Prinsip Dasar Manajemen Kesehatan.pdf

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

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LEARNING OBJECTIVES Memahami organisasi pelayanan kesehatan sebagai suatu sistem dan para manajer di dalamnya Memahami aspek manusia dalam melakukan perencanaan, pengorganisasian, pelaksanaan dan pengendalian upaya kesehatan; Memahami berbagai isu dalam pelaksanaan program. Memahami kebutuhan strategis agar lembaga pelayanan dapat hidup dan berkembang . 2

Organisasi dan Manajer -Teori Organisasi dan Manajemen Pelayanan Kesehatan (Bab 1) -Peran Manajer (bab 2)

Memotivasi dan Memimpin Orang serta Kelompok

Menjalankan Sistem Teknis

Memperbarui Organisasi

Memenuhi Kebutuhan dan Nilai-nilai Individu

Menentukan Kelompok Kerja dan Desain yang Tepat

Menentukan Desain Organisasi yang Tepat

-Memotivasi Orang Lain (Bab 3) Memberi Arah

-Kelompok dan tim dalam organisasi Pelayanan Kesehatan (Bab 6) -Desain Kerja (Bab 7) Menetapkan Mekasnisme Komunikasi dan Koordinasi

-Desain organisasi (bab 10) Mendapatkan Sumber Daya dan Mengelola Lingkungan

-Kepemimpinan: Sebuah kerangka kerja bagi pemikiran dan tindakan Mendorong Kerjasama -Manajemen Konflik dan Negoisasi (Bab 5)

-Koordinasi dan Komunikasi (Bab 8) Menggunakan Pengaruh -Kekuatan dan Politik dalam Organisasi Pelayanan Kesehatan (Bab 9)

-Mengelola Aliansi Strategis (Bab 11) Mengelola Perubahan dan Inovasi -Inovasi, Perubahan dan Pembelajaran organisasi (Bab 12) Mencapai Sasaran -Kinerja organisasi: Pengelolaan demi Efisiensi dan Efektifitas (Bab 13)

Merencanakan Masa Depan Mengelola secara Strategis -Penyusunan Strategi dalam Organisasi Perawatan Kesehatan (Bab 14) Mengantisipasi Masa Depan -Menciptakan dan Mengelola Masa Depan (Bab 15) 3

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Organization Theory and Health Services Management

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Learning Objectives 1 :  Identify the major forces affecting the delivery of health    

services. Understand how these major forces affect the role of the health service manager. Identify some of the commonalities and differences among major types of health services organizations. Identify and understand the basic processes that must be accomplished by any organization. Identify and understand the different units of analysis associated with studying organizations.

 Identify, understand, and apply the major perspectives on organizations to real problem facing health services organizations.

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OVERVIEW  Keadaan Ekonomi, Politik, Sosial dunia yang

selalu berubah membawa Continuos Paradigm Shift terhadap sektor pelayanan kesehatan.  Kompleksitas Pelayanan Kesehatan sendiri semakin menambah kebutuhan akan MANAJEMEN

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Organisasi  Dibutuhkan untuk membuat proses

pelayanan kesehatan bekerja secara efektif dan efisien dengan cara membawa greatest value.  Membawa kerangka berpikir baru dalam mensikapi perubahan dalam pelayanan kesehatan

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Klasifikasi Organisasi Pelayanan Kesehatan    

Health Maintenance Organizations Home Health Care Agencies Hospitals Pharmaceutical Companies

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

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Units of Analysis Environment E n v I r o n m e n t

Inter organizational Organization Group / Department Individual

Environment

E n v I r o n m e n t 12

Organizations Theory        

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

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

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

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Human Relations School Focused on Individual, The Characteristics :

 Greater Autonomy  Support with trainings to employee

Problem Occurred :  How to make Top and Middle Manager trust his employee to do the job Right

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Contingency Theory  Look an Organization as a Mechanic or

Organic depends on the External Environment needs.  A subunit in an Organization allowed to be managed differently (Mechanic or Organic)

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Resource Dependence Theory  Focused on the Importance of Organization in

securing needed resources in order to survive.  Forming certain coalitions to pool resources and reduce transaction costs

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Strategic Management Perspective  Focused on the importance of positioning

organization relative to its environment in order to survive.  This Perspective try to link environmental forces and internal organization design.

