Organization & Management by drsaiful

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									  DR SAIFUL’S
   NOTES ON
   MEDICAL &
ALLIED HEALTH
  PROFESSION
  EDUCATION:
ORGANIZATION
& MANAGEMENT


Dr. Muhamad Saiful Bahri Yusoff
            MD, MScMEd
Content

INTRODUCTION TO ORGANIZATION AND MANAGEMENT .......................2

EDUCATIONAL MANAGEMENT INFLUENTIAL THEORIES........................8

MANAGERIAL DECISION MAKING .......................................................... 16

CONTROLLING & MONITORING.............................................................. 20

ORGANIZATION & MANAGEMENT OF CLASSROOM............................... 26

LEARNING ORGANIZATION..................................................................... 30

PLANNING ................................................................................................ 34

LEADING & INFLUENCING ...................................................................... 43

HUMAN RESOURCE MANAGEMENT........................................................ 51

ENVIRONMENT & CORPORATE CULTURE ............................................. 68

QUALITY ASSURANCE IN HIGHER EDUCATION..................................... 72




                                                                                                          1
        INTRODUCTION TO ORGANIZATION AND MANAGEMENT




1. Organizing
  •   The process of grouping the responsibilities and activities into
      workable units, determining the line of authority and communication,
      developing patterns of co-ordination.
      o For example a car which is a unit with multiple components. It
         seems to be a complex thing but if it is broken down into
         components then it will look simpler. However it won’t work if it is
         in the components. It is only work when the components are
         combined and organized.


2. Organization
  •   A formal group of people with shared goals.
      o For example:
            Political party
            Business entity
            Learning institute
            Government agency
            Family
            Non-government organization (NGO)
            Voluntary
  •   Organizational behaviour:
      o How individuals, groups and structure have on behaviour within
         an organization that can be used to improve effectiveness.
  •   Organizational structure
      o How job tasks are formally divided, grouped and coordinated
      o 6 elements that decide organizational structure:
            Work specialization
            Departmentalization
            Chain of command
            Span of scope


                                                                           2
          Centralization and decentralization
          Formalization
•   Organizational type:
    o Simple structure
          Flat small organization with low work specialization
          Low degree of departmentalization
          Wide span of control
          Decentralization authority
          Little formalization
    o Bureaucratic structure
          High work specialization, routine and repetitive operation
          Departmentalized
          Narrow span of control
          Central authority
          High formalization
    o Another way to look at organizational structure:
          Can be divided into 2:
          •   Mechanistic
              o Bureaucratic
              o Tall hierarchy
              o Specialization
              o Top-down chain command
              o Very formal
          •   Organic
              o Flexible
              o Adaptable
              o Flat structure
              o Decentralize
              o Employee participation
          Matrix organizational structure
          •   Function and product dependent
          •   Pooling and sharing of resources
          •   Dual line of authority


                                                                       3
            Hybrid organizational structure
            •   A hybrid organization is a body that operates in both the
                public sector and the private sector, simultaneously fulfilling
                public duties and developing commercial market activities.
                As a result the hybrid organization becomes a mixture of
                both a part of government and a private corporation.
  •   The purpose of organizing is to make the best use of the
      organizational resources to achieve the organizational goals.

3. What is management?
  •   Purposeful and effective use of resources, manpower (modal Insaniah),
      material and money, for fulfilling of organizational objectives.


4. What do the managers do?
  •   The 5 elements of management (Fayol, 1970)
      o To forecast and plan
      o To organize
      o To command (lead)
      o To coordinate
      o To control
  •   14 principles of management (Fayol, 1970)
      o Division of work
      o Authority
      o Discipline
      o Unity of command
      o Unity of direction
      o Subordinate of individual interest (organization interest is the
         priority)
      o Remuneration (reward system such as salary, promotion and etc)
      o Centralization and decentralization
      o Scalar of chain (the authority and command must in a line)
      o Order (systematic)
      o Equity (justice and fair to everybody)


                                                                             4
      o Stability of tenure (sound assurance of position and promotion)
      o Initiative (let the worker put and share their ideas into the
        management for better benefit)
      o Esprit de Corps (teamwork)


5. Management Models
  •   Management by objectives, MBO




      o SMART method for checking validity of objectives:
           Specific
           Measurable
           Achievable
           Realistic
           Time-related
      o Management by objectives
           In “the practice of management, 1954”, Drucker posed 3 now-
           classic business questions:
           •   What is our business?
               o E.g. in educational business our businesses are teaching,
                 research and etc.
           •   Who is our customer?
               o E.g. students, members of public and nations


                                                                          5
         •   What does our customer consider valuable?
    o Some useful Drucker quoates:
         The aim of marketing is to know and understand the customer
         so well the product or service fits him and sells itself.
         Management is doing things right; leadership is doing the right
         things.
         Checking the results of a decision against its expectations
         shows executives what their strengths are, where they need to
         improve, and where they lack knowledge and information
         The most important thing in communication is hearing what
         isn’t said.
         Trying to predict the future is like trying to drive down a country
         road at night with no lights while looking out the back window.


•   Total Quality Management, TQM (Edward Deming)


                                  •   Key elements in customers’ satisfaction
                                      become the driving force.



                                  •   Foundation : integrity and ethics
                                  •   Building Bricks : leadership, teamwork,
                                      training
                                  •   Binding mortar : communication
                                  •   Roof : recognition



                                  •   Plan – plan ahead of change. Analyse
                                      and predict the result

                                  •   Do – execute the plan, taking small steps
                                      in controlled circumstances

                                  •   Study – study the result or check

                                  •   Act – take action to standardized or
                                      improve the process




                                                                                  6
•   Kaizen – change (kai)to become good (zen)
    o Continuous incremental improvement
    o The 5 elements of Kaizen
          Teamwork
          Personal discipline
          Improved morale
          Quality circles
          Suggestion for improvement
    o Kaizen work process
          Eliminates of waste and inefficiency
          5-S framework
          •   Seiri    Structurize     Struktur (sisih)
          •   Seiton     Systemize     Susun
          •   Seiso    Sanitize      Suci
          •   Seiketsu      Standardized      Sistem
          •   Shitsuke      Self-Discipline    Susila
          Discipline
    o Islamic 5 S
          Salam – greeting, mutual respect
          Sabar – patience, steadfast in duty
          Syukur – being thankful to God
          Setia – loyal to organization and leadership
          Sopan – politeness, good character




                                                          7
        EDUCATIONAL MANAGEMENT INFLUENTIAL THEORIES




1. Benjamin Bloom
  •   Learning Domain or Bloom’s Taxonomy
      o Cognitive domain: mental skills (knowledge)
           Knowledge: recall data or information.
           •   Example: Recite a policy. Quote prices from memory to a
               customer. Know the safety rules.
           •   Keywords: defines, describes, identifies, knows, labels, lists,
               matches, names, outlines, recalls, recognizes, reproduces,
               selects, states.
           Comprehension: understand the meaning. State a problem in
           one’s own words.
           •   Example: Rewrite the principles of test writing. Explain in
               one’s own words the steps for performing a complex task.
               Translates equitation into a computer spreadsheet.
           •   Keywords: comprehends, converts, defends, distinguishes,
               estimates, explains, extends, generalizes, gives examples,
               infers, interprets, paraphrases, predicts, rewrites,
               summarizes, translates.
           Application: use a concept in a new situation.
           •   Examples: Use a manual to calculate an employee’s vacation
               time. Apply laws of statistics the reliability of a written test.
           •   Keywords: applies, changes, computes, constructs,
               demonstrates, discovers, manipulates, modifies, operates,
               predicts, prepares, produces, relates, shows, solves, uses.
           Analysis: separates material or concepts into component parts
           so that its organizational structure may be understood.
           •   Examples: Troubleshoot a piece of equipment by using
               logical deduction. Recognizes logical fallacies in reasoning.
               Gathers information in a department and selects the require
               tasks for training.


