HEALTH SYSTEMS MANAGEMENT I

DIPLOMA IN CLINICAL MEDICINE & SURGERY

KMTC

2ND YEARS [YEAR 2 SEMESTER 1]

MODULE 26: HEALTH SYSTEMS MANAGEMENT I

Code: HSM 213; Hours - 30; Credits – 3

Pre-requisite (s): Communication Skills, Behavioural
Sciences
1
Module Competence

 This Module is designed to enable

the learner manage health services

2
 Module Outcomes

 By the end of this module, the learner should: -

1. Apply the concepts and principles in
leadership and management
2. Participate in organization and coordination of
health care services
3. Communicate and network effectively within
healthcare organizations
4. Manage commodities and supplies in
healthcare set ups

5. Discuss principles for effective leadership and

management of human resources 3
Module Units

Module Units Hours

Theory Practical
1. Introduction to leadership and management

14 2
2. Organization of Healthcare services 04 0
3. Communication and Networking 04 0
4. Commodity and Supplies management 04 2

4
 Module Content

1. Introduction to leadership and management:

definitions, importance of studying management,
historical development of management and concepts,
theories of management, principles and functions of
management, differentiate between leadership and
management, qualities of a leader and styles of
leadership, organizational behaviour and group
dynamics, definition of Mission and Vision, importance
of personal and organizational missions and vision
statements. Human resources management;
concepts, principles, practices in human resource
management, recruitment, orientation, deployment,
Performance management, counselling and coaching,
motivation, delegation, stress management, work
climate, conflict resolution; grievances; Code of
Regulations, change management, time management,
human resource development; cycle, 5
team
development and management, continuous professional
 Module Content

2. Organization of healthcare services: organization

structure: purpose, types, functions, organizational
structure of the health care system; structures,
functions, health services delivery; level of services,
health services at each level, actors, cadres, referral
system in Kenya.
3. Communication and networking: definition,
communication skills, types, channels, benefits,
barriers, public speaking, report writing, networking,
advocacy, negotiation, partnership, inter/intra-sectoral
collaboration, conducting meetings, interpersonal
etiquette. Basics of effective communication, effective
communication skills.
4. Commodity and supplies management: definitions,
logistics management cycle and distribution,
commodity storage, types of tenders and tendering
6
processes, assets disposal, inventory management
Teaching Strategies

1. Interactive lecture
2. Small groups discussions
3. Power point presentation
4. E-learning
5. Problem based learning
6. Study guides

7
 Reference

1. Armstrong, M. (2001). A hand book of human resource management

practice. Kegan page Ltd. London, U.K.
2. GoK (2007). Kenya Vision 2030, Government Printers, Nairobi, Kenya
3. Kotter J.P. (1990) ‘‘What Leaders Really Do.’’ (1 st Edition).Havard Business
Review: Pgs 1-12.
4. Lomax, S. (2001). Best practices for Managers for Expatiates. 1 st Edition.
John Wiley & Sons New York USA
5. Managers Who Lead: A handbook for Improving Health Services – available
on LeaderNet. Website http://erc.msh.org/leadernet in the leadership
Facilitation section
6. McCauley, Cynthia D., Russ S. Moxley, et al. (1998). The Centre for
Creative Leadership Handbook of leadership development. Greensboro,
(1st Edition). NC: Centre for Creative Leadership; San Francisco: Jossey-
Bass
7. Nyarango, P., Nordberg, E. Liambila (2005): Health planning and
Management for healthcare managers in developing Countries (2 nd
Edition). (Manuscript, edited by. W.N; Onyayo S, Nangami, M.)
8. Sullivan, Eleanor J., and Philip j. Decker. Effective Leadership and
Management in Nursing, 4th Menlo Park, CA: Addison Wesley Nursing,
1997.
9. Tim Hannagan (2011). Management concepts and practices. 5 th edition 8
Pearson Education Gate, Harlow England
 Content Delivery:
Week Dates Unit
From To
Week 1: Introduction to leadership and management; definitions; importance of studying
management; historical development of management and concepts, theories,
Week 2: principles and functions of management; differentiate between leadership and
management;
Week 3 qualities of a leader and styles of leadership,roles,skills
Week 4 organizational behaviour and group dynamics, definition of mission and vision;
importance of personal and organizational missions and vision statements
Week 5: organization of health care services; organization structure: purpose, types,
functions, organizational structure of the health care system
Week 6: structures, functions, health services delivery; levels of service, health services
at each level, actors, cadres, referral system in Kenya.
Week 7: resource management; concepts, principles, practices in human resource
management;
Week 8: recruitment, orientation, deployment performance management, counselling
and coaching, motivation, work climate
Week 9: CATs,
Week 10: conflict resolution; grievances; code of regulation, managing change, human
resource development; cycle, continuous professional development, job
description, job analysis,
Week 11 professionalism and work ethics, medico – legal issues, occupational hazards,
workman compensation act, disciplinary process; decision – making, planning
meetings
Week 12: . Communication and networking; basics of effective communication, effective
communication skills, public speaking, report writing
Week 13: networking, advocacy, negotiation partnership, inter/intra‐sectoral collaboration,
conducting meetings.
Week 14: . Commodity and supplies management; commodity management cycle:
selection, procurement, distribution, use and disposal 9
INTRODUCTION TO
LEADERSHIP AND
MANAGEMENT

10
MANAGEMENT:
 Getting things done through people
 Management is the art of getting things done through

people in order to achieve stated organizational

objectives.
 Getting people to work harmoniously together and make

efficient use of resources to achieve objectives

 Coordination and oversight of the work activities of
others so that their activities are completed efficiently
and effectively.
 Group of people involved in the four general Managerial

functions: planning, organizing, leading and coordinating.

 Management is also the systematic process involving

planning, organizing, staffing, leading and controlling the

efforts of organizational members and using all other
resources to achieve stated organizational objectives.
11
 Management is also defined as the process by which resources
are mobilized, combined and coordinated to effectively to
achieve organizational objectives.
 It is a process that utilizes organizational resources in the most
effective and efficient manner, in order to attain stated
organizational objectives.
 Efficiency – Getting the most output from the least amount of
input. “Doing things right”
 Efficiency in management refers to optimal utilization of
organization resources with minimal wastage. It is also the
relationship between achieving objectives and consumption of
resources.
 Effectiveness – completing activities so that organizational
goals are attained “doing the right things”
 Effectiveness refers to attaining specific organizational goals
that are timely and challenging. It is also an outcome measure
of the interventions that improve peoples health under ordinary
circumstances and in ordinary settings. 12
There are six main resources in an organization (6M)
1. Money
2. Manpower
3. Machines
4. Materials
5. Management (methods)
6. Minutes (time)
Management versus Administration
 Administration is part of management work but more concerned

with execution.
 A manager is said to be performing administrative work when

he/she is involved in interpreting policies of the organization and

putting into plans and having those plans implemented.
 At every level of management, managers perform some work

which involves execution or “doing” which is one that completes

the administrative process.
 Therefore administration is the total of planning, organizing,

controlling, coordinating and also operating work. 13

CONCEPTS OF MANAGEMENT.
Concept 1. Treat business as a series of
relationship.
Concept 2. Envision the corporation as a
community.
Concept 3. Redefine management as a service
position.
Concept 4. Treat employees like adults.
Concept 5. Use technology to create flexibility.

14
Who is a manager:
 Someone who coordinates and oversees the work of

other people in order to accomplish organizational

goals.
 Managers may have other duties not related to

coordinating and overseeing other works. Example,

a Clinical officer in charge of a health centre may
perform other clinical work.
 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, supervising, staffing, evaluating,
negotiating and representing. 15
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.
 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

 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. 16
Levels of management:
Top-Level Managers
 Are responsible for making organization wide

decisions and establishing plans and goals that

affect the entire organization.
Middle managers
 Manage the work of first line managers.

First Line Managers

 Are the lowest level of managers who manage

the work of non managerial employees . They

are directly or indirectly involved in production
of the organisation products or services.

17
Levels of Management:

18
1. First level management:
 The first level managers are also referred as first line

managers 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.
 Personnel development, ensuring compliance with

regulatory and professional standards, maintaining

discipline and motivating staff to achieve the
organizational goals.
 First level managers are also responsible for fostering

inter-disciplinary, collaborative and strategic planning.

19
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. They also

supervising and coordinate the activities of first line
managers
 A middle level manager maybe referred as a

supervisor, director or assistant director. This group

constitutes the largest group of managers.

20
3. Upper level management (top managers):
 This refers to top executives (such as Chief

Nurse, RCO) 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.
 They also ensure integration of work units to

achieve the organization mission and buffering

the effects of the external environment on
workers within the organization.
 Top managers are relatively a small group

21
Management Roles:
 Management roles refers to specific actions

expected of a manager.
 According to Henry Mintzberg (1973), there

are 10 (ten) roles grouped into three

categories:-
1. INTERPERSONAL ROLES
 Roles that involve people and other duties that

are ceremonial and symbolic in nature.

They are:-
 Figure head
 Leader
 Liaison
22
2. INFORMATIONAL ROLES
 Managerial roles that involve collecting, receiving

and disseminating information.

Include:-
 Monitor
 Disseminator
 Spokesman

3. DECISIONAL ROLES
 Management roles that revolves around making

decisions
Include:-
 Entrepreneur
 Disturbance handler
 Resource allocator
 Negotiator 23
Management Roles

24
Interpersonal roles:
 1.Figure head 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 and without the organization
25
Informational role:
 4. Monitor: As a monitor, the manager informally

seeks information about the organization through

internal networks, gossips, and observations.
(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)
26
6. Spokes person: The manager shares information with
individuals outside the organization, attends meetings, offering
continuing education and participates in professional
organizations

Decisional Roles:
7. The entrepreneur: The manager 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
e.g. Replacement of a sick staff, missing equipment, disease
outbreaks (shift staffs)
27
Management skills (according to Robert L. Katz 1955)
 Different types of skills are required to manage an

organization effectively.
 These skills have been classified into three categories

namely: (Managerial Skills).

TECHNICAL SKILLS
 Are job specific knowledge and techniques needed to
proficiently perform work tasks.
HUMAN / INTERPERSONAL SKILLS
 Ability to work well with others individually or in a group.

CONCEPTUAL SKILLS
 Ability to conceptualize about abstract and complex

situations.
 Ability to see the organization as a total entity. It includes

recognizing how the various units of the organization

depend on one another and how changes in any one part
affect all the others. 28
 Management skills?
(according to Robert L. Katz 1955)

 Interpersonal
skills
 Sensitivity
 Persuasiveness
 Technical skills
 Empathy
 Specialized  Conceptual skills
knowledge  Logical
 (Including when and
reasoning
how to use the  Judgment
skills)  Analytical
abilities
SKILLS NEEDED AT DIFFERENT
MANAGEMENT LEVELS
 Though the above skills are necessary at all
levels of management, their importance vary
according to ranks. Technical skills are
important at lower level whereas conceptual
skills are important at top levels.
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.
31
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. Such skills require a sense of feeling for
others and capacity to look at things from others
point of view. Managers interact with people
within and outside the organization and therefore
require these skills to assist them communicate
with, understand and motivate individuals and
groups

32
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. They allow managers to think in the
abstract and strategically so as to see the big
picture and to make broad based decisions that
serve the overall organization. Conceptual skills
also include the competence to understand a
problem in all its aspects and to use creative
thinking in solving the problem
33
ATTRIBUTES & QUALITIES OF A MANAGER:
 Technical competence
 Social & human skills
 Conceptual ability

34
HISTORICAL DEVELOPMENT OF MANAGEMENT:
 Management has been developed through the

following periods:
i) The classical theories
ii) Neo classical theories

SCIENTIFIC / CLASSICAL APPROACH =1910’s

 Described management as a science
 Focused on formal structure, technical requirements

of the organisation and general sets of principles

 Listed duties of a manager

Neo classical / HUMAN RELATIONS theories

 Focused on the informal organisation and the

psychological & social needs of people at work 35

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 (search for principles of
Management
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
NB. Classical/scientific managers relied on their
experience. They advocated for what worked.
36
Scientific Management Theory:
 Was developed by Fredrick Winslow Taylor (1856-1915)

(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.
 Systematically analyzed human behavior at work
 His model was machine with cheap, interchangeable

parts at doing a specific function

 Reduce complex organizations into machine like
 Make individuals into equivalent machine parts
37
He studied;
 Interaction of human characteristics
 Social environment
 Tasks
 Physical environment
 Capacity
 Speed
 Durability cost

FAYOL’S 6 ACTIVITIES OF INDUSTRIAL UNDERTAKING

1. Technical e.g. production
2. Commercial e.g. buying and selling
3. Financial activities e.g. securing capital
4. Security e.g. safeguarding property
5. Accounting e.g. providing financial information
6. Managerial activities e.g. Planning and organizing
38
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
6. Appointing a foreman for each aspect of the work and
instructing the production worker to report to a different
functional foreman for each aspect of the job 39
F. W TAYLOR’S ACHIEVEMENTS:
1. Raised productivity of shovellers from 16 to 59 tons/day i.e. 4 fold
2. Reduced no. of yard laborers from 500- 140
3. Revolutionarised the art of cutting metals
4. Doubled speed at which fine steelwork was done
5. Increased production in one instance by 369% and increased the
wages by 60%%= extra profit!!!
Was nicknamed "Speedy" Taylor for his reputation as an efficiency
expert.
FAILURES OF F. W TAYLOR’S
6. He dehumanized management theory
7. The aspect of mgt which the laws of science did not as yet apply
were to be subject to collective bargaining e.g. class interests
8. Taylor was hated by unions
9. Laws were passed to keep his methods out of military arsenal.
The federal government (the military, actually) thought his ideas
were dangerous, and scientific management was banned by
federal law from ever being implemented in that sector
40
Administrative theory:
 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.
 Henri Fayol (1925) also was the first person to

identify the management functions of planning,

organization, command, coordination, and control.
 Fayol also described fourteen management
principles as follows.

41
PRINCIPLES OF MANAGEMENT:
(H. FAYOL’S 14 PRINCIPLES OF MANAGEMENT)

42
H. FAYOL’S 14 PRINCIPLES OF MANAGEMENT:
1. Specialization or division of labor)
 Reduces span of attention or effort for any one

person or group.
 Develops practice and familiarity
 Specializing encourages continuous
improvement in skills and the development of
improvements in methods.
2. AUTHORITY
 Rights to give order
 Should be accompanied by responsibility
 The right to give orders and the power to exact

obedience.
43
3. Discipline.
 This is defined as respect for agreements which are

directed at achieving obedience. Obedience must

prevail throughout the organization as its essential for
smooth running of an enterprise.
 Outward mark of respect accordance with formal
 Informal agreement between firm and employees
 No slacking, bending of rules.

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
 One man, one superior
 Each employee has one and only one boss.
44
5. Unity of direction.
 According to this principle, each ground of activities having

the same objective must have one head and one plan.
 One head, one person (director) and one plan for a group
of activities with one objective.
 A single mind generates a single plan and all play their part

in that plan.
6. Subordination of Individual Interests to general
interests.
 Efforts should be made to reconcile individual interests with

common interests. When there is conflict between the two,

the interests of organization should prevail over individual
interests.
 Interest of one individual or one group should be subordinate

(not prevail over the general good (total workgroup)

 When at work, only work things should be pursued or

thought about. 45
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
 Pay should be fair to both employee and the firm
 Employees receive fair payment for services, not

what the company can get away with.

8. Centralization
 The degree of concentration of authority should be

based upon optimum utilization of all faculties of the

personnel depending on size of company and
quality of managers.
 Consolidation of management functions.
 Decisions are made from the top. 46
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
 There should be an unbroken chain of authority

extending from top executive to lowest level worker.

 Formal chain of command running from top to bottom

of the organization, like military.

10. Order.
 All materials and personnel have a prescribed place,

and they must remain there. The right man should be

in the right place.
 A place for everything & everything in its own place,

the right man in the right place 47

11. Equity.
 This means that employees should be treated with

justice and kindness. Managers should be fair and

impartial in their dealings with subordinates.
 Treat every employee with equity & justice.
 A combination of justice and kindliness towards

employees.
 Equality of treatment (but not necessarily identical

treatment).
12. Stability of tenure of personnel.
 Employees cannot work efficiently unless job security is

assured of them.
 Employees need time to settle into their jobs
 This may be lengthy times.
 Limited turnover of personnel.
 Lifetime employment for good workers. 48
13. Initiative.
 Employees at all levels should be given the opportunity to

take initiative and exercise judgment in the formulation and

execution of plans. 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.
 Thinking out a plan and do what it takes to make it happen
 Within levels of authority and responsibility all staff should
be encouraged to show initiative i.e. new ways of doing
things.
14.Esprit 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
 Harmony is a great strength to organizations
 Team work should be encouraged. 49
MAX WEBER

 ''Bureau' (French, borrowed into German) is a desk,

or by extension an office (as in 'I will be at the office
tomorrow'; 'I work at the Bureau of Statistics').
 'Bureaucracy' is rule conducted from a desk or
office, i.e. by the preparation and dispatch of
written documents - or, these days, their electronic
equivalent.
50
 A sociologist who began to study the new forms of
organization being developed for managing large
numbers of people in far-flung and complex activities.
 Germany had been an early leader in developing a civil
service. At the same time, German industry was
beginning to adopt the organizational methods
developed in the united states.
 Surveying this scene, weber attempted to isolate the
elements common to all of these new organizations.
 Weber concluded that all these new large-scale
organizations were similar.
 Each was a bureaucracy.
 Today many of us regard bureaucracy as a dirty word,
suggesting red tape, inefficiency, and officiousness

51
 The theory was developed by Max Weber (1864-1920).
Webber’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 and rationality of output.
 The following are the characteristics of an ideal organization

as described by Weber:
Characteristics of an ideal organization by Weber:
I. Division of labor: There should be clearly defined authority
and responsibility given as official duties
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 52
FEATURES DEVELOPED TO MAKE BUREAUCRACIES
RATIONAL:
1. Functional specialization
2. Clear lines of hierarchical authority,
3. Expert training of managers,
4. Decision making based on rules and tactics developed to
guarantee consistent and effective pursuit of organizational
goals.
RATIONAL BUREAUCRACY:
Weber noted additional features of rational bureaucracies that
are simple extensions of the four just outlined:
5. To ensure expert management, appointment and promotion
are based on merit rather than favoritism, and those
appointed treat their positions as full-time, primary careers.
6. To ensure order in decision making, business is conducted
primarily through written rules records, and
communications.
53
CONCLUSION & NOTE ON Scientific management :
 There is a best machine for each job, so there is

a best working method by which people should

undertake their jobs
 All job processes should be analysed into

discrete tasks & via this management find the

‘one best’ way to perform each task.

54
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.

 The major assumption of this theory is that

people desire social relationships, respond to

group pressures, and search for personal
fulfillment.
55
Definitions of Motivation:
 “Motivation takes place when people expect

that a course of action is likely to lead to the

attainment of a goal - a valued reward that
satisfies their particular needs”.
(Armstrong:1997).
 “The willingness to exert high levels of effort

toward organisational goals, conditioned by the

effort’s ability to satisfy some individual needs”.
(Robbins:1998).

56
.

57
Concept of Motivation:
 The underlying concept of motivation is some

driving force within individuals by which they

attempt to achieve some goal in order to fulfil
some need or expectation.
 Peoples behaviour is determined by what
motivates them. Their performance is a product
of both ability level and motivation.
 Performance = function (ability X motivation)

Types of Motivation Theories:

1. Content Theories
2. Process Theories
58
Content Theories:
 These theories attempt to explain those specific

things which actually motivate the individual at work.

 These theories are concerned with identifying

peoples needs and their relative strengths, and the

goals they pursue in order to satisfy these needs.
 Content theories place emphasis on what motivates

human behavior i.e. the wants and needs that people

are trying to satisfy
Process Theories:
 Process theories - These seek to explain specific

actions focusing on the thought process that people

experience prior to behaving in a particular manner
e.g. H. Vroom
59
Content Models:
 The Hierarchy of Needs Theory (Maslow:1943).
 The ERG Theory (Alderfer:1972).
 The Acquired Needs Theory/Achievement
Motivation Theory(McClelland:1961).
 The Dual-Factor Theory (Herzberg:1968

Process Models
 Theory X, Theory Y (McGregor:1960)
 Expectancy Theory (Vroom:1964 and Porter &

Lawler:1968)
 Equity Theory (Adams:1965)

60
Professor Elton Mayo (1880-1849 Hawthorne studies):
 Prof. Elton Mayo (Australian) (1880-1949) Psychologist, Carried

research at the Western Electric Company in the USA (1.1 1927-

1932). 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. Supervisors and 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.
61
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 as shown in:
 Basic proposition is that people are wanting

beings, they always want more, and what they

want depends on what they already have.
 Hierarchy ranges through 5 levels and is displayed

in the form of a pyramid implying a thinning out of

needs as people progress up the hierarchy.
 Ascending order implies that it is the next

unachieved level that acts as the motivator. 62

..

63
.

64
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. Social needs - Social needs include the need
for love, affection, care, belongingness, and
friendship.
65
4. Esteem needs - Esteem needs are of two types:
internal esteem needs (self- respect, confidence,
competence, achievement and freedom) and
external esteem needs (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. It also
includes desire for gaining more knowledge, social-
service, creativity and being aesthetic. The self-
actualization needs are never fully satiable. As an
individual grows psychologically, opportunities
keep cropping up to continue growing
66
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 them

67
Herzberg’s Dual-Factor Theory:
 Herzberg’s original study consisted of interviews

with 203 accountants and engineers.

 The object of the research being to design jobs

that provided job satisfaction, thereby

encouraging higher levels of performance.
 This process developed into job enrichment.
 He concentrated on satisfaction as 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. 68
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) / MAINTENANCE FACTORS
I. Company policy and administration
II. Supervision – the technical aspects
III. Salary
IV. Interpersonal relationships – supervision
V. Working conditions
69
Hygiene or Maintenance Factors (Herzberg):
 These are the factors, which if absent, cause

dissatisfaction.
 They are related to the job context and concerned

with the job environment.

 They serve to prevent dissatisfaction.
 They act as a ‘platform’ upon with the satisfaction

factors can be built.

Motivators or Growth Factors (Herzberg):
 These factors, if present, serve to motivate the

individual to superior effort and performance.

 These factors are related to the job content of the

work itself.
 The strength of these factors will affect feelings of
70
satisfaction or no satisfaction, but not dissatisfaction.
 Unsatisfactory hygiene factors lead to
dissatisfaction which lead to increased
absences, grievances or resignations. He likens
hygiene factors to water filtration pump. Not
having one will likely result to illness, but
drinking purified water will not necessarily keep
one from becoming sick

71
McGregor’s Theory X, Theory Y:
 McGregor put forward two suppositions about

human nature and behaviour at work.

 He argues that the style of management

adopted is a function of the managers attitudes

towards people and assumptions about human
nature and behaviour.
 McGregor –theory X and theory Y are essentially

sets of assumption s 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
72
Theory X (McGregor):
 Theory X represents the assumptions on which traditional

organizations are based, and was widely accepted and

practiced before the development of the human relations
approach.
 The central principle is direction and control through a

centralized system of organization and the exercise of

authority
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
73
Theory Y (McGregor):
 Theory Y represents the assumptions consistent with current

research knowledge.
 The central principle is the integration of the individual and

organization goals.
 It is recognized as the best way to elicit co-operation from workers.

Theory y assumptions
 For most people 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.

 Commitment to objectives is a function of rewards associated with

their achievement.
 Given the right conditions the average worker can learn to accept

and to seek responsibility.

 The capacity for creativity in solving organizational problems is

distributed.
 The intellectual potential of the average person is only partially

utilized.
 Motivation occurs at all of Maslow’s level
74
Expectancy Theory:
 Vroom’s expectancy theory(1964) maintains that
employees behave in ways they expect will produce
positive outcomes.
 The model suggest that the persons level of effort or

force (motivation) is not simply a function of rewards.

 It is a measure of the strength of a particular outcome

has for the individual

Vrooms expectancy theory is:
F = Sum (E * V) where,
F = Force - the motivation or the force used to achieve it.
E = Expectancy - the possibility of achieving a certain
outcome through certain actions.
V = Vacancy - the preference an individual has for a
particular outcome, the worth placed on a particular
result. 75
 Porter and Lawler (1968) develop Vroom’s
expectancy theory by suggesting that there are two
factors determining the effort people put into their
jobs.
1. The value of the reward to individuals in so far as
they satisfy their need for security, social esteem,
autonomy and self- actualisation.
2. The probability that reward depends on effort, as
perceived by individuals - in other words their
expectations of the relationship between effort and
reward.
 Thus the greater the value of a set of rewards and

the higher the probability that receiving each of

these rewards depends upon effort, the greater the
effort that will be made in a given situation. 76
Adams Equity Theory:
 Equity theory focuses on peoples feelings of how fairly

they feel they have been treated in comparison with

the treatment received by others.
 It is based on exchange theory.
 People expect certain outcomes in exchange for

certain inputs or contributions.

 Adams states that people will be better motivated if

they are treated equitably.

The exchange variables are:
 Inputs - what the individual brings to their
employment in terms of effort, experience and skills.
 Outcomes - the range of factors the employee

receives in return for their inputs i.e. all the financial

and non-financial rewards. 77
Alderfer’s ERG Theory:
This is a modified need hierarchy model and it condenses
Maslows five levels of need into only three levels based on
the core needs of:
 Existence
 Relatedness
 Growth

78
 Existence needs are concerned with sustaining human
existence and survival and cover physiological and safety
needs of a material nature.
 Relatedness needs are concerned with relationships to the
social environment and cover love or belonging, affiliation and
meaningful interpersonal relations of a safety or esteem
nature.
 Growth needs are concerned with the development of
potential and cover self-esteem and self- actualisation.
 More than one need can be activated at the same time - a
frustration-regression process e.g. if an individual is continually
frustrated in an attempt to satisfy growth needs, relatedness
needs may reassume most importance.
 ERG theory states that an individual is motivated to satisfy one
or more basic sets of needs.
 If a persons needs at a particular level are blocked then
attention should be focused on the satisfaction of needs at the
other levels. 79
LYNDALL URWICK’S 10 PRINCIPLES OF ORGANISATION:
1. Objective- every org or part must have an expression of purpose,
otherwise it is meaningless and therefore redundant.
2. Specialization-activities confined to a single function.
3. Co-ordination- facilitate co-ordination: unity of effort
4. Authority-a supreme authority must rest somewhere, a clear line
of authority to every individual in a group.
5. Responsibility-of superior for acts of subordinates is absolute
6. Definition-content of @position, duties involved, authority,
responsibilities and relationship with others must be clearly
defined in writing and published to all concerned!!
7. Correspondence- in every position, responsibility and authority
should correspond.
8. Span of control-no persons should supervise more than 5 or at
most 6 direct subordinates whose work interlocks!!
9. Balance- various units of organisation must be kept in balance.
10. Continuity-reorganization is a continuous process, in every
undertaking specific provision should be made.
80
FUNCTIONS OF MANAGEMENT:

81
 Management has been described as a social
process involving responsibility for economical
and effective planning and regulation of
operation of an enterprise in the fulfilment of
given purposes
 Remember in the definition of management we

stated that it is a process. The core functions of

management were identified by Henry Fayol as
we have already seen in the management
theories. The functions are planning, organizing,
staffing, directing, coordinating and budgeting—
as denoted by the mnemonic POSDCORB

82
Where FUNCTIONS OF Contemporary
MANAGEMENT (6) functions of
P – Planning
 Planning management
O – Organizing  Organising
 Planning
 Organising
S – Staffing  Directing/Leading  Directing
D – Directing  Controlling  Controlling
 Staffing  Staffing
Co – Coordinating
 Coordination  Decision making
R – Reporting  Communicating
B – Budgeting  Motivating
 Leading
 Budgeting
1. Planning  Reporting
 Best management function. Planning is deciding in advance what

to do, when to do and how to do.

