Trainer's Guide Health Service Management
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- Title
- Trainer's Guide Health Service Management
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Trainer's Guide
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Published by the Administrative Support Unit,
Ministry of Health, P.O. Box 30016, Nairobi,
and the African Medical and Research Foundation,
£.0. Box 30125, Nairobi, Kenya
© 1985 Ministry of Health, Government of Kenya
African Medical and Research Foundation
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Cover by
Justice G. Mogaki, P.O. Box 74611, Nairobi
Printed in Kenya by the African Medical and Research Foundation
Wilson Airport, P.O. Box 30125, Nairobi, Kenya
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CONTENTS
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Page
1
Foreword
Introduction
3
Opening Session
9
Introductory Session
10
Module
1: Integrated Rural Health and Family Planning Programme
12
Module
2: Functions and Composition of Your Health Management Team
13
Module
3: Identification of Problems
14
Module
4: Problem-preventing/Solving
17
Module
5: Introducing Change
20
Module
6: Decision-making
21
Module
7: Problem-preventiag/Solving at Your Station
27
Module
8: Principles of Management
29
Module
9: Health as Part of Socio-economic Development
34
Module 10: Group Working
35
Module 11: Organization and Co-ordination
38
Module 12: Communication
40
Module 13: Motivation
43
Module 14: Perception and Self—development
46
Module 15: Delegation
49
Module 16: Guidance and Supervision
51
Module 17: Leadership Behaviour
53
Module 18: Management of Hospital Outpatient Services (OPS)
55
Module 19: Forthcoming Problem-preventing/Solving Activities
at Your Station
57
Appendices
Appendix A - Comparison of Main Training Techniques
Appendix B - Choosing the Best Venue
Appendix C - Briefing Notes
Appendix D — Rank Problems in order of Priority Using Criteria
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Foreword
The Integrated Rural Health and Family Planning (IRH/FP) project is one of
the priority undertakings of the Ministry of Health. One of the components
of the IRH/FP project is ’Strengthening the Managerial Performance of
District/sub-District Health Management Teams’ (HMTs). During the implemen
tation of txhis project component the Administrative Support Unit (ASU)
in the Ministry of Health (MOH) - in co-ooperation with the African Medical
and Research Foundation (AMREF) - spent much effort on consolidating,
editing and publishing the learning materials on problem-preventing/
solving and health management in a manual called Health Service Management:
Learning Materials - Volume I.
At the beginning of 1985 a MOH/AMREF/Swedish International Development
Agency (SIDA) team carried out an evaluation to analyse the experience
gained so far in the actual implementation of this projecta component and to
suggest alternative interventions to strengthen the managerial perforamance
of health management teams. Prior to this evaluation, MOH/AMREF conducted
an internal evaluation which provided information for the final evaluation.
The main recommendation of the evaluation report reads as follows:
"Management development programmes tend to be long-term processes.
Despite the relatively short period of time - less than three years —
the programme ’Strengthening the Managerial Performance of HMTs’ has
been very encouraging in terms of learning results and impact at work.
Therefore, the evaluation team strongly recommends that the programme
continue during thea second phase of the IRH/FP project."
Concerning training-related interventions the evaluation reports states:
"The learning materials on problem-preventing/solving and health
management have been consolidated, edited and published in a MOH/AMREF
Manual Health Service Management: Learning Materials - Volume I. This
volume should be complemented by a Teachers’ Guide to facilitate the
use of the manual, both in basic training at the Department of
Community Health, at the MTC and in continuing education at the
MOH/Hqs, provincial, district and RHU levels."
In response to this recommendation the ASU, together with AMREF, started
preliminary work on the Trainer’s Guide in April 1985. The main task of
developing the guide was carried out by participants of a Working Seminar
on Trainer’s Guide Development which took place in Coast Province from 9 to
11 July 1985. The members of the writing team included:
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Dr S.O. Afubwa, Public Health Officer , Port Health, Mombasa
Mr K. Karuga, Provincial Health Education Officer,, Central
Central Province
Dr M.N. Kihindas, Provincial Medical Officer, Western Province
Dr J. Maneno, Assistant Director of Medical Services, Ministry of Health
Headquarters
Mr B.K. Mwalenga, Head, Faculty of Health Educatlon/College of Health
Professions
Dr E.W. Mwangi, Provincial Medical Officer, Central Province
Dr T.N. Uganda, Provincial Medical Officer, North Eastern Province
Dr L.W. Okombo, Provincial Medical Officer, Nyanza Province
Mr I.C. Okulla Omeri, Provincial Public Health Officer, Coast Province
Mr M. Yamo-Ondiege, Provincial Mealth Education Officer, Nyanza Province
Ms L.O. Ongaya, Senior Nursing Officer, E__
‘_
Eastern
Province
Mr S.N. Ong’ayo, Economist, Ministry of Health Headquarters
Dr A.O. Oyoo, Provincial Medical Officer, Coast Province
Ppllard» Project Director, Health Planning & Information Project,
Ministry of Health Headquarters
Dr P. Schluter, Health Systems Analyst, AMREF
Mr H.E. Singa, Provincial Health Education Officer, Western Province
Mr D.K.S. Stalker, Management Consultant, AMREF
Mr N.N. Waweru, Provincial Public Health Officer, Rift Valley Province
Dr C. Obwanga Yuka, Provincial Medical Officer, Rift Valley Province
The Trainer’s Guide does not provide strict rules of how to organize an
conduct training activities in health managemeant; as the title of this
publication Implies, the writing team put together some guides and
suggestions derived from their vast experience tn health managemeant
taining. Thus, the Trainer’s Guide aims at facilitating your task as a
trainer m health management and the use of the learning materials in the
manual Health Service Management: Learning Materials - Volume I.
Dr S. Kanani
Senior Deputy Director of Medical Services
Ministry of Health, Kenya
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IntFoduction
The purposes of this introduction are:
(a)
To e/plain the modular approach and thea framework of the learning
materials;
(b)
To demonstrate:
how to use the learning materials and to adapt them to particular
conditions;
how to select the most effective training methods and techniques;
how to organize health manageameant training activities.
