Shortell MANAGEMENT IKM

Shortell and Kaluzny
PROGRAM PASCA SARJANA IKM-FK UGM

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

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

Memotivasi
dan
Memimpin
Orang serta
Kelompok

Memenuhi
Kebutuhan dan
Nilai-nilai Individu
-Memotivasi
Orang Lain
(Bab 3)
Memberi Arah
-Kepemimpin
an: Sebuah
kerangka
kerja bagi
pemikiran
dan tindakan
Mendorong

Kerjasama
-Manajemen
Konflik dan
Negoisasi

Menjalan
kan
Sistem
Teknis
Menentukan
Kelompok Kerja dan
Desain yang Tepat
-Kelompok dan
tim dalam
organisasi
Pelayanan
Kesehatan (Bab
6)
-Desain Kerja (Bab 7)
Menetapkan

Mekasnisme
Komunikasi dan
Koordinasi
-Koordinasi dan
Komunikasi
(Bab 8)
Menggunakan

Memperb
arui
Organisas
i
Menentukan Desain
Organisasi yang Tepat
-Desain organisasi
(bab 10)
Mendapatkan Sumber
Daya dan Mengelola
Lingkungan
-Mengelola Aliansi

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

Merencana
kan Masa
Depan
Mengelola secara
Strategis
-Penyusunan

Strategi
dalam
Organisasi
Perawatan
Kesehatan
(Bab 14)
Mengantisipasi
Masa Depan
-Menciptaka
n dan
Mengelola
Masa Depan
(Bab 15)

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


















Organisasi dan Manajer
-Teori Organisasi dan Manajemen Pelayanan Kesehatan
(Bab 1)
-Peran Manajer (bab 2)
Memotivasi
dan
Memimpin
Orang serta
Kelompok

Memenuhi
Kebutuhan dan
Nilai-nilai Individu
-Memotivasi
Orang Lain
(Bab 3)
Memberi Arah
-Kepemimpin
an: Sebuah

kerangka
kerja bagi
pemikiran
dan tindakan
Mendorong
Kerjasama
-Manajemen
Konflik dan
Negoisasi

Menjalan
kan
Sistem
Teknis
Menentukan
Kelompok Kerja dan
Desain yang Tepat
-Kelompok dan
tim dalam
organisasi

Pelayanan
Kesehatan (Bab
6)
-Desain Kerja (Bab 7)
Menetapkan
Mekasnisme
Komunikasi dan
Koordinasi
-Koordinasi dan
Komunikasi
(Bab 8)
Menggunakan

Memperb
arui
Organisas
i
Menentukan Desain
Organisasi yang Tepat
-Desain organisasi

(bab 10)
Mendapatkan Sumber
Daya dan Mengelola
Lingkungan
-Mengelola Aliansi
Strategis (Bab 11)
Mengelola Perubahan
dan Inovasi
-Inovasi,
Perubahan dan
Pembelajaran
organisasi (Bab
12)
Mencapai Sasaran
-Kinerja
organisasi:
Pengelolaan demi
Efisiensi dan

Merencana

kan Masa
Depan
Mengelola secara
Strategis
-Penyusunan
Strategi
dalam
Organisasi
Perawatan
Kesehatan
(Bab 14)
Mengantisipasi
Masa Depan
-Menciptaka
n dan
Mengelola
Masa Depan
(Bab 15)

Organization Theory and
Health Services
Management

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




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

 Identify, understand, and apply the major

perspectives on organizations to real problem
facing health services organizations.

OVERVIEW
 Keadaan Ekonomi, Politik, Sosial

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

Organisasi
 Dibutuhkan untuk membuat proses

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

Klasifikasi Organisasi
Pelayanan Kesehatan
 Health Maintenance

Organizations
 Home Health Care Agencies
 Hospitals
 Pharmaceutical Companies

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

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

Environme
nt
Inter organizational
Organization
Group / Department
Individual

Environment

E
n
v
I
r
o
n
m
e
n
t

Organizations Theory









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

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 !