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Population Ecology Theory  Focused on population of Organization.  Organization can Achieve Success when they

can build a relationship to population of competitors and overall environmental forces influencing the population.

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Institutional Theory  Organizations are faced with environments

characterized by external norms, rules, requirements to which the organizations must conform in order to receive legitimacy and support

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Discussion Questions 1  Bila Anda memiliki wewenang didalam program

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

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THE MANAGERIAL ROLE

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Learning Objectives 2  Understand historical perspectives on the managerial role and

their underlying concepts.  Recognize the managerial challenges posed by changes in the

external environment and within health care organizations.  Understand the changing roles of managers in providing vision

and leadership, adapting the organization to its environment, and designing the organization to enact its mission and to achieve its objectives.  Recognize changing skiklls and knowledge required by

managers in light of environmental and organizational dynemics

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Conceptions of Managers  Traditional Conception  Political-Personal Conception  Organizational Conception

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

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

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Organizational Conception

 More Complex view, by taking into

account factors both within the organization and its environment and considering their respective effects.

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

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New Roles For Managers Leader

Designer

Strategist

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Discussion Questions 2  Cobalah deskripsikan apa yang dilakukan oleh manajer

dalam organisasi pelayanan kesehatan, dari fungsi, tugas, sasaran, dan pengetahuan serta keahlian yang dibutuhkan!  Apakah hal-hal seperti mengadaptasikan lingkungan, menentukan visi, misi, merancang organisasi merupakan hal yang sama-sama perlu untuk dilakukan? Cobalah pikirkan kekuatan dan kelemahan anda!  Seberapa pentingkah menurut anda bahwa manajer harus cukup menguasai semua aspek manajemen? Bagaimana menurut anda manajer harus bersikap menghadapi persaingan dimana dalam bidang itu dia tidak memiliki kapabilitas yang cukup 31















MOTIVATING PEOPLE

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Learning Objectives 3  Define Motivation and distinguish it from other factors

that influence individual’s performance.  Recognize popular but misleading myths about motivation  Understand that motivation depends heavily on the situations in which individuals work  Understand manager’s role in motivating people.  Identify key characteristics of the content of people’s

work that motivates them.  Identify important processes involved in motivating people  Asses and deal with motivational problems.

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Motivation and Management

 A State of feeling in which one is energized or aroused

to perform a task or engaged in a particular behavior

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Myths about Motivation  Motivated workers are more productive

Some people are just motivated while others aren’ aren’t Motivation can be mass produced Money makes the world go round 36

Manager’s Role  Assessing motivation to their

employee, periodically

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Framework of employee motivation Need Deficiency

Determination of future needs and search or choice for satisfaction

Evaluation of need satisfaction after Implementing alternatives

Search for ways to satisfy unmet needs

Choice of alternatives to satisfy unmet needs 38

Motivation Theories  Content Perspectives Theory that focus on needs and need deficiencies

 Process Perspectives Focus based on Process involved in motivation

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Content Perspectives    

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

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Comparison of need theories of motivation McClelland’’s McClelland

Self Actualization needs Ego and self esteem needs Social and belongingness needs

Safety and security needs Physiological needs

Herzberg’s Herzberg’ Model

Alderfer’s Alderfer’ Model

Growth Needs Relatedness Needs

Existence Needs

Motivation factors

Maslow ’S Model

Achievement Recognition Advancement The Work itself Possibility for personal growth REsposibility Status Company policy & administration Quality of supervision Relations with supervisor Relations with peers Relations with subordinate Salary Job Security Personal Life Working Cond