1.
Modular Approach, Content
The learning materials are structured as modules. Each module aims at
strengthening knowledge of and skills in a specific managerial duty,
ranging from problem-preventing/solving to guidance and supervision.
Each module stands on its own and has its educational objectives,
reading material and exercises.
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The learning modules are grouped into two parts as shown below:
Content
Module No.
Part
1. {Integrated Rural Health and Family {
{Planning Programme
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—------------------------------------ -
2. {Functions and Composition of Your
{Health Management Team
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:
{Part A:
{
{Problem-preventing/ {
{Solving
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{
. ...... .... !
3. {Identification of Problems
— —— I|
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4 ,{Problem-preventing/Solving
• _____________________ —--------------- ir—T!—r.---------
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5 .{Introducing Change
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__ •
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6. {Decision-Making
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7. }Problem-preventing/Solving at Your {
{Station
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8. {Principles of Management
i - ______________________ ,,------ „------ -------
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9. {Health as Part of Socio-economic
{Development
10. {Group Working
11. {Organization and Co-ordination
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12. {Communication
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i___ _ __ ,______ ________ „_________ „_________
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13. {Motivation
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PartB:
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Health Management f
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14. {Perception and Self-development
15. {Delegation
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16. {Guidance and Supervision
17.{Leadership Behaviour
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18. {Management of Hospital Outpatient {
{Services (OPS)
{
-- {----------------------------- {
19. {Forthcoming Problem-preventing/
{
{Solving Activities at Your Station {
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2.
Tailor-made Training Package
As a trainer, you will have to select the learning modules and adapt
them to your training needs without losing the advantages and benefits
which the different modules offer, namely:
they can be used in many kinds of conditions;
they cover almost all management functions of
Health Management Teams (HMTs);
they can easily and quickly be adapted to specific
training needs;
: since they are easily adaptable you do not have to start
from scratch with the laborious and costly design of a
totally new training programme.
universality:
completeness:
_
flexibility :
low cost
In selecting and designing the tailor-made package you as a trainer will
go through the following process:
(1)
(2)
(3)
(4)
3.
learn and understand the modular approach and content;
identify the training needs;
in accordance with the training needs, choose the right set of
modules and determine the sequence, e.g. module 10 can be
included in Part A.
adjust the set of modules selected to the training needs and make up
your own training package. This may include: modifying the module’s
objectives; re—writing some of the reading materials; and replacing
the exercises with your own, taken from your own experiences and
adapted as necessary.
Workshop Approach
The main didactic method should be the workshop approach. It is the
principle of this approach that those attending are not students in the
usual sense but active participants. This method puts great emphasis
on active participation by those attending the training activity. The
aim is to help participants to learn by doing and exchanging
experiences, including solving problems by group work in practical
exercises. A more detailed description of the workshop approach is
given in the manual Health Service Management: Learning Materials Volume I_, pp. 4-6.
Various training methods can be applied. The training method will vary
depending on the nature of the subject to be studied. Traditional
methods, such as lecturing, are used to convey facts and knowledge.
Discussion leading, homework, individual and group exercises, are
adopted if the emphasis of training is on the development of attitudes
and skills.
A comparison of the main training techniques is given in Appendix A.
4.
Visual Aids
During the training activity the trainers will be trying to: convey
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facts and ideas; develop understanding and insight; and impart skills.
It is important to get through with visual illustrations as well as
words, in order to consolidate the learning process. Where not provided
or, equipment for visual aids should be borrowed from any available
source.
Blackboard or Flipchart
Ensure that a blackboard and/or flipchart are available, They should be
positioned in good light, and clearly visible, Be sure to write in
large enough letters for people at the back to be able to see. Do not
speak whilst you are iwriting.
” ‘
~Do not crowd your board or chart and, if
possible, plan beforehand
how
and when you are going to use it.
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The flipchart is better than the blackboard because:
you can prepare it beforehand;
ii. you <can refer back to earlier points;
iii. it does
not have to be- cleaned
y
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----- —• you
just turn the page;
iv. participants do not have the feeling
that they have gone back to
school.
Overhead Projector
Participants like to see that some thought and preparation have
gone into
the session and you may have a number of diagrams,
graphs, etc., which
can be prepared on transparencies for use on the overhead projector.
Films and Slides
Always preview any film which you propose to. use in your session
At
the preview, make notes so that you can review the film in disc^sion
with the workshop participants after the showing.
Prior to showing the film or slides, tell the participants what they
are about and what to notice or identify.
After the show have a discussion about its main
are always more imeaningful when you discuss them points. Training films
with the workshop
participants afterwards.
C a discussion in plenary,
----- * Use
. j or groups with
reporting - back in plenary.
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Seating Arrangement (including Visual Aids
The following arrangement for visual aids is recommended:
cine/slide projector
OVERHEAD PROJECTOR
FLIP CHART
OR BLACKBOARD
5.
SCREEN
Workshop Planning and Organisation
Scheduling the Workshop
Examples of obvious times to avoid when scheduling your workshop are
holiday periods and periods of peak workload.
Choosing a Good Venue
Participants attending a workshop may have a number of work pre
occupations or possibly domestic or personal problems. It helps if you
can get them away from their workplace into a hotel or training centre
where they cannot be too easily disturbed.
It is very important to have all the facilities - training facilities,
accommodation and board - ’under one roof’. Frequently, you have to
select the ’best’ venue amongst competing facilities. The method
of. selected
’Setting priorities by means l
------- criteria’ will help you in
making a rational decision (see Appendix B).
Inviting the Participants
You will invite the participants in good time - some three to four weeks
prior to the workshop - and provide in writing all the information on:
1.
i. 1
background;
—:.o
2; ii. objectives of the workshop; iii. working approach;
iv. agenda; v. participants; vi. venue; vii. dates; viii. and most
important, any preparatory work to be carried out by the workshop
participants (see Appendix C). 1A follow-up should be made by telephone
to confirm participation.