THE MANAGERIAL
ROLE

Learning Objectives 2
 Understand historical perspectives on the managerial

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

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

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

managers in light of environmental and organizational
dynemics

Conceptions of Managers
 Traditional Conception
 Political-Personal

Conception
 Organizational Conception

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

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

Organizational Conception

 More Complex view, by taking

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

The New Managerial
Challenges
 Cost Efficiency
 Quality Improvement
 Greater Accountability in delivering

services
 Turbulence environment
 Interorganizational Complexity

New Roles For Managers
Leader

Designer

Strategist

Discussion Questions 2
 Cobalah deskripsikan apa yang dilakukan oleh

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

Organisasi dan Manajer
-Teori Organisasi dan Manajemen Pelayanan Kesehatan
(Bab 1)
-Peran Manajer (bab 2)
Memotivasi
dan
Memimpin
Orang serta
Kelompok

Memenuhi
Kebutuhan dan
Nilai-nilai Individu
-Memotivasi
Orang Lain
(Bab 3)
Memberi Arah
-Kepemimpin
an: Sebuah
kerangka
kerja bagi
pemikiran
dan tindakan
Mendorong
Kerjasama
-Manajemen
Konflik dan
Negoisasi

Menjalan
kan
Sistem
Teknis
Menentukan
Kelompok Kerja dan
Desain yang Tepat
-Kelompok dan
tim dalam
organisasi
Pelayanan
Kesehatan (Bab
6)
-Desain Kerja (Bab 7)
Menetapkan
Mekasnisme
Komunikasi dan
Koordinasi
-Koordinasi dan
Komunikasi
(Bab 8)
Menggunakan

Memperb
arui
Organisas
i
Menentukan Desain
Organisasi yang Tepat
-Desain organisasi
(bab 10)
Mendapatkan Sumber
Daya dan Mengelola
Lingkungan
-Mengelola Aliansi
Strategis (Bab 11)
Mengelola Perubahan
dan Inovasi
-Inovasi,
Perubahan dan
Pembelajaran
organisasi (Bab
12)
Mencapai Sasaran
-Kinerja
organisasi:
Pengelolaan demi
Efisiensi dan

Merencana
kan Masa
Depan
Mengelola secara
Strategis
-Penyusunan
Strategi
dalam
Organisasi
Perawatan
Kesehatan
(Bab 14)
Mengantisipasi
Masa Depan
-Menciptaka
n dan
Mengelola
Masa Depan
(Bab 15)

MOTIVATING
PEOPLE

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

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

Motivation and Management

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

to perform a task or engaged in a particular behavior

Myths about Motivation
 Motivated workers are more productive

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

Manager’s Role
 Assessing motivation to

their employee, periodically

Framework of employee
motivation
Need Deficiency

Determination of
future needs and search
or choice for satisfaction

Evaluation of
need satisfaction after
Implementing alternatives

Search for ways
to satisfy unmet needs

Choice of alternatives
to satisfy unmet needs

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

 Process Perspectives
Focus based on Process involved in
motivation

Content Perspectives





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

Comparison of need theories
of motivation Herzberg’s
McClelland’
Alderfer’
s
Model

Self Actualization
needs

Growth
Needs

Ego and
self esteem needs Relatedness

Needs

Social and
belongingness needs

Safety and security Existence
Needs
needs

Physiological needs

Model

Achievement
Recognition
Advancement
The Work itself
Possibility
for personal growth
REsposibility

Hygiene Factors Motivation
factors

Maslow
’ S Model

Status
Company policy &
administration
Quality of supervision
Relations with
supervisor
Relations with peers
Relations with
subordinate
Salary
Job Security

Model

Achievement

Power
Affiliation

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

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

Discussion Questions 3
 Bagaimanakah Teori motivasi Content

perspective dan process perspective dapat
digabungkan didalam aplikasi organisasi?
 Bagaimanakah cara mendiagnosa
masalah-masalah motivasi dari faktorfaktor lain yang mempengaruhi kinerja
individu?
 Bagaimanakah teori motivasi dapat
digunakan untuk memilih pemecahan
terbaik dari kepentingan individu?