 It bridges the gap from where we are and we want to be. A plan

is future course of action.

 It is an exercise in problem solving and decision making
 Planning is determination of course of action to achieve desired

goals .
 Planning is important to ensure proper utilization of human and

non human resources 83

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 or its functioning

i.e. Raw materials, tools, capital and personnel
Organization involves:-
 Identification of activities
 Classification of grouping of activities
 Assignment of duties
 Delegation of duties and creation of responsibilities
 Coordinating authority and responsibility
relationship 84
3. Staffing
 It’s the function of maintaining the organization structure

and keeping it manned.

 Staffing has assumed greater importance in the recent years

due to advancement of technology and increase in business

 The main purpose of staffing is to put the right man on the

right job
 Management is manning of the organizational structure

through proper and effective selection appraisal and

development of personnel to fill the roles
Staffing involves:-
 Manpower planning
 Recruitment, selection and placement
 Training and development
 Performance appraisal
 Promotion and transfer

85
4. Directing
 Is the part of managerial function which directs

the organizational to work efficiently for

achievement of organizational purposes
 It sets in the motion of action
 Direction is the interpersonal aspect of
management which deals directly with influencing,
guiding, supervising, motivating subordinates for
the achievement of organizational goals.
Directing has the following elements:-
 Supervision
 Motivating
 Leadership
 Communication
86
 Supervision – implies overseeing the work of
subordinates by their superiors. It is the act of
watching and directing work and workers
 Motivation – means inspiring, stimulating or
encouraging the subordinates with zeal to work.
Positive, negative, monetary, non monetary
incentives may be used
 Leadership – is a process by which manager
guides and influences the work of the
subordinates in desired direction
 Communication – is the process of passing
information, experience opinion from one person
to another. It is a bridge of understanding.
87
5. Controlling
 It implies measurement of accomplishment against

the standards and correction of deviation if any to

ensure achievement of organizational goal
 The purpose is to ensure that everything occurs in

conformity with the standards

 Controlling is the measurement and correction of

performance activities of subordinates in order to

make sure that the goals and objectives are
achieved
Controlling has the following steps:-
 Establishment of standard performance
 Measurement of actual performance
 Comparison of actual performance with standards
 Corrective action 88
6. Coordination
 This is the unification integration synchronization of the

efforts of the group of members so as to provide unity of

action in pursuit of common goals
 It is the hidden force which binds all the other functions of

management
 Is the integration of several parts in to orderly hole to
achieve the purpose of understanding
 Management achieves coordination through basic functions

of management like planning, organizing, staffing, directing

and controlling
Controlling is integral element through:-
 Coordinating through planning
 Coordinating through organizing
 Coordinating through staffing
 Coordinating through directing
 Coordinating through controlling 89
NB
 Managers engage in FOUR major functions

namely:- Planning, Organising, Leading (directing)

and Controlling.
 Planning: entails defining goals and establishing

strategies on how to achieve the goals.

 Organizing: entails structuring and arranging
work so as to accomplish the set goals.
 Leading (Directing): entails working with and

through people to accomplish the goals through

the set structures.
 Controlling: entails evaluating whether things

are working as planned.

90
PLANNING
 Management function of anticipating the future

and conscious determination of future course of

action to achieve the desired result.
 It is concerned with ends (what to achieve) and

Means (how to achieve)

Always plan
with the end in
mind

91
PLAN
 Projected course of action
 A blue print for a course of action

GOAL
 A desired result

Goals form the

foundation for
planning

You have to set the

desired result before
planning how to
achieve it

92
 Planning is a management decision making process by which
an organization decides what it wants to achieve, how it
intends to achieve, in what manner
 It is the process of deciding in advance what to do, who is to
do it and where it is to be done. Therefore all planning
involves choice; a necessity to choose from among
alternatives. Planning is a proactive and deliberate process.
 It is a function required of all managers so that personal as
well as organizational needs and objectives can be met. This
cyclic process allows for unity of goals, continuity of energy
expenditure (human and fiscal resources) and an opportunity
to minimize uncertainty and chance. The process also directs
attention to the objectives of the organization and provides
the manager with a means of control. Planning precedes all
other management functions and without adequate planning
the management process will fail
93
TERMINOLOGIES USED IN PLANNING
Philosophy
 It is a statement of beliefs based on core values –

inner forces that give us purpose. Philosophy

states the values and beliefs held about the nature
of work required to accomplish the mission and
the nature and rights of both the people being
served and those providing the service.
 Mission - It is a broad general statement of the

organization reason for existence. It states where

the organization is now, where it wants to go and
how it intends to get there. The mission identifies
the organization customers and the type of
services offered 94
 Vision - A vision statement describes the goal to which
the organization aspires. It delineates the set of values
and beliefs that guide all actions of the organization.
Vision statements are future oriented purposeful
statements designed to identify the desired future of an
organization. Within this context, mission and
philosophy statements are crafted.
 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. They are measurable and precise. Goals like
values and philosophies change with time and require
periodic re-evaluation
 Objectives: An objective is the desired end results of
any activity. They specify what an organization is meant
to accomplish 95
 Policy: Statements of conduct, principles
designed to influence decisions and actions).
They make managers take action in a certain
way. These are plans reduced to statements or
instructions that direct organization in decision
making.
 Procedure: A procedure is a series of steps for

the accomplishment of some specific project or

endeavor. It is a chronological sequence of steps
to be undertaken to attain an objective.
 Rules and Regulations: Are plans that define

specific action or non-action. Rules describe

situations that allow only one choice of action.
96
TYPES OF PLANNING:
 Planning can be classified on the basis of time,

nature and use of plans

1. Based on time
 We have the following types based on time
 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

97
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
2. Based on nature
 We have the following types based on nature

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. 98
Type of plans
Classified according to
A: Breadth (area covered)
 Strategic plans
o covers the entire organization
o Formulated by the top management
o Are long term
 Operational plans
o Are short term
o Designed to implement strategies formulated

under the strategic plans

 Functional plans
o Formulated by individual functional units of an

organization e.g. procurement, finance etc. 99

B: Timeframe
 Long term plans
o Formulated to be implemented in a span of over 5 years
o Guides future efforts of the organization
 Mid term plans
o To be implemented in a span of 2- 5 years
 Short term plans
o To be implemented in a span of 1 – 2 years

C: Frequency of use
 Standing plans
o Ongoing plans which guide repeated activities e.g.

policies, standard operating procedure, rules

 Single use plans
o Designed for a specific single use and discarded once

the situation is over e.g. time tables, budgets, programs

100
Features of planning
Planning:-

• Is goal oriented
• Is a primary function
• Is all pervasive
• Is a continuous
process
• Is time bound
• Its an intellectual
process
• Involves choice

101
Importance of planning:
 Provides direction
 Reduces uncertainty
 Improves uncertainty
 Sets basis for control
 Guides decision making
 Encourages creativity

Purposes of Planning (Significance)

 Planning has many important purposes which include some of

the following:
 Contributes to a purposeful organization.
 Reduces costs. Efforts will be better directed toward desired

results
 Provides for integration and coordination of activities.
 Haphazard approaches can be minimized and duplications

avoided.
 Provides for consistency of action which is necessary so that

both internal and external people can anticipate the

organizations 102
Difficulties Encountered In Planning
 Plans tend to be slow when joint efforts of

several individuals are needed.

 There is friction as people bring together their

ideas to make a decision.

 Differences in perception of objectives.
 Communication problems.
 Persuasive ability of the impressive individual.

103
Planning Process:
The process of planning is comprised of four
stages. These are:-
- Assessment
- Setting goals
- Implementation
- Evaluation

104
Steps in strategic planning process / planning
cycle:
1: Environmental scanning
 This involves assessment of the External and

Internal-environment
 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 includes review

of the effectiveness of the structure size,

programmes, financial resources, human
resources, information system, research and
development capabilities of the organization 105
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.
106
 Goal Setting: This is the process of developing, negotiating
and formalizing the targets or objectives that an employee s
responsible for accomplishing (performance standards). 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.
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.
107
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
108
Operational planning/tactical planning
 This is tactical planning and a short term

exercise designed to implement the strategies

formulated under strategic planning. It is based
on strategic plans.

109
ORGANIZATION
 It is the process of grouping the necessary responsibilities
and activities into workable units, determining the lines of
authority, communication, developing patterns of
coordinating and giving feedback.
 By organizing we are attempting to answer the question:

How will the work be divided and accomplished? To

answer the question the manager must define, group and
assign duties
There are certain basic issues to consider. These include:
 Setting up structure – structured aspects of the

organization must be sure up which indicate the activities

to be performed and lines of responsibility and authority.
 Developing procedures and policies.
 Determining organizational requirements and deciding

how duties will be performed

110
 Organizing
o Arranging and structuring work so as to accomplish
organizational goal.
 Organization
o A group of people with a common purpose
 Organizational structure
o Formal arrangement of jobs/works within an
organization
o Hierarchical arrangement of authority, communication
and duties in an organization.
o Determines how roles, power and responsibility are
assigned, controlled and how information flows
between different levels of management
 Organizational design
 The process of creating or restructuring the
organizational structure 111
Organizing involves the following steps:-
 Determination of the total work-load which is necessary for

the attainment of objectives.

 Classification of such work-load into groupings and sub-

groupings.
 Assignment of each grouping and sub-grouping of activities

to a distinct manager.
 Provision of necessary authority and facilities to each

manager; who, in turn, would divide the work assigned to

him among his group of subordinates.
 Establishment of clear-cut authority responsibility
relationship among managers, and subordinates-working in
different capacities throughout the enterprise.
 While organizing the work in the above manner, the

management must see to it that the roles of different

individuals (managers and subordinates) are co-ordinate-
both in a horizontal and in a manner. 112
ORGANISATIONAL DESIGN:
 The process of creating or restructuring the

organizational structure
 Involves making decisions about 6 key elements

1. DIVISION OF LABOUR
 Dividing activities into separate job tasks i.e.

What to be done by who.

2. DEPARTMENTALISATION
 Grouping common work activities together so as

to ensure work is done in a coordinated and

integrated way
3. CHAIN OF COMMAND
 Developing line of authority extending from the

upper organizational level to the lower levels. 113

 This clarifies who reports to who.
It applies the following basic concepts:-
 Authority – right inherent for managers to

tell subordinates what to do and expects

them to do it.
 Responsibility – obligation to perform any

assigned duty.
 Unity of command – each person should

report to one manager.

4. SPAN OF CONTROL
 Number of employees a manager can

efficiently and effectively manage

 Wider spans are more efficient in terms cost114
5. CENTRALIZATION AND DECENTRALISATION
 Centralization = degree to which decisions are

made at the upper level of management.

 De centralization = degree to which lower

level employees provide input to decisions or

actually make decisions
 NB. Decentralization or centralization is not

absolute. An organization is never completely

centralized or decentralized.
6. FORMALISATION
 How standardized organization jobs are.
 It portrays the extend to which employees

behavior is guided.
115
ORGANIZATIONAL CHARTS AND STRUCTURES
 An organization chart is a graphic illustration showing

the formal structure or relationships and authorities thro

which a business aims to achieve its objectives.
 It is considered as a circuit diagram of a business

structure.
Purposes
 The whole structure can be seen at a glance
 It is easy to analyze
 Management relationships are visible.
 The span of control for each supervisor or manager can

be seen.
 Spheres of responsibility and authority are defined.
 Lines of communication are visible.
 Weakness in an organization can easily be diagnosed

e.g. Weak lines of communication, unattached staff etc116

 It shows how an organization is divided. This
can be by function, geography, product,
customer, or a combination.
 To be effective, it should have:
 Names of personnel and their titles
 Brief job descriptions.
 Be reviewed and updated regularly.
 Organization charts can be vertical, horizontal,
or circular.

117
Organizational structure
Definition:
 It is the sum total of the ways in which it divides

its labor into distinct tasks in order to achieve

coordination between them.
 It defines the tasks, responsibilities, work roles,

relationships and channels of communication.

Common forms of organizational structure

1. Functional structure.
 Its based on groupings of all major business

functions e.g. production, marketing, finance,

personnel etc.
 Example: 118
.

119
Advantages
• It is logical, similar activities are grouped together.
• Coordination within functions is improved.
• Efficient use of resources, members share common
facilities or machinery.
• Better opportunities for promotion and career
development.
Disadvantages.
• Slow decision making- the chain of command is too
long.
• Limited management training.
• Less innovative.

2. Product based structure.

It is based on product ranges or services e.g. in health,
we can have medical, nursing, surgical services etc
120
3. Geographical structure.
It is based on geographical features e.g.
provinces, nations, subcontinents.

4. Divisionalised structure.
Based on products, geography or both, with
key functions such as planning and finance
at the HQ.

5. Matrix structures.
Is a combination of functional and product
based

121
Types of Organizations
1. Formal
 Those organizations whose membership and

activities are governed by certain specified rules

and procedures which determine the degree of
authority and behavior of each participating
member e.g. government ministries, non-profit
making organization, business companies.
 When designing the departmental
organizational structure, the manager should
plan for an ideal organization

122
Types of formal organization structures
Line Organizations
 It is the oldest and simplest type of formal

organization structure. Pure line structure is

straight forward and has direct chain of
command pattern that emphasizes superior
subordinate relationships
Functional Structures
 Employees are grouped in departments by

specialty with similar tasks being performed by

the same group. Similar departments reporting
to the same manager are grouped together

123
Service integrated structure/product line
 All functions need to produce a product or

services are grouped together, in self contained

units. units are based on product, service,
geographical location, or type of customer.
Hybrid Structure
 As organization grows it typically organizes both

self-contained units and functional units

resulting into a hybrid structure
Matrix
 Integrates both product and functional
structures into one overlapping structure.
Different managers are responsible for function
and product 124
2. Informal
 These are social groups or “cliques” which

develop within formal organizations in order to

fulfill individual social needs e.g. according to
social interests like welfare society.
 No formal organization will operate efficiently

without an accompanying informal organization

125
Organizational Structure
 Organizational structure refers to how work is organized,

where decisions are made and the authority and responsibility

of workers. Structure is a map of communication and decision
making paths. Organization structure is an important tool
through which managers can increase organization efficiency.
 It depicts the expression of responsibility relationships among

people and jobs. The organizational structure is graphically

portrayed by the organizational chart. This is a pattern to
show how parts are put together to accomplish a particular
purpose.
 Individual positions are shown as rectangular boxes each

representing a job. The chart shows:

 Areas of responsibility.
 To whom and for whom each person is accountable.
 Major channels of formal communication.
 Interdepartmental relationships.
126
ELEMENTS OF AN ORGANIZATIONAL
STRUCTURE
 In drawing up an organizational chart determine the
purpose of the plan considering administrative control,
Planning and policy making and relationships with
other departments and agencies.
 Review departmental functions and determine what
activities are needed in order to carry out the functions.
Avoid duplication of activities and include all-important
ones.
 Classify the functions and activities and draw up job
specifications and descriptions. Find out where the
responsibility for decision making should be placed and
allow for delegation.
 Review relationship with other departments in the
hospital or organization. 127
Purposes of Organizational Structure
The following are the main purposes of
organizational structure are:
 To have the right people taking right decision at

the right time.

 To establish who is accountable for what and

who reports to whom.

 To facilitate easy flow of information - channels

of communication.
 To depict interdepartmental relationships.
 To integrate and coordinate activities.

128
LEADING: (DIRECTING)
 Leading / Directing: This is the influencing process of

leaders and followers to achieve organisational

objectives through change
Key elements of leading:-
 Leaders-followers
 Influence
 Organizational objective
 Change
 People

Leadership: art of influencing the behavior and

performance of followers towards the most enthusiastic
attainment of common goals
 The ability of a manager to induce subordinates to work

with confidence and zeal. 129

 Leadership as 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.

 A leader is the person who influences and

guides direction, opinion, and course of action.

 Also a leader is anyone who uses interpersonal

skills to influence others to accomplish a

specific goal (good or bad).
Characteristics of a leader
 Leaders often do not have delegated authority

but obtain their power through other means,

such as influence.
130
I. Leaders may or may not be part of the formal
organization.
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.
VI. Often do not have delegated authority

131
Types of Leadership
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
 This implies that, all managers are formal leaders

while not all leaders are manager because we have

seen that there is informal type of leadership and
managers work in a formal organization 132
LEADERSHIP V/S MANAGEMENT:
Leaders are distinct from managers in the following
manner
1. Concept
 Management has a wider concept in that, all

managers are leaders.

 Leadership has a narrower concept in that a leader

may or may not be a manager.

2. Power and Authority
 A manager directs people through the use of formal

authority. A leader, on the other hand, may or may

not have formal authority (i.e. the right to
command) but always has power (i.e. the ability to
influence). Thus, a leader use informal authority to
influence people. 133
3. Applicability
 Leadership can exist in both organized and unorganized

structure. Management can only operate where there is a

formal structure; because the organizational structure
creates such roles.
4. Scope
 The scope of management is wider than that of leadership. A

manager has to perform all the functions of planning,

organizing, directing and controlling on top of the leading
function
5. Focus
 Managers focus on getting the work done, leaders focus on

working with people to achieve the objectives.

6. Sell and tell
 Leaders sell their idea to followers and persuades them to

conform. Managers tell their subordinates what to do

according to the laid plans. 134
 COMPARISON BETWEEN LEADERS AND
MANAGERS
LEADERS MANAGERS
1. May or may not be 1. Appointed officially
appointed
2. Have power to enforce 2. Have power and authority to
decisions as Long as followers enforce Decisions.
are willing to be led.
3. Influence others toward goal 3. Carry out predetermined
setting Either formally or policies, rules, and regulations.
informally.
4. Interested in risk taking and 4. Maintain an orderly control,
exploring new ideas. rational and equitable structure.
5. Relate to people personally 5. Relate to people according to
in an empathic manner. their role
6. Feel rewarded from personal 6. Feel rewarded when fulfilling
achievement organizations mission or goal.
7. May or may not be 7. Are managers as long as the135
Leadership styles
 Depending on the attitude of a leader towards

his followers and their work, the following major

styles of leadership can be identified:
1. Autocratic leadership style
2. Democratic leadership style
3. Laissez-faire or free-rein leadership style
4. Bureaucratic Leadership style

136
Autocratic Leadership Style
 Also known as authoritarian or dictatorial.

The leader:-
 Believes in centralization of powers.
 Takes all decisions himself without inviting
consultations from his followers.
 Dictates terms to subordinates
 Seems to have originated in military organization;

where, there is no provision for advice or request and

where the only 'rule of order' prevails.
 Sometimes, an autocratic leader might not be a strict

authoritarian. He might be a bit lenient towards

followers. Such a 'bit lenient' autocratic leader is
termed as a 'benevolent autocratic leader'; as
against the exploitative autocrat, who behaves as an
absolute dictator. 137
Authoritarian leader exhibits the following
behaviors
i) Strong control is maintained over the work group.
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)

138
Merits of Autocratic Leader
 Leads to quick-decision making; as decision-making

power is centralized in the hands of the leader.

 Suitable at lower levels in an organization; where

employees are less educated and may not work, in the

absence of fear of authority.
 It is suitable in emergency situations; when urgent

decisions are required.

Limitations
 Leads to development of frustration in subordinates.
 Invites hostile attitude of subordinates towards the leader.
 As subordinates are not allowed participation in decision-

making; their potential cannot be exploited. This

phenomenon retards human development.
 May yield fruit; but only in the short-run. In the long-run,

people might design plans' to overthrow leader.

139
Democratic Leadership Style:
 Also known as participative or consultative.

Under this style of leadership the leader:-

 Believes in decentralization of powers
 Invites followers to participate in the decision-making

process - especially on matters, which concern their work-

field or otherwise affect their interests substantially.
Merits of democratic style leadership:
 Subordinates are more inclined to implement decisions,

which have been made in consultation with them.

 Potential of subordinates is utilized, through capitalizing on

their creativity and imagination.

 Helps to increase-motivation, morale and job-satisfaction

for subordinates - because of the satisfaction of their social

and ego needs, during the process of decision -making.
 Lead to the emergence of good human relations, in the

enterprise. 140
Limitations of democratic style leadership:
 Delayed-decision-making, because of the involvement

of a number of subordinates, in the decision-making

process.
 The feature of having consultations with subordinates

by the leader might be taken as a sign of managerial

incompetence.
 May, in the long-run, lead to loss of leader's control,

over subordinates.
 There is usually witnessed, the phenomenon of passing

the buck, under this style of leadership. For wrong

decisions taken, leader and the led have a tendency to
pass the buck (sifting the responsibility) to each other.
 This style of leadership is not suitable; when decisions

on complex and strategic issues are required

141
Democratic leader exhibits the following
behaviors
I. Less control is maintained.
II. Economic and ego awards are used to motivate
III. Others are directed thorough 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.

142
Laissez-Faire Or Free-Rein Leadership Style:
 Also called 'free-style' leadership.
 Once instructions for doing assigned work are

imparted to followers, the leader plays only a

supervisory role over their functioning.
 Followed in circumstances, where subordinates

are educated and skilled and understand well as

to how to do their jobs independently, without
seeking consultation from the leader.

143
Merits
 Increased effectiveness if the subordinates are

highly skilled.
 Less work for leaders.
 Allows innovation
 Decision making is quick
 Promotes trust among the subordinates.

Demerits
 Poor performance if the subordinates are poorly

skilled.
 Less personal growth since there is no direct

training.
 Subordinates may relax and fail to meet

deadlines. 144
A 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.

145
Bureaucratic Leadership Style
 Also known as “by book leadership style”.
 The leader strictly adheres to organizational rules

and policies and ensures that the employees follow

them.
Merits
 Best when working on a risky environment where

rules need to be followed to the latter.

 Employees become specialized.
 Best approach in training

Demerits
 No room for innovation
 Allows little space for decision making.
 Needs a well-structured organization with correct

set of rules 146

 Lead
styl ershi
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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 intensity of supervision should match

situational requirements, employees needs and

managers leadership skills.
148
 Supervision must be appropriate in type and
intensity for work groups members to interact
effectively e.g. technical workers need closer
supervision than professional workers
 A manager can effectively supervise a large number
of subordinates when they are confined in a small
area, perform similar jobs and are fairly educated.
 Intensity of supervision should also depend on
manager-caregiver ration.
 The purpose of supervision is to inspect, evaluate
and improve worker performance. Therefore a
criteria is needed for judging the quality of work
processes and outcomes.
 Job description and associated performance
standards provide such evaluation criteria. 149
 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
VI. Support of administrator

2. Co-ordination
 This is another leadership activity. It includes all activities that enable

work group members to work together harmoniously.

 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
 The overall results of coordination should be orderly work, harmonious,

efficient and successful activities

150
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. 151
How leaders influence others
 Leadership, the foundation of the management

function of leading, and a critical element of the

health systems management building blocks is
the process of influencing others toward the
achievement of health care organizational goals
(better health outcomes).
 Power is the capacity to affect the behavior of

others.
 Effective leaders develop and use power, or the

ability to influence others.

 Legitimate, reward, and coercive are all

forms of power used by managers to change

employee behavior. 152
Legitimate power:
 Legitimate power stems from a formal management position

in an organization and the authority granted to it.

Subordinates accept this as a legitimate source of power
and comply with it.
Reward power
 Reward power stems from the authority to reward others.

Managers can give formal rewards, such as pay increases or

promotions, and may also use praise, attention, and
recognition to influence behavior.
Coercive power
 Coercive power is the opposite of reward power and stems

from the authority to punish or to recommend punishment.

Managers have coercive power when they have the right to
fire or demote employees, criticize them, withhold pay
increases, give reprimands, make negative entries in
employee files, and so on. 153
Expert power:
 Expert power results from a leader's special knowledge

or skills regarding the tasks performed by followers.

When a leader is a true expert, subordinates tend to
go along quickly with his or her recommendations.
Referent power:
 Referent power results from leadership characteristics

that command identification, respect, and admiration

from subordinates who then desire to emulate the
leader. When workers admire a supervisor because of
the way he or she deals with them, the influence is
based on referent power. Referent power depends on a
leader's personal characteristics rather than on his or
her formal title or position, and is most visible in the
area of charismatic leadership
154
155
Evolution of leadership theories
 Leadership has evolved over period of time.

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 and leadership styles:
 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. 156
 The behavioral theories includes the leadership styles,
system 4 management, the managerial grid and the
continuum of leadership behavior
 Leadership styles: Lewin, Lippitt and White studied

leadership styles. They identified three leadership styles

which are authoritarian, democratic and Leissez-faire
Authoritarian leader exhibits the following
behaviors
i) Strong control is maintained over the work group.
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)
157
Democratic leader exhibits the following
behaviors
I. Less control is maintained.
II. Economic and ego awards are used to motivate
III. Others are directed thorough 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.
A 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 158
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.
c) 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
 I. Autocratic leaders – have little trust in employees

and exclude them in decision making.

 II. Benevolent leaders – Are kind to employees but still

do not involve them in decision making. 159

 III. Consultative leaders – Seek employee’s advice
about decisions.
 IV. Participative or democratic leaders – they
value employees involvement, team work and
team building. They also have high levels of
confidence in employees and seek consensus in
decision making
 The managerial grid: Another model of
depicting leadership along a continuum is the
managerial grid. 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. These are:- 160
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 – High concern for people and low concern
for production.
5. Team – High concern for both production and people.

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 the organizational environment, the
task to be accomplished and the personal characteristic of
the people involved in each situation. People become leaders
because of their responsibility and situational factors. 161
d. Contemporary Theories of Leadership
 Leadership theory has continued to evolve. Contemporary

approaches to leadership are underpinned by the belief that

information power that was previously restricted to the
professionals or managers is now available to all.
The contemporary leadership theories includes
I. The quantum leadership: A leadership style based on the
concept of chaos theory
II. Shared leadership, an organizational structure in which
several individuals share the responsibility for achieving the
organization’s goals.
III. Servant leadership; the premise that leadership originates
from a desire to serve; a leader emerges when others’ needs
take priority.
IV. Transformational leadership; A leadership style focused on
effecting revolutionary change in organizations through a
commitment the organizations vision 162
 Burns (1978) suggested that both leaders and
followers have the ability to raise each other to
higher levels of motivation and morality. He
identified this concept as transformational
leadership.
 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.
163
Transactional Leader
Transformational leader
Focuses on  Identifies
management tasks common values.
Is caretaker (takes Is committed
care of tasks (extra mile).
Uses tradeoffs to Inspires others
meet goals. with
Shared values not Has long term
identified. vision
Examiner causes.
Uses contingency Looks at effects.
rewards Empowers others.

164
CONTROLLING:
Definition
 Process of monitoring, comparing and correcting

work performance.
 Generally involves comparing actual
performance to a predetermined standard and
takes corrective action.
 It determines whether the original plan needs

revision, given the realities of the day.

165
Importance of controlling:
 Helps managers know whether organizational

goals are been met.