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What is the number of participants? Experience shows that some 24 to 32
participants is good number. Avoid mammoth workshops with more than 40
participants; they are hardly manageable and not at all cost-effective.
6.
Budgeting for the Workshop
Trainers should make a budget for the workshop. Budget line items may
include: i. Full board for participants and facilitators; ii. Learning
materials, e.g. books, films; iii. Stationery; iv. Consultancy fees for
trainers; v. Transport; vi. Conference facilities; vii. Miscellaneous.
7.
Conducting the Workshop
Participants will spend a lot of time on doing group work. Trainers
should ensure that a good composition of participants exists in each
group, e.g. one medical doctor in each group. Depending on the group
assignment the participants will be grouped as HMTs.
Trainers should explain the exercises clearly. They should provide
guidance to the groups in doing the exercises but avoid unnecessary
interference.
Trainers should also inform and agree with participants on the homework
which must be done in preparation for the sessions on the following day.
8.
Evaluation
As part of the preparatory work the trainer will develop an evaluation
questionnaire (see illustrations in the Manual Health Service
Management: Learning Materials, Volume I,, pp. 75-78 and pp.307—310).
In addition to this -evaluation questionnaire thea trainer should have a
daily informal evaluation, (see p. 5 of Manual). This daily evaluation
will include a trainers1 meeting with representatives of participants.
Based on past experience it is suggested that you share the evaluation
results with the participants before the workshop is closed. Trainers
should be aware that the compilation of some 30 individual evaluation
questionnaires may take 1.5 person hours, i.e. two persons would have to
spend some 45 minutes to make the compilation.
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Opening Session
General
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Should you have a rather informal opening session or a very formal one?
There is no ready-made answer; local circumstances and your personal
preference 'will guide you in making your decision. In case you opt for
a more informal opening of the workshop you may start the session by you,
your co-trainers and the participans introducing themselves.
You may wish to conduct a more formal opening session with a prominent
speaker, e.g. the Provincial or District Commissioner or a highly placed
official from the Ministry of Health headquarters. Prominent speakers are
often not availble early in the morning. Thus, you may schedule the opening
session for 10.00 a.m., for example, and start the workshop with the
introductory session at 9.00 a.m.
• • j a draft speech prepared by you as
Have in mind that some speakers appreciate
trainer. Consult with the guest speaker whether he needs briefing notes or
a written speech.
Occasionally, prominent speakers are delayed.’.Do not wait for them for
15 minutes start with the next
t
hours, If they are delayed by more than
can
interrupt the on~going session.
session. As soon as they arrive you
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Timing:
approximately 30 minutes
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Introductory Session
General
This session is most crucial since it helps to set the right climate for the
workshop.
Timing: some 45 minutes
Process
Step
Visuals
Comments
1. a. Organizers, trainers and
participants introduce
themselves; e.g.
- educational background
- professional background
- present work station and
position
- civil status
- special interests
- name tags
- risking become
monotonous
- most likely
that you have
to ask partici
pants to speak up
- introduction
should be very
informal
b. Apologies (e.g. for non
arrivals)
!
2. Trainer discusses and agrees
with participants on workshop
objectives
- refer to briefing notes
- invite one of the
participants to read
the objectives
- ask for comments
- adjust the objectives if
necessary
- summarize
- workshop
objectives
as suggested
in the briefing
notes
- objectives with
modification
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Step
Visuals
- one-way
communication:
teacher and
participants
- with 27
participants
and 3 trainers
some 360 person
years of
professional
experience
(30 x approx. 12)
- communication
pattern in which
all participants
and trainers are
involved
3. Trainer discusses and agrees
with participants on the
learning approach
- together with the
participants determine
the approx, number of person
years of professional
experience available in
this conference room
- introduce the concepts of
traditional teaching approach
versus the workshop approach
- agree on the learning method
(preferably the workshop
approach)
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Comments
4. Trainer introduces and agrees
with participants on agenda
(refer to the briefing notes)
5. Discussion on administrative
matters including;
- accommodation
- meals and drinks
- telephone
- laundry
- reimbursement of transport
expenses
- recreation facilities
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Module 1: Integrated Rural Health and Family Planning Programme
------- (pp. 12-20 of Manual*)
General
The trainer should be
its implementation.
Timing:
conversant waith this programme, particularly with
some 75 minutes
Process
Usually the whole session will take place in plenary,
session objectives, group work may be included.
Depending on the
Visuals
Comments
2. Talk and discussion on IRH/FP
project
- evolution
- programme concept and
objectives
- programme description
- status of implementation
- constraints
— programme
objectives
(pp.12,13)
— components of
Part B
(pp.14—16)
information
on implemen
tation in
relevant
progress
reports
3. Talk and discussion on
Strengthening the Managerial
Performance of HMTs
- evolution
- situation analysis
- strategy
- status of implementation
- constraints
strategy
model
(figure 1.,
p.19)
Step
1. Trainer introduces session
objectives
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information
on implemen
tation in
relevant
progress reports
*A11 page reference in this Guide refer to the Health Service Management:
Learning Materials - Volume I, manual.
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Module 2: Functions and Composition of your Health Management Team
(pp. 21-26)
General
In the invitation letter to the participants * Briefing notes - you may
have asked the participants to do some work in preparation for this
session, e.g. to identify functions and composition of a District Health
Management Team.
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Timing: 75 minutes
Process
Step
Visuals
Comments
1. Trainer intraoduces session
objectives
2. (a) Trainer explains the
exercises 1.,2, and 3.
(pp. 21,22)
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reading materials
1. and 2.