Leadership

Learning Objectives 4
 Better appreciate why leadership skills are so








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

Overview
 Leadership is one of the most highly

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

Leadership Core concepts
 Is a Process, an action word, not a noun
 Locus of leadership is in a person
 Focus of leadership is other individuals

and groups
 Influence is leadership’s center of
gravity

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

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

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

 The Trait perspective
 The Behavioral perspective
 The Contingency

Perspective

The Trait perspective
The Nature Argument :

Traits

Leadership Effectiveness & Success

The Nurture Argument
Traits

Abilities and
Behavior

Leadership
effectiveness
& Success

Traits

Abilities and
Behavior

Situatio
n

The Situational Argument

Leadership effectiveness
& Success

The Behavioral perspective

Considerati
on

Low Initiating
Structure, High
consideration
Style

Low Initiating
Structure,
Low
consideration
Style

High Initiating
Structure,
High
Consideration
Style
High Initiating
Structure, Low
Consideration
Style

Initiating Structure

The Contingency
Perspective





Leadership Match Model
Path Goal Model
LEAD Model
Attribution Theory

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

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

High Performance leadership,
Depends on :

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

 Visioning
Effective managers lead by pulling, not pushing

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

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

Services Organizations

Discussion Questions 4
 Bagaimanakah menurut anda kepemimpinan

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

Conflict
Management
and
Negotiation

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

organizations.
 Understand several different types of conflict management

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

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

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

The Importance of Conflict
Management
 The Marketplace is growing

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

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

effects of conflict
 Jehn’s Typology of Conflict

Levels of Conflict
Individual Level
Group Level

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

Dual Concern Model
Assertive

Pressing

Collaborating

Negotiating

Concern
for Self

Compromising

Unassertive

Avoiding

Uncooperative

Accomodation

Concern for others

Cooperative

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

 The Distributive dimension of negotiation
1. Know your BATNA (Best Alternatives to a Negotiated
agreement)
2.

Determine your bottom line or reservation price

3.

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

4. Think of what objective Standards might be acceptable to
the
other party.
5. Plan your opening. An initial offer should not be to extreme,
but it
should prevent the other party from anchoring the
negotiation.
6.

Develop reciprocity. Avoid making unilateral concessions

Negotiation, the key points
(Con’t)
 The integrative Dimension of Negotiation.
The assumption is that one party can gain without
the other party necessarily having to lose.

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

 The Role of information sharing
Symmetric Information

Multiparty Negotiations
Difference between two and multiparty negotiations

Two party negotiations
is less complex
than multi party
negotiations

Fairness and Ethics in
Negotiation
Fairness Norm :
Equality
Equity
Need

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

strategies

Manager
as Inquisitor
as Arbitrator
as Mediator

Discussion Questions 5
 Jenis keahlian apakah yang dibutuhkan manajer dalam

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

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

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

yang paling sering mengalami konflik?
 Jika anda dalam posisi James Grover di Chiefland

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

Organisasi dan Manajer
-Teori Organisasi dan Manajemen Pelayanan Kesehatan
(Bab 1)
-Peran Manajer (bab 2)
Memotivasi
dan
Memimpin
Orang serta
Kelompok

Memenuhi
Kebutuhan dan
Nilai-nilai Individu
-Memotivasi
Orang Lain
(Bab 3)
Memberi Arah
-Kepemimpin
an: Sebuah
kerangka
kerja bagi
pemikiran
dan tindakan
Mendorong
Kerjasama
-Manajemen
Konflik dan
Negoisasi