                                                                                   8
      •   Keywords: analyzes, breaks down, compares, contrasts,
          diagrams, deconstructs, differentiates, discriminates,
          distinguishes, identifies, illustrates, infers, outlines, relates,
          selects, separates.
      Synthesis: builds a structure or pattern from diverse elements.
      •   Examples: Write a company operations or process manual.
          Design a machine to perform a specific task. Integrates
          training from several sources to solve a problem. Revises and
          processes to improve the outcome.
      •   Keywords: categorizes, combines, compiles, composes,
          creates, devices, designs, explains, generates, modifies,
          organizes, plans, rearranges, reconstructs, relates,
          reorganizes, revises, rewrites, summarize, tells, writes.
      Evaluation: make judgments about the value of ideas pr
      materials.
      •   Examples: Select the most effective solution. Hire the most
          qualified candidate. Explain and justify a new budget.
      •   Keywords: appraises, compares, concludes, contrasts,
          criticizes, critiques, defends, describes, discriminates,
          evaluates, explain, interprets, justifies, relates, summarizes,
          supports.
o Affective Domain: growth in feelings or emotional areas (attitude)
      Receiving Phenomena: Awareness, willingness to hear,
      selected attention.
      Responding to phenomena: active participation on the part of
      the learners. Attends and reacts to a particular phenomenon.
      Learning outcomes may emphasize compliance in responding,
      willingness to respond, or satisfaction in responding
      (motivation).
      Valuing: The worth or value a person attaches to a particular
      object, phenomenon, or behaviour. This ranges from simple
      acceptance to complex state of commitment. Valuing is based
      on the internalization of a set of specific values, while clues to


                                                                               9
     these values are expressed in the learner’s overt behaviour and
     are often identifiable.
     Organization: organizes values into priorities by contrasting
     difference values, resolving conflict between them, and creating
     a unique value system. The emphasize more on comparing,
     relating, and synthesizing values.
     Internalizing values (characterization): has a value system that
     controls their behaviour. The behaviour is pervasive, consistent,
     predictable, and most importantly, characteristic of the learner.
     Instructional objectives are concerned with the student’s general
     patterns of adjustment (personal, social, emotional).
o Psychomotor Domain: manual or physical skills (skills)
     Perception: The ability to use sensory cues to guide motor
     activity. This ranges from sensory stimulation, through cue
     selection, to translation.
     Set: Readiness to act. It includes mental, physical and
     emotional sets. These three sets are disposition that
     predetermine a person’s response to different situation
     (sometimes called mindset).
     Guided Response: The early stages in learning a complex skill
     that include imitation, and trial and error. Adequacy of
     performance is achieved by practicing.
     Mechanism: This is the intermediate stage in learning a
     complex skill. Learner’s responses have become habitual and
     the movement can be performed with some confidence and
     proficiency.
     Complex Overt Response: The skillful performance of motor
     acts that involve complex movement patterns. Proficiency is
     indicated by a quick, accurate and highly coordinated
     performance, requiring a minimum of energy. This category
     includes performing without hesitation, and automatic
     performance. For example, players are often utter sounds of
     satisfaction or expletives as soon as they hit a tennis ball or


                                                                       10
            throw a football, because they can tell by the feel of the act what
            the result will produce.
            Adaptation: Skills are well developed and the individual can
            modify movement patterns fit special requirement.
            Origination: Creating new movement patterns to fit a particular
            situation or specific problem. Learning outcomes emphasize
            creativity based upon highly developed skills.


2. Robert Mager
  •   Theory of behavioral objectives
      o Behavior: the behavior should be specific and observable.
      o Condition: the conditions under which the behavior is to be
         completed should be stated, including what tools or assistance is
         to be provided.
      o Standard: the level of performance that is desirable should be
         stated, including an acceptable range of answers that are allowable
         as correct.
  •   Criterion reference instruction for better educational management.
  •   Example of learning objectives:
      o After completing this course you will be able to: (not accurate)
            Operate your phone
            Know how to greet callers
            Understand the procedure for transferring a call.
      o After completing this course you will be able to: (more accurate)
            Place a caller on hold
            Activate the speaker phone
            Play new messages on the voice mail system
            List the three elements of a proper phone greeting
            Transfer a call to a requested extension
  •   Example in medical education:
      o Given a stethoscope and normal clinical environment, the medical
         student will be able to diagnose a heart arrhythmia in 90% of
         effected patients.


                                                                             11
  •   Common pitfall of objective writing:
      o False performance
             Have a thorough understanding of particle physics.
             Demonstrate a comprehension of the short-story form
             Be able to relate to others in a demonstration of empathy
             Be able to understand individual differences in patients
      o False criteria
             To the satisfaction of the instructor
             Must be able to make 80% on multiple choice exam
             Must pass a final exam


3. Malcolm Knowles (1913-97)
  •   A champion of Andragogy
  •   Self-directed learning
  •   Informal education
      o From educating people to helping them learn


4. Robert Gagne
  •   Instructional design “condition of learning”, 5 conditions:
      o Verbal information
      o Intellectual skills
      o Cognitive strategies
      o Motor skills
      o Attitudes
  •   Gagne’s 9 events of instruction
      o Gain attention
         •   Stimuli activates receptors
      o Inform learners of objectives
         •   Creates level of expectation for learning
      o Stimulate recall of prior learning
         •   Retrieval and activation of short-term memory
      o Present the content



                                                                         12
         •   Selective perception of content
      o Provide “learning guidance”
         •   Semantic encoding for storage log-term memory
      o Elicit performance (practice)
         •   Responds to questions to enhance encoding and verification
      o Provide feedback
         •   Reinforcement and assessment of correct performance
      o Assess performance
         •   Retrieval and reinforcement of content as final evaluation
      o Enhance retention and transfer to the job
         •   Retrieval and generalization of learned skill to new situation


5. Edward de Bono
  •   Lateral thinking
  •   Thinking outside the box
  •   6 thinking hats, proven use for:
      o Improve teamwork
      o Generate new ideas
      o Stimulate innovation
      o Hold more productive meeting
      o Implement change
      o Solve problem faster
  •   Pairing of thinking hats

       - White: objective &        - Red: emotion &
       factual                     intuitive

       - Yellow: merits &          - Black: demerits &
       strenghts                   weaknesses

       - Green: creativity &       - Blue: open sky &
       growth                      overall consideration


  •   The use of 6 thinking hats
      o Encourage parallel thinking



                                                                              13
      o Encourage full-spectrum thinking
      o Separate ego from performance


6. Tony Buzan
  •   Mind mapping:
      o Visual thinking and action




  •   Uses of mind mapping
      o Memory improvement
      o Communication effectiveness
      o Problem solving
      o Information management
      o Decision making
      o Project management
      o Leadership skill
      o Practical creativity
      o Time management
  •   Mind map vs. concept map
      o Mind map
            Originate from single concept or topic
            A tree structure


                                                     14
    Radiating linkages
o Concept map
    Originate from several related concept
    Network structure
    Multiple directions linkages




                                             15
                        MANAGERIAL DECISION MAKING




1. The impact of managerial decision?
   •   Commits resources and time.
   •   Affect whole organization or small segment.
   •   May be irrevocable or inflexible.
   •   Has degree of risk.


2. Definition:
   •   Decision making is study of identifying and choosing alternatives
       based on the values and preferences of the decision maker
       o Information gathering on alternatives
       o Choose the best alternatives (goals)
       o Minimize uncertainties (risk involve)


3. Types of decision making
   •   Decision whether (go or not go)
   •   Decision which (decision based on alternatives)
   •   Contingent decision (decision making based on alternative with
       conditions)
   •   Single decision maker
   •   Majority rules
   •   Consensus


4. Perception affect on decision making




                            PERCEPTION




 Problems/Agenda Building                Decision            Outcome




                                                                           16
5. What is perception?
   •   Perception is a process by which individuals organize and interpret
       their sensory impressions in order to give meaning to their
       environment.
   •   Some errors in perception of judging others
       o Self-serving bias
              Success due to internal factor and if failures due to external
              factors.
       o Selective perception
              Based on personal experience
       o Halo effect
              Based on single characteristics
       o Contrast effect
              Compare with other or we can call it norm-reference
       o Projection
              Based on what the perceiver likes
       o Stereotyping
              Based on group


6. Decision making methods
   •   Weighted pros and cons
       o E.g. decision option: should I buy a new car?
                 Pros                                    Cons
Comfort (3)                             Cost outlay will mean making
Lower fuel (3)                          sacrifices (5)
Better for family use (4)               Higher insurance (3)
It will be a load of my mind (5)        Time and hassle to choose it (2)
Better reliability (2)                  Sale or disposal of old car (2)
                                        Scare and upset me (4)
Total score = 20                        Total score = 16




