Health Administration
Leadership Roles and Responsibilities
A truly effective board: -has fiduciary (trust) responsibilities -Serves as a strategic partner with a health commissioner -Is a major component of the leadership team Board members must understand their board roles as trustees rather than volunteers
Applied Management Theory
Ability to delegate tasks is fundamental for a successful manager Some organizations never grow because senior managers cannot delegate All managers should understand their organizational and departmental missions Individual objectives should be linked to organizational goals
Population Education
Educating the public on disaster response must be in place prior to an emergency Developing messages is difficult Pathways to disseminate information are varied for different communities and types of disasters
Governance and Leadership (Cont.)
Governing body is an individual, board, council, commission, or other entity with legal authority over public health functions of a jurisdiction Governance activities must be tied to the core functions of assessment, policy development, and assurance, as well as the essential services of public health Important aspect of public health leadership is monitoring the activities of practitioners
Using the national incident management system
The IC must focus on saving and preserving life, stabilizing the scene of the event and protecting property The DECIDE system can be used to offset possible unintended consequences Detect the presence of a hazard Estimate likely harm without intervention Choose the response objectives Identify action options Do the best option Evaluate progress
Chapter 3: Organizational Behavior Introduction
A successful manager must be familiar with different theories and styles of leadership Causality: Forces acting on people are responsible for human behavior Directedness: Behavior is not only caused, but it points toward something Motivation: A push, want, need, drive, feeling or personal goal that can explain actions Each person has an individual constellation of behaviors.
After-Action Reports
After-Action Reports (AARs) are documents produced after an incident that discuss aspects of operations that are performed well as well as in problem areas. Standardized forms and formats for AARs should be developed and used Essential for evaluating and planning
Governance Roles and Responsibilities (cont)
All boards of health, regardless of the extent of their legal authority, are obligated to either enact or recommend policies that meet the needs of community members The work of governing and advisory boards usually goes unnoticed until a problem arises Effective governance in public health requires that individual members of governing entities within a local jurisdiction
Preparedness Planning
Assessment, policy development and assurance are important principles to apply in disaster preparation Identification of stakeholders and building relationships with those individuals is paramount Identifying resources, both internally and of other agencies, prior to their need is essential
Conceptual Foundations-Herzberg Motivators and Hygiene Factors
Based on Motivation Elements that are called Motivators - achievement, recognition, and the work itself bring satisfaction to individuals. Elements that brings dissatisfaction to individuals are called hygiene factors-these could be interpersonal relations, company policy.
Conceptual Foundations-Maslow Hierarchy of needs
Basic needs are physiologic such as air, water and food Safety needs include shelter and feeling protected Love and affection needs encompass wanting to belong or interact with others Esteem needs seek approval and respect from others Self-actualization needs allow people to achieve their full potential
Conceptual Foundations-Homans Exchange
Behavior is an exchange and when in groups, people interact to receive a reward. Each person communicates in a group Contributions must be consistent with group norms Rewards or sanctions (punishments) help to shape appropriate behaviors
History
Boards of health have been a component of public health democracy for more than 200 years Health departments have existed in New England since the late 1700s Paul Revere assembled several interested and influential citizens and formed the first board of health
Managerial Structure
Bureaucracy is the most common model Most organizations are hierarchical with several individuals reporting to one supervisor Provides clear lines of authority but is slow in responding to changes The optimum span of control is from three to seven individuals For some companies, span of control is 20 or more subordinates
History (Cont.)