 Provides feedback and information on
employee’s performance.
 Detects and gives room for addressing chances

of potential problems.
 Ensures minimal work disruption through
keeping work processes on the track.

166
Control process
-Three step cyclical process

Measure

Compare Act
Measure
 Getting information on the actual performance

i.e. determine what the actual performance is.

Compare
 Determining the variation between actual
performance against the standard.
 Some deviations can be acceptable therefore it is

critical to determine the acceptable range of

variation in the planning stage.
Act
There are three possible course of actions.
 Do nothing
 Correct the actual performance
 Revise the plan. 168
FORECASTING
 Forecasting involves assessing the uncertain future and

making provisions for it.

 It is a process of making some predictions about the future

shape of things by taking into account the past, the present

and the prevailing economic, political and social condition.
Importance of forecasting
 Forecasting provides a logical basis for determining in

advance, the nature of future business operations

 Provides the basis for managerial decision about the

material and personal requirements

 When organizations makes an attempt to look into the

future, in a systematic and concentrated way, it may

discover certain aspects special attention.
 It gives the people in the organization a sense of

participation in the planning process

 It’s a logical starting point in budgetary. 169
DECISION MAKING:
Definition
 Selection of an alternative from two or more

alternative to determine an opinion or a course of

action.
 Process involving choice of alternative actions,

implementation and evaluation that is directed to

the achievement of certain stated goal.
 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. 170
Types of decisions:
 Organizational and personal decisions

Organizational decision
 Those taken by an executive in his official capacity or

on behalf of the organization – such as bearing on the

functioning of the organization e.g. transfers of
employees made by the management.
NB: Organizational decisions can be delegated
Personal decision
 Those taken by an individual for himself in his

personal capacity. Such decisions normally influence

the personal life of the decision maker, though they
may at times affect the organization. Power for
personal decision making cannot be delegated e.g.
decision to leave an organization. 171
Routine and strategic decision
Routine/tactical decision
 Relate to day today operation of the organization

and are taken repetitively in accordance with

established polices, practices and procedural. These
are taken at lower levels of management.
Strategic decisions
 Taken by top management
 Are concerned with policy matters and exercise

fundamental influence on the objectives, facilities

and structure of the organization.
 They involve considerable risk and uncertainty

expense, considered opinion and operations research

techniques are used in making such decisions.
172
Policy and operating decision
Policy decision
 Affect entire organization.
 Set forth the basic policies and general direction

of the enterprise.
 They are sometimes published in the format

policy manuals for the guidance of lower level

executives.
Operating / administrative decisions
 Taken at lower levels of management.
 Transfer the policies into specific action.
 Are based on the policy decisions.

173
Programmed and Non-programmed decision
Programmed
 Decisions made according to specific
procedures that are established e.g. leave
procedure, Disciplinary procedures
 The nature of the problem in this case is clearly

defined and is well understood by the manager.

Non-programmed
 These are required to solve unstructured

problems.
 There exists no standard procedure for handling

such problems and every decision is a unique

case.
174
Individual and Group decisions
 Individual decisions are taken in small organizations

or those that operate under autocratic style of

management.
 They are taken in case of routine problems involving

simple analysis of variables and in situations where

definite procedures to deal with the problems already
exists.
Group decisions
 Taken by a group of periods e.g. Board of Directors

(B.O.D), executive committee.

 They tend to be more balanced, accepted and practical.
 Are time consuming and require more money and

effort. Its also difficult to fix responsibility for such

decisions.
175
STAGES OF DECISION MAKING:
 Decision making is a systematic and planned

process consisting of several interrelated

Phases.
 The key stages in decision making are:

1. Defining the problem

2. Analyzing the problem
3. Developing alternative solutions
4. Evaluating alternatives
5. Selecting the best alternative
6. Implementing the decision
7. Evaluation of decision

176
Defining the problem
 Assuming known goals and clear planning premises, the

first step is to recognize, identify and determine and define

the problem clearly.
 Defining or perception of the problem involves the

definition of desired results, identification of the

fundamental cause and magnitude of the problem and the
limits or boundaries within which it can be solved.
 The problem must be understood in relation to higher level

goals of organization. Clear definition of the problem helps

in collecting relevant data and in finding correct solution.
Analyzing the problem
 In terms of nature, impact, futurity, periodicity etc.
 it also involves enumeration of the limiting or strategic

factors relevant to the decision i.e. the obstacles. These

limiting factors may be material, internal or external
factors. 177
Developing alternative solutions
 In order to make a sound decision, search for and

identify viable or possible alternative. This step

requires considerable imagination experience and
judgment. The quality of a decision can be no
better than the quality of alternatives that are
identified.
 Alternatives are the hypothesis or tentative

explanations or conclusions.
 Ingenuity, research and creativity are required to

make sure that the best alternatives are

considered before a course of action is selected.
 Brain storming, Synectic and normal groupings are

the techniques of generating alternative action. 178

Evaluating alternatives
 In terms of costs, time, feasibility and
contribution to objectives.
 Alternatives solutions should be assessed in

terms of; critical or limiting factors both tangible

and intangible.
Selecting the best alternative
 That alternative which can make net maximum

contribution to the goal is selected.

179
Implementing the decision
 Converting decision to action.
 Once a decision is taken, steps should be taken

to put it into practice.

 Involves developing detailed plans,
communication of the decision, gaining
acceptance of the decision, getting support and
cooperation of those concerned with converting
the decision into outcomes and developing
controls to ensure that the decisions are carried
properly.

180
Evaluation of decision
 This is the final stage in decision making, it

involves appraisal of both the decision and the

process of decision making.
 If the appraisal shows unsatisfactory results,

then the process should be reviewed and the

decision may be modified. Evaluation enables
managers to learn from experience and thus
make better decisions in future

181
STAFFING:
 Allocating human resources is one of the many

responsibilities and a challenge to the manager.

 Staffing: This is the process of balancing the

quantity of staff available with the quantity and mix

of staff needed by the organization.
Objectives of Staffing
The following are the main objectives of staffing:
1. To provide appropriate numbers and mix of staff to
meet patient needs
2. To provide continuous quality care to patients
3. To periodically evaluate staffing practices in order to
determine the scope of staffing problems.
4. To utilize the talents and skills of each level of STAFF
to their fullest 182
5. To provide new employees with an adequate
orientation period.
6. To establish staff conditions of employment and
adjust as needed to current practices.
7. To utilize centralized or decentralized staffing
as means of scheduling
8. To establish a master-staffing plan for allocating
personnel based on assessment of patients needs.
9. To maintain records pertinent to staff data.

183
STAFFING PROCESS
 The process of staffing involves: Recruitment,
Selection, Induction and Scheduling
 Let us examine the meaning of each of the above

terms:
Recruitment
 This is the first part of the process and it involves

filling a vacancy. It is the drafting or revision of the job

specification for the vacant position, outlining the
qualifications, experience, skills and the
responsibilities involved.
 The vacancy is then advertised to source suitable

candidates. The sources could be internal, that is,

from within the organization or external.
184
Selection
 Selecting is the next stage which involves matching the

requirements of the job with the attributes of the candidate.

The process includes assessing the candidate by various
means e.g. Interviewing and screening. The purpose of this
is to obtain information. Selection testing including
achievement, aptitude, intelligence and personality may
also be used. These are followed by offer of employment.
Induction
 This is the process of receiving employees when they begin

work, introducing them to the organization and to their

colleagues and informing them of the activities, and the
culture of the organization. This may be regarded as the
orientation or beginning of training.

185
Scheduling (Duty Roster)
 After induction is given, the employee is assigned the tasks

to be performed. The schedules for work and time off

should meet organizational goals with fairness and equality
among personnel. A schedule should adhere to following:
 Policies, standards and practices of the organization on the

use of professional and paraprofessional personnel

(Supportive staff).
 Appropriate ratio or balance between professional and

supportive staff. This is in order to deliver continuity of

services nursing care.
 Approved budget. The manager should consider the

financial resources within the organization.

 Consideration of vacations and consideration of allowance

of adjustment in case of illness, emergencies or changes in

patient care needs.
186
Factors Affecting Staffing
 Patient factors e.g. Unpredictability of the patient census,

variety of patient conditions, patient population, and care

needs.
 Staff factors including, experiences and expectations of the

organization, job descriptions, education level and personnel

requirements.
 Health care organization factors e.g. policies and procedures,

resources available and number of beds per unit.

Since each setting is unique, there is no guide that can

stipulate the correct number of personnel needed to provide
quality care but systems have been developed for guidance
e.g.. patient classification system which is a method of
grouping patients according to the amount and complexity of
their nursing care requirements. In this case patients are
grouped according to the nursing time, effort and ability
required to provide care. 187
DELEGATION:
Definition
 Delegation is defined as the purpose by which

responsibility and authority for performing a

task (function, activity or decision) is transferred
to another individual who accepts that authority
and responsibility (Sullivan and Decker, 1992,
pg 216).
 Although the delegator remains accountable for

the task, the delegate is also accountable to the

delegator for responsibilities assumed.

188
Delegation is a dynamic process which
involves 3 factors:-
1. Responsibility for work delegated - willingness
to do the assigned work or an obligation to
accomplish a task.
2. Accountability - obligation to carry out the
responsibility or authority or act of accepting
ownership for the results or lack thereof.
3. Authority - the right to act or empower.

189
To clearly understand who is responsible,
the manager must consider the following:
 Practice acts – These determine the scope of

clinical practice.
 Policy statements regarding the quality of care

and the standards of care

 Job descriptions for various positions- This is to

enable delegate specific responsibilities

190
Principles for effective delegation:
I. Grant proper amount of authority: Responsibility
should not be less than authority delegated.
II. Define the results expected: Delegation 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: Authority
relationships should be clearly defined not only to the
subordinate but also to others concerned as well. 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).
191
VI. Follow unit of command/chain of command:
Authority should flow from the highest manager to all
subordinates (each individual reports to one superior
except in matrix organizations (according to functional
areas).
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

192
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.
X. Establish an effective control system:
Controls consent that authority delegated is used
properly. Superior should set performance standards
and evaluate subordinate periodically and help them
improve.
XI. Appropriate incentives: Suitable financial and
non-financial incentives should be provided to
reward subordinates for successful assumption of
authority and completion of responsibility
193
Delegation process
1. Defining the task – The manager should first determine
what can and should be delegated e.g.
- Routine tasks
- Tasks for which you do not have time
- Tasks that have moved down in priority
- Problem solving issues
- Staff development
2. Decide on the delegate: 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.
3. Define the task: Clearly define your expectations to the
delegate. Plan your meeting with the delegate .Provide enough
time to describe the task and your expectations and to
entertain questions. 194
4. Providing clear communication about expectations
regarding the task.
It is important to communicate effectively with the delegate.
To do this the manager must:
- Plan a meeting with the delegate
- Describe the task
- Give reasons for the task
- Inform the delegate by what standard the task will be
evaluated
- Identify any constraints for completing the tasks
5. Reach agreement: After outline your expectation you
must be sure that the delegate agrees to accept responsibility
and authority for the task.
6. Monitor performance and provide feedback:
monitoring performance provides mechanism for feedback
and control that ensures that delegated tasks are carried out
as agreed 195
Benefits of Delegation:
To the delegator
 Devote more time to these tasks that cannot be

delegated. With more time,

 Develop more skills and abilities facilitating the

opportunity for career advancement.

 Improve interpersonal relationship with
subordinates,
 Provides continuity of work in the delegator’s

absence and offers ready replacement.

196
To the delegatee,
 Gains new skills and abilities that can facilitate

upward mobility.
 Delegation also brings trust and support thereby

building self-esteem and confidence.

 Job satisfaction and motivation are also enhanced

as individuals feel stimulated by new challenges.

 Morale 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

197
To the Organization:
 Organization is able to achieve its goals more

efficiently due to team work,

 Overtime and absences decrease and
productivity increases and at the same time
organization’s financial position may improve.
 As delegation increases efficiency, the quality of

care improves and hence patient’s satisfaction

198
Some Problems That Hinder Delegation
 Manager is reluctant to delegate adequately to

his/her subordinates. In some cases some will

delegate responsibility and not authority.
 A manager will fail to delegate because she can

do a better job.
 A manager may lack the ability to communicate

to people what is to be done.

199
On the other hand, the subordinate or
delegatee may:
 Not accept delegated tasks because it is easier to

ask the manager than to decide for themselves

how to deal with a problem.
 Fear criticism for mistakes made. This keeps

subordinates from accepting responsibility.

 Lack necessary information and resources or non-

supportive environment which creates an

attitude that might make a person reject further
assignments).
 Lack self confidence.
 Fear liability - some individuals do not like to take

risks 200
Centralization and decentralization
 Centralization Is The Degree To Which Authority Is Retained By

Higher Level Managers With An Organization Rather Than

Being Delegated.
 If A Limited Amount Of Authority Is Delegated, The

Organization Is Usually Characterized As Being Centralized. If

Significant Amount Of Authority Is Delegated To Lower
Managers, The Organization Is Described As Being
Decentralized.
 All major policy decisions should be made at the top of the

management level or central point

 Delegation of duties from top-down
 Top most person is always answerable for the running of the

organization
Decentralization - Decisions are to be pushed down to the
lowest feasible level in the organization. The organizational
structure goal is to have working managers rather than managed
workers. 201
Advantages of centralization and decentralization
Advantages of Centralization
An effective centralization offers the following
advantages:
1. A clear chain of command
2. Focused vision
3. Reduced costs
4. Quick implementation of decisions
5. Improved quality of work
Disadvantages of Centralization
The following are the disadvantages of centralization:
1. Bureaucratic leadership
2. Remote control
3. Delays in work
4. Lack of employee loyalty 202
Advantages of decentralization
1. Reduces the burden on top executives:
2. Facilitates diversification:
3. To provide product and market emphasis:
4. Executive Development:
5. It promotes motivation:
6. Better control and supervision:
7. Quick Decision-Making:
Disadvantages of decentralization
1. Uniform policies not Followed:
2. Problem of Co-Ordination:
3. More Financial Burden:
4. Require Qualified Personnel:
5. Conflict: 203
MANAGING MATERIALS AND TIME
Managing Materials
 Materials are essential resources to achieve the

objectives of the health care institution. For

quality and efficient services, the materials
must be in the right place, at the right time
when needed and in right quantity

204
Activities Which Pertain to Materials
Management
i. Demand estimation
Since a large quantity of materials are used in
hospitals and in specific units/wards, you need to
identify your requirements or needs.
ii. Procurement
Having come up with your list the next step is
procurement or ordering. Some institutions have
laid rules and regulations regarding procurement.
This is aimed at reducing wastage and maximizing
the value of money

205
iii. Receipt and Inspection
The materials received should be subjected to either
physical or chemical inspection. This ensures that you
receive the right quality of material supplied to the
organization.
iv. Storage
The materials should be in a store within or near the
institution. The store should be of adequate size to
accommodate the materials required for different
types of usages e.g. Fridges, shelves, cupboards
v. Inventory Control (Issue and use)
This means stocking adequate numbers so that
materials are available whenever required. Close
supervision of movement of materials or consumption
rate is a good tool for proper control 206
Time management
 Definition:- act or process of exercising
conscious control over amount of time spent on
specific activities in order to increase efficiency
and effectiveness
Time management skills
 Set goals – realistic and achievable
 Prioritize work – make a list of task
 Delegate task – to your subordinates as per

their skills
 Avoid distractors - i.e. email face book politics
 Organize your time - identify when you waste

time and reduce

207
 Break down tasks – so as to accomplish one
step at a time
 Set deadlines – set realistic deadlines for task

and stick to it
 challenge your self and meet the
deadline ,reward your self for meeting difficult
tasks
 Avoid stress – stress occurs when we accept

more than our abilities resulting into tiredness

and loss of productivity ,delegate tasks and
leave time for relaxation

208
****Tasks time management***
1. Tasks which have to be done. These relate to
key responsibilities e.g. Clinical or
administrative duties.
2. Tasks into which you are pressurized by other
people.
Some of these are important and must be done
while others you do because you do not want to
say no.
3. Tasks which you do because you want to.

These are usually your own choices and include

tasks which someone else could do well e.g.
attending a association meeting
209
Time Wasters
 Interruptions such as telephone calls and drop-

in visitors.
 Lack of clear cut goals, objectives and priorities.
 Meetings both scheduled and unscheduled.
 Lack of daily and/or weekly plans.
 Lack of self discipline.
 Failure to delegate.
 Ineffective communication.
 Inability to say no.

210
Principles of Time Management
1. Goal Setting
The nurse manager sets both organizational and
personal goals. The goals are either short or long
term and provide direction and vision for actions
as well as time frames in which activities will be
accomplished.
2. Time Analysis
The manager should conduct a survey of how
she/he spends a day. Reviewing the daily schedule
and keeping it accurate may demonstrate how
time is used.

211
3. Priority Setting
Time frames for achievement of goals are
identified by the nurse manager. The "to do" list
should be prioritized by classifying activities as
e.g. "1" for urgent or "2" not urgent but important
and "3" less important.
4. Delegation
A number of activities may be delegated by the
nurse manager
5. Controlling Interruptions
Identify causes of interruptions and plan to reduce
them. Some could become a planned and
scheduled activity.
212
 ORGANIZATION OF
HEALTHCARE SERVICES

213
HEALTH CARE ORGANIZATIONS
 The health care organizations make up the

health care system which provides total services

offered by all health disciplines. Today many
types of health care organizations exist. These
differ in terms of: Ownership, Role or services
offered, activity and size.

214
Types of health care organizations:
1. Hospitals:
 These are institutions whose purpose is to serve

the whole community, sick or well. Hospitals

play a significant role and the services provided
include:- preventive, curative, rehabilitative,
promotive, education and research.
Hospitals are classified into:-
 Acute care: This is a facility in which average

length of stay is less than 30 days.

 Chronic or long term hospitals: These are

designated to care for patients whose average

length of stay is longer than 30 days.
215
2. Ambulatory-based organization
 This is the second type of health care organization.

Many health services are provided on ambulatory basis.

It is the care mainly given by private physicians or in
hospitals as out-patient care. The goal is to focus on out
of hospital preventive care and illness follow up care. It
also reduces the cost of expensive acute hospital care.
3. Health Managed Organization (HMO)
 The other type of health care organizations are the

HMO's. This is a newer concept in our country which is

catching up quickly. This is where an organization gets
people to enroll and pay a fixed periodic fee to the
organization which determines the amount of services
used. The HMO company offers hospital and outpatient
services. Examples of these include insurance
companies who cover medical expenses. 216
4. Home Health Care Organization
 The last type of health care organizations is

home-based.
 The services in this case are offered at home.

The care is given by professional with expert

skills in assessing patients self-care abilities and
identifying resources to overcome problems and
meet patients needs. These include patients'
requiring palliative care, chronically ill, disabled
or elderly.

217
The Kenya National Health System
The health system in Kenya include the
 National system and the county health system,
 National and county governments institutions engaged

in health service delivery,

 Research for health, health financing institution
 Health regulations,
 All health workers both in the public and private sectors,

traditional,
 Complementary and alternative health care providers,

and all institutions

 Professional societies (like the Kenya medical
association) who are involved in ensuring the promotion,
 Prevention, control and treatment of illness,
 Care and or rehabilitation of health.
218
Structure of the health care system in
Kenya

219
.

220
.

221
.

222
Public sector health service Delivery:
 The health sector comprises the public system,

with major players including the MOH, Parastatal

organization and the private sector, which
includes private for –profit, non-governmental
organization (NGOs) and faith-based
organization(FBO) facilities.
 Health services are provided through a network

of health facilities countrywide, with the public

sector system accounting for about 50 percent of
these facilities.
 The public sector health service delivery is

organized on a six level tier system as outlined

below. 223
Public Sector Health Service Delivery
System

224
.

225
.

226
.

227
Linkages and responsibilities in the health
care system:
 The constitution of Kenya (2010) assigns the

larger potion of delivery of health services to

the counties with the exception being the
national referral services.
 Counties bear overall responsibilities for
planning, financing, coordinating delivery and
monitoring of health services towards the
fulfillment or right to ‘the highest attainable
standard of health’.

228
Responsibilities for health services are
exercised at three levels:
1. The Ministry of Health (National Directorate for
health)
2. County Health Management Teams (CHMT)
3. County Health Facility Management Teams

The Ministry of Health

Under the devolved system of government, the
National Government through the Ministry of Health
is responsible for provision of overall direction
through
-Policy formulation,
-national strategic planning,
-Priority setting, 229
-Budgeting and resource mobilization,
-Regulating,
-Setting standards
-Formulating guidelines,
-Monitoring and evaluation,
-and provision of technical backup to the county level
Key mandates of the MOH:
1.Development of national policy.
2.Provision of technical support at all levels.
3.Monitoring quality and standards in health services
provision;
4.Provision of guidelines on tariffs for health services;
5.Conducting studies required for administrative or
management purposes
230
 The chief Technical Officer of the Ministry of Health
is the Director of Medical Services (DMS).The role of
the MOH is to provide strategic direction through
national health planning, development of services
and quality standards, health financing, HRH
planning, monitoring and evaluation.
These national functions are distributed
amongst six directorates namely:
1.Administrative Services;
2.Health Standards, Quality Assurance and
Regulations;
3.Curative and Rehabilitative Services;
4.Policy Planning and Health Care Financing;
5.Preventive and Promotive Services;
6.National Quality Control Laboratory. 231
 The role of the National Directorates for Health
is to provide overall direction- policy
formulation, national strategic planning, priority
setting, budgeting and resource mobilization,
regulating, setting standards, formulating
guidelines monitoring and evaluation and
provision of technical backup to the county
level.

232
COUNTY GOVERNMENT:
 At county level, the Kenya Health Policy 2012-2030

proposes the formation of county health

departments whose role will be to create and provide
an enabling institutional and management structure
responsible for ‘coordinating and managing the
delivery of health care.
 Mandates and services at the county level’. In
addition to the county health departments, the
policy calls for the formation of county health
management teams. These will provide ‘professional
and technical management structure’’ in each
county to coordinate the delivery of health services
through health facilities available in each county.
233
 The role of the county government is to provide strategic
and operational leadership and stewardship for overall
health management in the county, including provision of
health services, resource mobilization, creation of
linkages with national level referral health services,
monitoring and evaluation, coordination and collaboration
with state and non-state and non-state stakeholders at
the county level.
 Within each county, the Health Facility Management
Teams are charged with the responsibility of providing
health services, developing and implementing facility
health plans, coordinating and collaborating with
stakeholders through county Health Stakeholder Forums,
supervising, continuously monitoring and evaluating
health services provision and implementing health
policies. 234
SERVICES PROVIDED IN VARIOUS LEVELS OF
HEALTH FACILITIES:

235
.

236
.

237
.

238
COMMUNICATION AND
NETWORKING

239
INTRODUCTION:
 The term communication is derived from the Latin word

communis, meaning common and thus when we

communicate we try to establish a commonness of ideas
with someone.
 Communication can be defined as the process by which

people share ideas, experience, knowledge and feelings

through the transmission of symbolic messages.
 It’s the giving, receiving or exchange of information,

opinions or ideas by writing, speech or visual means or

any combination.
 Communication is the exchange of information between

two or more persons who are interacting with each other

in such a way the information is understood.
 Communication skills: the ability to convey or share

ideas and feelings effectively. 240

Communication is a Series of Experiences of

Hearing Smell

Seeing
Touch
Taste
Types of Communication
1. Formal Communication
 This is the official way of communicating with people

in an organization. The communication may be

passed orally or in written form.
 The messenger flows from top to bottom e.g. from

the top management to staff at the lower levels

following an hierarchy or chain or command in the
particular organization.
 Formal communication flows in three directions

namely: - [Direction of Communication flow in an

Organization]
1) Vertical Communication
2) Horizontal Communication
3) Diagonal Communication 242
Vertical communication [downward and upward]
Downward – directed
 Communication flows from the top management to the

lowest level of employees.

 Main purpose - to direct, instruct and evaluate, provide

information on goals/policies of organization.

 This type of communication is authoritative and can

lead to poor morale, low productivity, frustrates

employees, kills creativity/innovativeness of low level
employees
Upwards - directed upwards
 Communication flows from staff at lower level and

middle levels to the top management, to managers,

supervisors
 Forms of Communication include: memos, reports,

meetings, informal discussions etc. 243

Horizontal communication/lateral
 People of the same level/status
 Forms of communication includes: meetings, seminars
 Helps coordinate, problem solving
 Helps form relationships with peers, direct contact, reduce

communication inaccuracy
Diagonal communication
 Tasks frequently arise which involves more than one department

and there is often no obvious line of authority through which a

manager may follow.
 A manager may be dealing with a colleague more senior/junior

to him in another department.

 Relies heavily on cooperation/respect between parties
concerned.
External communication
 Occurs between managers and people outside the organization
 Customers, suppliers, government officers, other interest groups
 Helps link organization to the external world.
244
2. Informal communication
 An informal and unofficial form of communication between
groups of an organization. The messages are discussed
casually and are not recognized by the management.
 Informal communication is also known as “grapevine’’
 The grapevine is a form of Information containing some
half truths.
 Channel that disseminates news/gossips and rumors within
an organization
 Its fast pace, rapid and unpredictable
 Source of very confidential information/feedback
 As a result failure of formal system of communication,
carelessness
 Letters left on the desk unattended, loud voices from
closed doors,
 It’s a natural activity.
245
Grapevine communication
 Communication that has been released prematurely
but its source can be traced and has some truths.
 Used by management to test waters particularly

when implementing new policies that have adverse

effects on employees i.e. retrenchment.
 The management is thereby able to weight the pros

and cons of policy before implementing.

Rumour
 Information arise out of speculations. This happens

when people are kept in suspense and do not know

what is happening.
 The source cannot be traced
 Truth cannot be established
246
3. Unconscious Communication
 Its where a wrong meaning has been transferred
because of the way communication has been
conveyed unconsciously to the receiver.
 Usually the sender of the message is unaware that
their behavior is sending wrong signals e.g. if you
appear quite casual when giving important
information the recipient will misinterpret the
importance of the information because of the
manner in which you speak.
 Its important for health workers to be aware of their
unconscious communication

247
Note:
 There is no organization that can exist without

communication.
 Organizational communication involves is the
exchange of information within the organization.
 In any organization, there exists both formal and

informal communication
 The role of the manager is to use positive informal

communication to the maximum for the benefit of

organization. He/she must discourage any which
may not work in the interest of organization
success.
 There is need to establish proper formal channels

and use them for all information that employees

need to know. 248
Channels of communication:
 Channel: This the medium used to convey the message

from the source (sender) to the destination (receiver).

(e.g. speech, memos, telephones).
 The communication channel should suit the needs of

the audience receiving it.

 Direct channels - This includes the verbal and non-

verbal channels of communication.