7. Determine importance of decision by priority matrix:


                                                                               17
                           Urgent          Not so urgent

       Important
                              A                 B


Not so Important
                              C                 D


A priority = need to be resolved soon
B priority = time to think and plan
C priority = must be handled or will turn bad
D priority = issues that can be delegated


8. Steps in rational decision making
   •   Identify and verify problem
   •   Identify the decision criteria
   •   Allocate weights for the criteria
   •   Develop alternatives
   •   Evaluate alternative
   •   Select best alternatives
   •   Implementing alternatives
   •   Evaluating alternatives


9. Problem identification and verification




                                                           18
10. Criteria identification
    •   Example equipment purchase




11. Developing alternatives
    •   6 thinking hats (Edward de Bono)
        o White: objective facts
        o Red: view without explanation; hunches
        o Black: logical negative view
        o Yellow: logical positive view
        o Green: creative thinking, possibilities
        o Blue: chairperson, thinking about thinking


12. Cost-benefit analysis
    •   Work out how mush the change will cost to make and the negative
        possibilities
    •   Then calculate the benefits you get from it
    •   Compute pay back time (break even point)
    •   Input, process and output are measure $ - cost per unit output


13. Cost-effective analysis
    •   More efficient alternative
    •   Better alternatives of input and process that produce the same
        output
    •   Cost per unit input


                                                                          19
                       CONTROLLING & MONITORING




1. Control and monitoring:
   •   Measuring the status of work performed.
   •   Comparing the status with what was planned to be accomplished to
       date.
   •   Acting to correct any deviation to get back on target.


2. Controlling and monitoring activities
   •   Planning performance.
   •   Observing actual performance.
   •   Comparing actual and planned performance.
   •   Adjusting as required.


3. Feedback
   •   Timely provision of comprehensive control information at each stage of
       the implementation process.


4. Monitoring activities
   •   Monitor all aspects of project:
       o Budget
       o Schedule
       o Manpower
       o Material utilization
       o Team moral, etc.
   •   Regular feedback meetings with project team.
   •   Compare progress with schedule.




5. Project Control System




                                                                           20
6. Methods use in controlling and monitoring:
   •   Critical Path Analysis (CPA)
   •   Program Evaluation & Review Technique (PERT)
   •   Gantt Chart
   •   Benchmarking


7. Critical Path Analysis (CPA)
   •   List all activities for the plan.
   •   For each activity, determine starting, duration and ending,
       dependence, sequential or parallel to other activities.
   •   Plot the activity as circle and arrow diagram
   •   In summary CPA is:




   •   Listing activities




                                                                     21
•   In figure:




                 22
8. Program Evaluation & Review Technique (PERT)
  •   List all the activities for the plan.
  •   Estimate shortest possible time, longest possible and likely length of
      time.
  •   Use the formula below to calculate the time to use for each project
      stage:



  •   PERT is a variant of SPA that takes a more skeptical view of the time
      needed to complete each project stage.


                                                                               23
9. Gantt Chart
  •       A graphical representation of the duration of tasks against the
          progression of time.
  •       It is a useful tool for planning and scheduling projects.
  •       It is helpful when monitoring a project’s progress.
  •       Example of Gantt Chart:




   Example Gantt Chart with dependence




10. Benchmarking
      •    When organizations want to improve their performance, they
           benchmark. That is, they compare and measure their policies,




                                                                            24
    practices, philosophies, and performance measure against those of
    high-performing organizations anywhere in the world.
•   “Improving ourselves by learning from other.”
•   Benchmarking is simply about making comparisons with other
    organizations and then learning the lessons that those comparisons
    throw up.” (source: The European Benchmarking Code of Conduct)
•   “Benchmarking is the continuous process of measuring products,
    services and practices against the toughest competitors or those
    companies recognized as industry leaders (best in class).” (source:
    The Xeror Corporation)




                                                                          25
          ORGANIZATION & MANAGEMENT OF CLASSROOM


1. Managing classroom space and resources
  • Promote teacher-student interaction
  • Access learning resources
  • Promote efficient learning
  • Minimize behavior problem




2. Managing learning environment
  • Contribute to non-threatening, stress free environment
  • Create a positive, safe environment


                                                             26
3. Managing instructional time
  • Establish classroom schedule
  • Pace teaching appropriately
  • Organize lesson
  • Minimize open-ended discussion
  • Minimize non-instructional time: roll call, announcement, social,
    discipline, clean up.


 4. Managing the learner involvement
  • Encourage class participation
  • Reinforce good questioning
  • Throwback good question for response


5. Managing classroom events
  • Follow the 9 events of instruction (Gagne)

  Instructional Event                     Internal Mental Process

  1. Gain attention                       Stimuli activates receptors
  2. Inform learners of objectives        Creates level of expectation for learning

  3. Stimulate recall of prior learning    Retrieval and activation of short-term
                                           memory
  4. Present the content                   Selective perception of content
  5. Provide "learning guidance"           Semantic encoding for storage long-term
                                           memory
  6. Elicit performance (practice)         Responds to questions to enhance
                                           encoding and verification
  7. Provide feedback                      Reinforcement and assessment of
                                           correct performance
  8. Assess performance                    Retrieval and reinforcement of content
                                           as final evaluation
   • Gaining attention:
  9. Enhance retention and transfer to the Retrieval and generalization of learned
  job                                      skill to new situation
     o Be friendly to students
    o Display enthusiasm
    o Be focused on learning
    o Provoke curiosity



                                                                                      27
 o Use multimedia
• Inform learning objective
 o Clarify expectations
 o Emphasize learner initiative
 o Encourage self learning
 o Promote motivation to complete the lesson
 o Practice learning by objectives and criterion-referenced instruction
• Stimulate recall of prior learning
 o Build learning on what is already known
 o Provide linkage between old & new learning
 o Follow the spiral curriculum approach
• Present the content
 o Organize the content logically
        Problem oriented structure
        Sequential structure
 o Stress key points
        Signpost, encircling, enlarging
        Underlying, highlighting, voice inflection
 o Explain concept skillfully
        Demonstration
        Illustration
• Provide learning guidance
 o Guide for long term memory storage
        Examples, case studies
        Representations, analogies
        Mnemonics, acronyms
• Elicit performance (practice)
 o Provide opportunity for practice
 o Make session interactive, e.g. Q&A
 o Repeat to enhance retention
• Provide feedback
 o Create a non-threatening climate
 o Indicate correctness of performance


                                                                          28
       Right or wrong
       Hints & cue
       Explanation & suggestion
• Assess performance
 o Assess according to learning objectives
       Attitude
       Skill
       Knowledge
 o “Regardless of curriculum design, assessment determines learning
    methods. Objective, content, process & assessment are interrelated.”
• Enhancing learning
 o Conduct review & summary at the end of a lesson
 o Provide references, assignment reading, exercise
 o Reinforce learning




“If you lecture to me I forget, if you demonstrate to me I understand, but if
                          you let me do it I learn”




                                                                            29
                          LEARNING ORGANIZATION




1. What is learning organization?
   • Learning organization is an organization that facilitates the learning of
    all its members and continuously transforms itself. (Pedler et al. 1991:
    1)
   • Learning organization has developed the continuous capacity to adapt
    and change.


2. Why do we want learning organizations?
   • Because we want superior performance and competitive advantages
   • For customer relations
   • To avoid decline
   • To improve quality
   • To understand risks and diversity more deeply
   • For innovation
   • For our personal and spiritual well being
   • To increase our ability to manage change
   • For understanding
   • For energized committed work force
   • To expand boundaries
   • To engage in community
   • For independence and liberty
   • For awareness of critical nature of interdependence
   • Because the times demand it


3. Why we so bother about learning organization?
   • Its more fun to work in learning organization
   • Learning organizations give people hope that things can be better
   • Learning organizations provide a playground for creative ideas




                                                                             30
   • Learning organization provide a safe place to take risks with new ideas
    and behaviors and the challenge needed to stretch beyond perceived
    limit
   • In learning organizations everyone’s opinions are valued and amount
    the people can contribute is not determined by position in the
    organization
   • Learning institution should be learning otherwise dead


4. What are the barriers to learning?
   • Defensive routines
   • Dynamic complexity of systems
   • Inadequate and ambiguous outcome feedback
   • Misperceptions of the feedback
   • Poor interpersonal and organizational inquiry skills


5. What are the characteristics of a learning organization?
   • Have shared vision everyone agrees
   • Discard old ways and standard routine for solving problem or doing
    their jobs
   • Accept organization-environment interactions a system of
    interrelationship
   • Communicate openly with each other across vertical or horizontal
    boundaries
   • Suppress personal or fragmented departmental interests to work
    together for shared vision


6. Tools for change management; SWOT analysis
 • Strength, Weakness, Opportunity and Threat.
 • SWOT analysis focuses on the following questions:
   o What are our objectives?
   o What do our customers want?
   o How do we distinguish ourselves from competitors?