Cholera outbreaks in the early 1800's were the impetus for creating boards of health In 1848, the first national board of health was established through the Public Health Act The New York Metropolitan Health Act of 1866 resulted in the culmination of a citizens council, later named the New York Metropolitan Health Board These early efforts were initiated to identify and correct public health challenges
Common Good Approach
Common good states that living in a community is inherently good, was developed by Greek philosophers Common good presents the concept that members of the community pursue values and goals that they have in common Ethical actions advance the common good Some individuals find that the idea of common good is inconsistent with contemporary pluralistic societies
Rights Approach
Concerned with respecting and protecting the moral rights of anyone affected by a decision Humans have a fundamental dignity and the ability to choose freely They have a right to be treated well Must be given full knowledge about outcomes and freely consent to participate in the decision
Creating products that are wanted or needed
Customers do not simply purchase a product or service, they must want or desire the product or service The basic product mix of public health includes the 10 essentials of public health Market research is conducted to determine which products or services are relevant for a given population Public health agencies use community health assessments as their market research
After-Event Activities
Demobilization is the removal of equipment, personnel and systems when an incident is over Demobilizing should be included in practice drills and exercises Debriefing is used to review and evaluate past objectives and too set new objectives Critique of the response to an event facilitates adjusting plans, reviewing safety issues, evaluating how commands were given and received, and noting other needed changes
Changing Organizational Behavior
Effective leaders must promote good attitudes toward the organization May involve establishing closer working relationships with informal leaders to improve the output of an entire group Promoting subordinates' careers and career paths is essential Managers must assume the task of absorbing and preventing stress
Effective & Efficient Governance and Leadership (cont)
Effective organizations tend to have boards that are active and attuned to the interests, concerns, and expectations of those that they serve Six frames - contextual, educational, interpersonal, intellectual, political, and strategic can be used to analyze the effectiveness of boards of health There appears to be substantial evidence that more effective boards are differentiated from less effective ones in six areas of competence
Ethical Standards
Ethical decision makers are concerned with respecting and protecting the moral rights of individuals affected by the decision Individuals have free will They have the right to be treated well Individuals should be fully informed of outcomes and freely consent to participate in the decision
Chapter 8: Ethics Basics and Definition
Ethics refers to standards of behavior that provide guidance for people in how they should conduct themselves in many of the situations Ethics refers to principles that define behavior as right, good, and proper The terms ethics and values are not interchangeable: Ethics is concerned with how a moral person should behave Values are the inner judgments that determine how a person actually behaves
Structural Factors
Evolution of managerial structure is based on two fundamental needs: 1. Allocate people and jobs -Not all people are the same -People should be given jobs for which they are best suited -Workers should be assigned to jobs for which they are most qualified
Fairness or Justice Approach
Fairness or justice was developed by Aristotle and is concerned with equal treatment for all Focus is on how fairly or unfairly actions distribute benefits or burdens on a group Demands that all people receive the same treatment If morally relevant differences exist then exceptions can be made to fair treatment
Utilitarian Approach
Focuses on the consequences of outcomes of actions or policies Straight forward method for deciding on a morally correct course of action Direct application of teleology Greatest ratio of benefits to harm
Preparedness Planning (Cont.)
Formal agreements for use of resources should be made between agencies MOU (Memorandum of Understanding) and MOA (Memorandum of Agreement) are two types of agreements used Public health employees will be called to undertake disaster responses as well as their daily duties To communicate with the media a well trained Public Information Officer (PIO) is needed
Chapter 2: Governance and Leadership
Governance and leadership are key components in effective and efficient enterprises Leadership is defined as the skills necessary to integrate local rules, regulations and policies to enable an organization to exist, thrive and flourish Programs developed by CDC, NACCHO & NALBOH
Gantt Chart
Henry L. Gantt Developed an early pictorial system for planning and task allocation (Figure 1-3, page 12) Overall goals are considered as a series of interrelated steps Manager gains a clear understanding of timing and interrelationship of the components or events of a project Does not show dependent relationships between different project steps
Hospital Involvement
Hospitals are an integral part of the public health system Information obtained from hospitals can influence decisions during an emergency Relationships with hospitals must be developed prior to an emergency Early warning systems should be in place to limit the spread of disease Early warning systems should be tested prior to an emergency
Deontology
Immanuel Kent, a secular philosopher, described it Based on absolute, Many religions teach that the will of God is absolute These instructions give sufficient guidance for all situations and are not debatable Deontology breaks down when the rights or interests of third parties are considered Raises important questions regarding duty
Politics
In large organizations, human behavior responds to political variables, particularly authority Five attributes comprise authority: Authority is deep seated A few individuals make decisions for many Decisions are carried out over a long period of time or from a standing decision and often without explicit guidelines Decisions are communicated from managers to subordinates Subordinates will react to commands
Effective & Efficient Governance and Leadership (cont. 2)
Inefficient and ineffective board of health is not going to improve health Boards of health and health commissioners should return to the roots of their existence to reinforce collaborative team practices Collaborative leaders are sustained by their deeply democratic belief that people have the capacity to create their own visions and solve their own problems
Informal Organizations (Cont.)
