviour Managers must be concerned about motivators and also inventive in their use

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Motivation and Satisfaction

Motivation refers to drive and effort to satisfy a want or goal Satisfaction refers to contentment experienced when a want is satisfied Motivation implies a drive towards a outcome Satisfaction is the outcome already experienced From management point of view, a person might have high job satisfaction but a low level of motivation for the job
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Motivation: Carrot and Stick

Seldom reference is made to carrot and stick of motivation This relates to the use of rewards and penalties in order to induce desired behaviour Despite all research on motivation, reward and punishment are still considered strong motivators. There are of course others.

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An Early Behavioural Model: McGregors Theory X and Theory Y

One view of nature of people has been expressed in two sets of assumptions known as Theory X and Theory Y Managing should start with how managers see themselves in relation to others Some thought on perception of human nature is required Theory X and theory Y are two sets of assumptions about nature of people

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Theory X Assumptions
Average human beings have an inherent dislike of work and will avoid if they can Thus must be coerced, controlled, directed and threatened with punishment Average human beings prefer to be directed, wish to avoid responsibility, have relatively little ambition Want security above all

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Theory Y Assumptions
Expenditure of physical effort and mental effort in work is as natural as play or rest People will exercise self-direction and self control in the service of objectives to which they are committed Degree of commitment to objectives is in proportion to the size of the rewards associated with their achievements

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Theory Y Assumptions
Average human beings learn, under proper conditions, not only to accept responsibility but also seek it The capacity to exercise a relatively high degree of imagination, ingenuity and creativity is widely distributed in the population Intellectual potentials of the average human being are only partially utilized

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The Hierarchy of Needs Theory

Abraham Maslow put forth this widely mentioned theories of motivation Maslow saw human needs in the form of a hierarchy, ascending from the lowest to the highest Needs

Physiological needs. These are basic needs for sustaining human lives

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The Hierarchy of Needs Theory

Security or safety needs. To be free of physical danger Affiliation, or acceptance, needs. People are social beings. So they need to belong, to be accepted by others Esteem needs. People want to be held in esteem both by themselves and by others Need for self actualization. This is the highest need. This is desire to become what one is capable of becoming
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The Motivation-Hygiene Approach to Motivation

Frederick Herzberg and his associates considerably modified Maslow s need approach They propounded a two-factor theory of motivation In one group of needs are such things as company policy and administration, supervision, working conditions, interpersonal relations, salary, status, job security and personal life These were found by Herzberg to be only dissatisfies and not motivators
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The Motivation-Hygiene Approach to Motivation (contd.)

If they exist in work environment in high quantity and quality, they yield no dissatisfaction . Their existence does not motivate in the sense of yielding satisfaction Their lack of existence would result in dissatisfaction. These were called maintenance, hygiene or job context factors
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The Motivation-Hygiene Approach to Motivation (contd.)

There were certain satisfiers They were related to job content They include:
Achievement Recognition Challenging work Growth in the job

Their existence will yield feelings of satisfaction or no satisfaction (not dissatisfaction)

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Other Theories of motivation

Expectancy theory of motivation
Leader in this is Victor H. Vroom He holds that people will be motivated to do things to reach a goal if they believe in the worth of that goal

Equity theory
An important factor in motivation is weather individuals perceive the reward structure as being fair

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Other Theories of motivation (contd.)

Reinforcement theory
Positive reinforcement or behaviour modification Individuals can be motivated by proper design of work environment and praise for their performance Punishment for poor performance produces poor results
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Other Theories of motivation (contd.)

McCleland s Needs Theory of Motivation
Identified three types of basic motivating needs
Need for power Need for affiliation Need for achievement

Special motivational techniques

Money Participation Job Enrichment
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Controlling
Definition Controlling is the measurement and correction of performance in order to make sure that enterprise objectives and the plans devised to attain them are being accomplished
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Basic Control Process

Involves three steps
Establishing standards Measuring performance against these standards Correcting variations from standards and plans

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Establishment of Standards
Plans are the yardsticks against which managers devise controls The first step in the control process would be to establish plans Plans vary in detail and complexity. As managers cannot watch everything, special standards are established Standards are criteria of performance
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Measurement of Performance
Should, ideally, be done on forwardlooking basis Deviations may then be detected in advance of their occurrence and avoided by appropriate actions Though in some occasions this is possible, but in others it should be disclosed as early as possible
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Correction of Deviations
Standards should reflect the various positions in an organization structure If measured accordingly, it is easier to correct deviations Correction of deviation is the point at which control can be seen as a part of whole system of management and can be related to other system of management
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Critical Control Points and Standards

In a simple operation, managers might control through careful personal observation of the work being done In most operations this is not possible because of the complex nature of operations and managers have far more to do than observe personally A manager must choose points of special attention and then watch them to be sure that the whole operation is proceeding as planned The points selected should be critical, in the sense of being limiting factors in the operation With such standards, managers can handle a larger group of subordinates and may have a larger span of management
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Measurement of Performance
Should, ideally, be done on forwardlooking basis Deviations may then be detected in advance of their occurrence and avoided by appropriate actions Though in some occasions this is possible, but in others it should be disclosed as early as possible
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FEEDBACK LOOP OF MANAGEMENT CONTROL

Desired Performance Actual Performance Measurement of Actual Performance

Implementation of Correction

Comparison of Actual Performance against Standards

Programme of Corrective Action

Analysis of Causes of Deviations

Identification of Deviations
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