 Indirect channels - Includes body language that is

subconsciously recognized by the receiver but not

under the direct influence of the sender.
 Communication is achieved through three main
channels (methods) namely
1. Verbal communication
2. Non verbal communication
249
Verbal communication
 It is expressed through face to face conversations,

telephone calls, radio and television broadcasts

 You communicate verbally when giving patients
report to another member of staff and when sharing
health messages with clients.
 Verbal communication involves the art of talking and

listening. The tone of voice can communicate feelings

and emotions that are as significant as words being
spoken. It is important to use words that do not offend
in any way. Avoid using jargon, medical or other words
that the patient may not be familiar to.
Non- verbal communication
 This is what is commonly known as body position,

gestures and facial expressions 250

 It is also referred to as body language because it can be
used to communicate as much as words. The most common
body signs which can be observed from clients / patients
include winking, beckoning, crying, wriggling, facial
expressions yawning, restlessness, dilated pupils, constricted
pupils’ staring at a fixed point. It is often through body
language that we express our attitude towards an issue a
person or persons behavior. Its important for all nurses to be
skilled in interpreting the body language of patients and
clients. This will help you understand the needs and concerns
more carefully. You must also be aware of your own body
language and the signals that you may be unknowingly
sending to your patients and clients.
 The following show some meanings
 Beckoning- calling for help
 Raising hand- calling for attention
 Laughing- elated mood or being amused
 Restlessness- discomfort or feeling pain 251
WRITTEN COMMUNICATION
 This involves circulating messages through the printing

medium. This may be through examples newspapers,

newsletters, posters, letters, circulars, memoranda and
through electronic media like fax, e- mails and telegrams.
Some of the written communications found in health facilities
include policy documents, procedure manuals, circulars,
memoranda, letters, posters, journals, patients care plans and
observation charts.
Factors To Consider before Selecting a Channel
 Speed - the urgency of the communication
 Accuracy - will the information be received accurately
 Safety - the risk of losing the communication in transits
 Record - is it necessary to have a record of the communication
 Impression - the reaction of the recipients in terms of language,

quality of paper, print etc.

 Cost - all element of cost must be considered
 Secrecy - will other people have access to message.
252
Principles of communication
 Principle of clarity – Message must be clear.
 Principle of attention – Full attention to
message.
 Principle of timeliness – Right time.
 Principle of emotional appeal – Look for
pegs on which to hang the message i.e. Ideas
relating to receivers personal interest.
 Principle of organization – arrange and
present facts and ideas logically.

253
Benefits of effective
communication
 It promotes trust.
 It promotes team member loyalty.
 It enhances team member
engagement
 It improves teamwork.
 It improves productivity.
 Communication fuels innovation.
 Resolves issues.
 It creates better client relationships. 254
BARRIERS TO EFFECTIVE COMMUNICATION
 Barriers are factors which prevent effective

communication
 Barriers to effective communication may be

due to six elements of communication

process:
 Source
 Message
 Channel
 Receiver
 Effects
 Social setting

255
Barriers resulting from source
The sender should have the qualities that facilitate effective
communication. The sender should have sound understanding
of his audience and a good knowledge of his subject.
1. Semantic barriers - Failure to recognize social cultural
and psychological factors which can lead to
communication breakdown. e.g. when addressing illiterate
peasants one has to put oneself in their situation to be
able to appreciate their culture, values, perceptions,
worries and hopes
2. Physical barriers - these may attributed to climate e.g.
very cold or hot weather, wind, noise etc.
3. System overload - may occur when an individual
receives too much information at the same time.
4. Lack of privacy and confidentiality
5. Language barrier - the sender should appropriate
language according to the level and age of the receiver 256
Barriers affecting message
 If the massage do not have the qualities of a message

for effective communication there will be

communication break down. To avoid failure in
communication one should address the following
factors:-
1. The message should be addressed in simple language
2. It must be problem centered
3. It should be culturally relevant and not offensive to
values and beliefs of the community and individuals.
Religious believes are particularly important
4. The message should fall within socio-economic
abilities of the audience
5. The message must demonstrate that it is much more
important and beneficial to do what is proposed in the
message than what the message opposes 257
Barriers resulting from the receiver
 If the receiver of the message is inadequately prepared
physically, socially, and psychologically about the venue and
time of giving the health message, he/she may come late
 If the receiver does not know the benefits to gain from the
message he/ she may have little interest to listen to the
message
 If the receiver does not understand the language
 If the sender stammers and speaks inaudibly
 If the message is received in a noisy environment
 If the message is transmitted against religious beliefs of the
community
 If the sender does not know the socio-economic status of the
community
 If the message contains too much information
 If the message takes a longtime to reach the receiver the
audience will change their priorities
258
Barriers resulting from social setting
 The selected venue for receiving the message

has different posters which are not relevant to

the health message given.
 The sender does not consider the social status

of the audience
 The sender of the message must consider the

age and the marital status of the audience

when planning the venue
 The sender does not consider the cultural

beliefs of the audience

 The message is not action oriented

259
Barriers affecting communication channel
 If the sender speaks with a low voice that the receiver can't

hear well.
 When the media for communication is selected without

considering the socio economic status of the audience

 If you select a verbal communication channel without

considering the age of the receiver, the message content,

language sex etc.
Barriers affecting the impact/effects of
communication
 If the sender fails to use appropriate language and to

prepare the audience on the importance of the message

for improvement of their health status
 If the receiver of the message is emotionally disturbed
 The sender of the message may fail to involve the

audience in the planning phase and therefore disregards

the cultural beliefs of the community 260
Barriers affecting feedback
 If the sender of the message does not clarify all

the points to enable the receiver understand it.

 The sender of the message use symbols which the

receiver interprets wrongly without asking for

clarifications
 The sender may speak in un audible voice
 The receiver of the message may have a negative

or different attitude towards the message given

 The sender may send the message by verbal

communication without requesting the receiver to

have a pen and a paper to write down main points.
 The sender of message may take long time talking

to the receiver and as result they become bored261

SUMMARY OF BARRIERS FOR EFFECTIVE COMMUNICATION
Establishing a common bond through communication does not always
come easily. There are many barriers that make it difficult for
communication to achieve its goal. Some of these barriers are:
 Age/status differences: When the sender and the receiver are of

different age groups or social standings, communication may suffer. Old

men, for example, may not want to listen to a young
sender/extensionist, depending on the message. A lawyer may not want
to hear what a peasant farmer has to say.
 Language: The use of language that is not understood by the audience

will stop communication in its tracks. For example, the use of sheng’
may be appropriate for urban young people, but not a rural adult
audience. The audience may also use language in a way that is not
understood by the sender/ extensionist, e.g., the use of riddles.
 Political differences: People of different political orientations may find

it difficult to accommodate messages/ideas from each other.

 Communication overload: Too many messages at one time may be so

confusing that people cannot comprehend them.

 Mistrust: If either or both the sender and the receiver do not trust each

other, communication may be delayed or halted.

 Gender roles: Men may not agree to listen to women. 262
 Timing: The message may be too late for effective action, or the
audience may not have time to listen to it.
 Competition for attention: Everybody wants to talk, or other
distractions interfere with attention.
 Incomplete messages: When only part of the message is delivered,
either through ignorance or oversight, this causes confusion.
 Personal traits: The know – it – all, negative personality, inferiority
and superiority complexes, individual mannerisms, and so on, can all
cut communication short.
 SEMANTICS - Definition of words, Choice of words - When to use
certain channel.
 Poor choice, Use of channels - When to use certain channel
 Physical distractions
 Noise, physical, psychological
 Effects of emotions
 Perceptions
 Filtering, screening, negative information
 Evaluating the source
 Absence of feedback, poor feedback
 Poor listening 263
TO OVERCOME BARRIERS: [Barrier solutions]
 Learn to use feedback well.
 Be sensitive to receiver’s point of view.
 Listen to UNDERSTAND!
 Use direct, simple language, or at least use language
appropriate to the receiver.
 Use proper channel(s). Learn to use channels well.
 Learn to use supportive communication, not defensive
communication.
 Reinforce words with actions
 Present information in orderly/systematic manner
 Understand/manage your audience
 Know content of delivery
 Write clearly
 Avoid information under load/overload
 Provide right environment free from noise
 Plan communication carefully
 PUBLIC SPEAKING
INTRODUCTION
 Public Speaking is a ‘formal’ face-to-face communication method

where a person(s) uses the medium of speech to Inform and/or

Influence a group of listeners (an audience).
 Public speaking is the process of speaking to a group of people in a

structured, deliberate manner intended to inform, influence, or

entertain the listeners.
 Public speaking is commonly understood as a kind of face-to-face

speaking between individuals and audience for the purpose of

communication.
 Note that public speaking is not just what we traditionally think of –

giving a speech in front of a large audience – but also any time

someone speaks to members of the public or the press.
 This could include conducting interviews, but also speaking to

citizens, even one-on-one at a community event. When you think of

it this way, we are ALL public speakers.
 Public Speaking is any formal situation where you use speech to

inform and/ or influence an audience face-to-face. 265

Importance of Public Speaking:
Reasons Why is Public Speaking Important?
 Helps in building confidence
 Helps in making social connections
 Helps in proper team management
 Helps in enhancing one's leadership skills
 Helps in developing vocabulary and fluency in the language
 Recognition in the professional sphere

Public speaking is a great life skill to have as it is necessary in many

different areas.
 Class projects
 Job/internship presentations
 Club/organization meetings or events
 Speech at a family gathering such as a wedding, birthday, anniversary,

etc.

Examples of public speaking can include…

 Delivering lectures, seminars and training
 Making presentations
 Debating
 Conducting demonstrations 266
Key Terms:
 Gesture: A movement or position of the hand, arm, body, head

or face that is expressive of an idea, opinion, emotion, etc.

 Stage presence: The ability to command the attention of an

audience by the impressiveness of one's manner or appearance.

This term is usually used in describing actors in a play or movie.
 Body language: The gestures, postures and facial expressions

by which a person manifests various physical, mental or

emotional states and communicates nonverbally with others.
 Pitch: The quality of a sound governed by the rate of vibrations

producing it; the degree of highness or lowness of a tone.

 Tone: The quality or character of sound; a particular quality,

way of sounding, modulation, or intonation of the voice as

expressive of some meaning, feeling, spirit, etc.

267
 Conversation: is oral exchange of sentiments,
observations, opinions, or ideas.
 Conversation is interactive communication between
two or more people. The development of
conversational skills and etiquette is an important
part of socialization. The development of
conversational skills in a new language is a frequent
focus of language teaching and learning.
 This is a talk, especially an informal one, between
two or more people, in which news and ideas are
exchanged.

268
Differences between Public Speaking and Conversation:
1. Public speaking is a process of speaking to a group of
people in a structured, deliberate manner while
conversation is a form of interactive, spontaneous
communication between two or more people who are
following rules of etiquette..
2. In public speaking speeches involve thoughts which are
logically organized and structured where else conversation
may wonder around the subject.
3. Public speaking has formalized language while conversation
may involve use of slang or offer poor grammar.
4. Public speeches are often delivered in international settings
and context while conversation may arise spontaneously.

269
Public Speaking Opportunities:
At work
 Selling your ideas
 Technical presentations
 Customer Presentations and Reviews

Daily Life
 School Board Meetings
 Town Zoning Board Meetings
 PTA Meetings
 Boy and Girl Scout Meetings

270
Skills required for Public Speaking
The following three skills are required for effective Public
Speaking:
1. Planning & Preparation
2. Positive Non-Verbal Communications
3. Confidence
Planning & Preparation
 Before you can start to plan and prepare the message

and the structure for your Public Speaking activity you

will need to consider the:
o Audience (Who you are trying to inform and/or

influence)
o Purpose (What you want to achieve by informing and/or

influencing your audience)

o Timings (How long you have to inform and or influence

your audience) 271

 Public Speaking can only inform and/or influence an audience if
it is delivered in a structured way!
 The best way to ensure that your Public Speaking activity is
structured is to plan & prepare notes that can be used as a
guide when speaking.
 Your notes should be headings and key words bullet-point
format and not a word for word script of everything you want
to say.
 When you are planning & preparing notes for your Public
Speaking activity you should avoid writing an ad verbatim
(word for word) script of what you are going say to read from.
Instead you should look to use headings and key words in
bullet-point format to help you trigger what you want to say.
 It is actually incredibly difficult to speak effectively face-to-face
from just reading from a script. When people do speak from
reading a script it is usually a combination of memorizing lines
while using teleprompters rather than paper to display a script
for reference. 272
Non-Verbal Communication
 Public Speaking isn’t just about what you say;

It’s also about how you say it!

 When undertaking any Public Speaking activity

you need to be mindful of:

o Your Posture & Body Movements
o Your Facial Movements & Making Regular Eye Contact
o Your Voice Pitch & Tone
 Although planning and preparation are extremely important, all the

planning and preparation in the world will not help if you are unable to
project positive body language, and make effective use of the pitch
and tone of your voice.
 Like in any face-to-face communications, Public Speaking isn’t just

about what you say; It’s also about how you say it!
 The vast majority of the information we receive in face-to-face

communications in non-verbal sources. Around 70% of the information

we receive in face-to-face communications comes from body language
and around 23% comes from voice pitch and tone. Only around 7% of
the information we receive in face-to-face communications comes from
the words we say. 273
Non-Verbal Communication

Positive Examples Negative Examples

Of Non-Verbal Of Non-Verbal
Communication
Head Looking Up Communication
Head Looking Down

A Smile A Frown

Small Hand & Arm Exaggerated Hand

Gestures
& Arm Gestures
Free Arms
Folded Arms
Keeping To One Area
Of The Stage Wondering About
The Stage
Making Eye Contact
With Various Members Only Focusing Your Eye
Of The Audience Contact On One Or Two
Members Of The Audience
Confidence:
 After a successful planning and preparation learn to

without any Hesitation, Repetition or Deviation.

 Be able speak on your topic without being

successfully challenged by a member of your

audience for either Hesitation, Repetition or
Deviation.

275
Aspects of Public Speaking:
 Voice
 Presentation
o Stage presence
o Eye contact
o Body language
o Physical appearance
 Words

 Studies have shown that:

o 7% of any message is communicated with words.
o 38% is relayed by voice (tone, accent, volume,
rhythm).
o 55% is communicated by non-verbal body language.
276
Voice:
 The sound produced in a person's larynx and uttered through the

mouth, as speech or song.

 Voice is the sounds, especially speech, that a living thing makes using

their mouth or the ability to use vocal chords and air to make sounds.
 The ability to speak or sing. The sounds that you make when you speak,

or the ability to make these sounds.

Characteristics of a powerful voice:
 There are three characteristics of a powerful voice. When we speak,

most of us need to focus on being: Lower, Louder, Slower

1. Lower: Lower the pitch of your voice. People generally don’t respond
well to high-pitched or shrill voices.
2. Louder: Project your voice to the back of the room. Practice on the
microphone prior to speaking and remember to position it correctly.
Remember to articulate clearly and do not slur your words together. In
order to be heard, hold your head up and speak from the diaphragm.
Open your mouth wide.
3. Slower: Don’t forget to breathe, pause and add emphasis where
needed. Most of us tend to speed up when we get nervous. You are
probably speaking more quickly than you think. 277
o Use voice as a tool
o Use vocal variety
o Keep voice steady

Use voice as a tool

 Remember that your voice is the best tool you have. Listeners like to hear

enthusiasm & energy in your voice, but not too much.

Use vocal variety:
o Different tones of voice, appropriate pauses and changes in pace help hold

an audience’s attention.
o Vary your delivery rate (the speed at which you talk).
o Mix long & short sentences.
o Vary the tone and volume of your voice. Nothing puts people to sleep faster

than someone who speaks in a monotone voice.

o Don’t be afraid to be silent. Even brief moments of silence can be useful in

adding emphasis and holding your audience’s attention.

Keep your voice steady.
 Sometimes when people are speaking, their voices rise throughout their

sentences so that it sounds like they are asking a question instead of making
a statement: “I’m really happy to be here today? Take care to keep your voice
steady and raise it at appropriate times – when you ARE asking a question or
when you want to emphasize a particular word. 278
Public Speaking Scenarios:
 Broadcast journalists either on radio or television, or

local speakers. What makes their voices so

effective? How do they use their voice as a tool?

Check the video below:

 “”Five Aspects of a Powerful Speaking Voice” -
http://www.youtube.com/watch?v=wE7QJSO449o

279
STAGE PRESENCE:
 Imagine what people see
 Be confident
 Keep energy high

Your voice, if used properly, will help you to convey your message. However, as a speaker,
your audience will also take cues from your physical presence, how you carry yourself.
Imagine if you could see yourself as others see you – just on the basis of your appearance
and how you carry yourself. How would they describe you? How would you want them to
describe you?
 Imagine what people see: The key is to develop sensitivity and awareness of the

image you present. Know ahead of time what you want the impression of the audience
to be. And remember, you don’t get a second chance to make a first impression and
negative impressions are hard to overcome.
 Be confident: For one, you need to project confidence. Even on the days you feel less

than confident, think about some of your strengths, what you are most proud of, and let
it show through your voice, face and the way you carry yourself.
 Keep your energy high. You don’t won’t to seem overly enthusiastic but you do want

to appear happy to be there and excited to share your thoughts with the audience. By
the end of your speech, you want them to be as enthusiastic as you are about your
cause.
Remember that their audience may already have preconceived notions about who they are
based on the fact that they are men / women. How are men / women generally perceived
in your country as speakers? As political activists? Remind participants that they have to be
even stronger to overcome what are often negative perceptions and stereotypes. 280
EYE CONTACT:
 Maintain eye contact
 5 seconds per person
 -or- stare at their forehead or just above

 One form of body language is eye contact or the lack thereof. Be sure to
communicate and make contact with your eyes – they reveal your
sincerity and strength and tell someone how accessible and
approachable you are. What do you think of people who won’t look you
in the eye? They may seem untrustworthy or disinterested or they may
seem like they are lacking confidence. That isn’t the image that you
want to convey.
 Make eye contact with one person at a time and hold it for about five

seconds before moving to the next person and slowly make your way
across the room
 If you are too nervous to look people in the eye, try and identify a few

pairs of “friendly eyes” – people who seem to be sending you

encouragement and appreciating what you have to say, to make eye
contact with. If you are still too nervous, you could also look at their
foreheads or just above their heads. They will still think you are looking
them in the eye if you do it properly. 281
BODY LANGUAGE:
o Posture/stance
o Hand gestures

 Remember that 55% of any message is communicated by non-verbal body

language. Effective public speakers should have a strong presence. You are watched
even before you speak, from the moment you enter the room to the moment you
walk to the front to speak so pay attention to your body language right from the
beginning.
 Practice good posture and don’t slouch your shoulders. Your posture is important.
Do not lean on the lectern or clutch it for security; use it occasionally to rest your
hands. Standing up straight and tall projects confidence. Avoid making people
nervous by “dancing” or shifting the balance of your weight from side to side. It is
good practice to place your legs about shoulder-length apart and if sitting, to sit on
the edge of your chair.
 If hand gestures are natural for you when speaking, use them appropriately. Keep
your hands in the “hand box” – roughly the middle section of your body to avoid
wildly gesturing and distracting the audience from your words. Also avoid the
temptation to use your hands for other purposes – such as engaging in distracting
habits such as touching your hair or playing with a pen. You may not even notice
you are doing it, so watch yourself in a mirror while practicing your speech to make
sure your hands are complementing your words and not distracting from them.
Another idea would be to have someone videotape you practicing your speech and
watch it afterwards.
282
BODY LANGUAGE:
 Other gestures
 Walking and talking
 Smile!
 Use your whole body, not just your hands, to convey

your message. A raised eyebrow or shrug of the

shoulder gets across your view as effectively as a
nod demonstrates affirmation or a shake of the head
conveys disagreement.
 If you are “walking and talking,” pace yourself so

you aren’t moving too quickly. You don’t want to

look like you are pacing on the stage.
 Don’t forget to smile!
 Master on interpreting Non-Verbal Communication.
283
PHYSICAL APPEARANCE:
 Jewelry
 Colors
 Clothes
 Shoes
 Hair/scarf
 Makeup

 While many of us wish that our physical appearance

weren’t so important, the truth is that it does
contribute to the overall impression our audience
has of us.

284
GOOD AND BAD SPEAKING HABITS:
 Public speaking is a continuous learning cycle. It is not

something that you can learn and master overnight and

then you’re good to go for the rest of your life. Good
public speaking requires you to be persistent and to
develop and adopt habits that make public speaking a
normal part of your work.
 Good example: Standing straight, making eye contact –

introduce yourself loudly and clearly stating your name,

where you are from, and purpose for speaking
(convincing the group why you should be nominated for
a leadership position).
 Bad example: Wringing your hands, speaking softly,

stuttering, and looking at the ground, start into a

speech about why you should be nominated for a
leadership position. 285
Good Habits of Great Public Speakers
 Keep it simple.
 Keep it short.
 Use metaphors, not explanations.
 Don't dump.
 Try the problem/solution model.
 Don't use meaningless modifiers.
 Plan.
 Be more than brief. Be interesting.

Bad Public Speaking Habits

 Not Performing an Audience Analysis.
 Thinking of Yourself Instead of Your Listeners.
 Failing to Launch Your Speech
 Relying on Weak Body Language
 Using Vocal Skills that Lack Expressiveness
 Playing It Too Straight.
 Keeping Your Distance. 286
PREPARING YOUR REMARKS: BEFORE YOU START
Remarks: an expression of opinion or judgment. something that
someone says or writes to express an opinion or idea comment
Best Practices for preparing remarks:
Know your audience
Know the occasion
Know the room

Before you even put your pen to paper, you should first consider three
things – your audience, the nature of the overall event during which your
speech will take place, and the venue in which it will take place.
Know your audience and target your speech to their interests and
experiences. Know something about their background (religion,
ethnicity, age, education, etc.). Relate to them as much as possible
without losing your message in the process.
Know the occasion, including the venue and time of day, and how
your talk (speech, panel, etc.) fits into the larger program. Do your
research on the host organization and key people that will be present.
Know the room, if possible. This will help you feel more comfortable
and practice with the actual space in mind. It is a different dynamic
when you talk in a lecture hall as compared to a roundtable setting,
classroom environment, outside, etc. This will also help you to determine
whether or not to use visual aids.
287
WRITING REMARKS:
o Write like you speak
o Outline form
o Avoid technical terms
o Avoid words that are hard to say
 While it is generally advisable not to read your written remarks

word for word when you speak, it is still best to put something
in writing as you prepare for your speech. Remember to write
like you speak, not like you would normally write an essay.
 Put your remarks into an outline. Make sure your key points

are easy to read and then practice so that you are comfortable
filling in the details without having to read them. Underline,
bold and highlight key thoughts. If you print out your notes to
use during your speech, be sure to use a large font, double
space your sentences and leave big borders. End each page
with a complete thought so that you don’t lose focus or miss
making a point when you turn the page.
288
 Be sure to avoid technical terms or words that are not
commonly understood or used by your audience. Watch out for
alliteration and words that can trip you up when you are
speaking. Sound out difficult to pronounce words, such as
names of people and places, and be sure you are comfortable
saying them before your speech.
 In terms of the structure of your speech, start by telling people

what you are going to say, then tell them and finally close by
summarizing what you told them. This may seem obvious, but
you’d be surprised how many people don’t follow this rule. You
really want people to remember your message and repeating
your major themes throughout the speech is a good way to do
it.
Structure: Tell them
Summarize
what you Then, tell
what you
will tell them
told them
them

289
OPENING:
Tell them what you will tell them
o Address purpose/main objective(s)
o Relate to audience
o Establish credibility
o Grab attention

 During your opening remarks, you need to tell your audience what you are going to
tell them. Give them a sense of where you are going with your remarks.
 As you develop your speech, consider its purpose and main objectives. What are you
trying to accomplish? Refer to your objectives in your introduction. Example: “I hope
to convince you to support the proposed legislation on violence against women.”
 The introduction is also a good time to demonstrate that you have done your research
– that you know your audience. Try to find a way to relate and connect with them and
don’t forget to tailor your presentation to their needs.
 Use the introduction to establish your credibility. Tell them why you are in a good
position to talk about the subject of your speech. For example: “Having been a
teacher for the last 20 years, I’ve learned a lot about the important role early
education can play in the lives of our children.”
 Include something in the introduction that will grab their attention. You will be
surprised how quickly an audience will stop listening if they don’t quickly hear
something of interest.

290
BODY:
Then, tell them
o Main points
o Organization/transitions
o Examples and evidence
o Visual aids
o Anticipate questions
 As you prepare the body of your speech, consider the main points that you want to get
across. Be sure to focus on just a few key points. The shorter the speech, the fewer the
points, but even with long speeches, it is better to go into more detail on a few themes than
to try to cover too many topics.
 Once you have established your key points, consider how best to organize them
(chronological, topical, etc.). How will you transition between your main points? Think about
the flow of your presentation and how to keep the attention of your audience. Does the body
of your speech support the opening? Does the body build to a logical conclusion?
 What examples or evidence do you have to support your main points? Don’t forget to
include important statistics, real life stories, quotes, etc.
 What visual aids will support your main ideas? Don’t use them just for the sake of using
them, but if they help to illustrate a point, or make things more personal or engaging, they
can be useful. Remember to consider the space in which you will be delivering your remarks
to determine whether it is practical or possible to use visual aids. Be sure to inform the
event organizer if you plan to use visual aids that require equipment (such as power point
presentations) so they can be sure to have it ready.
291
CLOSING:
Summarize what you told them
 Summarize
 Tie back to your opening
 Call to action

 This is your opportunity to make a final case for

your research, policy, campaign, etc. How will you
summarize your main points? How will you tie the
closing back to how you began the speech? What’s
your call to action? What do you want/need the
audience to do (vote for you, support a cause, tell
others, vote for your draft law, etc.)?

292
BEFORE SPEAKING:
o Rehearse
o Anticipate questions
o Bring remarks
o Eat/drink with caution
o Have water handy
o Relax!

 Now that you have drafted your speech, there are several things you can do to help
prepare for your big moment.
 Rehearse so you are comfortable with the material. Practice with friends or tape
yourself if you have time and the necessary resources. Get feedback and seek to
incorporate it. The more you practice, the more comfortable you will become.
 If there will be a question and answer session after your speech, try to anticipate what
questions your audience will ask. Be prepared to address them. While you cannot
anticipate all questions, you can be prepared for those that are most likely.
 Bring a copy of your remarks.
 Eat and drink with caution. Avoid a big meal before speaking. Dairy products like milk
can create a lot of phlegm which may make it harder to speak. Carbonated beverages
may make you belch. Avoid alcohol.
 Have water handy and take a sip if your throat gets scratchy or dry.
 Breath deeply and try to relax. This may be the hardest advice to follow but there are
ways to get over your fear of public speaking. 293
CONTROLLING YOUR NERVES:
 Use nervous energy to your advantage
 Anticipate negative side effects to lessen their impact

 Being nervous in a public speaking situation is normal, natural

and even helpful. Adrenaline increases the human heart rate,
pumps blood quicker and gets more oxygen to body tissue. This
heightens mental activity and provides you with energy.
 Control and prepare for nervousness. While nervous energy is
positive, nerves and their accompanying behaviour are not. The
negative side effects range from sweating profusely to heaving
uncontrollably shaky hands.
 If your throat is scratchy, clear it away from the microphone.
Better yet, have an unwrapped cough drop in your pocket. To
prevent dry mouth, use lip balm on your lips prior to speaking.
Have a drink available if your voice breaks, remembering that ice
water constricts the throat. Water at room temperature or warm
beverages are better.
294
MEDIA INTERVIEWS:
 Consider your audience
 Always refer back to your message
 Formats:
o Newspaper
o Radio
o Television
 Preparing for a media interview is similar to preparing for
a public speech with some exceptions. As with a public
speech, you need to consider your potential audience and
adjust your remarks accordingly. Each of the three formats
(newspaper, radio and television) require a slightly
different approach. No matter the format, remember to
always tie in your response to questions to your
“message”.