Menjalan
kan
Sistem
Teknis
Menentukan
Kelompok Kerja dan
Desain yang Tepat
-Kelompok dan
tim dalam
organisasi
Pelayanan
Kesehatan (Bab
6)
-Desain Kerja (Bab 7)
Menetapkan
Mekasnisme
Komunikasi dan
Koordinasi
-Koordinasi dan
Komunikasi
(Bab 8)
Menggunakan

Memperb
arui
Organisas
i
Menentukan Desain
Organisasi yang Tepat
-Desain organisasi
(bab 10)
Mendapatkan Sumber
Daya dan Mengelola
Lingkungan
-Mengelola Aliansi
Strategis (Bab 11)
Mengelola Perubahan
dan Inovasi
-Inovasi,
Perubahan dan
Pembelajaran
organisasi (Bab
12)
Mencapai Sasaran
-Kinerja
organisasi:
Pengelolaan demi
Efisiensi dan

Merencana
kan Masa
Depan
Mengelola secara
Strategis
-Penyusunan
Strategi
dalam
Organisasi
Perawatan
Kesehatan
(Bab 14)
Mengantisipasi
Masa Depan
-Menciptaka
n dan
Mengelola
Masa Depan
(Bab 15)

Managing Groups and Teams

Learning Objectives 6
 Describe the importance and types of groups and

teams in health services organizations.
 Distinguish between different approaches to

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

group performance.
 Explain the relationship between work group

norms and group productivity.
 Identify the key roles assumed by individuals in

work groups.
 Describe key aspects of group process including

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

intergroup conflict and identify alternative
strategies for managing conflict.

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

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

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

Group
Process :
•Leadership
•Communicatio
n
•Decision
Making
•Stages of
group
development

Effectiveness :
•Performance
or Productivity
•Member satisfaction

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

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

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

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

 Dalam keadaan apa saja uncohesive group lebih produktif

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

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

Work Design

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

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

and individuals motivation and productivity.
 Discuss the differences between work and

working.
 Identify components of work, their characteristics

and their performance requirement.
 Analyze the interconnectedness of components of

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

individual jobs and work units.

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

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

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

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

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

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

Designing individual job
 It is important to match people and

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

the purpose of choosing among them

Coordinating interconnected
work within organizational units
 Interconnected elements of work are best placed within

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

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

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

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

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



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

Coordination
and
Communication

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










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

Interdependence

 Pooled interdependence
 Sequential interdependence
 Reciprocal interdependence

Skills needed by Managers

n&
o
i
t
ina
d
on
i
r
t
o
a
o
C
unic
m
Com

Within the Hospital

Managers
Coo
r
Com dinatio
m un
n
icat &
ion

With Other Organizations

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

Intraorganizational
Coordination
Interorganizational

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

 Autonomous arrangement, present when an organization

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

subordinated to the administrative structure with specific
responsibilities delegated to various professional groups.
 Conjoint arrangement, Professionals and administration

are equal in power.

Intraorganizational Mechanisms of
Coordination
 Hierarchical coordination, The various activities

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

Mintzberg’s Five Coordinating
Mechanism
M Manager

M Manager

Analyst A
Analyst A
O
O
Mutual Adjusment

O

Direct Supervision

M
A

Standardization
Worker Skills

O

Outputs

O

O

Interorganizational Coordination

Typology :
 Market Transactions, Involve the focal

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

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

unique ways of managing interdependence.

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

Communication
 Provides information people need to make

decisions.
 Communications from the Managers perspective,
has:

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

Elements of Effective
Communication
Reinforcement

Desire to
Communicate

Effective
Communication:

•Being Understood
•Making meaning, not agreemen

Understanding How
others Learn

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

Purpose
Content

Information Cues
Eliciting Cues
Decision Cues
Importance
Complexity
Ascribed

Sender
Credibility Achieved
Time Frame Long vs Short

Barriers to Communication

Environmental Barriers
Personal Barriers

Flows of intraorganizational
Communications





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

Upward
Downward
Communication
Communication
•Problems & Exceptions
•Implementation of goals,
•Suggestions for improvement
Strategies, Objectives
•Performance reports
•Job Instructions and rationale
•Grievances and disputes •Procedures and practices
•Financial and Accounting •Performance feedback
•Indoctrination
information