(pp. 23-26) are
Illustrations
(b) Participants split into
their teams and develop
solutions to the three
exercises in their teams
(c) The teams present their
solutions in plenary
3. Trainer and participants
draw conclusions and compare
them with reading material 2
(pp. 25,26)
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main
conclusions
4. Group rapporteurs may
prepare a summary of the
teams’ presentations and
alternatively, each
team presentation
should be typed and
reproduced
conclusions
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conclusions may
include:
- functions identi
fied by teams are
more or less the
same
- many functions
are managerial in
nature
- technical
functions
frequently have
a managerial
aspect
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Module 21 Identification of Problems (p. 27)
General
problems which they face are managerial in nature, or at least hav
managerial aspect.
Timing: 60*90 minutes
Process
Visuals
Step
Comments
1. Trainer introduces session
objectives
- alternatively,
participants
could identify
important problems
in groups
trainer to prepare
layout prior to
session
2. (a) Trainer invites
participants to write
down on a sheet of paper 3
important problems they
face in carrying out
their duties
(b) Each participant reads
his/her problems
see note on layout
on the following
page
(c) Trainer writes each
problem and frequency
on blackboard/flipchart
see note on layout
(d) Trainer and participants
determine priorities in
terms of frequency
see note on layout
(e) Trainer and participants
indicate whether each
problem is of a resource
or non-resource
(managerial) nature
see note on layout
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trainer to
encourage
participants to
read their problems
from sheet of paper
and not to refer to
the problems already
listed on the
blackboard/flipchart
problems which at a
first glance seem to
be only of a resource
nature often also have
a managerial aspect
a
Visuals
Step
Comments
3. Trainer and participants
draw conclusions:
number of problems of a
resource nature, non—resource
nature and of both resource
and non-resource nature
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Note of Layout
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Problems
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Nature
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Module 4; Problodem-preventing/Solving (pp. 29-42)
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General
This is a crucial session since it aims at initiating the process of
problem-preventing/solving at the participants’ health stations.
r
Timing: some 120 minutes (time to be extended if necessary)
Process
Visuals
Step
Comments
1. As part of their homework
participants study the paper
’Probloem-preventing/solving’
in preparation for this
session (pp.31-38)
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2. Trainer introduces session
objectives
trainer to note
that this session
will be continued
in module 7
(pp.73,74)
3. Trainer invites one or two
of the participants to read
aloud the ’Calf Path’ story
(pp. 39-41)
for trainer: see
step 5.(c) for
lessons to be
derived from story
4. (a) Trainer introduces the
exercise 3. ’The Fly’
(p. 42)
for trainer: see
ste 5. (c) for
lessons to be
derived from the
exercise
(b) Each participant does
the exercise individually
in plenary
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Step
(c) Trainer and participants
illustrate how to find
the solution
Visuals
Comments
using
blackboard/
flipchart
solution: 40 miles.
It is important to
structure the
information of the
story, e.g.
i. distance between
the 2 cyclists;
ii. speed of the
2 cyclists;
iii. speed of the
fiy.
Question: How much
time does it take
for the 2 cyclists
to collide?
Answer: 1 hour.
Question: What is
the distance the
fly covers during
1 hour?
Answer: 40 miles.
- in doing the
exercises 1,5,6,
and 7
participants
should refer to
the paper
’Problem-preventing/
Solving’
- participants
should be concerned
with the time
available. Approx.
40% of the total
time may be spent on
exercise 1.
5. (a) Trainer introduces
the Exercises 1,2,4,5,
6, and 7 (p. 30)
trainer and
co-trainers provide
guidance
(b) Participants split into
groups and do exercises
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1
1
Visuals
Step
(c) Groups report their
findings in plenary
* all groups report
fi*3t on Exercise 1.
Trainer and
participants draw
conclusions
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problem
preventing/
solving
steps
(figure 1.,
p. 32)
lessons too be
derived from
Exercise 2:
- we follow our
daily routines
- many roads lead
to Rome
- use your imagi
nation to explore
new avenues
lessons to be
derived from
Exercise 3:
- do not panic when
confrpnted with
a new problem
- structure the
information
available in order
to arrive at a
solution easily
- same procedure used
in Exercise 1 to be
followed on the
reporting of
Exercise 2,4,6 and 7.
■
i
i
■ -1
1
I
-i
«
<
19
1
JlAuw. >. ..........
Comments
7 ■*- •
:
Module 5: Introducing Change (pp. 43—^7)
General
changes. Most people resist
Preventing and solving problems often inimples
which
people can be helped to accept
change, This session discusses ways change.
Timing:
some 60 minutes
Process
Steps
Visuals
Comment
1. Preferably, participants will
read the paper ’Introducing
Change’ (pp. 45-47) as part of
their homework in preparation
for this session
2. Trainer introduces session
objectives
using
blackboard/
flipchart
3. Participants do Exercise
1 (a) and (b) (pp. 43,44)
in plenary with the
guidance of the trainer
trainer to invite the
participants to refer
to reading material
’Introducing Change’
(pp. 45-47)
4. (a) Trainer introduces
Exercise 2 and 3
(p. 44)
trainer to refer to
’Calf Path’ story
(pp. 39-41)
(b) Participants split
into groups and do
the exercises
(c) Groups report on their
findings in plenary
5. Trainer and participants
draw conclusions
20
n
i
Module 6: Decision-making (pp. 49-71)
General
Decision-making is an essential part of most managerial ^tivities_and it is
The session aims at improving
particularly important in problem-solving.
anils .nd dWnusslng . syst.-atlo approach
to decision-making including the importance of consultation.
Timing:
135-150 minutes
Process
Visuals
Step
Comments
1. Trainer introduces session
objectives
s
I
I
1
- time for exercise
approx. 10 minutes
- trainer to emphasize
that the exercise is
not a ’test’, but is
intended to put
participants in a
decision-making frame
of mind. Participants
are usually hesitant
and need encouragement
to make the various
decisions
2. Trainer introduces Exercise
6 (a) (pp. 69,70) and invites
participants to try out their
own decision-making skills
3. Trainer leads discussion
with participants on what
is a decision? Why do we
make decisions? Why is
decision-making difficult?