295
Newspaper interview:
 Never go “off the record”. These are remarks that are not meant

to be published or shared with anyone else. They are meant to

provide a journalist with information or an explanation.
Unfortunately, not every journalist will respect your wish to keep
this information private so assume that anything you say will
become public.
 Have the journalist read back your quotes to you to make sure

they have been recorded correctly and reflect your intentions.

Radio interviews:
 Never give a radio interview while you are distracted. If you are

doing the interview over the phone, be sure to be in a quiet room

where you can focus.
 Act as if you are on television.
 Try to repeat the question back to the journalist to make sure you

understand what she or he is asking you.

296
Television interviews:
 How you dress is vital as you will be on camera.
 Consider the location of the interview. If the

journalist/camera crew will come to you, consider

getting out of your office. Consider how the location
of your remarks can reinforce or detract from your
message.
 Suggest that the journalist include a visual of some

sort that will support the message you are trying to

get across.
 Don’t forget to smile, when appropriate.
 Enunciate your words carefully and be slightly (but

not overly) energetic. You want to convey strength,

enthusiasm and confidence.
297
DEBATES:
 Preparation is key
 Pause to gather your thoughts
 Keep time limits in mind
 Respond to the question you want to answer
 There may also be occasions where you participate in debates or public

forums. This may be a local event during which multiple perspectives

and policy options are discussed, or a bigger, more formal debate
between candidates. Regardless, it is important to prepare in advance so
that you can respond to questions that arise and to your opponents
comments. Remember to reiterate your message as often as possible
during the debate.
Preparation could include:
 Coming up with15 questions that are likely to be asked and preparing

and practicing responses.

 Researching your opponent’s debate history and style.
 Putting together arguments to counter what your opponent is likely to

say.
 Thinking through both positive points to stress about yourself/your

position and points that

 challenge your opponent’s position/record/etc. 298
 Finding statistics to back up your points as well as
stories that show the personal side of the issues.
Remember:
 Preparation is key. The more prepared , the more

confident you will be and the better you’ll do.

 Pause to gather your thoughts before responding to

a question. A moment of silence is perfectly

acceptable.
 Keep any time limits in mind when responding. If

you only have 30 seconds to respond, you will need

to get to the point quickly.
 Respond to the question you want to answer, even if

it’s not exactly what was asked. Remember to refer

back to your message.
299
Ways to Improve Your Public Speaking Skills:
1. Watch the Experts
 Watch clips from great public speakers and find out

what they do right. Pick up on their posture, tone,

volume, hand gestures, eye contact, attire, any
audio/visual aids, message, and more!
2. Dress to Impress
 Be sure to look the part. Know your audience and

don’t fall short of their expectations. If it is a formal

event, be sure to look the part. Remember it is
always best to overdress than to underdress.
3. Visit the Space Before Presenting
 Get to know the space that you will be presenting

in. Test out any audio and visual aids that you will
be using. 300
4. Know Your Material:
 Be sure to have a strong knowledge base for the

material that you are covering. This will be helpful if

a question arises about the topic.
 Also, know your presentation! Know the content and

order of your slides.

5. Content
There are 6 C’s to consider:
 Clear
 Concise
 Concrete
 Coherent
 Complete
 Correct

Tip: Try to share one thing no one knows 301

6. Body Language and Personality
 Watch yourself in the mirror when you are

practicing or record yourself on camera. Be

aware of your body language, what is it
conveying to your audience?
 Let your personality shine through! Some

speakers find it useful to share a personal story

that is relevant and appropriate.
7. Practice, Practice, Practice
Run through your presentation on your own. Pay
attention to your:
 Voice- Tone, inflection, volume, speed, pauses
 Filler Words- ‘um,’ ‘you know,’ ‘like’
 Areas of difficulty in your presentation 302
8. Get Feedback:
 Share your presentation with a friend, classmate,

professor, or anyone who is willing to give you

feedback. Adjust your presentation with their
feedback and then get feedback again.
9. Prepare for the Unexpected
Are you ready for:
 No Internet
 Lost PowerPoint
 Cell phone ringing
 Late entrance
 Different size audience than expected
 Forgot handouts
 Lost index cards
 Too many questions 303
10.Do’s and Don’ts
 Don’t:
Do: ● make excuses
● Always repeat ● read your slides or verbatim
from notes
audience ● defer answering questions
questions ● overload your slides
● Give audiences
something to walk
away with
● Respect your
audience’s time
Building confidence and Conquering Fears
Plan and Prepare
 Proper preparation and rehearsal can help to reduce

fear by about 75%.

 Proper breathing techniques can further reduce this fear

by 15%.
 Your mental state accounts for the remaining 10%.

10 Steps to Reduce Speaking JITTERS

(Nervousness, Scaredness, Uneasiness, Agitation):
1. Know the Room
 Arrive early and walk around the room
 Stand up front by lectern or podium
 Test out the microphone if using one
 Walk around where the audience will be seated
 Walk from where you will be seated to the place where

you will be speaking 305

2. Know the Audience:
 Try to greet some of the audience and chat with them
 Friends are easier to talk to than a group of strangers

3. Know Your Material

 Research topics thoroughly
 Provide specific examples and scenarios to illustrate your

point
 Read your material aloud and get a feel for how it sounds as

it is explained
 Be mindful and monitor your speed when going over your

presentation
4. Learn How to Relax
 Sit comfortably with your back straight
 Breathe in slowly, hold your breath for 4 to 5 seconds, and

then slowly exhale

 To relax your facial muscles, open your mouth wide and eyes

wide, and then close them tightly. Pause and open them
again. 306
5. Visualize Yourself Speaking
 Imagine yourself walking confidently to the

podium
 Imagine yourself speaking, your voice loud, clear,

and assured
 When you visualize yourself as successful, you

will be successful
6. Realize People Want You to Succeed
 Audiences want speakers to be interesting,

informative, and entertaining

 They want you to succeed, not to fail

7. Don't Apologize for Being Nervous

 Most nervousness does not show
 If you don't say anything, nobody may notice 307
8. Concentrate on Your Message:
 Your nervous feelings will ease as you focus your

attention away from your fears.

 Concentrate on your message and your audience,

not yourself.
9. Turn Nervousness into Positive Energy
 The same nervous energy that causes stage fright

can be an asset to you

 Harness it, and transform it into vitality and

enthusiasm
 Learn a quick stress-reducing routine for relaxing

your neck, shoulder and facial muscles just before

giving your talk
 Transform this energy into vitality and enthusiasm in

delivering your speech 308

10. Gain Experience
 Experience builds confidence, which is the key to

effective speaking. Most beginning speakers find

their anxieties decrease after each speech is
delivered.

Conclusion
 Preparation + Practice = Perfection
 Remember, he who fails to prepare is preparing for
failure!

309
Challenges of Public Speaking:
 Lack of Confidence. If you don't have confidence in

yourself, you'll risk alienating the audience.

 Lack of Attention to Audience. Make sure you know

the audience, or the presentation will be

unsuccessful.
 Lack of Organization.
 Lack of Preparedness.
 Lack of Time Management.
 Others include distance, background noise, poor or

malfunctioning equipment, bad hearing, poor

eyesight, speech impediments.

310
Speech:
 Speech is communication through talking or a talk

given to an audience. An example of speech is a

conversation between two people. An example of
speech is the presidential address
 The expression of or the ability to express thoughts

and feelings by articulate sounds.

 Speech is human vocal communication using

language.
 Speech writing is the method of conveying a

thought or message to a reader using the correct

punctuation and expression.

311
Main areas in organizing a speech:
1. Organizing your main points
a. Each point must be dependent on each other and
balance time from one point to the other.
b. You should have supportive materials e.g. quotes,
statistic's, testimonies etc.
2. Language: The language must be suitable to
a. The organizational
b. Occasion
c. Audience.
d. To speaker
3. Speech delivery.
a. The speech must be spontaneous, the speaker
should not hesitate within the delivery of speech
b. The speech should not look much rehearsed. 312
4. Vocalization
a. Volume – loudness or softness, adjust to the situation (electronically if
necessary, don’t yell)
b. Pitch – highness or lowness of the voice use inflections in your voice to
avoid “monotone”
c. Rate speed at which you speak 120-150 wpm is normal, too slow leaves
people hanging on your words, too fast and they get confused and miss
information
d. Pauses – momentary breaks in your speaking takes experience to know
when to pause, pause at the end of thought units avoid vocalized pauses
(“uh”, “er”, “um”...)
e. Variety; vary the loudness, pitch and rate to make the speech sound
more natural and interesting
f. Pronunciation – use correct pronunciation of common words genuine,
arctic, theater, err, nuclear, February, library
g. Articulation – physical production of speech sounds we habitually chop,
slur and mumble, rather than enunciating “ought to”, “didn’t”, “for”, “don’t
know”, “ask”
h. Dialect – variety of language distinguished by variations of accent,
grammar or vocabulary
313
5. Non-verbal communication
a. Use some gestures which are allowed and consider eye
contact with your audience.
b. Always dress official when delivering speech.
6. Visual aid; Use of maps, photography, graphs to give
strength to speech.

Types of Speech Delivery

1. Impromptu speaking - Is a presentation of a short massage
without advance preparation.
2. Extemporaneous speaking - presentation of a carefully
planned and rehearsed speech.
3. Manuscript speaking is word for word interaction of written
message; the speaker maintains his or her attention on the
printed page except when using visual aids.
4. Memorized speaking - consists of reciting of written
message that speaker has commitment to memory. e.g.
actors. 314
Factors Consider When Delivering a Speech
 Use the power of eye contact -eye contact make personal

engage in speech
 Posture matters a lot (stand straight) facing your audience
 Project your voice; attempt to project your voice and sustain

this projection through the presentation

 Be confident; confidence is the core elements of effective
speech delivery
 Speak passionately; invest your speech with passion best

excited about your topic.

 Non-verbal communication: Is the transmission of messages or

signal through a non verbal platform such as eye contact, facial

expression, gestures and postures.
 Visuals aids : They are item of a visual manner such as graph,

photograph, video clips etc used in addition to spoken

information (chosen depending on their purpose)
 Vocalization using the voice appropriately when delivering a

speech 315
 REPORT WRITING:
Definition of terms
 Report - a short, sharp, concise document written

for a particular purpose and audience

 A report is a spoken or written account of something

that has been observed, done, heard or

investigated.
 An account given of a particular matter, especially

in the form of an official document.

 Report writing - a systematic and well organized

presentation of facts and findings of an event that

has already taken place
 Record - a thing constituting a piece of evidence

about the past especially an account kept in writing

or some other permanent form. 316
Characteristics / features / qualities of a good report:
1. Content: Clear picture of what happened, includes
relevant facts as well as pertinent negatives.
2. Accurate: contains specific details relevant to the
incident. Specific details related to call
3. Objective: details are based upon findings, i.e. specific
facts that in general are not disputed.
4. Factual: based on facts, no assumptions or conclusions.
5. Complete: all the relevant and necessary details
included
6. Timely: Same day completion
7. Precise
8. Consistency
9. Simple
10. Relevancy

317
A Complete Report should be:
 Timely
 Concise
 Makes every word count
 Concrete fact with descriptive detail
 Clarity
 Uses accepted abbreviations
 Short sentences or phrases

318
COMPONENTS / PARTS / ELEMENTS OF A REPORT
1. Title page - This gives the title of the report, name of the
person the report is being submitted to and completion
date.
2. Table of contents - this shows the sections of the report;
it gives the headings, sub-headings and page headings.
3. Executive Summary - a brief overview of the report that
is designed to give the reader a quick preview of the
report’s content.
4. Introduction - a brief description of the content and
background of a report. It describes the change, problems
or issues to be discussed on.
5. Discussion - This is the main body of a report and has
two main key purposes:
i) Explain the conclusions
ii) Justify recommendations
319
6. Conclusion - Brief statement of the key findings
of the report. It is arranged so that the major
conclusions come first.
7. Recommendation - Opinions of the writer of
the report about possible changes or solutions to the
problem.
8. References - a list of the sources that are used
in and referred to in the report.
9. Appendices - Additional relevant information
may include interview questions or surveys.

320
The components / parts of report writing can be
summarized into three sections:
Heading / introduction; Discussion and conclusion /
recommendations.

Heading / Introduction
 The heading section includes:
o The date the report is written
o The recipient (s) of the report
o The subject of the report, including the topic and the

focus of the report

 The introduction is general overview of the report

including:
o The purpose of the report,
o The people involved,
o And the time period the report represents. 321
Discussion
 This section of the report is the largest.
 In the discussion section, you sum up the

activities and problems you run into at

work.
 When developing this section consider:
o Whom is involved—be specific
o When did the incident take place—provide

details
o Why are you composing this report?
o Where did the incident take place?
o What exactly was the process? 322
Conclusion/Recommendations
 This part of the report is the place

to summarize what has been

learned from work or incident or to
share any decisions that have
been made.
 The recommendation allows you to

share your opinion concerning any

future action regarding the issue.
323
COMMON TYPES OF REPORTS:
i) Formal or Informal reports
a. Formal reports are carefully structured. They contain
much detail and written in a style that tend to eliminate
elements such as personal pronouns.
b. Informal reports are short messages with natural casual
use of language, example MEMO.
ii) Short or Long Reports - a one page report is a short
report e.g. MEMO. A report that has twenty pages is a long
report.
iii) Informational or Analytical reports
a. Informational reports carry objective information from
one area of an organization to other e.g. annual reports,
monthly financial reports.
b. Analytical reports present attempts to solve problems
e.g. scientific research, feasibility reports and real estate
appraisals. 324
iv) Proposal reports - a problem solving report. It
describes hoe one organization can meet the needs of
another e.g. governmental agencies advertise their needs
by issuing “requests for proposal.”
v) Vertical or lateral reports -
a. Vertical reports move up or down a hierarchy.
b. Lateral reports assist in the coordination in the
organization (moves between units of the same
organization level e.g. production and finance
department.)
vi) Internal or external Reports -
a. Internal reports travel within the organization.
b. External reports are prepared for distribution outside
the organization .e.g. annual reports of companies.

325
vii) Periodic reports - They are issued on regularly
scheduled dates. They are generally upward directed.
viii) Functional reports- they include accounting
reports, marketing, financial reports and a variety of
other reports.
ix) Verbal or written reports -
a. Verbal reports are given by word of mouth while
written reports are put down on paper.
b. Verbal and written reports can either be formal
or informal.

326
IMPORTANCE / SIGNIFICANCE OF REPORTS:
 Reports are decision making tools. They can be used in

making business decisions and reach solutions by managers

 Evaluation- Reports are a collection of evaluated information.

It is impossible for managers to keep an eye on the different

activities in each department, so every department writing
and maintaining periodic reports keeping a tab of ongoing
activities becomes easier on the management.
 Professional improvement- during appraisals, staffs are

asked to write reports to explain their positions level of work

and performance. Promotions occur this way.
 Quick source of problem solving- business reports issued to

managers are used as a source of information to make quick

decisions.
 Reports justify a budget.
 Reports form a basis for evaluating individual/departmental

performance.
 Reports are relevant in legal proceedings. 327
Importance of Written Reports:
1. Compilation of statistical data/research
2. Legal documentation (Emergency
Medical Services/Fire)
3. Record Keeping Regulations
4. Justify budget requests, code
enforcement, resource allocation
5. Prepare court cases with relevant facts
6. Evaluate individual/department
performance
328
COMMON DOCUMENTATION PROBLEMS:
 Deficiencies- Missing information in the
report
 Discrepancy- Information not matching e.g.

records and reports not matching

 Omission- completely failing to report.
 Unapproved abbreviations- use of
abbreviations that have not been approved
in a professional field
 Errors of Omission- failure to document
 Errors of Commission- giving incorrect or

erroneous information
329
Style of report writing:
 The style of each report varies, but consider

“conciseness, simplicity, and highlighting techniques”

 Remember to be concise.
 You may choose to use graphics to illustrate a point.
 Be aware that using too much data will overwhelm

your reader.
Checklist for Writing a Report
1. Analyze the report problem and purpose
2. Collect Data
3. Document data sources
4. Interpret and organize data
5. Prepare visual aids
6. Compose first draft
7. Revise and proofread
330
 NETWORKING:
 Networking: Communication and cooperation between
groups and individuals sharing a commitment to a common
goal, ideal or objective.
 Sharing resources and/or ideas
 Providing mutual support and assistance
 Networking usually involves meeting new people, who
share a profession, industry, or interests. Networking
involves exchanging ideas and information between these
individuals.
 Networking is the exchange of information and ideas among
people with a common profession or special interest,
usually in an informal social setting. Networking often
begins with a single point of common ground.
 Networking: “using the personal relationships people have
with one another to increase your exposure to information
and opportunity” 331
 Networks: are a one-to-one connection used for
communication and other purposes.
 Network is to interact socially for the purpose of getting
connections or personal advancement.
 Collaboration: The process of two or more people or
organizations working together to complete a task or
achieve a goal.
 It is also defined as two or more people working together to
achieve shared goals.
 Collaboration is when a group of people come together and
contribute their expertise for the benefit of a shared
objective, project, or mission.
 Collaboration is a working practice that allows individuals to
work together to achieve a common goal
 A process where people with diverse interests share
knowledge and resources to improve outcomes and/or
enhance decisions. 332
Importance of Networking:
 Networking contributes to social well-being
 Networking leads to the exchange of ideas
 Networking increases confidence
 Gives methods to exchange practice knowledge

while performing important works.

 Enables people to complete their tasks on time.
 Networking requires a small amount of time and

yields great rewards

 Networking helps you meet people at all
professional levels.
 organization can enhance the performance levels of

employees effectively
 Organization they can handle complex issues in a

project to overcome unwanted issues. 333

Principles of Effective Networking:
 Win/Win Situations Produce Strong Connections
 Give More Than You Get
 Prioritize quality over quantity
 People Do Business With People They Like
 Activity Beats Inactivity (Be proactive)
 Be genuine
 Take a long-term approach
 Don’t focus only on industry leaders
 Be approachable

334
Barriers / Challenges of networking:
 A lack of confidence
 Failure to ask questions or for help
 Fear of not being able to return favors
 Over-sharing.
 Communication styles and how these relate when

collaborating and networking

 Lack of time – not finding the time to network
 Not understanding the benefits of developing and

maintaining networks
 Inability to find groups that you ‘fit’ with

335
Networks: different forms:
 National / International
 Informal / More Structured
 Virtual / Face-to-face
 Short-term / Long-term
 Small Selective / Open

What makes networks effective?

 Mutual trust and solidarity
 Active participation
 Decentralized activities
 Clearly shared goals
 Coordination
 Flexibility for rapid response
 Expertise and experience
 Cooperation and collaboration
 Resources for key activities 336
Threats and pitfalls to networking:
 Lack of money
 Lack of focus
 Inability to agree on strategy and priorities
 Domination by one or few partners
 Tendency to centralize power/resources

How can you use networks?

 Get in touch with others, allies, sympathetic

experts etc.
 Ideas and examples
 Attention for your work
 Potential funding contacts
 Back-up in trouble 337
What can you contribute?:
 Share your successes
 Help others get started
 Share information
 Share expertise
 Give support to others

338
 INTER/INTRA-SECTORAL COLLABORATION:
 Collaboration: The process of two or more people
or organizations working together to complete a
task or achieve a goal.
 Intra- and intersectoral collaboration: WHO
definition (2008) “Recognized leadership between
parts of the health sector with parts of another
sector which has been formed to take action on an
issue to achieve health outcomes in a way that it is
more effective, efficient or sustainable than could
be achieved by the health care sector acting alone.”
 Intersectoral collaboration is the collective
actions involving more than one specialized agency,
performing different roles for a common purpose.
339
 Intra-sectoral collaboration is a collective actions of
different sub-processes and activities, which take
place within an organization.
 Intra-sectoral collaboration is a composite process of
implementation and reconciliation of different sub-
processes and activities, which take place
simultaneously or consecutively within an
organization between its various sub- systems and
units or agents
 Intra-sectoral collaboration: between sectors within
health (hospitals, community health centers, home
care agencies)
 Inter-sectoral collaboration: between health and non-
health care sectors (social services, transportation,
housing, private sector, employment). 340
Objectives of Collaboration:
 Multiplication of strengths
 Sharing of skills and strengths
 Use limited resources effectively
 Learn lessons from others
 Bringing together different actors

Principles of Effective collaboration:

 Efficiency
 Trust - Manage through trust
 Empathy
 Positivity
 Clarity
 Accountability
 Focus on mission before organization
 Not control
341
Importance of collaboration:
 It’s the foundation of all work processes
 It’s essential to overall work success
 It’s what brings teams together to achieve

common goals
 It’s how teams focus on individual
responsibilities
 It helps drive growth and innovation
 Improved flexibility
 Higher engagement
 Productive meetings

342
Types of collaboration within an organization:
1. Team collaboration
2. Contextual collaboration
3. Cross-functional collaboration
4. Community collaboration
5. Social collaboration
6. Cloud collaboration
7. Virtual Collaboration

 Team Collaboration: It involves collaboration within a

team where everyone knows everybody else, their skill sets
and their contribution to work at large.
 Contextual collaboration: happens when you bring all of
your digital tools together on one single digital workplace
platform so your entire team can access all the files and
data they need without having to switch between apps or
tools when they need to collaborate. 343
 Cross-functional collaboration: happens when teams from
various departments or verticals come together to accomplish a
common goal for the entire organization.
 Community collaboration: is all about fostering a sense of
community in shared work within teams. It is centered around
learning and sharing knowledge within teams as opposed to
carrying out tasks or completing work in team collaboration.
 Social collaboration: its when team members can reach any
other team member or a group of team members on a real-time
basis on a platform designed to accommodate such features.
 Cloud collaboration: teams can upload, access, work on and
deliver their work entirely on a cloud based digital workplace
platform. All stakeholders can be added to a document as it
exists live on the cloud.
 Virtual Collaboration: With the advent of digital workplace
technology, virtual collaboration has become a buzzword that
resonates around the world. Virtual meetings are no longer the
forte of distributed teams. They have become mainstream.
344
 ADVOCACY
 Advocacy is a key health promotion activity for
overcoming major barriers to public health and
occupational health such as poor living and
working conditions, rather than individual or
behavioural barriers
 Advocacy can be used as part of a community
initiative, nested in with other components
 Health promotion aims at making these conditions
favourable through advocacy for health”. (WHO,
2013) as envisaged in the Ottawa Charter on
Health i.e. “political, economic, social, cultural,
environmental, behavioural and biological factors
can all favour health or be harmful to good health
345
Definition:
 Advocacy simply means actively supporting a cause, and

trying to get others to support it as well.

 Advocacy is speaking up, drawing attention to an

important issue and directing decision makers towards a

solution.
 Public support for or recommendation of a particular

cause or policy
 The act of pleading for, supporting, or recommending;

active espousal
 Active promotion of a cause or principle
 “The processes by which the actions of individuals or
groups attempt to bring about social and/or organizational
change on behalf of a particular health goal, program,
interest, or population” (2000 joint committee on health
education and promotion terminology, 2002)
346
Advocacy Steps:
1. Taking action - overcome obstacles to action
2. Selecting your issue - identifying and drawing attention to
an issue
3. Understand your political context - identify the key people
you need to influence
4. Build your evidence base - the issue, map out the potential
roles of relevant players
5. Engaging others - win support of key individuals and
organisations
6. Elaborating strategic plans - collectively identifying goals
and objectives and best ways to achieve them
7. Communicate messages and implementation plans
8. Seize opportunities - time interventions &actions for
maximum impact
9. Being accountable - monitor and evaluate process and
impact
10. Catalyse health development - build sustainable capacity347
 Advocacy Principles
Principle Description
Consumer The consumer is at the centre of the
centred interaction.
Opportunitie Stakeholders promote and support
s opportunities for both individual and
systemic advocacy
Recognition Stakeholders recognise that advocacy is
legitimate and that it can take many forms.
Relationships All those involved work together with
respect and recognise each other’s roles
and contribution to the process
Response Matters raised are acknowledged and
responded to.
Resolution Aim of all parties is to find a solution which
is acceptable to the consumer.
348
Effective Advocacy:
1. The rightness of the cause
2. The power of the advocates (i.e., more of
them is much better than less)
3. The thoroughness with which the advocates
researched the issues, the opposition, and
the climate of opinion about the issue in the
community
4. Their skill in using the advocacy tools
available (including the media)
5. Selection of effective strategies and tactics

349
Advocacy Tools and Processes
 Framing
 Formative research
 Working with media (media interviews

and advocacy)
 Networking
 Social marketing
 Lobbying
 Internet based advocacy

350
Advocacy Approaches
1. Self-advocacy
2. Citizen advocacy
3. Peer advocacy
4. Parent advocacy
5. Family/group advocacy

351
Advocacy Approaches

352
Health Advocates
1. Individual consumer,
2. Friends/family/carers/volunteers,
3. Independent patient advocates,
4. Non-profit organisations,
5. Non-government policy/advocacy
organisations,
6. Statutory authorities,
7. Health professionals, patient liaison
officers,
8. Public servants 353
ADVOCACY BENEFITS
1. Positive changes - Legislation, policies,
practices, service delivery and developments
and community behaviour and attitudes
2. Promotion of wellness and resilience in
individuals, families and communities in
conjunction with health literacy and patient
activation strategies
3. Raised awareness of the significant impact on
an individual’s health and wellbeing of
broader social and environmental factors
(such as housing, education, employment,
and cultural identity, gender and sexuality
354
4. Empowering health consumers to
become more involved in their
healthcare decision-making and
broader health policy and initiatives
5. Resolution of consumers’ issues as
they arise, mitigating escalation and
lengthy complaints processes
6. Consumer focused, affordable and
responsive health services that are
cost-effective
355
356
Effective advocacy:
 Understand the problem
 Define your objectives
 Focus your ideas

Issues for Advocacy:

 Enhancing Gender Equity, Equality and
Empowerment of Women
 Promoting Reproductive Health and Rights
 Population and Development Linkages
 Mobilizing and Monitoring Resources

357
Gender Issues:
 Violence against women
 Early marriage of girls
 Gender disparities in education
 Male responsibility
 Gender disaggregated data
 Unequal social and political participation
 Female economic empowerment

Reproductive Health (RH) Issues:

 The reproductive health approach
 Reproductive rights
 Maternal and newborn care
 STDs and HIV/AIDS
 Adolescent reproductive health
 RH in conflict situations 358
Population and Development Services (PDS)
issues:
 Reorienting national population policies
 Strengthening national data systems
 Integrating population factors into development
planning process
 Addressing needs of special population
 Achieving basic social services for all

Major areas of advocacy work

 Leadership development
 Coalition building
 Networking
 Political Lobbying
 Promoting legislative change
 Briefing media 359
Stakeholders of Advocacy:
 Beneficiaries
 Decision makers
 Allies and partners
 Resistant groups (Adversaries)

Techniques and Tactics of Advocacy

 Sensitizing
 Mobilizing
 Dialoguing
 Negotiating
 Lobbying
 Petitioning
 Pressuring
 Informing
360
Advocacy Skills:
 Listening
 Communication
 Resourcefulness
 Assertiveness
 Self-care, such as taking holidays as needed

Identify influence
 Who makes decisions?
 How are decisions made?
 What is the time-frame?
 What are key moments?