Informal groups consist of individuals with similar status and prestige Members of many professional group are able to differentiate themselves on the basis of clothing or other signs of elite status Established groups can promote competition George Orwell stated that some people want to be more equal than others
Informal Organizations
Informal groups exist in most formal organizations Informal groups consist of individuals with similar status and prestige Employees with minimal or no opportunity for social contact find jobs unsatisfying Groups take on lives of their own
Documentation
Information gathering and record keeping are extremely important Individuals should be assigned to gather information and keep records Collecting data after an incident may result in cloudy or incorrect information Inadequate or inaccurate information may cause problems with reimbursement, legal issues and plan improvements
Command
Integrated Emergency Management System (IEMS) is a conceptual framework The primary goal of IEMS is to optimize the allocation of resources IEMS and NIMS are related but different NIMS is tactical and IEMS is strategic An incident commander is in charge of IEMS
Theory Y
Integrates individuals and organizational goals The expenditure of physical and mental effort in work is as natural as play or rest External controls and threats of punishment are not the only means for eliciting efforts toward achieving organizational objectives Individuals will exercise self-direction and self-control in the service of objectives to which they are committed
Conflict
Interdependence of parties relies on positive relationships across boundaries Communication problems are the leading cause of interpersonal conflicts Group members must be able to talk to each other Erratic groups display inconsistent behavior towards management
Personal Ethics
Knowing what is right is harder with the current rapidly changing environment They tend to compartmentalize ethics into two domains: private and occupational Personal ethics differ from person to person Beware of rationalizations
Governance Roles and Responsibilities
Local health departments have the day-to-day responsibility for public health matters Summarized within six basic service areas: -Collecting and analyzing vital statistics -Sanitation -Communicable disease control -Maternal and child health -Health education -Laboratory services
Chapter 1: Management Theory & Applications Fundamental Goals and Activities of Management
Management consists of a basic set of tools to achieve an organization's mission Mission statement: why an organization exists Management provides a framework for control Controls are circular & plans are made and elaborated Plans should be periodically reviewed and audited
Theory Z
Management makes longer-term commitments to its employees It also expects a high degree of loyalty from employees Resembles the paternalism in some US companies in the 1800s Employers provide day-care, health clubs and other off the job activities IBM had a no-layoff policy; dropped it when the economy slumped Japanese companies dropped Theory Z for economic reasons
Informal Organizations (Cont.) 2
Managers assign duties to individuals that are part of their job responsibilities External and internal factors influence status within a group Positive informal group attitudes toward an organization can assist managers Interactions between formal and informal groups can cause problem
Marketing local health departments
Marketing public health programs and services results in social exposure Social exposure is a state of awareness in which community residents can readily identify and describe benefits Public health should start small and slow with marketing campaigns Could be started with something small like telephone messages
Linking products and consumers
Marketing strategies depend on delivery systems and effective promotional campaigns to interest consumers Marketing channels and distribution systems are needed to deliver products and services to consumers Promotional campaigns inform, persuade or influence a consumer's decision to purchase a product or service Advertising strategies are paid communications
Governance Roles and Responsibilities
Members of boards of health are appointed or elected to oversee, guide, and establish policy Roles of boards of health vary by state State statutes define the legal powers and duties of local boards of health
Structural Factors (Cont.) 2
Most common form of organization is a bureaucracy (pyramidal hierarchy) Authority flows downward Matrix is another form of organization Matrix is primarily used in research and project oriented operations Change versus stability Stability allows for cooperative human relationships
National Incident Management System (NIMS)
NIMS is a system that provides coordination and control during a disaster Designed to initiate and maintain control of an emergency from onset to resolution It is a comprehensive resource management system, which ensures that resources are provided at the right time and at the right place.