Influence

Interpret

Communication Flows in Health care
Organizations

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

Discussion Questions
 Diskusikan perbedaan koordinasi intra dan inter

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

komunikasinya!
 Anda baru saja diangkat menjadi manajer sebuah

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

menerima sebuah pemberitaan yang buruk.
Bagaimanakah organisasi anda akan bereaksi?

Power And Politics in Health
Services Organizations

Learning Objectives 9
 Distinguish between rational and political models of

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

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

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

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

organizations.
 Know the key approaches for consolidating and

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

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

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

Sources of power





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

Mintzbergs Political Games
 Games to resist authority
 Games to counter the resistance to

authority.
 Games to build power bases.
 Games to defeat rivals
 Games to Effect Organizational
change

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

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

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

Organisasi dan Manajer
-Teori Organisasi dan Manajemen Pelayanan Kesehatan
(Bab 1)
-Peran Manajer (bab 2)
Memotivasi
dan
Memimpin
Orang serta
Kelompok

Memenuhi
Kebutuhan dan
Nilai-nilai Individu
-Memotivasi
Orang Lain
(Bab 3)
Memberi Arah
-Kepemimpin
an: Sebuah
kerangka
kerja bagi
pemikiran
dan tindakan
Mendorong
Kerjasama
-Manajemen
Konflik dan
Negoisasi

Menjalan
kan
Sistem
Teknis
Menentukan
Kelompok Kerja dan
Desain yang Tepat
-Kelompok dan
tim dalam
organisasi
Pelayanan
Kesehatan (Bab
6)
-Desain Kerja (Bab 7)
Menetapkan
Mekasnisme
Komunikasi dan
Koordinasi
-Koordinasi dan
Komunikasi
(Bab 8)
Menggunakan

Memperb
arui
Organisas
i
Menentukan Desain
Organisasi yang Tepat
-Desain organisasi
(bab 10)
Mendapatkan Sumber
Daya dan Mengelola
Lingkungan
-Mengelola Aliansi
Strategis (Bab 11)
Mengelola Perubahan
dan Inovasi
-Inovasi,
Perubahan dan
Pembelajaran
organisasi (Bab
12)
Mencapai Sasaran
-Kinerja
organisasi:
Pengelolaan demi
Efisiensi dan

Merencana
kan Masa
Depan
Mengelola secara
Strategis
-Penyusunan
Strategi
dalam
Organisasi
Perawatan
Kesehatan
(Bab 14)
Mengantisipasi
Masa Depan
-Menciptaka
n dan
Mengelola
Masa Depan
(Bab 15)

Organization Design

Learning Objectives
 Understand the principles of organization






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

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

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

improve performance in the organization.

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

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

Feed Back

Strategy Development
& Implementation

OD
Information Needs
Rewards
Performance Evaluation

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

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

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

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

MANAGING STRATEGIC
ALLIANCES

Learning Objectives
 Understand why strategic alliances are increasing in

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

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

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

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

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

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

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

Alliances in health care
industries
 Strategic alliances dalam organisasi

selalu diibaratkan dengan orang yang
sedang membina hubungan pacaran,
dimana ada kemungkinan hubungan
yang harmonis dengan kekuatan yang
sinergis atau konflik yang
menghancurkan.

Types and forms of alliances

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

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

and risk sharing.

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

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

symptom.

Organizational Innovation
and Change

Learning Objectives
 Describe the change process that occurs within health

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

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

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

structural, or strategy mechanisms and the approaches
that affect such change processes.
 Describe human resource changes and identify methods

for managing such changes.

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

 Awareness
 Identification
 Implementation
 Institutionalization

Types of Changes
 Technical Changes
 Product or service changes
 Administrative, structural, or

strategy changes.
 Human resources changes.