                                                                           31
  o How can we improve our services?
  o How can we distinguish internal framework conditions (strength and
     weakness) from external framework conditions (opportunity and
     threat)


  Items                         Definition                      Typical example
               Any internal asset (know-how, motivation,      - Well trained man-
               technology, finance business link) which       power
               will help to meet demands and to fight of      - Well established
               threats                                        knowledge base
                                                              - Good contact to target
 Strength      Key questions:                                 group
               - What are we good at?                         - Technology, etc
               - How are we doing competitively?
               - What are our resources?
               Internal deficits hindering the organization   - Lack of transport
               in meeting demands                             - Low reputation
                                                              - Problems in
Weakness
               Key questions:                                 distribution of services
               - What are we doing badly?                     or products
               - What annoys our customers most?              - Lack of motivation
               Any external circumstances or trend that       - Increasing purchasing
               favors the demand for an organization’s        power
               specific competence                            - Development of new
Opportunity
                                                              markets for high quality
               Key questions:                                 products
               - What changes of demand do you expect to      - New technologies that
               see over the next years?                       favor our product
               Any external circumstances or trend which      - Establishment of
               will decrease the demand for the               strong competitors
               organization’s competence                      - Lack of cash at
  Threat
               Key questions:                                 household level.
               - What do other people do that we don’t do?    - Governmental
               - What future changes will affect our          regulation that limit
               organization?                                  distribution of our
                                                              products




                                                                                         32
  • For organization to grow it must change in its environment from time to
    time


7. Planned change
  • Change activities that are intentional and goal oriented
    o Reception
    o Resistant
    o Strategy in implementation
  • Types of change
    o 1st order change
           Linear and continuous
    o 2nd order change
           Multidimensional
           Multilevel
           Discontinue
           Radical
  • Change agent
    o Person who act as catalyst and assume the responsibility of
       managing change activities
           Internal
           •   From top to down – it mean the change is initiated by Boss to
               the staff.
           •   From bottom to up – it mean the change is initiated by the
               staff to the Boss
  • What can change?
    o Organizational structure
    o Technology
    o Physical setting
    o People




                                                                            33
                                 PLANNING




1. Definition
   • Planning is setting the direction towards a goal and then guiding the
     system to follow the direction for desired outcome.
   • Strategic Planning defines objectives, assesses both internal and
     external situations to formulate strategy, implement the strategy,
     evaluate the progress, and make adjustments to stay on track.




                                                                             34
2. Phases in Planning
   • Establish goals
   • Environmental scanning
   • Analyse situation
   • Establish strategies to reach goals
   • Establish objectives for processes/tasks
   • Communicate plan document
   • Delegate responsibilities and time lines
   • Establish monitoring mechanism
   • Acknowledge completion/ celebrate success


3. Establish Goals
   • In line with organizational vision, mission.
   • SMARTER
    o Specific
          Tangible
          E.g.



                                                    35
          •   To improve quality (not that specific)
          •   To achieve ISO certification (more specific)
    o Measurable
          Can be audited, indicators
          E.g.
          •   To build 4 health centers
          •   To decrease maternal mortality by 30%
          •   To increase attendances at toddler clinic by 20%
    o Achievable
          Within the capability of system
    o Realistic
    o Time frame
    o Extending
          Stretching performer’s capabilities
    o Rewarding
          Worth the effort.
          Recognition


4. Environmental Scanning
  • Internal analysis of the firm
  • Task environment
  • External macro environment




  • SWOT analysis (internal analysis and task environment)
    o Strengths
          What are the advantages do you have?
          What do you do well?
          What relevant resources do you have access to?
          What do other people see as your strength?
          Consider strengths in relation to your competitor/rival.
    o Weaknesses


                                                                     36
     What do you do badly?
     What should you avoid?
     What could you improve?
     What do other people see as your weaknesses?
     Consider form internal and external basis
     •   What other perceive as your weaknesses
o Opportunities
     Opportunities within the system?
     Favourable trends?
     •   Changes in technology
     •   Changes in government policy
     •   Local events
     •   Changes in population profiles
     Consider opportunities based on strengths
o Threats
     What obstacle do you face?
     Do you have cash flow problems?
     Are specifications to your jobs changing?
     Changes in policies?
     Are there risks involved?    risk analysis
     Risks analysis
     •   Definition
         o To assess risk
         o To determine measures to be taken to minimize disruption
            to plans
         o To determine strategies to control risks
         o Risk = perceived extend of possible loss
         o Risk = probability of event x cost of event
     •   Identify risks/threats
         o Human – transfer, illness
         o Procedural – system failures
         o Nature – floods, epidemic
         o Technical – tech failure


                                                                  37
            o Political – regime change
            o Financial – reduced budget
       •    Estimate risks
            o Assess likelihood of threat being realized
            o Assess possible impact
            o Probability x cost project
       •    Manage risks
            o Using available resources
            o Contingency planning
            o Investing in new resources
       •    Review risk management
            o Post mortem of risk analysis and management exercise
            o Test systems and plans
• PEST analysis (external environmental screening)
 o Political
       Government policies
       Employment laws
       Environmental regulations
       Political stability
       •    Local political figure
 o Economic
       Budget cuts
       Budget policies
       Economic slowdown
       •    Cutting down economic deficit
 o Social
       Demands
       •    Demand for short services waiting times
       •    Accountability in service
       Community demand via media
       Population migration
       Emphasis on safety
       Population growth rate


                                                                     38
   • Force-Field analysis




5. Establish strategies to reach goals
   • Strategic planning for achieving targets
    o Specialist involvement in the projects
    o Funding for quality training
    o Strategies for motivating staff




6. Establish objectives for processes/tasks




                                                39
7. Communicate plan documents
   • A leader is as good as he communicates
   • Communication
    o Who – to communicate to
    o Where – to communicate
    o When – to communicate
    o What – to communicate
    o How – to communicate
   • Selling the project plan to different groups – accreditation
    o Doctors & specialist
           We Doctors deserve to work in
           •   A quality environment
           •   Using dependable equipment
           •   Assisted by personnel proficient in their jobs
           •   To achieve this, our roles are…
    o Middle managers
           Easier management through guidelines, procedures, protocols
           Not dictated by personal whims and fancies of seniors
           Objective assessment
           Clear goals for achievement
           And our roles for accreditation are…
    o Support groups
   • When communicating an idea
    o Do it everywhere
    o As often as possible
    o People remember most what they are most often reminded to do.


8. Delegate responsibilities and time lines
   • Delegation & Monitoring enable and empowered by
    o Training
    o Continuous support
    o Timely back up
    o Allow creativity and initiative


                                                                         40
    o Monitor agreed milestones for progress
    o Feedback – positive/negative
    o Emphasis on what could be done to improve


9. Recognition
   • Pat on the back
   • Letter of appreciation
   • Award
   • Favourable appraisal
   • Promotion


10. Input for Planning




   • Man
    o Management
           Skill, leadership style, competence
    o People
           Skill level, age, mix
    o Knowledge
           Experience
           Training in related field
    o Attitude
           Ability to adapt, cooperative, motivated, resourceful
   • Money
    o Specific budget for project
           Applying for budget
           Justification for budget
           Cost benefits analysis
           Cost effective analysis
    o Using available funds


                                                                   41
      Prioritization
 o Allocation of funds
      Monitoring expenditure
      Final accounts
• Machine
 o Equipment
      Accessible
      Functioning
      Fit for the purpose
 o Materials
      Appropriate quality
      Sufficient quantity
• Method
 o Processes
      Processes adopted, technology employed, system used
 o Systems
      Procedure adopted to ensure conversion process (input > output)
      proceeds efficiently
• Environment]
 o Refer to the PEST analysis