Preparation is critical in understanding the rules of the

game to enables you to become a player.
361
Get to know decision makers:
 Who are they?
 Are they accessible?
 Do they know you and your purpose?
 Do they hear from you regularly?
 What can you do for them?
o Information
o Access to your group
o Press coverage for positive action

Building a strong case

 Anticipate counter arguments
 Select useful facts and examples
 Formulate goals carefully
 Deal positively with criticism
362
Identify allies and helpful experts:
 Look at different levels of influence
 Look at those who partially share your views
 Look at different roles
o The expert witness
o The popular hero
o The powerful voice

Identify and understand your opponents

 Who are they?
 What are their reasons?
 What are their interests?
 What strategy are they likely to adopt?
 Can you dialogue with them?
 Do you have good counter-arguments?
363
Develop a campaign timeframe:
 Don’t wait till the last minute
 Make the most of a launch moment
 How to keep momentum
 Windows of opportunity
 Do you need to end?

Evaluation of advocacy
 Look carefully at your campaign
 What are the lessons?
 What have you gained?
 Have their been negative spin-offs?
 Do you need to modify your strategy? 364
Summary advocacy and networking
 Develop clear objectives and an advocacy plan
 Be imaginative in identifying partners and allies
 Be creative in using windows of opportunity
 Find out about international and national networks

in which you can participate

 Maybe you need to create your own network

365
Summary framework

Components Strategie
•Research s

•Stakeholder •Networking

analysis
Advocacy
•Collaboration
•Plan
•Activities •Lobbying

•Evaluation

366
 NEGOTIATION:
 Negotiation is a process which takes place when two
or more interdependent parties who have different
needs and goals, work together to find a mutually
acceptable & beneficial outcome.
 This often involves both parties making concessions.
 Negotiation is about getting the best possible deal in
the best possible way.
 Negotiation is the process of communication back
and forth for the purpose of searching a joint
agreement about differing means or idea.
 Negotiation is a process which takes place when two
or more interdependent parties who have different
needs and goals, work together to find a mutually
acceptable & beneficial outcome. 367
How to influence others:
The three ‘Ps’:
 Position (power?)
 Perspective (empathy)
 Problems (solutions)

Alternative to Negotiation:
 PERSUASION (convincing the other party)
 GIVING IN COERCION (threatening)
 PROBLEM SOLVING INSTRUCTION (employer /
employee relationship)
 ARBITRATION (seeking fairest 3rd party ruling)

368
Qualities of a good negotiator
 Empathy – participating in other people's feelings
 Integrity - sticking to agreements without needing
to be reminded and giving honest answers to
questions.
 Confidence - negotiator should be courageous
during negotiation.
 Patience - should be sufficiently steadfast and
patient to bring it to fruition.
 Flexibility - should be flexible in case of new
situations or obstacles.
Others: A successful negotiator needs to be:
 Professional
 Confident, Relaxed, at ease
 Open, honest, sincere & credible
 Respectful of other peoples vales
 Show empathy, and understanding
 Committed to a WIN: WIN result 369
Reasons for a failed negotiation
1. Lack of preparation. Basically this means that both
parties come to the negotiation table with nothing but
excitement and hope that a deal can be made even
when evidence suggest that there is no real possibility
of reaching a deal even in the best of circumstances.
2. Confrontation skills. This is a situation where two
parties or sides compete to win a contest or an element
of conflict where parties directly engage one another in
the course of dispute between them.
3. Lack of trust and respect. Parties who trust each
other less tend to argue for and justify their own
preferences and listen less to the others hence are less
likely to understand the representative and more likely
to force their views on other parties. 370
4. Failure to build a relationship. A relationship in negotiation
is perceived connection that can be psychological, political or
personal, whatever its basis, relationship are important not only
because they provide warmth but also build a trust which is fatal
in negotiation.
5. Misunderstanding. It can lead to a breakdown in
conversation in which one participant cannot interpret some
utterance or get wrong interpretation.
6. Solo negotiation. Is a sabotaging tactic that keeps us from
changing our habits in order to resist changes and they argue
that change in uncomfortable.
Others: Why do negotiations fail?
 Getting too emotional
 Focus on personalities, not issues
 Not trying to understand the other person (too focused on our

own needs)
 Wanting to win at all costs
 Regarding negotiation as confrontational 371
4 Stages / phases of negotiation.

372
Stage 1 : Preparation:
 You are fully briefed on the subject matter of the

negotiation
 You are clear about your objectives and what you are

trying to achieve:
o The LIM Model:
o Like to Achieve (most favoured option, ideal settlement)
o Intend to Achieve (expected result, realistic settlement)
o Must Achieve (fall back position, bottom line)
 You have worked out your tactics and how best to put

your case.
 You have tried to figure out what the other parties

objectives will be
 You have gathered background information
(personalities involved, power balance, attitudes etc.)
373
Preparation is instrumental to the success of the
negotiation process. Being well-prepared generates
confidence and gives an edge to the negotiator.
Preparation involves the following activities:
i. Gathering Information: One needs to learn as
much as one can about the problem and ascertain
what information is needed from the other side.
Understanding clearly the issues involved are also
needed.
ii. Leverage Evaluation: Evaluation of one’s
leverage and the other party’s leverage at the
outset is important because there may be a number
of things one can do to improve one’s leverage or
diminish the leverage of the other side. 374
iii. Understand the people involved: It is important to
know the people with whom the negotiation is to take
place. An understanding of their objectives, roles and the
issues likely to be raised by them will facilitate better
handling of the situation during the negotiation process.
iv. Rapport: It is helpful to establish a rapport with the
opponent during the early stages, that is, before the
bargaining process begins is helpful. This was, one can
determine early on how cooperative the opponent is
going to be.
v. Know your objectives: Clarity of objectives is
absolutely essential. It needs to be decided in advance
how much you are willing to concede to the opponent
and what your priorities are. All arguments and
justifications should be ready.
375
vi. Type of negotiation: Anticipate the type of
negotiation expected, that is, ascertain whether it will be
highly competitive, cooperative or something unusual;
whether the negotiation will be face to face, by fax,
through a mediator, or in some other manner.
vii. Plan: Decide on the negotiation approach and plan
accordingly.

Stage 2 : Exchanging Information: / opening phase

 This is the single most important stage of negotiation.

Both parties will be trying to find out and understand

the other’s position and requirements.
 Successful negotiators ask twice the number of

questions and spend over twice the amount of time

acquiring and clarifying information than do average
negotiators. 376
Here the two sides come face to face.
 Each party tries to make an impression on the

other side and influence their thinking at the first

opportunity.
 Psychologically, this phase is important because it

sets the tone for the negotiation to a large extent.

 It involves both negotiating parties presenting

their cases to each other.

Stage 3 : Bargaining phase
 As soon as a number or term is mentioned by one

party, you have begun to move out of information

exchange and into bargaining
 Exchange of terms
 Never give a concession. Trade it reluctantly
377
 Reject constructively: Do not cause offence. “I’m
afraid we can’t possibly agree to a reduction in the
service charge, but there might be room for
manoeuvre on the wording of clause16”. Retain a
constructive atmosphere.
 Note the moving base line: As each issue is
agreed, acknowledge the fact, summarize it, and
move on to the next point after you have noted
the issue of agreement.
 Be firm on broad issues: be flexible on specifics.
 Look for the agreement signals: Certain formulae
of words indicate that agreement is very close.
“If….then….”“Let’s put that in round numbers.
”“Well, that’s hardly worth holding us up..” 378
 The bargaining phase involves coming
closer to the objective you intended to
achieve when you started the negotiation.
 In this phase, the basic strategy is to

convince the other side of the

appropriateness of your demands and
then persuading the other party to
concede to those demands.
 In the bargaining phase, one needs to be

logical in one’s approach and frame

clearly-thought-out and planned
arguments. 379
Stage 4 : Closing and Commitment /
closure phase
Your judgement: Is this best and final offer? If
yes:
 List the agreement in detail
 List the points of explanation, clarification

and interpretation
 Record agreed summary with all at the table
 Re-start negotiations if any dispute over

agreement

380
The closing phase of a negotiation represents
the opportunity to capitalize on all of the work
done in the earlier phases.
 The research that has been done in the

preparation phase, combined with all of the

information that has been gained is useful in
the closing phase.
 It also involves the sealing of the agreement

in which both parties formalize the agreement

in a written contract or letter of intent.
 Reviewing the negotiation is as important as

the negotiation process itself.

381
Types / Categories of Negotiators:
 Most people can be categorised as “hard” or

“soft” negotiators.
Soft:
 Tends to see negotiators as friends
 Sees agreement as the goals prepared to

make concessions to cultivate the relationship

 Is willing to trust the other side
 Is willing to modify position at an early stage
 Discloses “bottom line” early in discussions
 Avoids contests of will on particular points
 Concedes to pressure

382
Hard:
 Sees negotiators as opponents or
adversaries
 Sees victory as the goal
 Demands concessions to establish a

relationship
 Tends to mistrust the other side
 Is reluctant to alter position in any way
 Misleads as to “bottom line”
 Expects to win contests of wills
 Applies pressure
383
 NB: How about you?

 We all have certain tendencies

influenced by our socialisation, our
personalities, and above all by our
managerial histories….
 Rate yourself as ‘hard’; or ‘soft’, and

give some evidence for this.

 Does your preference work for you?

384
The Successful Combination of negotiators:
a) Separate personality and issues: don’t see the
issues as necessarily reflecting in any way on your
personality – hard or soft. An important point should be
made with conviction, and without fear as to the
negotiator’s image
b) See the other side’s case unemotionally: try to be
objective about your case, and the case of your
opponent. This is the best way to serve your client.
c) Avoid confrontation: confrontation is the weak point
of hard and soft negotiators alike. The hard negotiator
will find that (s)he is required to lose face to accept a
compromise, or allow negotiations to fail when it is not
in client’s best interests that they should do so. The
soft negotiator is more likely to succumb to pressure
from a more aggressive counterpart. Be calm! 385
Final Advice:
Be unconditionally constructive. Approach a
negotiation with this—‘I accept you as an
equal negotiating partner; I respect your right
to differ; I will be receptive.’

Some criticize my approach as being too soft.

But negotiating by these principles is a sign of
strength.”

R. Fisher, Getting to Yes

386
Skills and techniques used in negotiations
1. Prepare. Enter a negotiation without proper preparation
and you’ve already lost. Start with yourself. Make sure you are
clear on what you really want out of the arrangement.
Research the other side to better understand their needs, as
well as their strengths and weaknesses. Enlist help from
experts, such as an accountant, attorney or tech guru.
2. Pay attention to timing. Timing is important in any
negotiation. Sure, you must know what to ask for, but also be
sensitive to when you ask for it. There are times to press
ahead, and times to wait. When you are looking your best is
the time to press for what you want. But beware of pushing too
hard and poisoning any long-term relationship.
3. Leave behind your ego. The best negotiators either
don’t care or don’t show they care about who gets credit for a
successful deal. Their talent is in making the other side feel
like the final agreement was all their idea. 387
4. Ramp up your listening skills. The best negotiators are
often quiet listeners who patiently let others have the floor while
they make their case. They never interrupt. Encourage the other
side to talk first. That helps set up one maxims: whoever mentions
numbers first, loses. While that’s not always true, it’s generally
better to sit tight and let the other side go first. Even if they don’t
mention numbers, it gives you a chance to ask what they are
thinking.
5. If you don't ask you don't get. Another tenet of
negotiating is, “Go high, or go home.” As part of your preparation,
define your highest justifiable price. As long as you can argue
convincingly, don’t be afraid to aim high. But no ultimatums,
please. Take-it-or-leave-it offers are usually out of place.
6. Anticipate compromise. You should expect to make
concessions and plan what they might be. Of course, the other side
is thinking the same, so never take their first offer. Even if it’s better
than you’d hoped for, practice your best look of disappointment and
politely decline. You never know what else you can get.
388
7. Offer and expect commitment. The glue that keeps deals
from unraveling is an unshakable commitment to deliver. You
should offer this comfort level to others. Likewise, avoid deals
where the other side does not demonstrate commitment..
8. Do not absorb their problem. Most negotiations, you will
hear all of the other side’s problems and reasons they can’t give
you what you want. They want their problems to become yours, but
don’t let them. Instead, deal with each as they come up and try to
solve them. If their “budget” is too low, for example, maybe there
are other places that money could come from.
9. Stick to your problem. As an individual and a business
owner, you likely have a set of guiding principles and values that
you just won’t compromise. If you find negotiations crossing those
boundaries, it might be a deal you can live without.
10. Close with confirmation. At the close of any meeting (even
if no final deal is struck) recap the points covered and any areas of
agreement. Make sure everyone confirms. Follow-up with
appropriate letters or emails. Do not leave behind loose ends.
389
COLLECTIVE BARGAINING:
 Collective bargaining is a formal and highly developed

form of negotiating.
 It is very similar to diplomacy.
 Collective bargaining is the formal process of
negotiation between an employer and a group of
employees, often with their main representative that
sets the terms and conditions of work.
 The purpose of negotiations is to secure an outcome as

close as possible to your objectives.

 The aim of the people you are negotiating with is to

secure an outcome as close as possible to their

objectives
 Doing it successfully requires analytical skills,
forethought, preparation, presentational skills,
realism and detachment. 390
 Forethought means determining and
evaluating the objectives carefully and
objectively.
 Key tests include the credibility of the
objectives and the strength of the supporting
evidence.
 Preparation means being well briefed and
knowledgeable about what you are seeking to
achieve and how that can be justified.
 Presentation is about how you can present
your case in an accessible and persuasive way
to the employer or government.
 Try to show how your objectives will benefit
employer/government as well as your own
members.
391
 Present your claims in a pleasant, logical,
friendly and firm way.
 Realism means being aware from the start

that it is very unusual to achieve 100 per

cent of your objectives.
A Negotiated Agreement is normally a
compromise between opposing objectives
which both parties are prepared to accept.
 Detachment means not believing all your

own propaganda.

392
Concept of collective bargaining
 Collective bargaining is the process in

which the working people through their

unions, negotiate contracts with their
employees to determine their terms of
employment, including pay, benefits,
hours, leave, job health and safety
policies, ways of balance work and
family, and more.

393
Skills and Techniques used in collective
bargaining
 Try to imagine yourself as the other side to the

negotiations and consider how they might view or

react to your proposals and arguments.
 There is no one perfect style of negotiating.
 Different people do it equally successfully in

different styles and manners .

 To be successful your individual style has to be the

one you are most comfortable with and which

matches your individual personality
 Successful negotiators range from colourful
charismatic performers to quiet, calm and
methodical people. 394
Skills and techniques used in collective bargaining
1. Problem analysis to identify interests and goals-
effective negotiators must have the skills to analyze a
problem to determine the interests of each party in the
negotiations.
2. Preparation before a meeting-before entering a
bargaining meeting, the skilled negotiator prepares for the
meeting like determining goals, areas of trade and
alternatives to the stated goals.
3. Active listening skills - they have skills to listen to the
other party during a debate, it involves the ability to read
body language as well as verbal communication
4. Keep emotions in check - while a negotiation in
contentious issues can be frustrating, allowing emotions to
take control during the meeting can lead to unfavorable
results. 395
5. Clear and effective communication - negotiators must
have ability to communicate clearly and effectively to the
other side. During bargaining meeting, an effective
negotiator must have skills to state his desired outcome as
well as his reasoning.
6. Collaboration and teamwork - they must have skills to
work together as a team and foster a collaborative
atmosphere during negotiations.
7. Problem solving skills - individuals with negotiation
skills have the ability to seek a variety of solutions to
problems, which instead of focusing on solving his only goal
but also benefitting both sides.
8. Decision making ability - leaders with negotiations
skills have the ability to act decisively during a negotiation.
It may be necessary during the bargaining agreement to
agree to a compromise quickly to end a stalemate. 396
The Collective Bargaining Process
 Collective bargaining negotiations are a ritual

process, a stately minuet, a symphony or a novel.

 There are different stages / sequence of which is

essential to the whole process.

 The process of collective bargaining comprises steps

that are followed by both the employee and the

employer to reach an amicable solution.
1. Preparation:
2. Discuss:
3. Propose:
4. Bargain:
5. Settlement:
6. Sealing the deal:
397
Process of Collective Bargaining

398
 1. Preparation: At the very first step, both the
representatives of each party prepares the
negotiations to be carried out during the meeting.
Each member should be well versed with the issues to
be raised at the meeting and should have adequate
knowledge of the labor laws. The management should
be well prepared with the proposals of change
required in the employment terms and be ready with
the statistical figures to justify its stand. On the other
hand, the union must gather adequate information
regarding the financial position of the business along
with its ability to pay and prepare a detailed report on
the issues and the desires of the workers.

399
 The opening presentation of the claim should set the scene
and seek to define the parameters for the subsequent stages
of the negotiations.
 It is a strategic exercise setting out the case and the

supporting evidence.
 It should not be too long or too detailed as that can obscure

and weaken the case.

 Dealing with detail comes later.

2. Discuss: Here, both the parties decide the ground rules that
will guide the negotiations and the prime negotiator is from the
management team who will lead the discussion. Also, the issues
for which the meeting is held are identified at this stage. The
issues could be related to the wages, supplementary economic
benefits (pension plans, health insurance, paid holidays, etc.),
Institutional issues (rights and duties, ESOP plan), and
Administrative issues (health and safety, technological changes,
job security, working conditions).
400
3. Propose: At this stage, the chief negotiator
begins the conversation with an opening statement
and then both the parties put forth their initial
demands. This session can be called as a
brainstorming, where each party gives their opinion
that leads to arguments and counter arguments.
4. Bargain: The negotiation begins at this stage,
where each party tries to win over the other. The
negotiation can go for days until a final agreement
is reached. Sometimes, both the parties reach an
amicable solution soon, but at times to settle down
the dispute the third party intervenes into the
negotiation in the form of arbitration or
adjudication. 401
Key areas of bargaining step:
Initial Response:
 The next stage is the employer/government
response – again it should be strategic and address
the union’s arguments.
 It may make counter proposals, make an offer for an

agreement, and/or give a broad indication of what

they might offer.
 You need to listen carefully and closely to that

response.
 Take a written note of the key parts of the response.
 Evaluate and analyse the language, the precise

words used and their body language

 Assess the extent to which any of their counter

arguments do or do not weaken your case. 402

Countering to Response:
 Do not feel obliged to respond immediately

other than in a preliminary way, or to seek

clarification-but not necessarily too much at
that stage.
 Have a break/adjournment of the plenary joint

negotiations to consider their response in more

detail and depth with your colleagues.
 The employer/government first response is

unlikely to be their final response.

 Usually they will be prepared to offer more

particularly if they believe an agreement

between the two sides is possible. 403
 Consider how you can respond and show how your
arguments and supporting evidence have not been
properly addressed or, hopefully, seriously
weakened.
 Look for weaknesses and inconsistencies in their
response which you can objectively demonstrate and
exploit.
 Look for any clues or indications of how or where
they might move closer to your objectives.
 On return to plenary negotiating meeting answer
their response – normally in a logical, firm and not
insulting way.
 Try to show a willingness to consider more favourably
an improved offer – if possible with some indications
of what might be acceptable in general terms. 404
 Do not make explicit threats unless you are confident
they can be delivered and that they would be
effective.
 Consider using more general expressions of potential
adverse consequences of the initial offer if not
improved upon.
 Present the response in the resumed plenary in a
calculated and persuasive way emphasising the
strong parts of your case.
 Try to avoid immediate subsequent exchanges
becoming too confrontational. Encourage them to
have an adjournment to consider your response
carefully and in depth.
 At such an adjournment review your position, identify
possible employers responses and how you might 405
Final Stages:
 Third plenary session likely to be key session.
 Final or near final response from
employer/government very likely if negotiating
seriously and constructively.
 Do not summarily reject it unless it really is a

deliberately poor and provocative offer.

 Withdraw to consider it with your side. If it is a

deliberately poor and provocative offer respond

quickly by asking them to go away and reconsider
their position and come back to a future meeting with
an improved offer.
 If it is a sensible offer consider what modest further

improvements might be possible and decide which

are the priority issues. 406
 Consider without prejudice/informal/behind the chair
meetings between a small number of key
representatives from both sides - generally the smaller
the better but start with a minimum of two
 Consider possible improvements through staging a
settlement- some now- more later - end loading a pay
award – continued negotiations on unresolved issues
while reaching agreement on those that can be agreed
by both sides.
 Employer/government may be prepared informally to
improve the offer through a without prejudice offer if
your side can confirm that they would accept such an
offer if made formally. These offers are in effect
confidential -they have not been made unless they are
accepted. Respect that negotiating protocol or forget
about that facility for future negotiations. 407
5. Settlement: This is the final stage of the
collective bargaining process, where both the parties
agree on a common solution to the problem
discussed so far. Hence, a mutual agreement is
formed between the employee and the employer
which is to be signed by each party to give the
decision a universal acceptance.
6. Sealing the deal: both parties sign a written
agreement to prevent future arguments about what
has been agreed. Conclude on good terms.
Remember collective bargaining and
employer/employee negotiations are a long term
business – circumstances will vary and at different
times in the future will favour one side or the other.
408
 If there is an agreement acceptable to both sides go
through it in detail jointly before resuming plenary
session in order to be sure that both sides have the
same understanding
 Resume in plenary. If an informal agreement has been
reached the employer/government representatives
make the offer formally and the trade union side
accept it
 Try to have a written agreement at this stage to
prevent future arguments about what has been agreed
 Conclude on good terms. Remember collective
bargaining and employer/employee negotiations are a
long term business – circumstances will vary and at
different times in the future will favour one side or
the other
409
 PARTNERSHIP:
 Partnership - a relationship where people work together
to achieve goals that are meaningful to all parties.
 Refers to a close relationship between people who have
joint rights and responsibilities.
 “arrangements that are voluntary, mutually beneficial,
and entered into for the purpose of mutually agreed
upon objectives.”
 Partnerships often result from collaborative efforts.
 Refers to a relationship between families and
professionals in which families and professionals
mutually agree to defer to each other’s judgments and
expertise for the purpose of securing benefits for the
students, other family members, and professionals.

410
 Partnerships may be formal or informal. We may
partner with others toward a common goal without
any formal agreement. In some cases partnerships
will require some type of agreement such as a
volunteer agreement, a collection agreement, or a
memorandum of understanding.
 Incases of business: partnership is a formal
arrangement by 2 or more parties to manage and
operate a business share its profits.
 All partners share liability and profit equally. While
in others, partners may have limited liability.

411
Principles of Partnerships:
Partnerships are characterized and
achieved through seven principles:
 Communication
 Professional Competence
 Respect
 Commitment
 Equality
 Advocacy
 Trust

412
Seven Principles of Partnership:

413
Principle 1: Communication:
 Family-professional partnerships are enhanced when

professionals use effective communication strategies.

The partners must maintaining an open and positive line
of communication.
 Salient communication strategies include:
o Be friendly
o Listen
o Be clear
o Be honest
o Provide and coordinate information
Principle 2: Professional Competence
 According to families and federal policy, highly qualified

professionals:
o Provide a quality education to all students
o Are committed to life long learning.
o 414
Principle 3: Respect
 Respect in partnerships means that members regard each

other with esteem and communicate that esteem through

their words and actions
 The respectful professional seeks to:
o Honor cultural diversity and the personal values of the

family.
o Affirm family and student strengths.
o Treat each other, students and families with dignity/respect

Principle 4: Commitment
 Commitment occurs when professionals consider their

relationship with a child and family to be more than an

obligation incurred through work.
 Indicators of committed professionals include:
o Being sensitive to emotional needs.
o Being available and accessible.
o Going “above and beyond.”
415
Principle 5: Equality
 Equality refers to the condition in which families and professionals

feel that each has roughly equal power to influence a student’s

education.
 Indicators of equality within the family-professional partnership

include:
o Avoiding hierarchies and sharing power.
o Fostering empowerment.
o Providing options.

Principle 6: Advocacy
 Advocacy refers to speaking out and taking action in pursuit of a

cause.
 Indicators of professional advocacy within the family-professional

partnership include:
o Preventing problems
o Keeping your conscience primed
o Pinpointing and documenting problems
o Broadening alliances with families and professionals
o Creating win-win solutions for all involved 416
Principle 7: Trust
 Trust is having confidence in someone else’s reliability,

judgment, word, and action to care for and not to harm the
entrusted person.
 Trust exists when people believe that the trusted person will

act in the best interests of the person extending the trust

and will make good faith efforts to keep their word.
Trust Practices
Trust means:
 Being reliable:
o Doing what you say you are going to do.
 Using sound judgment:
o Demonstrating professional competency.
 Maintaining confidentiality:
o Following stipulated guidelines.
 Trusting yourself:
o Having confidence in your capacity to effectively serve the
needs of your students. 417
Trust the Keystone of Partnerships
Why Partner?:
 Leverage funds and resources
 Meet objectives and public expectations
 Solve problems
 Engage people in the management of their

own issues
 Shared support

419
Importance of partnership:
 Partnerships help us solve problems
 Helps leverage resources / Increase resources

available to make better products

 Helps in meeting objectives
 Helps to build support.
 Increase your level of knowledge and expertise
 Helps to reach a greater audience and hence It

Increases Customer Base

 It Enhances organization Credibility and Image
 Enhances long term stability

420
Challenges of partnership:
There are the challenges that will be faced by all agencies
and collaborative leadership which affect achieving
success.
 Varying engagement makes decision-making more

diffuse and highly complex. The key here is the

formalization of decision making and resource allocation
to guide collaborations through this initial challenge
 Creating and sustaining the collaborative partner's

interest and engagement, which is often difficult without

meaningful financial investments or contractual
obligations
 How to bring about tangible and measurable
improvement in the health of the population being
served. It is very difficult to tell if the curve is being
bent from your efforts or something else. 421
 Identifying and attaining sustainable funding. The
reliance on predominantly external funding has been
shown to limit the ability of collaborative partnerships
to take a long-term view in development and ultimately
necessary support Work to ensure sustainable funding
 Limited staff hours and reliance on volunteers to
perform on many initiatives. This is tied in with funding
as lack of dedicated staff hours and reliance on
voluntary effort however engaged tends to result in
higher than desired turnover.
 Another challenge for collaborative partnerships is
working to build "community recognition, credibility,
and respect“. There is also a level of trust that is very
important and needs to be built, which can be a
challenge as well
422
Qualities of a good and successful partnership:
 Open Communication
 Accessibility
 Flexibility
 Mutual Benefit
 Measurable results.

Open Communication: Open communication is the

backbone of any effective partnership. Each party
depends on the other to keep informed; this can be
achieved by offering regular status reports and/or
scheduling a regular touch base. It is better to
overcommunicate and be transparent than to keep
one another in the dark and surprised or confused if
an issue arises. 423
 Accessibility: Access to the right team members is the
difference between a partnership that yields results and
one that is just on paper. Ask your partner to help you
understand which people or departments are involved in
implementing your new partnership.
 Flexibility: It is important to keep your overall goal
front and center, but it is also good to acknowledge the
likelihood of everything going as planned is unlikely.
Being prepared and flexible is the key to overcoming
curveballs in partnerships.
 Mutual Benefit: In a mutually beneficial partnership,
each partner takes an active interest in the other, while
working together to develop shared success. A balanced
commitment and investment from each party ensure the
partnership will drive impact, innovation, and longevity
in overall returns. 424
 Measurable Results: Partnerships can create
great outcomes but require commitment and
resources. Measuring the value of these
relationships helps assess the success of the
partnership and should be included in every
agreement.