Model

Achievement

Power Affiliation

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Process Perspectives  Equity Theory  Expectancy Theory  Reinforcement Theory  Goal Setting

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Motivational Problems & Solutions

Problems

 Inadequate performance definition  Impediments to employee performance  Inadequate performance-reward linkages

Solutions  Behavior Modification Pay For Performance Enhanced Achievement Well Defined Performance Standard 43

Discussion Questions 3  Bagaimanakah Teori motivasi Content perspective dan process perspective dapat digabungkan didalam aplikasi organisasi?  Bagaimanakah cara mendiagnosa masalahmasalah motivasi dari faktor-faktor lain yang mempengaruhi kinerja individu?  Bagaimanakah teori motivasi dapat digunakan untuk memilih pemecahan terbaik dari kepentingan individu? 44

Leadership

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Learning Objectives 4  Better appreciate why leadership skills are so important.  Understand what leadership is and what it is not.  Understand the distinction between management and     

leadership. Understand the leadership role and how it is executed in health services organizations. Understand the major leadership perspectives as well as some emerging theories and concepts. Consider how different leadership perspectives can be combined into a more integrative framework. Appreciate several distinctive challenges of leading in health services organizations. Continue developing leadership knowledge and skills. 46

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

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

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Key points of Leadership  Leadership is Multidirectional.  Although its multidirectional, Leadership

focus on the downward.  The focus is generally other managers; Managers lead other managers.  Leadership depends on the power associated.

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Leadership effectiveness and Success: What We know Perspectives of Leadership :

 The Trait perspective  The Behavioral perspective  The Contingency Perspective

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The Trait perspective The Nature Argument : Leadership Effectiveness & Success

Traits

The Nurture Argument Abilities and Behavior

Traits

Leadership effectiveness & Success

The Situational Argument Traits

Abilities and Behavior

Leadership effectiveness & Success 51

The Behavioral perspective Low Initiating Structure, High consideration Style

High Initiating Structure, High Consideration Style

Low Initiating Structure, Low consideration Style

High Initiating Structure, Low Consideration Style

Initiating Structure

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The Contingency Perspective    

Leadership Match Model Path Goal Model LEAD Model Attribution Theory

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Emerging Theories & Concepts  Transformational Leadership Concerned with changes than exchanges. Seeking to alter both the objective and nature of manager-follower interactions, lead by empowering.

 Charismatic Leadership Distinct social relationship between the leader and follower, in which the leader presents the revolutionary idea & Follower accepts the idea not by rationally, but by believes

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High Performance leadership, Depends on :

 Systems Thinking, Mastering a conceptual framework and associated set of analytical tools or technique which allow us to understand these patterns and how they can be changed.

 Visioning Effective managers lead by pulling, not pushing

 Facilitating learning Organizations and the environments in which they operate are not static. Changes tends to revolutionary than evolutionary

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

Services Organizations

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Discussion Questions 4  Bagaimanakah menurut anda kepemimpinan itu? Dan apa

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

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Conflict Management and Negotiation 58

Learning Objectives 5  Identify reasons that conflict is prevalent in health care

organizations.  Understand several different types of conflict management

technique, based on various concerns of the disputants.  Identify the basic concepts and dimensions of negotiation.  Appreciate the importance of planning for a negotiation and

know the key issues to consider when preparing to negotiate.  Identify and understand special types of conflict management

situations, such as multiparty negotiations and third-party intervention.

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The Importance of Conflict Management  The Marketplace is growing increasingly global as firms face competition from foreign company.  The epidemic of corporate restructuring experienced during the past decade produced the framework for the development of todays organized delivery systems  Shift from manufacturing based to a service based 60

The Causes of Conflict  The role of resource scarcity  Beneficial vs. Detrimental effects of

conflict  Jehn’s Typology of Conflict

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Levels of Conflict Individual Level Group Level

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

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Dual Concern Model Assertive

Pressing

Collaborating

Negotiating

Concern for Self

Compromising

Unassertive

Avoiding

Uncooperative

Accomodation

Concern for others

Cooperative 64

Negotiation, the key points  Basic Concepts A Negotiator never has to negotiate; there always alternatives to reaching an agreement through a negotiation.