(pp. 51,52)
5 actions
(pp. 52,53)
4. (a) Trainer explains the
5 different kinds of
action involved when
making a decision
(b) Trainer introduces
Exercise 1 (p. 66)
approx. 10 minutes
(c) Participants do
exercise individually
in plenary
21
^4 .
Comments
Step
*
■
pai-.
(d; Trainer
answers: (p. 66)
1. Adaptive 2. Contingency
3. Corrective 4. Interim
5. Corrective 6, Contingency
7. Interim 8. Adaptive/
Preventive
1
5K
Trailer e-ut.
5 na i n f
•J C' J L '
6.
(a;
iges
the 5 stages are
Important and will be
referred to throughout
the session
3,54
trainer to explain the
film in detail prior to
showing and ensure that
participants are familiar
with the various
characters in the film
to illustrate the 5
stages of decision-making
.
' ><.
'.'•••■r,r ' " ■
arU ' *
■ .?
tfv I Vv?
i
s .■■ 1 Im
- film time: 30 minutes
- ’Decisions, Decisions*
available from KIA,
AMREF or Manplan
Consultancy Services,
Nairobi
U>) Trau.?w :
:j,s
a F&f'crftr
«
■
‘
p<
{. . ■. .‘.c ip ant s
.of
1
• ,v’. in
y
* *
-/.pC' \
(b) ’UV/’ 'V**)
‘■g.-? c.
'
?; .:rts
<
!1
A
trainer to emphasize the
importance of clarifying
the objectieves at the
start of the decision
making process
.T
r
III
Ifl
I Ha
ft
Visuals
Step
trainer to emphasize
benefits of consul
tation
8. Trainer and participants
discuss stage 2 ’Consulting
People’ (p. 56)
- optional
- trainer to hand out
form Exercise 5
’Must’ and ’Wants’
Factors (p. 68)
- trainer to explain
that he is introducing
his own personal
criteria for purchasing
a car
- participantsi to fill
in answers as
u follows:
1. Must 2. Must 3. Must
4. Want 5. Want 6. Must
7. Must 8. Must 9* Want
9. (a) Trainerrintroduces
Exercise 5 (p* 68)
l
I
1
c
i
I
1
t
I
I
*
■
(c) Participants complete forms
— participants fill in the
’Must’ and ’Want’ constraints
as per Exercise 5
- trainer provides details of
cars A, B and C (see pp. 58-60)
to be filled in by participants
I
' S- I
fl
s|
III
I
these forms should be in
format shown in Tables
1..2. and 3. <PP* 58-60)
(b) Trainer hands out blank
decision-making forms
I
Comments
(d) Participants decide which car
to purchase
Iji
correct answer: car B the choice that complies
with all the 'Must'
constraints
(e) Trainer and participants
summarize stage 3 ’Making
the Decision’ (p. 57)
trainer to make
reference to the film
10. Trainer continues with the
discussion on Stage 4
’Communicating the Decision’
and Stage 5 ’Follow-up*
(p. 61)
■I
I
11. Trainer leads discussion on
ways of stimulating the
generation of alternative
courses of action (pp. 61-63)
23
I
trainer may refer to
’Calf Path’ story
(pp. 39-41)
Step
Visuals
— participants to be
divided into 3 groups
12. (a) Trainer and participants
continue to do Exercise
6 b (pp. 70,71)
— trainer to select a
leader from each group
— each leadear is assigned
to play one of the
following roles:
(a) Autocrat;
(b) Democrat;
(c) Consensus
— trainer to brief leaders
on their different roles,
and to give them copies
of exercise 6 b (p. 71)
— it is very important that
‘ the different roles are
not disclosed to the
groups
roles:
(a) - the Autocratic leader is
instructed to introduce
the exercise to his group,
to encourage discussion
for 4-5 minutes, and
shortly after announce
that he will not tolerate
any further discussion
and fill in his own
answers at random. He
should then announce
that the exercise is
finished, leave the group
and hand in his completed
form to the trainer
(b) - the Democratic leader is
instructed to introduce
the exercise to his
group, encourage
discussion, and provide
firm but reasonable
guidance in making
decisions. He should
aim at achieving
approximately 50%
completion of the
answers within the
10-minute period
(
24
n
Comments
?■
I
•I
I
Comments
Visuals
Step
(c) - the ’Consensus1 leader
is instructed to intro
duce the exercise to
his group and allow
totally free discussion.
He will NOT enter any
decision until there is
TOTAL agreement within
his group
- the exercise should be
terminated promptly
after 10 minutes and the
results from each group
compared on the blackboard/flipohart in
plenary
Group leaders are asked
to call out their group
decisions which the
trainer enters on blackboard/flipchart. When
ever a group has failed
to reach a decision, a
nil result is recorded.
The results usually
illustrate the following:
(i) The Autocratic
manager who makes the
decision and announces
it, achieves a high
volume of work but
serious dissatisfaction
within the group,
(ii) The Democratic
manager who provides
decisions for the group
discussion, achieves a
satisfactory volume of
work and satisfaction
with participants,
(iii) The Consensus
manager achieves a small
volume of work and
frustration amongst the
group participants
(b) Trainer and participants
discuss merits of the
different management
styles
25
Table 4,
p. 63
trainer to be aware of
similar visual
presentation (p. 282)
I
II
II■
I
I
■
Visuals
Step
13. Trainer and participants
summarize session
26
M
I
I
Comments
1
73’74)
Module 7:
General
U.e longest session ^^^^^^Se'problems^thePheaKh
This is by far the
’ ’*- *^ **
organisers
management
,01ving tecX: ^i^^uS K ^le^eventlng/Sol^ng.
participants
Timing: 3OO-36O minutes
Process
Visuals
Comments
Step
1. Trainer introduces session
objectives
I
— trainer to inform
participants to use
their own method
including criteria
to select problems
alternatively,
trainer may advise
participants to use
method as described
in Appendix D
(a) Trainer introduce-.
