Preface

This book is about managing health programs. Effective management of programs is important because these are mechanisms through which a great many health services are organized and provided in both the public health and health care sectors. I provide information drawn from management research to assist you in developing a comprehensive approach to the practice of management in health programs. A focused reader will take away a solid overview of the current best practices in management that apply to managing health programs.

Health programs target any of the determinants of health. They can focus on some aspect of the physical environments in which people live and work, on human behavior, on biology, on the social factors that affect people, or on the health services offered to them. There is therefore a broad array of health programs. For example, at the prevention end of the health services spectrum, people receive information about safe sex practices or how to eat healthier in the context of health education programs. At the advanced acute care end of the spectrum of services, people receive kidney transplants within the context of transplant programs.

A persistent, decades-long trend has created ever larger and more elaborate structures that organize, deliver, and finance health services throughout the industrialized world. Current manifestations of this phenomenon can be seen in major public health agencies, such as the California Department of Public Health (www.cdph.ca.gov), or large health services organizations, such as the Massachusetts General Hospital (www.massgeneral.org). Within these large and complex structures, however, health services are provided directly through relatively small units called programs.

A substantial literature exists pertaining to the management of large and complex public- and private-sector health agencies, organizations, and systems. I have contributed to this literature myself. Nevertheless, there is a relative paucity of literature about managing at the level of health programs, where so much of the direct delivery of health services occurs. With this book, I seek to partially address this imbalance.

The intended audience for this book includes students in public health, in health services management, and in a wide variety of health professions who want to prepare themselves for the challenges of managing health programs. Even those who aspire to leadership positions in large agencies, organizations, and systems may begin their management career at the level of programs. The book will also be useful for those who already occupy a program management position, because it comprehensively and systematically presents current information about management.

Programs are defined in this book as organizational units intended to accomplish one or more objectives through a plan of action that describes what work is to be done, by whom, when, and how, as well as what resources will be used. Programs are embedded in organizations and should be of benefit to the larger host organization. Program management is defined as the activities through which the mission and objectives of a program are established and pursued by means of various processes using human and other resources.

As a way of organizing the discussion of program management, and to give a sense of the structure of the book itself, I present in Chapter 1 a model of the activities managers engage in as they manage programs. These activities are divided into two sets: core activities and facilitative activities. All health program managers engage in three core activities as they perform management work: developing/strategizing, designing, and leading. In addition, managers also engage in other activities that facilitate and support the accomplishment of a program's mission and objectives. Program managers engage extensively in such facilitative activities as decision making and communicating as they carry out their management work. Increasingly, they also engage in managing quality, marketing, and evaluating. Individual chapters of the book are devoted to each of these activities, presenting in-depth information about each of them. A brief précis of each chapter follows.

Chapter 1, “The Work of Managers in Health Programs,” contains key definitions and a background discussion of programs and program management. The work of managers is considered in terms of the core activities in which all managers engage as they do management work: developing/strategizing, designing, and leading. Consideration of this work is extended to include managers' facilitative activities: decision making, communicating, managing quality, marketing, and evaluating. The entire set of core and facilitative activities in management work is modeled graphically in Figure 1.4. This figure is the chapter's centerpiece, depicting the core and facilitative activities of management work as an integrated and interactive set of activities. There is also a discussion of the roles played by managers and the competencies necessary to manage health programs well.

Chapter 2, “Developing/Strategizing the Future,” emphasizes the initial development and strategizing that bring programs into existence. Developing a program initially simply means conceptualizing the program as a vehicle for delivering services or products that may succeed in the marketplace. In ongoing programs, development pertains to improving established services or products, or to expanding a program's portfolio of services or products. Development triggers strategizing, which is the work that managers do as they establish or revise the specific mission and objectives of a program and plan the means of achieving them.

Chapter 3, “Designing for Effectiveness,” is built around discussion of the work managers do when establishing and changing the intentional patterns of relationships among human and other resources within a program, and when establishing and changing the program's relationship to its external environment, including to the larger organizational home in which it is embedded. Attention is also given to designing logic models for programs.

Chapter 4, “Leading to Accomplish Desired Results,” describes leading as the work managers do when influencing other participants to contribute to the performance of a program. Emphasis is given to the fact that leading requires managers to help participants be motivated to contribute to programs in positive ways. Attention is given to specific leader behaviors that can improve management in programs.

Chapter 5, “Making Good Management Decisions,” emphasizes that decision making permeates all management work. The discussion of decision making represents a turn from core management activities to facilitative activities. Decisions are divided into two subsets: problem-solving decisions and opportunistic decisions. Problem-solving decisions are made to solve existing or anticipated problems. Opportunistic decisions are typically sporadic and arise with opportunities to reshape or advance accomplishment of a program's mission and objectives. Although decision making is defined simply as making a choice from among alternatives, the decision-making process is discussed in terms of seven steps: (1) becoming aware that a decision must be made, whether it stems from a problem or an opportunity; (2) defining in as much detail as possible the problem or opportunity; (3) developing relevant alternatives; (4) assessing the alternatives; (5) choosing from among the alternatives; (6) implementing the decision; and (7) evaluating the decision, and making necessary follow-up decisions.

Chapter 6, “Communicating for Understanding,” stresses that communicating activities are also ubiquitous in facilitating a manager's performance of all other management activities. Communicating is discussed as being both vital to the successful performance of management work and a challenge for managers. It is described as an activity that involves senders (individuals, groups, or organizations) conveying ideas, intentions, and information to receivers (also individuals, groups, or organizations). Communication is effective when receivers understand ideas, intentions, or information as senders intend, but several environmental and interpersonal barriers must be overcome to communicate effectively. The communicating activity is discussed as a key to managing relationships with a program's internal and external stakeholders.

Chapter 7, “Managing Quality—Totally,” discusses why managers of health programs typically make effectively managing the quality of the services provided a high priority. Quality is important not only to those who use the services of a program, having an important impact on their service-seeking decisions, but also to people who work in programs. This chapter stresses that above all else, managing quality in a health program requires a systematic approach. Three components of what is called a total quality approach to managing quality in health programs are presented: patient/customer focus, continuous improvement, and teamwork.

Chapter 8, “Commercial and Social Marketing,” discusses two important ways managers of health programs can use marketing to facilitate program performance. The financial or commercial success of many programs is affected by the use of commercial marketing. In addition, especially in programs focused on health promotion and education, social marketing is used in the provision of services. The...