 The Distributive dimension of negotiation 1.

Know your BATNA (Best Alternatives to a Negotiated agreement)

2.

Determine your bottom line or reservation price

3. Set a Goal of aspiration level that is significanly better than bottom line and optimistically realistic.

your

4. Think of what objective Standards might be acceptable to the party.

other

5.

Plan your opening. An initial offer should not be to extreme, but it should prevent the other party from anchoring the negotiation.

6.

Develop reciprocity. Avoid making unilateral concessions

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Negotiation, the key points (Con’t)

 The integrative Dimension of Negotiation. The assumption is that one party can gain without the other party necessarily having to lose.

 The Mixed motive nature of negotiation. Simultaneously balance cooperative and competitive behavior

 The Role of information sharing Symmetric Information

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Multiparty Negotiations Difference between two and multiparty negotiations

Two party negotiations is less complex than multi party negotiations

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Fairness and Ethics in Negotiation Fairness Norm : Equality Equity Need

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Managing conflict through third party intervention  There are several types of intervention strategies

Manager as Inquisitor as Arbitrator as Mediator

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Discussion Questions 5  Jenis keahlian apakah yang dibutuhkan manajer dalam mengelola

konflik yang ada? Apakah anda memilikinya? Bagaimana meningkatkan kelemahan anda dalam mengelola konflik ini?  Setelah melihat debate time 5.1, apakah indikasi sebuah HSO

memiliki konflik? Bagaimanakah sistem untuk memantau indikator itu.  Strategi pihak ketiga apakah yang akan dijalankan oleh manajer

sebagai pihak ketiga?  Dalam menangani konflik antar-group, kelompok mana yang paling

sering mengalami konflik?  Jika anda dalam posisi James Grover di Chiefland memorial hospital

tindakan apa yang harus anda ambil untuk meredakan konflik antara hoffman and Young? Jelaskan langkah-langkah anda!

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Managing Groups and Teams

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Learning Objectives 6  Describe the importance and types of groups and teams in health

services organizations.  Distinguish between different approaches to assesing work group

performance  Analyze the effect of a work group’s structure on group

performance.

 Explain the relationship between work group norms and group

productivity.  Identify the key roles assumed by individuals in work groups.  Describe key aspects of group process including communications

structures, decision making, and stages of group development.  Define major causes and consequences of intergroup conflict and

identify alternative strategies for managing conflict.

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Types of groups and teams in organizations        

Reference Groups Friendship Groups Interest Groups Work Groups Management teams Temporary Groups or task forces Intermittent Groups Standing Committees

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A Model of Work group Performance Group Characteristics: •Group composition and size •Group norms •Role relationships •Group role clarity •Group cohesiveness •Status differences

Group Process : •Leadership •Communication •Decision Making •Stages of group development

Effectiveness : •Performance or Productivity •Member satisfaction

Intergroup Conflict : •Interdependence among groups. •Group role and task ambiguity. •Intergroup differences in work orientation. •Intergroup goal incompatibility. 75

Discussion Question 6  Direktur yang baru-baru ini bekerja, diserahkan tugas untuk

memimpin rapat mingguan team manajemen. Team manajemen ini membutuhkan beberapa dokter, perawat, asisten dokter, dan petugas sosial. Apa kebijakan yang akan anda berikan pada direktur RS untuk membantu meningkatkan kerja team? 

Sebuah kelompok interorganisasional telah dibentuk untuk mengidentifikasi kendala-kendala dalam memberikan pelayanan kesehatan. Bagaimanakah anda mengelola organisasi dalam lingkup divisi dan global terjaga dengan manajemen yang baik.