Exercise 1 (a)» (b)» ^c)
(pp. 73-74)
o
(b) Participants split iRto
groups and do Exercise 1
back in
(c) Groups report
;
’
on
Exercise
1
plenary
o
problem
preventing/
solving
steps (figure
1., P. 32)
Trainer summarizes again
problem-preventing/solving
method
4. (a) Trainer introduces
Exercise 2 (p. 74)
it is important that
trainer/co-trainers
provide guidance if
necessary
(b) Participants split int0
groups and do Exercise 2.
(c) Groups report back in
plenary on Exercise 2
27
,' '.
i
I
1__
•>--■
■
-
Step
Visuals
5. Organizers/trainers
and participants
agree on the kind of
guidance to be provided
by, e.g. Provincial Health
Management Team, trainers
I
i
28
f1
L
Comments
Module 8£ Principles of Management (pp.
General
j at introducing some
Of stimulator and as such alma
kind
easily
used whenever
This module is a
The module can be
basic principles of management, invited to give a talk on management.
you as a trainer
t.--- or speaker are
Timing:
some 150 -180 minutes
Process
Visuals
Comments
Step
1. Trainer introduces session
objectives
trainer may start
with any other step,
e.g. step 4
2. (a) Trainer introduces one of
the exercises, e.g.
Exercise 3. A
Questionnaire (pp. 101,102)
(b) Each participant does the
exercise
directives 1.
and 21.
(pp. 101,102)
(c) Trainer and participants
draw conclusions
3
I
I
I
I
(a) Trainer introduces another
exercise, e.g. Exercise 4.
’The Story1 (pp. 103J04)
(b) Each participant does the
exercise
(c) Trainer finds out frequency
of ’true', 'false' and ?
(•doubtful') for each
statement
table with the
4 columns:
statement,
T, F, ?
— see particularly
directives 1. and 21.
— exercise illustrates
communication, e.g.
inadequate reading
leads to poor
task accomplishment
■i
the discussion is
likely to be very
lively
29
tt
----------------- - -
—
-
Visuals
Step
Comments
answers to the
statements
(d) Trainer and participants
agree whether each single
statement is ’true’,
’false’ or ’doubtful’
1. = doubtful
(owner and business
man can be two
different persons)
2. s doubtful (a man
who demands money
robber)
need not be a 1
--3. = false
4 = doubtful (owner
could be a woman)
5. - doubtful (a
draught of wind
could scoop up
the contents)
6. = true
7. = <doubtful
_____ (see also
5.)
8. = doubtful (contents
of cash register
may not include
money)
=
doubtful (see
9.
also 2.)
=
false (member of
10.
police force)
11. = true
other possible
-’management
definitions
is getting
things done
through other
people’
-figure 1.t P« 90
4. Trainer and participants
define management and
identify management
functions
figure 2., p*91
5. Trainer introduces
'planning* (pp. 90,91)
aub-functions of
implementation
(p. 92)
6. Trainer introduces
’implementation’
(pp. 92-94)
30
I1
’ Iff TF
!
Comments
Visuals
1
Step
7. (a) Trainer' invites partici—
pants to
t write down on a
—important
sheet of—r paper
_•
*
•
which
motivating factors
1——
affect their job performance
(b) Each participant reads out
his/her 3 motivating factors
blackboard/
(c) Trainer writes motivating
flipchart
factors and frequency on
blackboard/flipchart
trainer to encourage
participants to read
their motivating factors
from sheet of paper and
not to refer to those
already listed on the
blackboard/flipchart
(d) Trainer and participants
draw conclusions
8. Trainer introduces ’ motivation’
(pp. 92,93)
figure 3*> P-93
9. Trainer introduces ’delegation’
(pp. 93.94)
guides for
delegation,
p-94
main steps of
evaluation,
p.95
10. Trainer introduces
’evaluation’
(p- 95)
figure 4.,
p. 95
11. Trainer introduces
’communication’
(pp. 95,96)
12. (a) Trainer introduces
Exercise 6. (p-88)
(b) He invites participants
to list on a sheet of
paper 3 explanations
(reasons) why the
decision went ’right’
(c) Each participant reads out
his/her 3 reasons
(d) Trainer writes reasons and
frequency on blackboard/
flipchart
(e) Trainer and participants
draw conclusions
13. Trainer introduces ’decision
(pp. 96,97)
making’ (PP-
I
trainer to refer to
Exercise 3- A
Questionnaire
blackboard/
flipchart
decision-making
using:
- central authority
- democratic method
- consensus method
£^17
31
09241
--------..
)
;
Visual
Step
text of this exercise
is incomplete; should
read as follows:
"In a hospital OPD,
there are 3 clinical
officers (COs) on duty.
Together the COs see
90 patients per hour.
They prescribe an
injection for 40% of
those patients. There
is one nurse working
in the injection room
(IR). She can give 18
injections per hour.
Questions: (i) What
happens at the IR?
(ii) What
would you do?