                                                                    42
                           LEADING & INFLUENCING


1. Leadership definition
   • Leadership is the ability to influence a group toward the achievement of
    goals – Stephen P. Robins, Organizational Behavior –
2. Leadership vs. Management
   • Managers adopt interpersonal attitudes toward goals.
   • Leaders adopt a personal and active attitude towards goals.
                           Abraham Zaleznik, Harvard Business School

   • Management copes with complexity, bringing about order
   • Leadership copes with change. Leaders develop a vision and establish
    direction. They then communicate this vision and inspire followers to
    overcome hurdles.
                            John Kotter, Harvard Business School
3. Leadership theories
   • Traits theories
   • Behavioral theories
      o Ohio state studies
      o University of Michigan studies
      o The Managerial Grid
      o Scandinavia studies
   • Contingency Theories
      o Fieldler Model
      o Hershey and Blanchard’s situational model
      o Leader-Member exchange theory
      o Path-goal theory
      o Leader-participation model
   • Attribution theory
   • Charismatic theory
3. Traits Theory
   • Personality, social, physical or intellectual traits that differentiated
    leaders from non-leaders
      o Ambition and energy


                                                                                43
     o Desire to lead
     o Honesty and integrity
     o Self-confidence
     o Intelligence and
     o Job-related knowledge
     o …Born Leaders      Margaret Thatcher – charismatic, enthusiastic,
        courage.
4. Behavioral Theories




                                                                       44
  • Theories proposing that specific behaviors differentiated leaders from
    non-leaders
     o Ohio state studies
     o University of Michigan studies
     o The Managerial Grid
     o Scandinavian studies
     o … Leaders can be trained       Florence Nightingale
  • Leadership style related to situation
     o In time of crisis
     o In times of peace




5. Contingency theories
  • Fieldler Model
  • Hershey and Blanchard’s situational model
  • Leader-Member exchange theory
  • Path-goal theory
  • Leader-participation model



                                                                             45
            Leadership style related to follower
                 Contingency Theories
        Hershey & Blanchard’s situational theory

ISO Implementation in General Hospital
•Able and Willing        - Core Team         - delegating
•Able and unwilling      - Specialists        - participating
•Unable and willing      - Sokongan 1         - selling
•Unable and unwilling - Sokongan 2            - telling




                                                                46
6. Critical Factors for Effective Leadership
   • Direction setting
    o Vision
           A dream for a better organization
           •   “I prefer to be a dreamer among the humblest, with vision to
               be realized, than lord among those without dreams and
               desires.” – Kahlil Gibran –
           •   Martin Luther King, “I have a dream…”
           Visualize in clear term
           •   “Make sure you visualize what you really want, not what
               someone else wants for you.” – Jerry Gillies –
           Loves for the cause
           •   Nelson Mandela, “If one is to become a leader, one will have to
               be in love with ‘the cause’.”
           Clear and focused regarding goals
           Have a plan
           •   “A good idea is worth a dollar. The plan for implementing is
               worth a million dollars.”
           •   Clear instruction to the staff
           •   Speak often about this plan at various forums
           •   Hallway chats
           Be involved directly in the implementation




                                                                              47
• Authority
 o Sphere of influence




 o Integrity
       Demanding respect vs. commanding respect
 o Humility
       Ability to take criticism
       •   “He that is down needs fear no fall, He that is low, no pride.” –
           Pilgrim’s Progress –
       •   “You don’t lead by hitting people over the head, that’s assault,
           not leaderships.” – Dwigth D. Elsenhower –
• Communication skills
 o Give staff vivid pictures of the objectives
       “Make sure the blacks do not have to sit in the back of the bus.” –
       Martin Luther King, Civil Rights Movement –
 o Communicate goals in very simple and clear terms


                                                                          48
       ‘Maternal Mortality for HKB in 2002 was 9. We must improve this
       indicators
       Better way “In 2002, there was 36 children who lost their mothers
       through childbirth in Hospital Kota Bharu. We Shall Stop This!!!”
 o Marketing skills
       Selling quality to different groups
       •   Doctors and Specialist
       •   Paramedic staff
       •   Support groups
• Task competence
 o Knowledge of core business
 o Knowledge of related quality activity
       “You cannot support what you do not understand.”
• Diligence
 o “There are no office hours for leader.” – Cardinal J. Gibbons –
• Risk taking
 o Be willing to look foolish
       Be less concerned with thought such as ‘what will the neighbours
       think?’
       “I’m going to build a billion-dollar empire based on a mouse, a
       fairy and seven dwarfs. Will you help me?” – Walt Disney –
 o The will to get the job done – every problem, a challenge.
       “When you see a problem coming down the road, holler ‘Hello
       Problem!’ where have you been? I’ve been training for you all my
       life!” – Dr. Norman Vincent Peale –
• People management skills
 o Emotional Intelligence (EQ)




                                                                         49
o Request noble things
      Taxes vs. Donation        Donations fund more than taxes fund
o Clearly define work related benefits




o Systemic leadership: at different level
o Train them, empower them
o Trust them, defend them
o Recognize them
      Recognition
      •   Acknowledge in private and public
      •   Self-actualization
      •   Feel good situation
      •   Celebrate every little success
      •   Play down failures
o Train replacement
      “The ultimate leader is one who is willing to develop people to the
      point that they eventually surpass him or her in knowledge and
      ability.” – Fred A. Manske, Jr –




                                                                       50
                  HUMAN RESOURCE MANAGEMENT




1. Human resource management:
  • Human Resource planning
  • Recruitment
  • Selection
  • Training and development
  • Safety and Health
  • Performance and Appraisal


2. Human Resource Planning:
  • Identifying needs
   o The leader must know their needs and work based on the needs.
  • Employee requisition (permohonan jawatan/ pengisian)
   o The leader must know the protocol how to request additional
      employee from the government e.g. filling up ABM form
  • Jobs description
   o Leaders must have in their mind about jobs description for every
      posts before they recruit people to fill up the posts
  • Based on Malaysian Plan, Dasar Baru, Annual Planning
   o Good Leader usually have strategic plan for e.g. they follow the flow
      (government policies) not against the flow in planning their needs.




                                                                            51
3. Recruitment and Selection:
  • Recruitment is the process of attracting individuals
    o On a timely basis
    o In sufficient numbers
    o With appropriate qualifications to apply for jobs with an organization
  • Recruitment process




    o Alternatives to recruitment
          Overtime
          •   Pro – inexpensive, short term
          •   Con – pacing of work, false expectations
          Subcontracting
          •   Outsourcing service
          Contingent workers (part time workers)
          •   Fastest growing segment of the US economy
          •   Women – flexi time (flexible work time according to the women
              free time)
          •   As and when required
          •   Avoids costs of recruitment, absenteeism, employee benefits
          Employee leasing (pinjam staff dari agensi lain)
          •   Lease from agency



                                                                            52
         o Pro – mobility for staff, no problem with trade unions
o Internal sources
     Promotion from within (pfw)
     •   Motivating
     •   Aware of employee’s capability
     •   Con – no new idea, lack of creativity
o Internal methods
     Management and skill inventories of current employees
     Job posting
     •   Informing employees of job openings
     Bidding procedures
     •   Allow employees who believe they qualify apply for a posted job
         o Con – disappointed bidder – need to be told why they are
            not selected.
o External sources
     Recruitment sources
     •   Vocational school – occupational skills, repair
     •   Colleges – middle managers
     •   Universities – on-campus recruitment
     •   Human resource raiding amongst competitor
     •   Employment agencies
     •   Retirees
     •   Military personnel – discipline, team orientation
o External methods
     Dependent on job market (high demand/ low demand)
     •   Advertising is suitable if the job market is low demand
     •   Employment agencies if the job market more demanding
     •   Executive search firms (high demand job)
     •   Professional organization (prestige demand)




                                                                      53
• Selection is the process of choosing from group of applicants, the
 individual best suited for a particular position
• Selection process




• Legal considerations
 o Gender
 o Marital status
 o Disabilities
 o Religion
 o Race
 o Age
 o Arrest record
 o Conviction record
• Applicant pool
 o Selection process is determined by the number of applicants
    available for a particular job




• Preliminary interview
 o Screening to eliminate those obviously not qualified
 o Match applicant with other job positions