 Dalam keadaan apa saja uncohesive group lebih produktif daripada

cohesive groups? Strategi apa yang harus dibuat oleh pemimpin untuk membuat Cohesive group lebih produktif?  Strategi apa yang digunakan pemimpin group untuk meningkatkan

komitmen dari anggota group? Bagaimanakah pemimpin group dapat memantau apakah anak buahnya telah memiliki komitmen atau tidak? 76

Work Design 77

Learning Objectives 7  Identify the range of approaches to work design, including the

psychological and task inventory approaches.  Understand the relationship between work design and individuals

motivation and productivity.  Discuss the differences between work and working.  Identify components of work, their characteristics and their

performance requirement.  Analyze the interconnectedness of components of work among

individuals and among work groups.  Understand how to approach the design of individual jobs and

work units.

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Approaches to job design  Task Inventory approaches.  Psychological approaches

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Analysis of Work  Work, is objective and impersonal, it is energy directed at organizational goals, identifiable separately from the person who does it.

 Working it is a workers affective response to work. Is an individual personal and subjective reaction.

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Types of Work  Direct work effort that directly contributes to the accomplishment of an organization’s goals

 Management Work Providing the resources and and context within which direct work can be perform.  Support Work Does not directly result in achievement of an organizational goal, but it needed for effective accomplishment of other job 81

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

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Designing individual job  It is important to match people and their

needs to jobs and their inherent work requirements.  People evaluate courses of action for the

purpose of choosing among them

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Coordinating interconnected work within organizational  Interconnected elements of work are best placed within an units individual job.

 In this section, focus on how to achieve coordination.  Van de Ven et al. Found variations in patterns of coordination among

unit facing different level of task uncertainty.  Charns et al extended the findings, Mintzberg suggest that work

groups use a combination of six approaches to coordination and that the use of these approaches is related to the effectiveness of patient care. 

The Six approaches fall into two categories: programming methods and feedback methods.

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Discussion Questions 7  Under what conditions does a job with a high motivating potential    

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

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Coordination and Communication 86

Learning Objectives  Differentiate between pooled, sequential, and reciprocal           

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

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Interdependence

 Pooled interdependence  Sequential interdependence  Reciprocal interdependence

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Skills needed by Managers

Within the Hospital Managers With Other Organizations

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

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Intraorganizational Coordination Since the activities of health professionals are seen as being complex, uncertain, and of great social importance, three distinctive structural arrangements has evolved to support the autonomy of these professions.

 Autonomous arrangement, present when an organization delegates to

a professional group goal setting, implementation, and evaluation of performance and the administration manages the support staff.  Heteronomous arrangement, Professionals are subordinated to the

administrative structure with specific responsibilities delegated to various professional groups.  Conjoint arrangement, Professionals and administration are equal in

power.

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Intraorganizational Mechanisms of Coordination  Hierarchical coordination, The various activities are

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

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Mintzberg’s Five Coordinating Mechanism M Manager

M Manager

Analyst A Analyst A O O Mutual Adjusment

O

O

Direct Supervision

M A

Standardization Worker Skills

O

Outputs

O

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Interorganizational Coordination Typology :  Market Transactions, Involve the focal organization and

other organizations entering into relationships in order to obtain operational resources or product markets.  Voluntary interorganizational relationship transactions,

Distinguished by the voluntary dimension of the transactions.  Involuntary Interorganizational Transactions, lead to unique ways

of managing interdependence.

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

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Communication  Provides information people need to make decisions.  Communications from the Managers perspective, has:

Intraorganizational Communication, depends on formal establishment of channels and networks within the organizations. Interorganizational Dimensions, occurs between organizations or between organizations and constituencies outside them.