14. (a) Trainer introduces
Exercise 1 (p 87)
Time available:
5 minutes
(b) Each participant does the
exercise
blackboard/
flipchart
(c)Trainer and participants
answer the two questions
16. (a) Trainer introduces Exercise 2
(p. 88)
(b) He invites participants to
write on a piece of paper
3 relevant factors for
managerial effectiveness
(c) Each participant reads out
his/her 3 factors
32
L*
-it is important to
structure the infor
mation which is avail
able
—generate many remedial
actions
-consider feasibility
after having
identified possible
remedial actions
trainer and partici
pants to provide
illustrations
15. Trainer introduces the
’systems approach*
(pp. 97,9b)
n
Comment
I
1
i Step
Visuals
Comments
blackboard/
flipchart
(d) Trainer writes3 factors and
frequency on Lblackboard/
flipchart
(e) Trainer and ^participants
draw conclusions
<--
trainer to emphasize
the relevance of these
factors for all of us
as managers
I
3 main skills,
pp.98,99
17. Trainer introduces ’skills
of an effective manager’
(pp. 98,99)
optional
18. (a) Trainer introduces
Exercise 7 Cp. 105)
time available:
5 minutes
(b) Each participant does
exercise
blackboard/
flipchart
(c) Trainer and participants
develop solutions
possible solution:
19. (a) Trainer introduces
Exercise 8 (p. 106)
4
i'
- time available:
3 minutes
(b) Each participant does
the exercise
1
I
— one possible
solution - dwarf
who cannot reach
the 15th button
(c) Trainer and participants
discuss solutions
1
summary of
Table 1,
p. WO
20. Trainer introduces
’Vertical Lateral
Thinking’ (p. WO)
21. Trainer summarizes
session
t
I
33
1
BMWWIMlWlllU i.wiWHWWiwmM
.....
AA
M
Module 9: Health as Part of Socio-economic Development (pp. 107-116)
General
During this session participants have» an opportunity to practise their
• *-- » Participants
will spend a considerable amount of
conceptual- skills.
1
time :in doing the exercises in their groups.
Timing:
some 120 minutes
Process
Visuals
Step
Comments
1. As part of their homework
participants study the
paper ’Health and the
Development Process’
(pp. 109-116)
2. Trainer introduces session
objectives
3. (a) Trainer introduces the
paper ’Health and the
Development Process’
(b) Participants raise questions
related to the paper
4. (a) Trainer introduces
Exercises 1 to 5
(pp. 107,108)
i
I
(b) Participants split into
groups and do all exercises
(c) Groups report on their
findings
5. Trainer and participants
summarize session
not necessary if
participants wish
’individual’ group
reports
6. Group rapporteurs prepare
’consolidated* solutions/
answers to exercises
34
M
I
Module 10: Group Working (pp- IIT-I1*^)
General
be done in groups. Participants
Much of the wo^k during this session willworking
and develop their strength
should recognize the importance of group
in group working.
. of the more difficult ones. There is a risk that the
The module is one
The trainer should avoid
session may turn
t— - out to be too academic and boring, and responsibilities,
extensive lecturing on group definition, group roles
the participants will
group dynamics, etc. In tdoing the exercises in groups themselves some basic
have to refer to the reading materials and find out for
principles and requirements of effective group working.
i
Timing: 150-180 minutes
Process
Visuals
Step
1. (a) Trainer identifies one
’Observer’ for each group
and briefs them on ’Process
AV
Observation’ and the
’Observer Worksheet’
(pp.130—134) and provides
them with the sheets
(b) Each observer observes his/
her group and writes
comments on Observer
Worksheet
Comments
this step has to
take place prior
to one of the
sessions preceding
this session on
Group Working
group work to be
observed should last
at least 30 minutes.
(n) Trainer discusses completed
Observer Worksheets with
observers prior to the
session on Group Working.
Observers may rephrase some
of their comments to avoid
offensive statements
2. As part of their homework
participants study the
reading materials 1 to 6
(pp. 119-134)
3. Trainer introduces session
objectives
35
I
...
1
Visuals
Step
Comments
4. (a) Trainer introduces Exercise
1 and distributes handouts
for Progress Check
(pp. 135,136)
(b) Each participant completes
sheet
his/her Progress Check
Cl.—
“
(c) Participants keep their
sheets
(d) Participants complete
similar sheets 2 days
later and on the last
day and compare them
with the previous sheets
see step l.c. (avoid
mentioning names where
negative statements are
made)
5. Observers report their
observations; groups comment
on observations
some 20 minutes
-definitions
of a group
(p. 119)
-roles (p. 121)
—group perfor
mance and
development 5 stages
(pp.123,124)
-commitment
grid (figure 1.»
p.129)
6. (a) Trainer introduces the
topic referring to
reading materials
(b) Participants raise
questions concerning
reading materials
7. (a) Trainer introduces
Exercises 2 (p. 118),
3 (p. 118) and 4
(pp. 137-140)
I
i
for Excercise 4
participants should
not refer to suggested
answers (pp. 141-146
allocation of time to
the exercises is
important
(b) Participants split into
groups and do all three
exercises
(c) Groups report on their
findings in plenary
36
Visuals
Comments
Step
i
8. Trainer and participants
summarize session
r
some of the
visuals of
step 6.
not necessary if
participants wish
’individual’ group
reports
■-
f-S’d
Q. Group rapporteurs prepare
’Consolidated’ solutions/
answers to exercises
I1
>;
■
-
11
I 1I
I
i
.1.
■
w
.1
37
x•
.
z'
Module 11: Organization and Co-ordination (pp. 147-160)
General
is designed to illustrate and discuss with participants the
The session is designed to illustrate and
of: (i) good organization; (ii) the need for management to set
importance
** ! importance of key result areas;
(iii) to
nh*iprtives and to recognize the
areas, (m)
°^ives and to re og
for co.ordinating work between all
appreciate management’s responsibility for
departments.
Timing: 135-150 minutes.
Process
Comments
Visuals
Step
1.
As part of their homework
participants study the paper
Organization and Co
ordination (pp. 149—^59) in
preparation for this session
2.
Trainer introduces session
objectives
3.
Trainer leads discussion on
natural groupings and the
importance of good
good organization (pp. 149»150)
4.
Trainer leads discussion on
Organization Structure
(pp. 150-152)
5.
Trainer invites participants
to sketch an organization
chart of their own work
station
6.
Trainer leads discussion on
the different types of
informal relationships
commonly found in
organizations (p.153)
examples
- figure 1 and 2
(pp. 150,151)
- other illust
rations
illustrations
- trainer to ask
participants to
identify any informal
relationships at their
own work stations
— trainer to inform
participants of
possible negative
informal relation-
38
fl
V
V V’*’
W6
I
- the examples of key
result areas listed on
p.155 should be
referred to
- thereafter the parti
cipants are asked to
identify two or three
personal key result
areas
Trainer leads discussion on
the importance
of communicating the
organization’s objectives to
all staff and also of
identifying both organization
and personal key result areas
(pp.154,155)
7.