Organizational Performance

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

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

Overview of performance
 The terms widely used in assessing health service

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

Issues in assesing effective
performance

 Fundamental perspectives about

organizations.
 Domain of activity
 Different levels of analysis

Technical issues in assessment
Classes of measures
 Structural measures
 Process measures
 Outcome measures
Factors associated with effective performance :
 Quality of professional staff
 High standart
 experience with other cases
 more professional staffs with high capability in managing

conflict.
 Participative organization cultures emphasizing team

approaches.
 Timely and accurate performance feedback.
 Active management of environmantal forces.

Two models for changing
performance

 Quality Assurance
 Quality Improvement

Cause and effect diagram for
continous improvement

Environmental
Characteristics

Unit Characteristics

Patient
Characteristics

Outcomes
of care

Interorganization
al
Characteristics

Organizational
Characteristics

Provider
Characteristics

Managers role in creating high
performance Health care Organizations

 Problem in measuring performance are a challenging

factor in HCO.
 The task of defining, measuring, and influencing

performance is so difficult that management can play a
key role.

Managing Trade-offs
 Need a paradigm shift from

mechanical model to a new model
of commitment, and a cycle of
continous improvement
 Each department determines who
are the customer and what are
they really want.

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

Organisasi dan Manajer
-Teori Organisasi dan Manajemen Pelayanan Kesehatan
(Bab 1)
-Peran Manajer (bab 2)
Memotivasi
dan
Memimpin
Orang serta
Kelompok

Memenuhi
Kebutuhan dan
Nilai-nilai Individu
-Memotivasi
Orang Lain
(Bab 3)
Memberi Arah
-Kepemimpin
an: Sebuah
kerangka
kerja bagi
pemikiran
dan tindakan
Mendorong
Kerjasama
-Manajemen
Konflik dan
Negoisasi

Menjalan
kan
Sistem
Teknis
Menentukan
Kelompok Kerja dan
Desain yang Tepat
-Kelompok dan
tim dalam
organisasi
Pelayanan
Kesehatan (Bab
6)
-Desain Kerja (Bab 7)
Menetapkan
Mekasnisme
Komunikasi dan
Koordinasi
-Koordinasi dan
Komunikasi
(Bab 8)
Menggunakan

Memperb
arui
Organisas
i
Menentukan Desain
Organisasi yang Tepat
-Desain organisasi
(bab 10)
Mendapatkan Sumber
Daya dan Mengelola
Lingkungan
-Mengelola Aliansi
Strategis (Bab 11)
Mengelola Perubahan
dan Inovasi
-Inovasi,
Perubahan dan
Pembelajaran
organisasi (Bab
12)
Mencapai Sasaran
-Kinerja
organisasi:
Pengelolaan demi
Efisiensi dan

Merencana
kan Masa
Depan
Mengelola secara
Strategis
-Penyusunan
Strategi
dalam
Organisasi
Perawatan
Kesehatan
(Bab 14)
Mengantisipasi
Masa Depan
-Menciptaka
n dan
Mengelola
Masa Depan
(Bab 15)

Strategy making in HCO

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








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

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

Schools of thought
School

Strategy Formulation as

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

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

Strategy
 Positioning a business to maximize the

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

Strategic comfort zones for
shifting pace

Prospector

Analyzer
Reactor

Defender

Five forces Michael Porter
Potential
Entrants

Supplier

Competitors

Substitutes

Buyers

Creating and Managing the
Future

Learning Objectives
 Identify the major trends likely to affect the

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

The organization and the
environment
 Changing social norms and






expectations
Demographic composition and
epidemiology
Technology Development
Organizational arrangements
Financing
Social experimentation

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

professionals

Health Services Policy

 Dalam menetapkan kebijakan sangat

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

The Managerial Role

 Role performance and

emerging challenges
 Preparing future managers