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Elements of Effective Communication Reinforcement

Desire to Communicate

Effective Communication:

•Being Understood •Making meaning, not agreement

Understanding How others Learn

•Perceive and Process information •Analytic vs Intuitive •Abstract vs Concrete,etc

Purpose Content Sender Credibility Time Frame

Information Cues Eliciting Cues Decision Cues Importance Complexity Ascribed Achieved Long vs Short

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Barriers to Communication

Environmental Barriers Personal Barriers

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Flows of intraorganizational Communications    

Downward Flow Upward Flow Horizontal and Diagonal Flows Communication Networks Communication networks Chain Networks Y Pattern Wheel Pattern Circle Pattern All-Channels Network 99

Interpret

Communication Flows in Health care Organizations Upward Communication •Problems & Exceptions •Suggestions for improvement •Performance reports •Grievances and disputes •Financial and Accounting information

Downward Communication •Implementation of goals, Strategies, Objectives •Job Instructions and rationale •Procedures and practices •Performance feedback •Indoctrination

COORDINATE HORIZONTAL AND DIAGONAL COMMUNICATION •Intradepartmental problem solving •Interdepartmental coordination •Staff advice to the departments

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Discussion Questions  Diskusikan perbedaan koordinasi intra dan inter organisasional.

Apa sajakah cara-cara yang dapat digunakan oleh manajer untuk mencapai koorinasi tipe tertentu?  Jelaskan model komunikasi dan gambarkan model

komunikasinya!  Anda baru saja diangkat menjadi manajer sebuah proyek

bersama antara RS tempat anda bekerja dengan beberapa staff medis untuk mengoperasikan fasilitas bedah. Program yang anda pentingkan adalah untuk menjalin kerjasama yang efektif dengan RS. Buatlah rencana proyek ini berdasarkan materi pada bab ini!  Bayangkan Organisasi pelayanan kesehatan anda menerima

sebuah pemberitaan yang buruk. Bagaimanakah organisasi anda akan bereaksi?

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Power And Politics in Health Services Organizations

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Learning Objectives 9  Distinguish between rational and political models of

organization of their appropriateness to health services organizations.  Know the practical, managerial implications of the effective

use of power in health services organizations.  Identify the conditions that promote the use of power, politics,

and informal Influences in health services organizations.  Understand the range of political strategies and tactics

employed by members of health services organizations  Understand the sources of power in health services

organizations.  Know the key approaches for consolidating and developing

power by managers, physicians, and other groups in health services organizations. 103

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

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

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Sources of power    

Access to resources Access to information Formal Authority Skill in dealing with uncertainty

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

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

 Coalition Building

108

Power, Politics, and Organizational Performance  In an organizations, the use of power is to

maintain the importance of a decision has been made.  Such Strategies for reducing the level of influence are available for manager who simply do not feel comfortable for using power.

109















Organization Design

111

Learning Objectives  Understand the principles of organization design  Have an awareness of the evolution of organization

design.  Use a framework for understanding organization design considerations.  Analyze common organization designs in terms of their applicability, Strengths, and limitations.  Consider guidelines for changing organization designs.

112

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

113

Management role in OD  Management primary task is to maintain and improve

performance in the organization.

 In designing OD managers should consider input from employee. OD must be design bottom-up not Top down.

114

Organization design in relation to other management activities. Statement Of Organizational Mission

Feed Back

Strategy Development & Implementation

OD Information Needs Rewards Performance Evaluation 115

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

116

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

117

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

118

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

119

MANAGING STRATEGIC ALLIANCES

120

Learning Objectives  Understand why strategic alliances are increasing in use, particularly

among health care organizations.  Distinguish between different types or forms of strategic alliances,

using number of dimensions.  Classify an alliance both in terms of what it looks like and what it is

meant to do.  Understand how alliance motivation is often related to alliance

structure and outcomes.  Identify whethet your motivations for a strategic alliance are

compatible with those of your alliance partner.  Think about strategic alliances in terms of the likely stages of

development that alliances often experience and the critical issues that you may face at each stage.  Distinguish between an alliance problem and an alliances symptom

and recognize the different implications for managerial intervention.  Understand both the pros and cons of alliances. 121

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

122

Types and forms of alliances

 Ownership and control  Number of members  Governance Structure  Mandated vs Voluntary Participation

123

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

sharing.