                                                                       54
• The employment interview
 o Content
       Academic achievement
       Occupational experience
       Personal qualities skills
 o Types of interviews
       Structured
       •   Questions related to worker requirements, job knowledge
       •   Consistent
       Unstructured
       •   Open-ended questions, time consuming
 o Methods of interviewing
       Group interview
       Board interview
• Personal references checks/ background investigation
 o Reference checks
       From previous employers
       Data obtained not objective
       Investigations of previous employment provide better picture
 o Background information
       Issues: privacy act
       Applicant to sign waiver to allow employer to contact references
• Selection decision
 o Human Resource Manager or supervisor
 o Decision best made by one directly responsible for the worker


• Physical examination
 o Vision – color blindness
 o Physical disabilities
 o Drug dependency
 o Infectious diseases
 o Foreign workers (FOMEMA requirement)
• Rejection of applicants


                                                                          55
    o Diplomatic feedback
          “There does not appear to be a proper match between your
          qualification and our needs.”
    o Deeper into process, greater the trauma


4. Training and development
  • Definition
    o Training and Development is a planned continuous effort by
       management to improve employee competency levels and
       organizational performance through training and development
       programs
    o Training – focuses on the process of providing employees with
       specific skills or helping them correct deficiencies in their
       performance
    o Development – an effort to provide employees with abilities the
       organization needs
  • Factors influencing training and development:
    o Top management support
    o Technology advances
    o Behavioral science knowledge
    o Organizational complexity
    o Performance of other human resource functions
    o Learning principles
  • Recent studies:
    o …most firms do not offer any formal training.
          Ronald Henkoff – “Companies that Train Best” – fortune magazine
          …only 15,000 companies (0.5%) of the total amount for 90% of
          the billions spent on training annually.
          …most of training the training was directed towards executives
          and managers
    o Reason for apathy
          …difficulty to identify and demonstrate the benefits that training
          produces in the short term.


                                                                           56
       …lack of external controls such as training boards which
       recognized training activities in organizations.
       …drop in staff turnover, which drastically reduced initial training
       and induction.
       …lack of commitment towards training especially on the part of
       personnel managers.
• Successful companies
 o Xerox
       …over 300 million a year spent on training and retraining its
       employees
 o Motorola, Federal Express, Corning and Singapore Airlines
       3% of payroll cost on training
• Training and Development objectives
 o To increase productivity
 o To prevent obsolence (declination) of skill at all level of the
    organization
• Matter must be considered in training and development
 o Identify training needs
       For different groups of employee
 o Develop training objectives
       Organizational goals
 o Match trainees with resources available for training
 o Methods of training
 o Conducting training
 o Evaluation of training
• Identifying training needs
 o Based on request
 o Job performance
 o Organizational change
 o Technological development
 o Career development
 o Credentialing and privileging
• Types of organizational training


                                                                        57
 o Management skills
 o Computer skills
 o Communication skills
 o Technical skills
 o Customer relations
 o Labor relations
 o Sales skills
 o Secretarial skills
 o New methods/procedures
• Training methods
 o Conference
       Lectures and discussion
       Used by companies and universities
       In house – university
       Expert     professional conference (according to the needs)
       conference
 o Lectures
       Most common method
       Classroom style teaching
       Audience usually homogenous
       In-house and invited lectures
       Part of continuous professional education
       Integral part of short and long courses
 o Group discussion
       Forum an important training method
       Members interact with one another
       Share experiences and update
       Especially useful when facilitated by senior staff
 o Simulation
       An approach that uses a training set up that is identical to a live
       setting
       Vestibule training used by pilots in a mock-up cook-pit is a type
       of stimulation training


                                                                         58
     CPR
     •   The correct technique in applying pressure in Cardiac Arrest is
         important, in order to achieve optimum results, without
         injuring the rib cage
     Light indicators for correct technique
     Uses in Emergency Medicine
     •   Disaster drills
         o Training is provided to staff on action to be taken, in the
            event of a disaster e.g. plane crash or a natural disaster
            involving a large number of victims needing medical
            assistance
         o In collaboration with:
               Police
               Fire brigade
               The army
               The Red Crescent
               St. John’s Ambulance
               HUSM
         o E.g. of a scenario
               A crash is simulated with victims at crash site.
               •   Students nurses role play the part of victims are
                   triaged (screened)
               •   Vehicles in the form of ambulances and helicopters
                   and public vehicles from various agencies rush to the
                   site and ferry patients to various hospitals.
               At the hospital
               •   In-house disaster drill is set in motion
               •   All relevant departments on alert
               •   Operations and media rooms set up
               •   Warts and spaces cleared for management of survivor
                   of the crash
o Apprenticeship



                                                                         59
     Structured process by which individuals become skilled workers
     through a combination of classroom instructions and on the job
     training
     Basically involves having the learner/apprentice study under the
     tutelage of a master craftsman
     Hospitals
     •   Integral to medical training
     •   One year of internship training before doctors are registered as
         Medical Officers, and Pediatrics
     •   Placed in various departments under the tutelage of senior
         medical officer and specialist
     •   Compulsory posting are required in the disciplines of
         Medicine, Surgery, Obstetrics and Gynecology, and
         orthopedics
o Demonstration
     Usually used in the training of staff on new techniques or skills
     Used extensively in the public and private sector
     Used for both induction and on the job training
o On the job training
     Carried out on the job or off the job
     Trainee works in actual work setting
     Guidance of experienced people
     Referred to as informal training
     Practiced in the public and private sectors
o Job rotation
     Training provided by allowing staff to be placed in different
     departments for designated periods of time
o Computer based learning
     Revolutionized training in the private and public sector
     Provides just in time (JIT) information
     Customized to user’s needs and convenience
     Continuing Professional Education
     •   Updating knowledge


                                                                         60
           •   Shorten periods of institution based learning
           •   Provides JIT medical knowledge and practice guidelines at
               point of care
           •   Electronic textbooks, local and international databases,
               electronic medical journal, linkages to medical/health
               websites, etc.
   • Training methods should match
    o The organization
    o Staff
           Category
           Skill level
    o Available resources




       Training Methods                  Manager          Technical staff
Conference                                   O
Job rotation                                                     O
Lectures                                     O                   O
Simulation                                                       O
Apprenticeship                                                   O
On the job training                                              O
Computer based training                      O                   O
Group discussion                             O                   O




   • In conclusion
    o Traits of good CEO
           Willing
           •   To teach
           •   To share
           •   To demonstrate
           Willing to train one to replace him



                                                                            61
5. Safety and Health
  • Occupational safety and health
    o Safety: protecting employee from injuries caused by work related
       accidents
    o Health: employee freedom from physical and emotional illness
    o Critical for:
          Productivity
          Effectiveness of the organization
          Staff morale
          Quality of work life
    o Principles of OSH act
    o Job related accidents
    o Safety programs at the workplace
    o Cumulative trauma disorders
    o Workplace violence
    o Health and wellness programs
    o Stress
    o Smoking in the workplace
    o Employee assistance programs


6. Performance and Appraisal
  • Definition
    o Performance appraisal is a formal system of periodic review and
       evaluation of an individual’s or team’s job performance
  • Performance Appraisal consist of
    o Uses of performance appraisal
    o Process of performance appraisal
    o Responsibility for appraisal
    o Appraisal period
    o Appraisal method
    o Problem related to performance appraisal
    o Characteristics of effective appraisal


                                                                         62
 o The appraisal interview
 o Legal implication
• Uses of performance appraisal
 o Human Resource Planning
       For placement based on ability identified
       Staff with potential for consideration for promotion
 o Recruitment and selection
       Based on favorable appraisal reports
       Used as reference
 o Human resource development and career planning
       Identification of training needs
       •   Computer skills
       •   Course of disciplinary procedures for managers
       •   Subspecialty training for specialist
       To assess employee potential for activities
       •   Specialist for quality activities
 o Compensation program
       Excellence in service cash award
 o Internal employee relation
       Basis for
       •   Promotion
       •   Transfers
       •   Counseling
       •   Termination
• Process of performance appraisal
 o Identify goals
       Organization wide
       Department wide
       Individual
 o Establish job expectation
       Sasaran kerja tahunan
 o Examine work performance