425
 CONDUCTING MEETINGS
Introduction:
 The process used in a meeting depends on the kind

of meeting you plan to have, e.g., staff meeting,

planning meeting, problem solving meeting, etc.
 However, there are certain basics that are common

to various types of meetings

Why Have Meetings?
 Important issues are addressed
 High quality decisions are made
 Work gets done that could not be done by

individuals working alone

426
Topics for discussion in conducting
meetings (describing and understanding
the basic concepts in conducting
effective meetings) are as follows:
1. Selecting Participants
2. Developing Agendas
3. Opening the Meeting
4. Establishing Ground Rules
5. Time Management in Meetings
6. Evaluating the Meeting Process
7. Evaluating the Overall Meeting
8. Closing the Meeting
427
Selecting Participants:
 The decision about who is to attend depends on what you

want to accomplish in the meeting. Don't depend on your

own judgment about who should come. Ask several other
people for their opinion as well.
 If possible, call each person to tell them about the meeting,

it's overall purpose and why their attendance is important.

 Follow-up your call with a meeting notice, including the

purpose of the meeting, where it will be held and when, the

list of participants and whom to contact if they have
questions.
 Send out a copy of the proposed agenda along with the

meeting notice. · Have someone designated to record

important actions, assignments and due dates during the
meeting.
 This person should ensure that this information is distributed

to all participants shortly after the meeting.

428
Developing Agendas:
 Develop the agenda together with key participants in the

meeting.
 Think of what overall outcome you want from the meeting

and what activities need to occur to reach that outcome.

The agenda should be organized so that these activities are
conducted during the meeting.
 In the agenda, state the overall outcome that you want

from the meeting ·

 Design the agenda so that participants get involved early

by having something for them to do right away and so they

come on time.
 Next to each major topic, include the type of action needed,

the type of output expected (decision, vote, action assigned

to someone), and time estimates for addressing each topic.
 Ask participants if they'll commit to the agenda.
 Keep the agenda posted at all times. 429
Opening Meetings:
 Always start on time; this respects those who showed

up on time and reminds late-comers that the

scheduling is serious.
 Welcome attendees and thank them for their time. ·
 Review the agenda at the beginning of each meeting,

giving participants a chance to understand all proposed

major topics, change them and accept them.
 Note that a meeting recorder if used will take minutes

and provide them back to each participant shortly after

the meeting.
 Model the kind of energy and participant needed by

meeting participants. Clarify your role(s) in the meeting

430
Establishing Ground Rules for Meetings:
 You don't need to develop new ground rules each time you

have a meeting, surely. However, it pays to have a few

basic ground rules that can be used for most of your
meetings.
 These ground rules cultivate the basic ingredients needed

for a successful meeting.

 Four powerful ground rules are:
o Participate,
o Get focus
o Maintain momentum
o Reach closure. (You may want a ground rule about

confidentiality.)
 List your primary ground rules on the agenda.
 If you have new attendees who are not used to your

meetings, you might review each ground rule.

 Keep the ground rules posted at all times. 431
Time Management:
 One of the most difficult facilitation tasks is

time management – time seems to run out

before tasks are completed.
 Therefore, the biggest challenge is keeping

momentum to keep the process moving.

 You might ask attendees to help you keep

track of the time.

 If the planned time on the agenda is getting

out of hand, present it to the group and ask

for their input as to a resolution

432
Evaluations of Meeting Process:
 It's amazing how often people will complain about a

meeting being a complete waste of time -- but they

only say so after the meeting.
 Get their feedback during the meeting when you

can improve the meeting process right away.

 Evaluating a meeting only at the end of the meeting

is usually too late to do anything about participants'

feedback.
 Every couple of hours, conduct 5-10 minutes

"satisfaction checks".
 In a round-table approach, quickly have each

participant indicate how they think the meeting is

going
433
Evaluating the Overall Meeting:
 Leave 5-10 minutes at the end of the meeting to evaluate

the meeting; don't skip this portion of the meeting.

 Have each member rank the meeting from 1-5, with 5 as

the highest, and have each member explain their ranking.

 Have the chief executive rank the meeting last

Closing Meetings
 Always end meetings on time and attempt to end on a

positive note.
 At the end of a meeting, review actions and assignments,

and set the time for the next meeting and ask each
person if they can make it or not (to get their
commitment).
 Clarify that meeting minutes and/or actions will be

reported back to members in at most a week (this helps

to keep momentum going).
434
Steps for an Effective Meeting
BDA Strategy
 Before the Meeting
 During the Meeting
 After the Meeting

Before the Meeting

 Notify everyone as soon as you know about it. “Save

the date”
 Remind everyone in a fun way – use eye-catching

graphics, color, etc.

 Remind your team to bring items/assignments needed

for meeting.
 Create an agenda that is realistic for the amount of

time you have and that reflects team members input.

 Be sure they have an agenda before arriving.
435
Before the Meeting – Continued’
Prioritize the agenda.
 Your first few topics are generally the most

important.
 Have additional copies of the agenda or overhead or
chart paper with agenda visible so all will have a
copy even if they forgot to bring theirs.
 Establish group norms, post the norms and follow the

norms.
During the Meeting
 Begin and end on time.
 Clearly state the purpose and objectives of your
meeting.
 Have a warm-up activity. Brain teaser, sharing
successes, etc.
 Feed them, they will come. 436
During the Meeting – Continued’
 Assigning roles
o Sample Roles: Recorder, Reporter, Time Keeper,
Facilitator
 Creating and sustaining working committees
o Sample Committee: Attendance, Achievement /
Promotion, Discipline, Communications, Business
Partners, Internships, Assemblies, Field Trips, etc.
After the Meeting
 Be sure everyone receives a copy of the minutes.
 Reminders to team members:
 Date, time, location of next meeting, what is needed
(homework) at the next meeting.
 Personalized notes of thanks.
 Example: Thanks for sharing your idea about ____ at the
meeting. Thanks for bringing the pretzels and juice! Thanks
for volunteering to help plan our assembly this month! 437
Meeting Management:
 Justice and courtesy to all
 One thing at a time
 The rule of the majority and
 The rights of the minority

Elements of Good Meetings

1. Planning and preparation
2. Efficient disposal of business
3. Open participation with adherence to the rules
4. Effective follow-up

 In good meetings, people nod in agreement;

 In poor meetings, people just nod.
438
Planning and Preparation Ensures:
 Access to documents and materials
 Attention to the meeting environment
 Follow through on decisions

Items Needed for the Meeting

 Minutes of previous meeting
 Copies of reports
 Correspondence

Director Responsibility
 Awareness of topics, context, and stakeholder

positions
 Review of documents prior to meeting
 Preparation for debate and decision-making 439
Meeting Environment:
 Bright room with adequate lighting
 Comfortable heating level
 Good air circulation
 Good seating arrangement
 Early opening of the room

Role of the Chair

 Ensure orderly debate and opportunities for

participation
 Remain impartial during the debate
 Vacate the chair when presenting personal

viewpoints
 Use a gavel to keep order
 If in doubt, consult the secretary’s notes
440
Role of the Secretary:
 Keep records of procedures
 Produce minutes summarizing discussions
 Maintain copies of bylaws, policies, and previous

minutes
 Maintain correspondence
 Oversee use of the Corporation seal
 Notify participants of meetings

441
Agenda:
1. Call to order
2. Review and approval of agenda
3. Reading and adoption of minutes
4. Business arising from minutes
5. Treasurer’s report
6. Correspondence
7. Reports from committees
8. New business
9. Date and time for next meeting
10.Adjournment

442
Minute –Taking
 Minutes are the official record of proceedings
 Minutes maintain the individual’s
confidentiality
 Official opposition to the course of action

must be recorded
 Minutes are adopted and signed off at the

following meeting
 Minutes include: the time, date, place, and

names of attendees the exact wording of

motions, naming mover and seconder.

443
Conclusion:
 Review objectives
 Review any additional expectations
 Review Parking Lot
 Point out Certificates of Participation
 Complete evaluation
 Thank you!

444
 INTERPERSONAL ETIQUETTE:
COURTESY GROOMING AND ETIQUETTE
Overall objective of the topic
 To enable officers and students to practice courtesy,
embrace grooming and etiquette as away of influencing one
another and the rest of their staff / students to practice the
same in order to improve the organization’s corporate image
and client satisfaction and maintain high standard discipline
and morale.
Specific objectives of the topic
 Practice courtesy to enhance the organization’s corporate

image.
 Appreciate the significance of grooming in promoting

officer’s and student’s confidence

 Apply hints of grooming and etiquette to boost the workers /

student’s self image.

 Describe the ways courtesy, grooming and etiquette can

impact on the organization’s public image. 445

Introduction:
 Today many organizations both private and public, are

spending millions and millions of dollars to train their

employees on public relations and in posting
advertisements to boost their corporate images.
 Staff and student is expected at all times to present a

professional, business like image to visitors, customers,

and the general public.
 Workers do spend one-third of their working lives at

their offices. This means that the office environment

plays a significant role in shaping our attitudes and
perceptions.
 The people we work with, do affect our productivity and

our career and vice versa. One way in which they do

this is through their communication presentation.
446
 Practicing office courtesy and etiquette
makes the workplace and workday more
favorable.
 One sure truth is that, you can be the best

worker in the office and still fail on your job if

you are careless about your talk and
personal presentation.
 It is therefore important that every worker

appreciates the importance of courtesy,

grooming and etiquette in the workplace.

447
Meaning of the terms:
 Courtesy is a mark of a gentleman. (Gesture of

politeness). It simply salutation or greetings for

civilians.
 Grooming refers to outward appearance in terms of

clothing and general body cleanliness and neatness.

(work dress code-very strict among disciplined forces)
 Etiquette refers to the codes or rules governing

social or diplomatic interaction. These codes vary

from the more or less flexible laws of social usage to
the rigid conventions of court and military circles.
 Interpersonal means pertaining to the relations

between persons; is being, relating to, or involving

relations between persons
448
ETIQUETTE:
 Rules governing professional conduct i.e. diplomatic,

parliamentary, County, medical.

 Etiquette therefore are guidelines which control the

way a responsible individual should behave

amongst others or in a society.
 It has to do with good manners, making others feel

comfortable in social situations, following rules of

proper behavior.
 Etiquette is dependent on culture and like culture it

varies from society to society.

449
Examples: Disciplined forces courtesy
 All soldiers are required to salute each other whenever

they meet or pass one another, subordinate saluting first.

 Respect to superiors will not be confined to obedience on

duty, but will be extended to all occasions.

 It is very undisciplined to salute with the coat unbuttoned

or with the hand in the pocket, or cigarette in the mouth.

Benefits of courtesy
 Basis for relationship building and trust.
 Encourages customer participation
 Makes others feel appreciated
 Keeps dialogue going and lively
 Earns officers respect in the eyes of the public
 Enhances discipline and keeps the morale high among

officers.
450
GROOMING
 First impressions count.
 An initial impression is made up of:
o Non-verbal perceptions (55%)
o Vocal quality (38%)
o Words (7%)
 First impressions are made within five (5)

seconds.

451
YOU ARE WHAT YOU WEAR!
People make the following decision about you in the
wink of an eye when they meet you for the first time:
 Your economic level
 Your education level
 Your trustworthiness
 Your social position
 Your level of sophistication
 Your economic heritage
 Your social heritage
 Your educational heritage
 Your moral character
 Your success

452
THE SUCCESS FORMULA:
The following attire gives a person complete
control over the group.
 Black \ Blue suit: Black and blue are the

colours of authority
 White Shirt
 Red color tie up to the waist
 Black socks
 Black shoes
 Sober buckled belt

453
Why observe etiquette and mind about grooming
 Restores public confidence among members of the

public and workers.

 With the right grooming and mannerism you present

an attractive, businesslike appearance and build

your self-confidence.
 Well mannered and dressed officers create a

favorable impression to both their juniors and

seniors.
 Attitude formation - What one wears and how

he/she wears is very likely to help or hinder ones

general attitude.
 Good appearance, builds the officers poise. Poise is

a quality or trait that enables one look calm and

composed despite internal turmoil. 454
 It is personal hygiene. It speaks volumes about how you
treat your body and how you treat the working
environment around you. People who are neat in their
body tend to be neat in their desk.
 First impression lasts. It’s always good to be ready and
presentable when you meet someone for the first time.
 The Gossip Mill. Coworkers will always talk about people
who look untidy and miserable. Could do you prefer to be a
cause of gossip?
 It makes you feel good. If you feel good on the outside,
you'll feel good on the inside. If you feel good about
yourself, your attitude towards people and your work will
be better.
 An indicator of a good time manager and smart worker.
 Office workers who are well groomed tend to be well
liked. People tends to associate more with smart and
presentable colleagues. 455
Rationale for acceptable Workplace Attire
 To ensure safety while working;
 To present or create a professional or identifiable

appearance for patients, visitors, customers, students

or the public; and
 To promote a positive working environment and limit

distractions caused by provocative or inappropriate

dress.
Tips on grooming and etiquette:
Clothes:
 Select your office wear carefully. Do not go in for
“showy” clothes for office wear.
 Tailored suits and dresses are most preferred for

business.
 Skirts and blouses are acceptable as long as the

blouses are not too revealing and skirts are tailored. 456
 Have your clothes cleaned and pressed frequently.
 Make sure that the colors in your collection
harmonize. Avoid colors that are too loud or too
contrasting.
 Select your office shoes with care.
 Be conservative about jewelry and wear only as
much as will improve your appearance
 Keep your under things clean and in good repair.
 Be sure that your clothing is free from rips and stains

Make-ups
 Apply make-up carefully and do not over use.
 Keep your nails clean, polished and neatly trimmed.
 Ensure your hair is well done and clean at all times.
 Avoid extremes in hair styles. 457
 Bathe daily and use a mild deodorant when
necessary unless your are allergic or otherwise
instructed by your doctor. Remember, there is no
substitute for soap and water. Do not try to conceal
uncleanliness by using perfumes or lotions.
 Brush your teeth daily and have them cleaned as
often as your dentist recommends. Use mouth wash
to avoid unpleasant breath.

How can we develop a standard grooming culture

 By providing basic guidelines and relying on staff

members’ judgment and supervisors’ enforcement of

the policy.
 Listing specific acceptable and unacceptable clothing

and grooming habits.

 458
TIPS ON ETIQUETTE:
Watch out on your behavior in the office and during
social events. In particular be keen on:-
 Respecting people’s privacy
 Observing punctuality during meetings
 Keeping the office clean and orderly
 Solicitations, avoid borrowing or lending
unnecessarily.
 Check on your eating habits
 Control such mannerisms as laughing, rubbing the

nose, scratching, cleaning the throat etc.

 Use a hand kerchief while sneezing, coughing etc.
 Avoid eating in the office, particularly while serving

clients.
 Avoid picking your teeth while in the office. 459
Sensory reminders of how to get along in the
workplace:
Sound
 Monitor the volume of conversations
 Keep personal telephone conversations and emails

to a minimum
 Maintain privacy - keep all workplace conversations

professional
 Avoid interruptions
 DON’T GOSSIP!

Scent
 Be sensitive to scents and smells surrounding you,

i.e. perfumes, cologne

 If eating at your desk avoid eating foods strong in

smells and aromas - can become unpleasant 460

Sight
 Keep your personal workspace clean

and neat at all times

 Use shared areas with respect and

courtesy - clean up after yourself:

Telephone Etiquette
 Never leave a caller on hold for more than a minute
 If you need to speak to a co-worker who is on the

phone, leave and try again later

 Don’t listen in on co-workers’ phone conversations
 When using a cellular phone in public, try not to

bother others - keep it short and discrete

 Use your speakerphone sparingly
461
EMAIL ETIQUETTE:
 Check the organization's email policy
 Think about the message content before you send it

out.
 Make sure that content is relevant to the recipients.
 Be polite.
 Trim any quoted message down as much as possible.
 Use humor and irony sparingly

COMPLIMENTING
 Never ask people where they got their clothes or what

they cost.
 Don’t talk about what you paid for clothes or brag

about designer labels.

 If someone compliments you, it’s not necessary to

return the compliment. 462

MASTERING MANNERS:
 Eyes are the windows to a person’s soul.
 Eye contact creates a strong connection between

two people and also creates an impression of

sincerity and trustworthiness.
 Listen actively
 Punctuality Is The Politeness Of Kings

CREATE AN IMPACT
 Integrity
 Manners
 Personality
 Appearance
 Consideration
 Tact
463
CONCLUSION:
 The quality of our work may be

excellent, but the way we handle

people, appear and conduct
ourselves, adds value to our
existence and service delivery.
 Employers prefer workers who
always create a favorable
impression.

SO BE THE ONE
464
HUMAN RESOURCES
MANAGEMENT

465
HUMAN RESOURCE FOR HEALTH
MANAGEMENT
Introduction
 The greatest asset of health care organizations is

the collective and individual knowledge and

intelligence of their employees and
nurses/clinical 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.


466
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: All that mediates the

interactive process between work motivation of the

individual the performance rewards and
development opportunities provided by the
organization (Frank 1998).
467
 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 attitude
468
 Strategic Human Resource Management: This is the
linking of HRM 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.

OBJECTIVES OF HUMAN RESOURCE MANAGEMENT

According to Basavanthappa (2002) the main objectives of
human resources management are the following:-
 Effective utilization of human resources to the achievement

of organizational goals.
 Establishment and maintenance of an adequate
organizational structure and desirable working relationship
among staff.
 Securing integration of the individual and informal groups

with the organization ad thereby ensuring their commitment,

involvement and loyalty. 469
 Recognition and satisfaction of individual needs
and group goals.
 Provision of maximum opportunities for
individual development and advancement.
 Maintenance of high morals in organizations

470
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 incentive sand benefits
7. Appraising performance
8. Communicating ( interviewing, counseling, disciplining)
9. Training and development
471
Main Responsibilities in Management of Human
Resources
 Its main responsibility is human resource planning

Human Resource planning

 Human resource planning is the process of identifying

the member’s skills, occupational categories, and

performance and development needs of personnel in
an organization.
 This identification has to be linked to the strategic

plan of the organization. While the strategic plan of

the organization is to identify the future direction.
 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. 472
Human Resource Planning involves the following
activities:
 Forecasting future manpower requirements:
Estimating the institutions demand for labor, matching this
with what is available and identifying whether there are
shortfalls or more than required. Such planning is
accomplished through analysis of current and expected skill
needs, vacancies and department expansions and
reductions.
 Formulating and proposing policies: Policy formulation

is carried out in Human Resources Department. The policies

have to be agreed by the top management team. The key
areas of personnel policy include recruitment and selection;
terms and conditions of employment, training and
development. These personnel policies are guidelines for
behavior stating what the organization will do or will not do
in relation to employees and employee affairs. 473
 Recruitment: This involves preparing job descriptions
and specifications, drafting job advertisements,
interviewing candidates and assessing appropriate
salary levels for new employees. As discussed earlier a
job description states the principal duties,
responsibilities and the scope of authority while A job
specification refers to human quality or personnel.
Specifications which are necessary to perform a job
adequately e.g. The knowledge details, skills, ability
and behavior.
 Training and Development: Once the employees join
the organization, they require training. Induction or
orientation of new employees is an integral part of
training .

474
 Training and Development of human resources is
the most dynamic of all the organization's
resources. The process aims at increasing the
ability of employees to contribute to organizational
effectiveness. Training and development is
important in order to maintain the key skills within
the organization and motivate the staff. This is to
enable them to realize their full potential in their
work. The human resource department has the
responsibility of assessing the training needs,
designing methods of training needs, designing
methods of training to be employed and evaluating
the training to determine how effective it was.

475
In planning, consideration must be given to:
1. The type of patient care management used
2. The education and knowledge level of staff to be recruited
3. Budget constraints
4. The historical background of staffing needs
5. 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
IV. Implications of the actions envisaged should be assessed
V. Instructions to individuals and departments must be
incorporated into the plans
VI. Plans should be concise and easy to understand

476
Reasons for Training and Development
 A change in working methods
 Realization that performance is poor,
inadequate and not up to the standards.
 Manpower shortage necessitating the upgrading

of some employees to new positions.

 Desire to improve the quality

477
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).

478
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. 479
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. 480
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.
481
The structured interview
 The interviewer uses a prepared list of questions and does

not deviate from them.

 This type of interview requires greater planning time yet

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 482
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

483
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

484
Some terms:
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; induction, orientation and socialization.
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.
485
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, colleagues and to their tasks. Recruiting
and selecting high potential employees does not
guarantee they will perform effectively. People who do
not know what to do or how to do it can’t perform
effectively even if they want to.

486
Socialization:
 Socialization involves inducting new employees to

the expectations and behaviors of the organization.

This is a 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.
Role models:
 These are examples of experienced, competent

employees. The employee sees the role models are

skilled and tries to emulate them.
487
 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)
 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.

488
HUMAN RESOURCE DEVELOPMENT
Training:
 Training is the planned process of modifying employee

behavior, attitude, and skill through learning in order to

increase the probability of goal achievement.
Development
 This usually suggests a broader view of knowledge and

skills acquisition than training. It is less job oriented than

career oriented. It is concerned more with employee
potential than with immediate skills. It sees the
employees as adaptable resources
Training and development cycle
 The primary objective of training is to reduce the gap

between what employees know and what they should

know. Systematic training is initiated by the organization’s
policy and sustained by its training organization
489
Training involves five steps
 Needs analysis/identifying training needs: The
first priority is to establish what the training and
development needs of the organization are. A
training need is any shortfall terms of employee
knowledge, understanding, skill, and attitudes
against what is required by the job or the demands
of organizational change. This will involve use of job
descriptions, employee’s appraisal records and any
other data that may indicate such needs.
 Plan training required: The next step is to plan
the training required to the needs identified. This
involves such matters as setting budgets and
timetables, and deciding on the objectives, content
and methods of training to be employed 490
 Implementation/carry out the training: This
is training the targeted employee/ group. The
implementation of plan is a joint affair between
the training specialist and their line and
functional colleagues.
 Evaluation and follow up: Management

assesses the programme success. This is by

evaluating the results so that subsequent
changes can be made if necessary. Then the
cycle starts again.

491
The systematic training basic cycle
 The systematic training cycle is a model.
 It emphasises that training is a continuous process, a

circle in which the end leads back to the beginning,

rather than a single linear and isolated event with a
defined start and finish.
 In its classical form the systematic training cycle

consists of four stages (Armstrong 2001: 549; Kenney

and Reid 1986: 15; Donelly 1987: 3).
 First stage: the training needs on organisational or job

level are identified and specified.

 Second stage: designing a training programme.
 Third stage: mainly consists of the implementation of

training
 The fourth and last stage: the evaluation of training.
492
Methods of training
1. On the job training
2. Apprenticeship training (combination of classroom,
institutions and on the job training
3. Vestibule training: This is an internal off the job
training method in which the environment of the actual
work place is simulated. Used by organizations where
specific skills are needed before actual job performance
4. Job Rotation; In this training method the employee is
moved from one job to another. It gives the employee a
chance to use a variety of skills and abilities.
5. In coaching/mentoring: A senior experienced manager
takes charge of training and development of a new
incumbent. The mentor/trainer helps the employee to
adjust both to the organizational culture and work setting
493
Approaches to training and development:
On The –Job-Training
 This is informal training which employees, receive while

performing the job.

Off –the –Job Training
 This is internal training by other personnel. It is done

through coordination of human resources department

or a trainer in the organization with expertise in the
subject
Internal Training by External Consultants
 The Organization may lack expertise and therefore has

to source elsewhere. The training is held either inside

or outside the organization and facilitated by external
consultants. The course(s) are tailored to specific needs
of the organization.
494
Job Descriptions and Specifications
Job descriptions
 Job descriptions state the principal duties and

responsibilities of the various jobs and the scope of

authority. They may be based on information obtained
from employees who hold positions and supervisors,
as they perceive the jobs.
 Generally they describe function elements of a

position in relation to duties and responsibilities.

 This is a written statement of what the worker actually

does, how he or she does it, and what the jobs

working conditions are.
 A job description set out the purpose of the job, where

it fits in the organization structure, the context within

which the job holder functions and the principal
495
accountabilities of job holder(s) or the main tasks they
Job Specifications
 This refers to human qualities or personal

specifications which are necessary to

perform a job adequately.
 It includes the details of the knowledge,

skills and abilities and behavior required to

perform a job.
 Most organization manuals combine jobs

specifications as part of each job description.

496
Sections of job description
A job description mainly contains the following sections.
 Job identification: This contains the job title e.g.

manager, etc. It also contains the date that the job

description was written, who prepared it, who approval
the job description and the location of the job e.g.
hospital in charge
 Job summary: This describes the general nature of

the job and includes only it major functions or

activities e.g. plan, directs, co-ordinates hospital
activities.
 Relationships: This shows the job holders
relationship with others inside and outside the
organization e.g. reports to, supervises who? Works
with etc. 497
 Responsibilities and duties: This section
presents the jobs main responsibilities and
duties. e.g. conducting performance appraisal,
giving medication to patients etc.
 Standards of performance and working

conditions: This lists the standards the

employee is expected to achieve under each of
the job description duties and responsibilities.
 Job specifications: It shows what kind of a

person to and for what qualities that person

should be tested e.g. the skills, knowledge,
experience, attitudes etc.

498
Tools Used By Manager:
1. Organizational manuals
 These provide in comprehensive written form, the

decisions which have been made concerning the

organizational structure.
 The manual should clearly specify: The
responsibilities of each supervisory position and how
they are related to other positions.
 They should state the objectives of the organization

and each department.

 Manuals should have major policies of the
organization particularly relating to personnel e.g.
Human resource issues, disciplinary policy, terms
and conditions of service, training and development,
leave. 499
2. Policy
 A policy is a guide which clearly spells out

responsibilities and prescribes actions to be

taken under a given set of circumstances.
 It provides general direction for decision making

so that action can be taken within the framework

of organizations beliefs and principles.
3. Procedure
 This prescribes steps that should be followed in

order to conform or carry out a policy.