124

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

125

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

126

Organizational Innovation and Change

127

Learning Objectives  Describe the change process that occurs within health services

organizations and identify factors which facilitate or inhibit that process.  Identify and understand the types of changes associated with technical

operations and the methods to manage such changes.  Identify and understand the types of changes and methods associated

with identify \ing and introducing new services.  Describe the types of changes involving administrative, structural, or

strategy mechanisms and the approaches that affect such change processes.  Describe human resource changes and identify methods for managing

such changes. 128

The Change Process Both changes and innovation involve a number of distinct stages :

 Awareness  Identification  Implementation  Institutionalization

129

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

130

Organizational Performance

131

Learning Objectives  Understand the importance of assesing organizational      

performance. Define performance measures for organizations. Understand the important issues in defining, measuring, and using performance measures. Evaluate professional work. Compare management models based on quality assurance and quality improvement. Manage for quality improvement in health care. Understand management roles to create high performance organizations. 132

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

133

Issues in assesing effective performance

 Fundamental perspectives about

organizations.  Domain of activity  Different levels of analysis

134

Technical issues in assessment Classes of measures  Structural measures  Process measures  Outcome measures Factors associated with effective performance :  Quality of professional staff  High standart  experience with other cases  more professional staffs with high capability in managing conflict.  Participative organization cultures emphasizing team approaches.  Timely and accurate performance feedback.  Active management of environmantal forces. 135

Two models for changing performance

 Quality Assurance  Quality Improvement

136

Cause and effect diagram for continous improvement Environmental Characteristics

Unit Characteristics

Patient Characteristics

Outcomes of care

Interorganizational Characteristics

Organizational Characteristics

Provider Characteristics

137

Managers role in creating high performance Health care Organizations

 Problem in measuring performance are a challenging factor in

HCO.  The task of defining, measuring, and influencing performance is

so difficult that management can play a key role.

138

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

139

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

140















Strategy making in HCO 142

Learning Objectives  Define the concepts of strategic management.  Undewrstand the major school of thought in strategic management and



   

how the relevance of each might be dependent upon the degree of turbulence in the environment. Understand the major sources of competitive advantage, some major examples, of these sources, and why they are important in the design of strategy. Understand how multiorganizational structures can facilitate implementation of health care strategies. Identify the major structural features of markets and be able to apply them in the analysis of health care strategies. Identify the major force of threat in the porter framework and be able to use them in conducting strategic analyses. Understand the relationship between strategy and market structure and be able to apply this understanding to the analysis of health care markets. 143

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

144

Schools of thought School

Strategy Formulation as

Prescriptive School Design Planning Positioning Descriptive Schols Entrepreneurial Cognitive Learning Political Cultural Environment Configuration

A Conceptual process A formal Process an analytical process A Visionary Process A Mental Process An Emergent Process a Power Process an ideological process a passive process an episodic process

145

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

146

Strategic comfort zones for shifting pace

Prospector

Analyzer

Defender

Reactor

147

Five forces Michael Porter Potential Entrants

Supplier

Competitors

Buyers

Substitutes

148

Creating and Managing the Future

149

Learning Objectives  Identify the major trends likely to affect the delivery of

health care.  Understand the changing role of physicians, nurses, and other allied health care providers within health services.  Understand the changing role of management and the competencies required to function in the managerial role.

150

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

151

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

152

Health Services Policy

 Dalam menetapkan kebijakan sangat dipengaruhi oleh

keadaan masa depan.  Untuk meramalkan masa depan perlu melakukan riset  Kadangkala Manajer tidak memiliki waktu dalam melakukan riset sehingga diperlukan kerjasama dengan para peneliti.

153

The Managerial Role

 Role performance and emerging

challenges  Preparing future managers

154

Prinsip Dasar Manajemen Kesehatan.pdf

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