                                                              63
       Documented proof of achievement
       Evidence based
 o Appraise performance
 o Discuss appraisal with employee
• Responsibility for Performance Appraisal
 o Immediate supervisor
       Able to observe daily activities
       Responsible for output of unit
 o Subordinate
       Evaluate the effectiveness of the superior
       Popularity
       Anonymity
 o Peer appraisal
       Participative culture
       Selection of excellence award candidates
 o Group appraisal
       Assessing subordinates as a team
       Senior staff providing feedback on staff performance
       Improve disciplines
       Vertical job enrichment for senior officer
 o Self-appraisal
       Staff appraise himself and discusses with superior ob gaps in
       evaluation
       Self-evaluation in accreditation of hospitals
 o Combination
       Peer appraisal + group appraisal
       Self-appraisal + group appraisal
       Subordinate appraisal + superior appraisal
• Appraisal Period
 o Annually
 o Six monthly
       Revision of target
 o Four monthly


                                                                       64
      Housemen
      Attachment
• Appraisal Method
 o Rating scale
      Judgement of performance recorded on a scale (5-7).
      (outstanding, average, unsatisfactory)
      Job related factors and personal characteristics for evaluation
      Popular – simple, allow for quick assessment
 o Critical incident methods
      Good event write up
      Unfavorable event write up
      Used along with other records for assessment
 o Essay
      Difficult to assess
      Used as reference. Self appraisal + Group appraisal
      Subordinate appraisal + superior Appraisal
 o Work standard
      Assesses performance of staff against a predetermined standard
      •    Record officer: % medical reports made available within one
           month of application
 o Ranking
      Numerical
      Best… worst
 o Forced distribution
      Based on normal frequency distribution
 o MBO – management by objective
      Set objectives
      Monitor performance
      Keep communication channels open
      Discuss achievement and issues at appraisal meeting
 o BARS – behavioral anchored rating scale
      Set statements to define performance with different weight given
      to each statement


                                                                         65
       Assessment factor: ability to absorb and interpret policies
       For example:

           1. This officer could serve as an information source for other in
           the department concerning USM policies and procedure 10

           2. ……..      8

           3. ……..     6

           4. …….      4

           5. Even after repeated explanations, this officer is expected to be
           unable to learn required procedures 2


• Problem related to performance appraisal
 o Halo error
       High or low ratings based on a single criterion
       •     Sensitivity to personal characteristics
 o Leniency/strictness
       Too generous – undeserved high ratings
       Too strict/critical
 o Central tendency
       Playing safe
       Avoiding high/low rating which require explanations
 o Lack of objectivity
       Personal characteristics
       Poor goal setting
       Poor job related performance indicators
 o Personal bias
       Assessment based on own rating by assessor’s supervisor
       Bias toward staff
 o Recent behavior bias
       Based on events/behavior during immediate period before
       assessment
• Characteristics of effective appraisal
 o Job related criteria


                                                                                 66
 o Performance expectations clearly explained
 o Standardization
 o Qualified appraiser
 o Open communication to staff – to avoid unpleasant surprise
 o Employee access to result
• The appraisal interview
 o Essential for employee development
 o Problem solving rather than fault finding
 o Discuss performance
 o Set objectives for future performance
 o Discuss means for achieving those objectives
• Legal implications
 o Employee not informed of level of performance
 o Wrongly termination
       Employees won 64% of cases brought to trial




                                                                67
                ENVIRONMENT & CORPORATE CULTURE




1. Definition
   • Corporate culture can be defined as a network of shared
     understanding, norms and values that lie beneath the surface of
     organizational life – Bayer and Trice –
   • Corporate culture is the manner in which a body or organization
     conduct itself
   • Corpus = body       Culture = way of life
   • Corporate culture basically the personality of the organization
    o Not tangible but can be sensed within the organization
    o Differs from organization to organization


2. Types of corporate culture
   • Academy Culture
    o Highly skilled employees, stable environment
    o Employee development emphasized
    o E.g. universities, hospital
   • Club culture
    o Employees start at the bottom, stay with the organization
    o Highly value seniority
    o E.g. military
   • Baseball team culture
    o Employees “free agent” – highly skilled, in great demand by other
        organizations
    o High risk environment
    o E.g. investment Banking
   • Fortress culture
    o Employees unsure when they will be laid off
    o Organization frequently undergoes reorganization
    o E.g. large car companies



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3. Assessing Corporate Culture
  • Understanding and assessing your organization’s culture can mean the
    difference between success and failure
  • Around here what is really important?
  • Around here who get promoted?
  • Around here what behaviors get rewarded?
  • Around here who fits in and who doesn’t?
  • “Hail the Chief”!
  • “The lower the rung, the greater the flak” – blame and fault-finding –
  • Why assess culture?
    o To analyse the gap between the current and desired culture
    o To maximize its ability to attain its strategic objectives
    o To understand if the prevailing culture supports and drives the
       actions necessary to achieve its strategic goals
    o You may need to change some of its practices and secondary values
       while keeping a few precious and non-negotiable core values intact.


4. Subcultures
  • Seen in large organization
  • Can differ
    o By function, (engineering vs. clinical dept.)
    o By their place in hierarchy, (administrator vs. professional)
    o By division
    o By site
    o By geographic region and country
  • Core values e.g.
    o Caring
    o Teamwork
    o Professional
  • Secondary values e.g.
    o Architecture
    o Décor



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    o Slogans
    o Clothing
    o Logos
    o Brochures


5. Unhealthy Corporate Culture
  • Symptoms of unhealthy corporate culture
    o There is a great sense of complacency about organizational
       performance
    o There is lack of sense of urgency in addressing customer needs
    o There is very little innovation in their products or services or the way
       they serve customers
    o Staff are reactive, taking little initiative to change and improve, and
       they adopt the “wait for the top” attitude
    o Staff, including senior executives, are very operation-driven and are
       not business-oriented
    o Leaders are slow in taking action on people for non-performance
    o Leaders do not implement changes but preach about their plans and
       intentions
    o People accept the deteriorating organizational performance and
       conveniently attribute it to the economic slowdown


6. Changing Corporate Culture
  • Set a clear vision and strategic direction
  • Develop clear performance measurements
  • Follow up on achievement of goals
  • Reward performance on a fair basis
  • Create a transparent work environment
  • Eliminate company politics
  • Develop a strong team spirits
  • Building an achievement-oriented culture
    o Current       Desired



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• Corporate Culture in Kementerian Kesihatan Malaysia
 o Professionalism
    • Appearance
    • Conduct
    • Knowledge
    • Working in a quality environment
    • Performance
 o Teamwork
    • Horizontal team – with colleagues
    • Vertical team –with superior (boss) and subordinate
 o Caring service
    • External clients
     •   Hotline/pusat informasi
     •   Suggestion box
     •   Walk-in compliant system
     •   Incident reporting
     •   Siaran mesra
     •   Tabung kebajikan pesakit
    • Handling patient
     •   Bedside manner
     •   Teaching self-reliance
     •   Health education
     •   Managing relatives
    • Dignity of patient
     •   Decorum
     •   Privacy
     •   Respect


“Plans don’t accomplish anything. Theories of management don’t matter
   either, Endeavors succeed or fail, because of the people involved”
                              – Colin Powell –




                                                                        71
             QUALITY ASSURANCE IN HIGHER EDUCATION




1. Introduction
   • Quality assurance is the process whereby customers are satisfied that
    standard will be consistently met.