Chapter 7: Emergency Procedures and Response Basics and Definitions
Officials responsible for responding during an emergency should review material associated with disaster planning Planners should design plans that meet needs and vulnerabilities Plans should be tested and critiqued The federal government should not be counted on for immediate help during a disaster
Theory X
Provides direction and control Human beings have an inherent dislike of work and will avoid if it at all possible. Because of this characteristic of disliking work, most people must be coerced, controlled, directed, or threatened with punishment to get them to put forth adequate effort toward achieving organizational objectives
The 21st Century
Public health encompasses a broad spectrum of practices and disciplines Health departments in the United States are the governmental providers of public health services The majority (74%) of health departments have a local board of health Currently, there are over 3,200 boards of health across the United States
Marketing local health departments (Cont.)
Public service announcements can be used to promote social causes or address social concerns Local newspapers, TV and radio stations can help to market information Web pages provide a marketing channel to make agency programs and services available to the community Long-term survival may depend on incorporating promotion and marketing strategies into the planning process
Communications
Reliable communications during an emergency are critical Amateur radio operators (HAM radios) can be used when other communications fail Runners are people that convey messages More than one means of communication, modality, device, or pathway will be needed to manage and effectively respond in a crisis situation
Shelters
Shelters must provide basic needs: food, water and clothing Staffing for shelters depends on the time frame of operation and services provided Responsibility for managing and staffing of most shelters is delegated to the Red Cross Dispensing sites should be recognizable locations such as churches, schools, or other notable places
Social marketing and public health
Social marketing incorporates the basic principles of marketing to modify individual behaviors Public health practitioners and health agencies are in the business of marketing health improvement The ultimate goal of social marketing is to change the social norms of a community Public health must convince people to believe that the benefits of changing individual behaviors outweigh personal sacrifices
Structural Factors (Cont.)
Someone must be responsible -Individuals that make decisions must be differentiated from others -Leaders should be rewarded -Rewards should be based on risk and responsibility that have evolved from the needs of an organization
Mental Health
Stress and mental health concerns accompany all disaster and emergency situations Stress management is important for both the public and responders during and after a crisis Mental health services are frequently required long after an incident has been concluded
Conflict (Cont.)
Strong management policies toward personnel may encourage the establishment of strong informal groups Informal communications flow more easily than formal communications Apathetic groups impose the least pressure on management
Ouchi - Theory Z
Successful in Japan Based on paternalism Did not gain acceptance in the United States Fell from favor in Japan with recent economic difficulties
Chapter 6: Marketing Public Health Know the consumers
Successful marketing strategies focus on consumers from the beginning to end Marketing companies conduct surveys and sponsor research to determine the age, gender, race, income, geographic location, and how much of a product consumers will use within a potential market. Marketing strategy is to determine if the product/service should be offered to an entire audience or total market
Surveillance
Surveillance activities do not differ from day to day versus during an incident Needed information includes the number of affected people, areas of concern, and issues surrounding the incident Syndromic surveillance involves gathering information from coded medical data Sentinel site surveillance involves sites reporting on specific health parameters Pre-determined thresholds of the parameters are used
Scientific Management (Frederick Taylor)
Systematically described by Frederick Taylor Scientific management focuses on the most productive use of time Measuring the length of tasks with a stopwatch and organizing them Theory's appeal is largely intellectual: Minimizing waste of time
Teleology
Teleology seeks balance and harmony (MC # 80) Jeremy Bentham and John Stuart Mill are most influential in teleological thinking Utilitarian thinking seeks the greatest good for the greatest number of people The right or best decision is the outcome with the greatest net value
The 21st Century (cont)
The National Profile of Local Boards of Health is the only published national survey A majority of American health districts are governed by a board of health having policy making authority Boards of health are not unique or limited to the United States Boards of health have both a moral and legal obligation to carry out their duties in a responsible manner
Teleology (Cont.)