4. Standards
 These coordinate and articulate the operations

of organizations.
500
JOB ANALYSIS
 Job analysis is the procedure through which you

determine the duties of positions to be staffed

in an organization and the characteristics of the
people to hire for them.
 Job analysis produces information used for

writing Job descriptions (a list of what the Job

entails) and Job specification ( what kind of
people to hire for the Job).
 The following types of information is gathered

during Job analysis:

501
1.Work activities: identifying the tasks involved in the Job
e.g. giving medications, monitoring vital sign etc.
2. Human behavior: Included here is information regarding
Job demands such as lifting weights or walking long distances
3. Machines, tool equipment's and work aids:
4. Performance standards: This is the Jobs performance
standards in terms of quality or quantity level of each Job
duty. (The standards will be used to appraise the employees
5. Job context: This includes physical working conditions,
work schedule number of people with whom the employee
wound normally interact, information about incentives etc.
6. Human requirements: This is the job related knowledge
or skills (education, training, work experience) and the
required personal attribute (attitudes, physical
characteristics personality interest)

502
Deployment
 A deployment is the move of an employee from one

position to another within the same occupational group

or, where authorized by regulations of the Public Service
Commission, to another occupational group.
 A deployment cannot result in a promotion or a change of

tenure and it may be made for an indeterminate or a

specified period.
 A deployment requires the consent of the employee

concerned except in those situations where a willingness

to be deployed is a condition of employment of his or her
current position.
 Deployments are to be made in a fair, reasonable and

transparent manner, taking into account the needs of the

organization and the legitimate career interests and
aspirations of employees. 503
Performance management
 Performance management: All that mediates

the interactive process between work

motivation of the individual the performance
rewards and development opportunities
provided by the organization (Frank 1998).
Managers exist to achieve results
 Managing performance = improvement of the

performance of the organization by getting

better result from team and individuals
 The process should encourage dialogue
 Should not be see as an end it self but as one of

the process for improving performance

504
 Performance management should address the
needs of the individuals within the organization
as well as the needs of an organization
 Performance management should not be a
controlling process but, an enabling process
concerning on how to help an individual to
realize their potential
 Performance management requires coaching
individual hence managers require to invest time
in the process
 Performance management should occur as
natural process to all managers, not one
imposed by the personnel department or top
management. 505
Managing expectations
 Managing performance is corned about managing

expectations
 Organization develops purpose objectives and have

strategic plans to meet the expectations

 Organization also defines value as guiding principles

in achieving their purposes

 The expectation of an organization determines its

functions
 Departmental and team expectations are then

translated into what individuals are suppose to do in

terms achieving targets and standards of
performance
 The organization defines core competency
506
Integration
 This takes care of corporate, team and

individual objectives, integration of core values

and competency requirement
 Integration is important in managing
performance to ensure that the expectations
are shared and understood
 This makes every one move in the same

direction of achieving goals

507
Cascading:
 This corporates objectives to individual
objectives often take the form of bottom
approach.
 But a bottom up approach should be
encouraged to ensure that there is ownership of
the process and the expectations developed

508
Managing performance
cycle
 PLAN ACT

REVIEW MEASURE

509
 PLAN – agreement of objectives targets and needs
for the development of competencies or capabilities
and the preparation of the plans to achieve the
objectives, improve performance and develop
capabilities
 Act – the implementation of the plan in the normal
course of work and through special improvement
and developmental programmes
 Measure – monitor performance (actions )by
reference to performance measures (outcome )with
what should have been achieved (plans )
 Review – take stock at regular interviews but not
once a year, of achievements in relation to plans as
established by measuring outcomes.
510
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 or past performance relative to the person’s

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.

Performance appraisals are regular reviews of employee

performance within organizations and begin when an
employee is hired and stops when he/she leaves 511
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
IX. Validate selection techniques and human resource policies
X. Provide information for succession planning

512
Types of appraisal:
 Formal – This Involves written documentation

according to specific organizational guidelines.

 Informal – It involves e.g. praising the

individual for good performance in a job or a

compliment from a supervisor, customer
/patient.
 The key is that the praise or corrections be

made as close to time to the episode as

possible.

513
Appraisal Process

514
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
VI. Conduct the appraisal interview and provide
feedback

515
Appraisal Methods
1. Rating Scale
A common method which consists of a list of personal
characteristics or factors against each of which is a
scale. This focuses on attributes and not targets or
job. One of the weaknesses is that there is an element
of subjectivity. It is usually on a 5- point scale where 1
is the lowest and 5 the highest score. The following is
example of assessing Initiative on an employee:
- Requires detailed supervision - 1
- Requires frequent supervision - 2
-Requires occasional supervision - 3
-Rarely requires supervision - 4
-Never requires supervision - 5
516
2. Performance Management
 This method encompasses objective setting for

individuals and departments and performance

related pay and training programs. The duties
and responsibilities focus on results or targets
which are set by individual employees in
consultation with their supervisors. The
objectives set must be measurable.

517
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.
518
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 and sex affect performance appraisal ratings
employees receive. How employees performed in the past can
affect current appraisal
6.Recency and primacy effects: This occurs when the a
superior (appraiser) places to much weight on factors that
occurred recently (recency) or in the beginning (primacy
6.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.
519
Performance Appraisal Tools and Techniques
 Written Essays
 Critical Incidents
 Graphic Rating Scales
 Behaviorally Anchored Rating Scales (BARS)
 Multi-person Comparisons
 Management by Objectives (MBO)
 360-Degree Feedback

520
Others appraisal tools
Following are the tools used by the
organizations for Performance Appraisals of
their employees.
 Ranking
 Paired Comparison
 Forced Distribution
 Confidential Report
 Essay Evaluation
 Critical Incident
 Checklists
 Graphic Rating Scale
 Forced Choice Method
 Field Review Technique
 Performance Test 521
Human resource management functions:
1. Staff discipline
 Some of the very challenging problems for

managers is what to do when an employee fail

to perform as per their expectations
 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 agreement with the agency’s
official behavior codes. It can also be a
managerial action to enforce employee
compliance with agency rules and regulations.

522
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

 Insubordination e.g. lack of respecting authority

Factors that must be present to foster a climate of self

discipline.
 Employee awareness and understanding of rules and regulations

that govern behaviour. These must be clearly written and

communicated to subordinates.
 There must exist an atmosphere of mutual trust. The managers

must believe that employees are capable of and actively seeking

self discipline. Conversely, the employees must perceive the
manager as honest and trustworthy.
 Employees should identify with the goals of the organization.

When this happens, they are more likely to accept the standards of
conduct deemed acceptable by the organization. 523
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.
1. Preliminary investigation.
2. A discussion (cordial) with the offender and a brief
warning as to why further violations will not be tolerated.
3. A stronger verbal warning after a further violation of
regulation.
4. A formal written warning.
5. A written warning accompanied by suspension from the
job for a prescribed number of days.
6. Suspension from the job for a longer period of time.
7. Discharge with opportunity to appeal
524
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. Before entering
into a coaching session the coach should prepare for
the interaction. 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 525
 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. Performance
deficiency coaching helps employees, over time,
to improve their performance to the highest level
of which they are capable. As such, the
development, use, and mastery of performance
deficiency coaching should result in improved
performance for all.
526
3. STAFF MOTIVATION
 Motivation describes the factors that initiate and

direct behavior.
 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 of
each employee position.
527
Definition
 Motivation: Those processes both instinctive

and rational by which people seek to satisfy the

basic drives, perceived needs and personal
goals which trigger human behavior. They are
the entire class of wants, drives, desires, needs,
wishes which people strive to satisfy
 Motive: Inner state which energizes, activates,

moves and directs human behavior toward

fulfillment of the desire etc.
 Motivator: Something which influences body’s

behavior to perform a task with a certain degree

of enthusiasm e.g. rewards or penalties
528
Motivation theories are classified into two:
i. Content theories- these focus on the needs
that motivate people to behave in certain ways
e.g. Maslow's and McGregor's theories (Topic 1)
ii. Process theories- These seek to explain
specific actions focusing on the thought process
that people experience prior to behaving in a
particular manner e.g. victor Vroom ( Topic 1)

529
Practical Steps in Motivation
i. Make people feel valued by:
 Regularly monitoring and appreciating each

employee’s work.
 Showing an interest in whatever they hold

important.
 Creating a good working environment by being

approachable.
 Ensuring everyone understands the importance

of their contribution to the team’s objectives.

 Ensuring everyone understands the objectives

of the organization

530
ii. Provide a challenge and scope for development by:
 Setting targets, after consulting, and review at regular

intervals.
 Providing relevant training- where appropriate by using

people to train others, in the specialty skills they may

have.
 Restructuring or grouping tasks to use people’s skills to

the fullest.
 Rotating jobs to broaden experience.
 Providing scope for individuals to take greater
responsibility.
 Training at least one deputy- succession planning
 Encouraging ideas and suggestions and listening.
 Delegating and allowing staff to take decisions and to

implement them.
531
iii. Recognize achievements by:
 Praising and communicating individual successes
 Reporting regularly to the team on its progress.
 Holding regular meetings with each individual to

monitor progress and give feedback.

iv. Communicate by:
 Explaining the organisation's results and
achievements.
 Setting and communicating the team’s objectives

and regularly appraising them of its progress.

 Ensuring the team knows how the organization is

doing and commutating any changes taking place in

the organization.
 Explaining decisions made to assist people to accept

them 532
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.
Supportive supervision should aim at
encouraging team members to apply their ability
and energy to work. It also means understanding
what makes people dissatisfied at work.

533
CONFLICTS AND CONFLICT
RESOLUTION
Introduction
 Conflicts are generally defined as the internal or

external disorder that results from differences in

ideas, values, or feelings between 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
534
.

535
Types of Conflict
1. Intrapersonal – within a person. e.g. personal and
professional priorities
2. Interpersonal – among people e.g. best way to …….,
information giving.
3. Organizational – e.g. role differentiation, communication,
policies and practice, new system or change.

 Individual conflict (intrapersonal)

 Common type is role conflict occurs due to incompatibility between

one or more role expectations

 When staffs do not understand the role of the other staff
 Misunderstanding can occur – for not doing some work
 interpersonal conflict
 Occurs between two people due to differences and personalities or

competition
Intergroup conflicts (interpersonal) – conflict occurs between groups
e.g. unit service team ,health care professional groups, agencies.
536
In organizations conflict may be caused by
the following:
- Unclear authority structures
- Personal disputes
- Conflicts of interest
- Competition of resources
- Poor coordination of activities
- Incompatibility of group and organizational goals

537
Conflict resolution methods (strategies)
a) Avoiding/Avoidance:
 This method/strategy attempts to keep the conflict from

surfacing at all e.g. ignore the conflict or impose a solution

(especially where concern for people and production is low.
 Important if in conflict a quick action is needed to prevent

the conflict from occurring.

b) Accommodating:
 This is also known as smoothing or co-operating. It is used

when a person ignores his or her own feelings about an

issue in order to agree with (accommodate) the other side.
 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.
 More conflict can ensue if parties disagree about

importance of the issues being accommodated

538
c) Competing:
 One side wins the conflict and the other side loses. It

is also called forcing because the winner forces the

loser to accept his or her perspective on the conflict.
 This can cause anger and resentment to increase

withdrawal/avoidance.
 The method is useful when an issue is critical or time

to resolve it is limited. Can also help move a critical

but unpopular decision quickly through an origin
d) Compromising:
 Each side gives up something as well as gets

something. Used when both sides have a reasonable,

important goal and losing is not required.

539
e) Negotiation:
 This is an extension of compromise with higher stakes

and more deliberate techniques to bargain for each

side’s give and take. It is useful for high stake issues and
solutions are seen as formal and more permanent than
compromise. Conflicts tend not to recur once the
negotiations are finished.
f) Collaborating:
 In this method both sides in a conflict work to develop

the outcome that is best for both sides.

 The emphasis is on creative problem solving so that

each side meets its key goals.

g) Confronting:
 This method attempts to block the conflict from the

start. The method brings the parties together, clarifies

issues and achieves an outcome. 540
Causes of conflicts
 Differences in information, values, beliefs, and

interest
 Competition for resources, e.g. Money skilled

manpower
 Inter group rivalry for rewards
 Take difficulties
 Skill differences
 Pressure to avoid failures
 Unworkable organization structure

541
Effects of conflict
Advantages
 Prevents intellectual stagnation
 Decreases likelihood of group think
 Stimulates employees curiosity
 Facilities employees change

Disadvantages
 Disputes puts others in to conflict
 Unresolved causes violence
 Spread from peripheral to other issues

542
Managing Conflict:
Communicating to self and others that conflict is a
necessary process.
 Determining similarities and differences in facts,

goals, methods and values.

 Assessing the degree of conflict – ask questions

about quality of decisions.

 Assessing each situation and matching the best

approach regardless of which is your favourite.

 Assisting others in assessing conflict and seeing

how best they can approach.

543
The manager may also overcome
organizational conflict through the
following:
 Improving team spirit
 Enhancing effective communication
 Regular job rotation
 Employee counseling services

544
Grievances:
Grievance Process = When a union member
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.

545
3. The meeting is held and the employee should be
accompanied at the meeting. 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 impartially
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.
546
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.

547
b. Types of change
 Planned change: Results from deliberative,

collaborative effort to improve system

operations and facilitate acceptance of the
improvement by involved parties
 Unplanned /accidental change: Accidental or

reactive change is an adaptive response to an

outside stimulus that is directed toward re-
establishing balance between system and
environment.

548
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 :-

 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. 549
 Planning: During planning the change agent
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 component
to assess if the change met the organizational
goals for the change is also constructed
 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.
550
 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
 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

551
d. Change theories
There are several theories that have been
developed concerning the change process. These
theories are
I. Lewis force field theory
II. Lippitt’s phases of change
III. Rogers diffusions of innovations
IV. Bridges’ model of managing transitions

552
Overcoming Resistance to Change
Lewin’s force-field model - 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
553
 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
a) 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 their attitudes,
actively involve the participants in identifying
problems and generating solutions. 554
b) Move the target system to a new level of
equilibrium (moving)/change: 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
c) Refreeze the system at the new level of
equilibrium: This involves reinforcing the new
patterns of behavior (e.g. rewarding for desired
behavior or research on new
system).Reinforcement can also be done through
formal and informal mechanism (e.g. formulating
policies, establishing communication channels. 555
To implement the above process the
following approaches will be necessary:-
 Education and Communication
 This is to make employees fully aware of all

aspects of the situation and convince them that

change is essential.
 Participation and Involvement
 The employees should actively participate and

get involved from the beginning so as to

stimulate commitment.
 Patience and Tolerance
 Give support and assistance needed.

556
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
There are several reasons why people resist change.
Among them are the following
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
557
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 is
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. 558
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
559
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

560
TEAM LEADERSHIP:
a. Differentiating groups from teams
 A group is an aggregate of individual who interact

and mutually influence each other. Both formal and

informal groups exist in an organization
 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.
561
Teams:
 Teams are real groups in which individuals must

work cooperatively with each other in order to

achieve some goals. They demonstrate healthy
interdependence. A team is composed of a small
number of people with complementary skills who
are committed to a common purpose, set of
performance goals and approach for which they
hold themselves mutually accountable. Teams
have command or line of authority to perform
tasks and membership is based on the specific
skills required to accomplish the task.

562
b) Group and team processes
Groups whether formal or informal typically form through the
following phases
 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 very are cautious..
 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.
 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 develops.

563
 Performing: This is the fourth stage. The group
members agree on basic purposes and activities
and came out the work. Cooperation improves
and emotional issues subside. Members
communicate effectively and interact in a
relaxed atmosphere of sharing.
 Adjourning: This is the final stage of group

development, in which a group dissolves after

achieving its objectives or reforming with some
major changes takes place in the environment

564
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,
questioners and or group meetings about the team
and its functioning.
b) Diagnosing the team strengths and arcsine need
of development.
c) Holding semi- structured retreat sessions usually
directed by an experienced facilitator aimed at
addressing priority team problem
565
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

566
COLLABORATION:
 Effective teams are characterized by trust, respect

and collaboration.
 Collaboration in health care is defined as health

care professional assuming complementary roles

and cooperatively working together, sharing
responsibility for problem-solving and making
decisions to formulate and carry out for patients
care.
 Collaboration between physicians, nurses and other

healthcare professionals increases team members

awareness of each others type of knowledge and
skills, leading to continued improvement in decision
making (o’ Daniel and rosentein, 2008).
567
 When considering a teamwork model in health
care, an interdisciplinary approach should be
applied. Unlike a multidisciplinary approach, in
which each team member is responsible only for
the activities related to his or her own discipline
and formulates separate goals.
 For the patient, an interdisciplinary approach
coalesces a joint effort on behalf of the patient
with a common goal from all discipline involved in
the care plan. The plan of care takes into account
the multiple assessments and treatment
regiments, and it packages these services to
create an individualized care program me that
best addresses the needs of the patient 568
COMPONENTS OF SUCCESSFUL TEAMWORK
 Open communication
 Non-punitive environment
 Clear direction ;
 Clear and known roles and tasks for team

members
 Respectful atmosphere
 Shared responsibility for team success
 Appropriate balance of member participation for

the task at hand

569
COMMON BARRIERS TO INTER-PROFESSIONAL
COLLABORATION:
 Personal values and expectations
 Personality differences
 Hierarchy
 Disruptive behavior
 Culture and ethnicity
 Generation differences
 Gender;
 Historical inter-professional
 Generational differences
 Differences in language and jargon
 Differences in schedules and professional
routines 570
 Varying levels of preparation,
qualifications, and status.
 Fear of diluted professional identity
 Differences in accountability,
remuneration, and rewards
 Concerns regarding clinical responsibility.
 Emphasis on rapid decision making
 Complexity of care

571
LEADERSHIP ACTIVITIES AT DIFFERENT
GROUP FORMATION STAGES:

572
.

573
Barriers to effective teamwork:
 1. Changing roles - there are currently considerable

change and overlap in the roles played by different

health-care professionals. Example include
radiographers reading plain film x-rays, nurses
performing colonoscopies and nurse practitioners
having prescribing rights .These changing roles can
present challenges to teams in terms of role
allocation and acknowledgement.
 2. Changing settings - The of health care is

changing including increased delivery of care for

chronic conditions into community care and many
surgical procedures to day-care centers. These
changes require the development of new teams and
the modification of existing ones. 574
 3. Medical hierarchies. Medicine is strongly
hierarchical in nature and this counter
productive in terms of establishing and
effectively running teams where all members
views are accepted and the team leader is not
always a doctor. While these has been a
growing acknowledgement that teamwork is
important in heath care, this has not necessarily
been translated into change practices,
especially in environment where cultural norms
of communication may mitigate against
teamwork

575
 4. Individualistic nature of medicine - The practice
of medicine is based on the autonomous one-on-one
relation between the doctor and patient. While this
relationship remains a core value, it is challenged by
many concepts of teamwork, and shared care. This
can be at many levels including doctors being
unwilling to share the care of their patients through to
medico-legal implications of teams-based care.
 5. Instability of teams - As already indicated,
health-care teams are often transitory in nature,
coming together for a specific task or event(such as
cardiac arrest teams).The transitory nature of these
teams places great emphasis on the quality of training
is often relegated at the expenses of services delivery

576
TYPES OF MEDICAL TEAMS:
 There are many types of teams in health care. They include

labour and delivery units, ICUs, medical wards, primary care

teams in the community, teams assembled for specific task
such as emergency response team or multi-professional
teams such as multidisciplinary cancer care teams that
come together to plan and coordinate patient's care.
1. CORE TEAMS
 Core teams consist of team members who are involved in

the direct care of the patient.

 Core team members include direct care providers (from the

home base of the operation for each unit) and continuity

providers (those who manage the patient from the
assessment to disposition, for example, case managers).
The core team, such as a unit-based team (physician,
nurses, physiotherapist, and pharmacist.
577
2. COORDINATING TEAMS
A coordinating team is group responsible for:
 Day-to-day operational management;
 Coordination functions.
 Resource management for core teams.

3. CONTINGENCY TEAMS.
Contingency teams are:
 Formed for emergent or specific events;
 Time-limited events (e.g. cardiac arrest teams,

disaster responsible teams, rapid response

teams)
 Composed of teams members drawn from a

variety of core teams.

578
4. ANCILLARY SERVICES
Ancillary services consist of individual such as
catering, cleaners, and other support staff who:
 Provide direct, task-specific, time-limited care to

patients;
 Support services that facilitate care of patients;
 Are often not located where patients receive

routine care.
 Ancillary services are primarily a service delivery

team whose mission is to support the core team.

This does not mean that they should not share the
same goals. The successful outcome of a patient
undergoing surgery requires accurate information
on catering and instruction. 579
5. SUPPORT SERVICES
Support services consist of individuals who:
 Provide indirect, task-specific services in a

health-care facility;
 Are services-focused on integral members of the

team, helping to facilitate the optimal health

care experience for patients and their families
6. ADMINISTRATION.
 Administration includes the executive leadership

of a unit or facility, and has 24-hour

accountability for the overall function and
management of organization. Administration
shapes the climate and culture for a teamwork
system to flourish by: 580
 Establishing and communicating vision;
 Developing and enforcing policies;
 Setting expectation for staff;
 Providing necessary resources for successful
implementation
 Defining the culture of the organization.

581
Problem solving:
a. Definition of 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. 582
c. Steps of the scientific problem solving process
Problem solving process has the following seven steps
 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 The
definition of the problem should be a descriptive
statement of the state of affairs but not a judgmental
or a conclusion.
 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. 583
 Analyze the information/data: Categorize
information in order of reliability. List information
from most important to least important and set
information into a time sequence Information can
also be categorized in terms of cause and effect e.g.
is A causing B. The information can also Classified
into categories e.g. human factors, technical factors
rules/procedures, legal and ethical issues.
 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.
584
 Make a Decision: Select one solution that is most
feasible and satisfactory and has the fewest
consequences.
 Implement the decision: The manager
implements the decision after selecting the best
cause of action.
 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?

585
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. 586
CODE OF REGULATIONS
 These are the rules, regulations and procedures for the conduct of

government business, the public servants and civil servants.

 It consists of the following sections:

Section A
 Deals with organization of the government, and procedures for

conduct of government business e.g. allocation of functions to

ministries, departments, permanent secretaries, PCs, DCs, AG, DPM
etc
Section B
 Deals with public service commission- recruitment, promotion,

disciplinary control.
Section D
 Deals with correspondence- publication and printing.

Section E
 Terms and conditions of employment, Appointments, promotions,

transfers, secondments and other related matters.

Section F
 Annual staff appraisal reports
587
Section G
 Rules of conduct, general rules of conduct to be observed by a civil servant to

maintain integrity and loyalty to the government

Section H
 Salaries, increments, and seniority.

Section I
 Advances

Section J
 Allowances. Deals with various allowances granted to a public servant.

Section K
 Transport facilities available to an officer.

Section L
 Housing.

Section M
 Medical privileges.

Section N
 Leave

Section P
 Examinations and courses of training.

Section Q
 Ceremonial uniforms and dress.

Section R
 Miscellaneous

Section E: Terms and conditions of service 588

COMMODITY AND
SUPPLIES
MANAGEMENT

589
COMMODITY AND SUPPLIES MANAGEMENT
Introduction:
Reliable and affordable supplies of commodities are
critical for the success of health services.
They affect the quality of the services, their availability,
cost and influence the uptake of health services.
Public procurement in all government entities is governed
by the public procurement and disposal Act and the
Regulations. The public procurement Act was established
to achieve the following objectives: -
1) To maximize the economy and efficiency.
2) To promote competition.
3) To promote integrity and fairness.
4) To increase transparency and accountability.
5) To increase public confidence.
6) To promote the local industry. 590
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 management

effectively.
 The other importance is to improve quality of life

patients and to increase the consumer confidence

in the healthcare system 591
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) and use.
 Product Selection: 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. 592
 Procurement: This is the process of obtaining the required
medicines and supplies through purchase, donations or
manufacturing. Key components of procurement includes
quantification which is the need to know how much to buy. It
also includes supplier selection where who to buy from and
how to buy is identified. In procurement also quality
assurance in order to ensure quality of the products you buy.
 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.
 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.
593
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

594
The Procurement:
 Procurement means the purchasing, hiring or

obtaining by any other contractual goods,

construction and services. Public Procurement
means procuring by public funds. Procurement
also means acquiring affordable commodities of
good quality, either by purchase or from
donations.

595
Procurement cycle
Procurement follows a series of steps
1. Select the commodity / Review the selection
2. Forecast & quantify the quantities needed
3. Reconcile the needs and the funds available
4. Choose the procurement method
5. Locate and select suppliers
6. Specify terms of supply
7. Monitor supply order progress
8. Receive and check supplies
9. Make payment to suppliers
10. Distribute the commodities
11. Collect consumption data
596
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:
 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
597
 Closed or 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 a certified quality. 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.
 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.
 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
598
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:
 Transparency and Accountability: Procuring

entities should ensure there is openness and

clarity on procurement policy and its delivery.
 Efficiency: This encompasses the performance

of the procurement process as cost effectively as

possible and in a timely manner.
 Consistency: The application of the
procurement process should be the same across
all procuring entities. 599
 Open and Effective Competition: Provision of
ample and equal opportunities for participation
by interested and qualified suppliers of goods,
works or services.
 Ethics and Fair Dealing: Under the Public

Officers and Ethics Act (2003), it is an offence

for those employed by contracting authorities 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

600
Legal Framework The legal framework for
public procurement includes:
I. Public Procurement and Disposal Act, 2005
II. Public Procurement and Disposal Regulations
2006 and 2009
III. Public Procurement and Disposal Regulations
(Public Private Partnerships) 2009
IV. Supplies Practitioners Management Act, 2007.

601
Organization of health facilities in supplies
management
All public entities are required to establish the
following; -
1. User department-
 The user department is the end user of the

purchase or the department that will benefit from

the purchase.
 The user initiates the purchase request, prepares

the technical specification of the purchase,

participates in the evaluation of tenders and
ensures that the purchase conforms to the
requirements.
602
2. Procurement unit – The procurement unit
should be staffed with procurement professionals.
This unit is in-charge of supplies management in
the health facility. Some of the duties of the
procurement unit include;
 Maintaining a data base of suppliers.
 Preparing tender documents.
 Maintaining procurement documentation.
 Coordinating the evaluation of tenders and

proposals.
 Preparation of contracts.
 Implementing decisions of the tender and

procurement committees amongst others.

603
3. Procurement committee – The members off a
procurement committee are appointed by the Medical
superintended or the officer in-charge. An accounting
officer will serve as the chairman off the committee.
The secretary of the committee is appointed by the
head of the procurement unit and is procurement
professional. The other members are appointed by
the Medical superintended or the officer in-charge.
The procurement committee functions include ;
 Evaluating tenders as may be prescribed by the

procurement Act in sub-county hospitals.

 Approval or rejection of submissions made by the

procurement unit.

604
4. Tender committee –
 The tender committee is established in accordance to the

Act.
 The members of this committee are appointed by the

Medical superintended or the officer in-charge.

 They should consist of not less than 5(five) members.
 The secretary of the committee should be a procurement

professional in-charge of the procurement unit.

Some of the roles of the tender committee includes;
 Evaluating tenders as prescribed by the procurement Act in

sub-county hospitals.
 Reviewing the report prepared by the evaluation committee.
 Approving the selection of the successful tenders.
 Awarding procurement contracts.
 Approving the list of tenderers.
 Approving the amendments of contracts among other roles
605
5. Evaluation committee – The health facility
establishes an evaluation committee for every procurement
within the threshold of the tender committee for the
purposes of carrying out the technical and financial
evaluation of the tenders or proposals. The report of the
evaluation committee is presented to the tender committee
for consideration of award.
6. Inspection and acceptance committee- This is
composed of the chair and at least two members. The
members of this committee are appointed by the Medical
superintended or officer in-charge. The functions of I & A
committee include;
 Ensuring the correct quantities are received.
 Ensuring the services and goods meet the technical

specifications.
 Issuing completion certificates amongst other duties.
606
7. Disposal committee-
 The health facility establishes the disposal

committee.
 The committee has five members appointed by

the Med. Sup. or officer in-charge.

 The role of this committee is to dispose- off un-

serviceable, obsolete or surplus stores and

equipment in the health facility.

607
Procurement process.
The procurement process involves;
1) Identification of the need.
2) Procurement planning.
3) Preparation and approval of the
specifications.
4) Publication of the bid (offer).
5) Receiving and opening documents.
6) Evaluation of the bid documents.
7) Notification of award.
8) Contracting.
9) Contract management and delivery.

608
The inventory management cycle.
The inventory management cycle involves;
 Ordering.
 Receiving.
 Storing.
 Issuing of consumables and non-consumables

609
END

610
THANKS

611