2. Quality Assurance process guiding & policing
   • Regulating bodies scrutinizing documentation
    o Ministry of Higher Education (MHE)
    o Lembaga Akreditasi Negara (LAN)
    o Malaysia Medical Council (MMC)
   • Accreditation exercise
   • Monitoring and visits for compliance
   • External examiners
   • Internal review
    o Faculty Council
    o Curriculum Committee
    o Examination Board
    o Department of Medical Education


3. Quality Assurance customer
   • Students/parents
   • Parliament and investors
   • Ministry of Health and Defense
   • Private health care industry
   • Public/consumer organization
   • Medical/Nursing Association




4. Quality Assurance and standard
   • WFME (World Federation Medical Education)



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    o Internal standards in basic medical education
  • General Medical Council (GMC), UK
    o Tomorrow’s Doctor
  • Institute International Medical Education (IIME), America & China
    o Essential requirements for medical education
  • Liaison Committee on Medical Education (LCME)
    o Accreditation standard for US & Canada


5. Standard from WFME
  • Areas
    o Broad components of structure and process of Medical Education
  • Criteria
    o Specific aspects of an area corresponding to performance indicators
  • Standards
    o Specific for each criterion, using two levels of attainment i.e. must
       have and should have


6. Areas
  • Mission and objectives
  • Educational program and principles
  • Assessment of educational outcomes
  • Students
    o Criterion A: Recruitment & admission policy
    o Criterion B: Methods of selection
    o Criterion C: Student intake
            Basic standard: must be defined and related to the capacity of
           the Medical School at all stages of education
           Quality development: should be reviewed in consultation with
           stakeholders and regulated periodically in line with the national
           need
    o Criterion D: Student support & counseling
    o Criterion E: Student representation & governance



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          Basic standard: must have a policy on student representation &
          leadership
          Quality development: should encourage & facilitate student
          organizations, self-government, social-activities & ensure student
          representation on bodies relevant to education
   • Academic staff and faculty
   • Educational resources
   • Monitoring and evaluation of programs
   • Governance and administration
   • Continuous renewal
    o PPSP curriculum review 2007 22-24 February, Kuala Terengganu
          To present the final draft of the Cameroon review
          To fine tune and add current needs to the final draft
          To document the final draft of the curriculum review
          •     This exercise satisfy the continuous renewal requirement and
                include 2 students to satisfy their representation in
                curriculum


7. Tools in Quality Assurance
   • Benchmarking
   • ISO – International Organization of Standardization
    o ISO is a network of the national standards institutes of 157
       countries
    o ISO (9000) is the Generic Management Standards
    o ISO (14000) is the Environmental Management Standards
    o Management Standards


8. ISO (9000)
   • Quality management
    o Principle 1: Customer focus
          Organizations depend on their customers and therefore should
          understand current and future customer needs, should meet



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     customer requirements and strive to exceed customer expectation
     in curriculum. Key benefits:
     •   Increased revenue and market share obtained through flexible
         and fast responses to market opportunities
     •   Increased effectiveness in the use of the organization’s
         resources to enhance customer satisfaction
     •   Improved customer loyalty leading to repeat business
     Applying to principle of customer focus typically leads to:
     •   Researching and understanding customer needs and
         expectations
     •   Ensuring that the objectives of the organization are linked to
         customer needs and expectations
     •   Communicating customer needs and expectations throughout
         the organization
     •   Measuring customer satisfaction and acting on the results
     •   Systematically managing customer relationships
     •   Ensuring a balanced approach between satisfying customers
         and other interested parties (such as owners employees,
         suppliers, financiers, local communities and society as a
         whole)
o Principle 2: Leadership
     Leaders establish unity of purpose and direction of the
     organization. They should create and maintain the internal
     environment in which people can become fully involved in
     achieving the organization’s objectives. Key benefits:
     •   People will understand and be motivated towards the
         organization’s goals and objectives
     •   Activities are evaluated, aligned and implemented in a unified
         way
     •   Miscommunication between levels of an organization will be
         minimized
     Applying the principle of leadership typically lead to:



                                                                          75
      •   Considering all needs of all interested parties including
          customers, owners, employees, suppliers, financiers, local
          communities and society as a whole
      •   Establishing a clear vision of the organization’s future
      •   Setting the challenging goals and targets
      •   Creating and sustaining shared values, fairness and ethical
          role models at all levels of the organization
      •   Establishing trust and eliminating fear
      •   Providing people with the required resources, training and
          freedom to act with responsibility and accountability,
          inspiring, encouraging and recognizing people’s contributions
o Principle 3: Involvement of people
      Peoples at all levels are the essence of an organization and their
      full involvement enables their abilities to be used for the
      organization’s benefit. Key benefits:
      •   Motivated, committed and involved people within the
          organization
      •   Innovation and creativity in furthering the organization’s
          objectives
      •   People being accountable for their own performance
      •   People eager to participate in and contribute to continual
          improvement
      Applying the principle of involvement of people typically leads to:
      •   People understanding the importance of their contribution and
          role in the organization
      •   People identifying constraint to their performance
      •   People accepting ownership of problems and their
          responsibility for solving them
      •   People evaluating their performance against their personal
          goals and objectives
      •   People actively seeking opportunities to enhance their
          competence, knowledge and experience



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     •   People freely sharing knowledge and experience
     •   People openly discussing problems and issues
o Principle 4: Process approach
     A desired result is achieved more efficiently when activities and
     related resources are managed as a process. Key points:
     •   Lower cost and shorter cycle times through effective use of
         resources
     •   Improved, consistent and predictable results
     •   Focused and prioritized improvement opportunities
     Applying the principle of process approach typically leads to:
     •   Systematically defining the activities necessary to obtain a
         desired result
     •   Establishing clear responsibility and accountability for
         managing key activities
     •   Analyzing and measuring of the capability of key activities
     •   Identifying and interfaces of key activities within and between
         the functions of the organization
     •   Focusing on the factors such as resources, methods and
         materials that will improve key activities of the organization
     •   Evaluating risks, consequences and impacts on customers,
         suppliers and other interested parties
o Principle 5: System approach to management
     Identifying, understanding and managing interrelated processes
     as a system contributes to the organization’s effectiveness and
     efficiency in achieving its objectives. Key benefits:
     •   Integration and alignment of the processes that will best
         achieve the desired results
     •   Ability to focus effort on the key processes
     •   Providing confidence to interested parties as to consistency,
         effectiveness and efficiency of the organization
     Applying the principle of system approach to management
     typically lead to:



                                                                          77
     •   Structuring a system to achieve the organization’s objectives in
         the most effective and efficient way
     •   Understanding the interdependencies between the process of
         the system
     •   Structured approaches that harmonize and integrate
         processes
     •   Providing better understanding of the roles and responsibilities
         necessary for achieving common objectives and thereby
         reducing cross-functional barriers
     •   Understanding organizational capabilities and establishing
         resource constraints prior to action
     •   Targeting and defining how specific activities within a system
         should operate
     •   Continually improving the system through measurement and
         evaluation
o Principle 6: Continual improvement
     Continual improvement of the organization’s overall performance
     should be a permanent objective of the organization. Key points:
     •   Performance advantage through improved organizational
         capabilities
     •   Alignment of improvement activities at all levels to an
         organization’s strategic intent
     •   Flexibility to react quickly to opportunities
     Applying the principle of continual improvement typically lead to:
     •   Employing a consistent organization-wide approach to
         continual improvement of the organization’s performance
     •   Providing people with training in the methods and tools pf
         continual improvement
     •   Making continual improvement of products, processes and
         systems an objective for every individual in the organization
     •   Establishing goals to guide, and measures to track, continual
         improvement



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      •   Recognizing and acknowledging improvements
o Principle 7: Factual approach to decision making
      Effective decisions are based on the analysis of data and
      information. Key points:
      •   An increased ability to demonstrate the effectiveness of past
          decisions through reference to factual
      •   Increased ability to review, challenge and change opinions and
          decisions
      Applying the principle of factual approach to decision making
      typically leads to:
      •   Ensuring that data and information are sufficiently accurate
          and reliable
      •   Making data accessible to those who need it
      •   Analyzing data and information using valid methods
      •   Making decisions and taking action based on factual analysis,
          balanced with experience and intuition
o Principle 8: Mutually beneficial supplier relationships
      An organization and its suppliers are interdependent and a
      mutually beneficial relationship enhances the ability of both to
      create value. Key points:
      •   Increased ability to create value for both parties
      •   Flexibility and speed of joint response to changing market or
          customer need and expectations
      •   Optimization of costs and resources
      Applying the principles of mutually beneficial supplier
      relationship typically leads to:
      •   Establishing relationships that balance short-term gains with
          long-term considerations
      •   Pooling of expertise and resources with partners
      •   Identifying and selecting key suppliers
      •   Clear and open communication
      •   Sharing information and future plans



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          •   Establishing joint development and improvement activities
          •   Inspiring, encouraging and recognizing improvements and
              achievements by suppliers
  • The next step:
    o Document what you do
    o So according what was documented
Further reading:


  1. http://www.iso.org/iso/en/iso9000-14000/understand/qmp.html
  2. WFME Task Force on Defining International Standards in Basic
     Medical Education. Report on the Working Party, Copenhagen, 14-16
     Oktober 1999. Medical Education. 34(8):665-675, August 2000
  3. www.IIME.org




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