The best or most correct outcome is the one that leads to the greatest net gain Money is the unit often used when assigning value Personal preferences are subject to variation or manipulation Ethical basis of behavior is difficult to predict or assess
Change and adaptation
The life cycle of a product or service moves through several phases The introduction stage is the first phase when a product is first presented, Growth occurs with acceptance of the product, Maturity occurs when product sales peak, Decline is the final stage Local, state and federal laws mandate certain public health programs and services
Management Theories
The most familiar form of organizational structure is the classic bureaucracy. widely used by Governments, militaries, and churches First systematically described by Weber Regular duties are known to all Jobs are distributed to individuals having specialized competence to handle them.
Effective & Efficient Governance and Leadership
The quality, continuity and assurance of public health in the United States depends on the effectiveness of boards of health Public health consists of organized efforts at the community level with the goal of reducing disease and improving the health of the populations being served Effectiveness is the goal desired by all boards Effective governing boards are knowledgeable, coordinated, collegial leadership teams
Conceptual Foundations-McGregor Theory X and Y
Theory X assumes that people are lazy and require constant and close supervision Theory Y assumes that people seek responsibility and control over their work or production and will reward management with increased productivity
Equity (John Stacy Adams)
Theory of motivation based on the notion of equity If inputs are rewarded by outputs, people will feel happy in their work When setting benchmarks, people are influenced by partners, colleagues and friends People will try to re-establish balance and equity by reducing their level of effort, becoming inwardly disgruntled or outwardly rebellious Equity can often be achieved by greater pay or a new position
Theoretical Models
There are two different theoretical models for making ethical decisions Deontology Teleology
Conceptual Foundations-Whyte Interaction
Three main dimensions: 1. Interaction is synonymous with personal contact 2. People interact when they engage in activities together 3. Individuals have sentiments Measurable deviations can be quantified and used as the basis for change
Planning Aids and Devices
Timely completion of assignments is essential to successful management Effective organizations have a three- to five-year strategic plan that is reviewed and updated each year Financial status is reported quarterly and summarized annually The simplest way to visually depict progress is with a timeline (Fig 1-2 page 11)
Volunteers
Trained volunteers are extremely useful in a crisis Volunteers must be identified, organized, trained, credentialed, engaged, evaluated and recognized Volunteers should always be utilized Unutilized volunteers lose interest
National Incident Management System (NIMS) Cont.
Ultimate authority in NIMS is the Incident Commander (IC) The IC assigns leaders to one of four sections Operations Section leader uses resources to resolve the situation Logistics Section Leader obtains resources Planning Section Leader uses experts to guide the operations to resolve the situation Finance Section Leader tracks costs and purchases of resources needed or used in a situation
Translating Values into Principles
Values are translated into principles to make decisions and motivate ethical conduct Behavior becomes ethical when principles are acted upon Rights that are available may be legal but not ethical Personal ideas of what is right or wrong are usually based on religion, cultural roots, family teaching, personal experience, laws, organizational values, group norms or political habits
Virtue Approach
Virtue encompasses the attitudes, disposition, or character traits that contribute to human development to the greatest extent or degree possible Applying virtue enables individuals to develop their personal character Behaviors become ethical when they contribute to morality and moral virtues
