Managers of health services today have a difficult position, but a very necessary one. They must make their service run smoothly and, in particular, contain costs when most spending decisions are frequently outside their control. Primary care is ‘mainly demand-led and referral is, to managers and many professionals as well, an impenetrable black art’ (Bureau of Labour, 2004, p. 1).
Healthcare as an organisation is a business and, like every other business, it needs good management to keep it running efficiently and effectively. The structure and financing of healthcare is changing rapidly. Future medical and health services managers must be ‘prepared to deal with evolving integrated healthcare delivery systems, technological innovations, an increasingly complex regulatory environment, restructuring of work, and an increased focus on preventive care’ (Australian Healthcare Association 2004). They will be called upon to improve efficiency in healthcare facilities and the quality of the healthcare provided. Increasingly, medical and health services managers will work in organisations in which they must optimize efficiency of a variety of interrelated services.
According to Robbins and Barnwell, ‘an organisation is a consciously coordinated social entity, with a relatively identifiable boundary, that functions on a relatively continuous basis to achieve a common goal or set of goals’ (2002, p. 6). Based on this, one can see that health services organisations have the primary goals (objectives) to provide health care in the most efficient yet cost effective manner.
Management seeks efficiency and effectiveness. Efficiency refers to the relationship between the inputs and the outputs. Basically resources usage should equal a certain amount of goals attained. The greater the amount of goals attained with the least amount of resources used equals the greater the efficiency. According to Robbins, Stagg and Coulter ‘a manager is someone who integrates and coordinates the work of others’ (2000, p. 7). Therefore it is important for managers to spend their time ‘managing’ things as opposed to doing things themselves. By delegating work their function management can increase organisational achievements. Poor management spends its time ‘doing rather than managing, and this limits their day-to-day achievements’ (College of Nursing 2002, p. 10).
Organisational structure defines how tasks are to be allocated, areas of responsibility and authority, who reports to whom, and the formal coordinating mechanisms and interaction patterns that will be followed. For an organisation to work efficiently there must be a management structure to implement ‘good planning, organizing, leading and controlling to ensure paramount achievement of the organisation’s stated purpose’ (Clinton and Scheiwe 1998, p. 151).
Through planning, management determines the ‘specific goals of the organisation, establishing an overall strategy for achieving these goals, and developing a comprehensive hierarchy of plans to integrate and coordinate activities’ (Robbins, Bergman and Stagg 1997, p. 8). For example, in the NSW health system the government determined a shortage of health staff due to growing demands of an ageing population (NSW Health 2005). Through the hierarchy of the NSW health system, the senior management defined specific goals such as: ‘to increase nurses.’ Management then developed a strategy to achieve that goal and sub-plans to coordinate the activities. In this case, management have decided to ‘double the size of the state’s intake of trainee enrolled nurses, re-launch the re-connect nursing program and support nursing scholarships’ (NSW Health 2005).
Organising is the process management undertakes to ‘design an organisation’s structure and includes the determination of what tasks are to be done and who is to do them, how tasks are to be grouped and where decisions are to be made’ (Robbins, Bergman and Stagg 1997, p. 8). In this case decisions would be made about where the funding would come for each program, who was responsible for the management of each program, and the structure and framework of the programs.
Leading is the function in which management undertakes to coordinate its human resources. When managers ‘motivate subordinates, direct the activities of others, select the most effective communication channel, or resolve conflicts among members, they are engaging in leading’ (Robbins, Bergman and Stagg 1997, p. 8). In this case the state government would direct the CEOs of individual hospitals, the CEOs would lead the individual managers of each department and the managers of each department would coordinate the people (the operating core).
Controlling deals with ‘monitoring activities to ensure that they are accomplished as planned’ (Robbins, Bergman and Stagg 1997, p. 8). This would include audits of the intake of the nurses, nurses on duty, how many nurses are short for individual hospitals/departments per shift.
The role of management has varied throughout time and different definitions are numerous. According to Anderson, management is described as: ‘the process of organisational goal setting and decision making about the efficient and effective use of organizational resources in order to ensure high organisational performance’ (cited by Clinton and Scheiwe 1998, p. 144). Mary Parker Follet, an early management theorist and writer, believed that management is ‘the art of getting things done through people. Follet was the first advocate for the concept of participative/collective decision making, suggesting that managers should have authority with, rather than over, employees’ (Marquis and Huston 1996, p. 10).