I
8.
Comments
Visuals
Step
Ii
II
IIIII
Trainer briefly refers to:
(a) Relationship between authority
and responsibility (p. 156)
9.
I
(b) The effect of a manager’s
span of control (p. 156)
figure 4.,
p. 156
(c) The number of levels of
authority within the
organization (p. 157)
figure 5.,
p. 157
Ll
figures 6. and 7.»
p. 158
Trainer leads discussion on
the importance of vertical
and lateral co-ordination
(pp. 157-159)
10 (a) Trainer introduces
Exercise 1 to 5 (p. 148)
(b) Participants split into
their teams and do all the
exercises
trainer to ensure
that participants
split into their
health management
teams
(c) Groups report on their
findings
trainer to refer to
existing ’standard’
organization chart
11. Trainer and participants
summarize session
12. Group rapporteurs prepare
summary in addition to
group reports
39
PWWPWr-y—' "....
■
.. ;....
I
Module 12: Communication (pp. 161-185)
General
This session is to ensure that participants recognize the vital importance of
good communication.
good
communication. The exercises are designed to develop and improve the
communication skills of participants.
Timing: some 120 minutes
Process
Visuals
Step
1.
Trainer introduces session
objectives
2.
Trainer leads discussion on
definition, objectives and
general principles of good
communication (p. 162)
Comments
use blackboard/
flipchart
3. (a) Trainer introduces
Exercise 1 (p. 179)
*
it is most important
to ensure that:
- each person repeats the
message only once
- the receiver of the
message is not allowed
to seek clarification
or question transmitter
- the observers will note
that as the exercise
progresses, the message
gets both shorter and
distorted, thus
illustrating the
importance of feedback
(b) Exercise is done
(c) Trainer and participants
draw conclusions
I
l
(d) Trainer contrasts advantages
and disadvantages arising
from good and poor
communication (p. 163)
figure 1.,
p. 165
(e) Trainer emphasizes the
importance of feedback
40
1
fl
Step
Visuals
4. Trainer leads discussion on
methods of commumnication
(pp. 166—168)
figure .2.,
p. 166
r
5. Trainer leads discussion on
the 5 ’C’s of communication
(pp. 168-170)
I
each of the 5
•C’s
!•
1
I
41
JI
exercise 2 (p. 181)
is part of step 5» This
exercise illustrates that
the receiver often inter—
pretes a different
message from the communi
cation that is sent by
the transmitter. Allow
participants 2-3 minutes
for this exercise. Upon
completion trainer will
find out the number of
’F’s seen in the message
by participants. Correct
answer is 6. Most
participants will score
between 2 and 4. They will
overlook the 3 ’F’s of
the words ’OF’
Exercise 3 and 4 are
part of step. 6
- Exercise 3 (p.182)
This exercise illustrates that
communication often breaks down
because the receiver assumes
that he has understood. Allow
participants 2-3 minutes to
complete the exercise. Many
will omit the duplication of
the word ’THE’ in the fist 2
triangles and the word ’A’ in
the third triangle
- Exercise 4 (p. 183) - optional
This exercise illustrates that
simple short messages are
usually more easily understood.
The possible answers include:
1. It depends upon.... 2. Use
if system fails. 3- This is
unacceptable. 4. The delivery
of spares resulted in.... 5.
The report refers to defective
material. 6. Find •••• 7. We
did not proceed because....
8. We cannot give any opinion
because the proposal is not
clear. 9. Economic aspects are
also important. 10. We have....
6. Trainer leads discussion on
the 6 skills of communication
(pp. 171-174)
I
Comments
l
Module 13: Motivation: (pp. 187-207)
General
•
? of motivation and how it
meaning and importance
This session is to discuss the
motivation in practical work situations.
is possible to apply the theories of
Timing: 135-150 Minutes
Process
I
Visuals
Step
Comments
trainer to stress that
participants read only
paper and not to do
any of the exercises
1. As part of their homework
participants study the paper
’Motivating employees’
(pp. 188-200) in preparation
for this session
2. Trainer introduces session
objectives
3. Trainer leads discussion on
leadership and management
styles and the progress from
the Disciplinary Stage to
the Motivation Stage
(p. 188,189)
- definition of
leadership
- list of
qualities that
make a good
leader
— authority/
4. Trainer leads discussion on
responsibility
the relationship between
diagram
Authority and Responsibility
(pp. 189-193) and the
qualities a manager requires
to fulfil hiw work satis
factorily (PP« 189-193)
5. Trainer introduces and
discusses:
- Theory X and Theory Y
(p. 193)
- People’s needs
(pp. 194-197))
6
trainer to build up step
by step a visual display
of the Authority/Respons
ibility diagram (pp. 190,
191)
figure 1.,
p. 194
trainer not to disclose
scoring (see step 6. c.)
(a) Trainer introduces
Exercise 1 (pp* 201,202)
10-15 minutes
(b) Participants do exercise
individually in plenary
43
> !
trainer to invite
participants to contribute
their definition of leader
ship and compile a list of
the qualities that make a
good leader on blackboard/
flipchart
Visuals
Step
Comments
for scoring: Always = 3;
Nearly always = 2;
Sometimes = 1; Never = 0
- average score: 20-26 out of
36 possible
(c) Participants assess their
own scores
participants with low
scores have problems
with motivating their
staff
(d) Trainer and participant
interpret scores
(e) Trainer leads discussion
on each of the questions
contained in the
exercise. Each of the
questions highlights an
important aspect of
motivation
it is advisable to read the
quotations out laying
emphasis on originator of
the quotation. After 10
minutes, compile on
blackboard/flipchart the
number who agree/disagree
with each quotation. In a
typical response the majority
will agree with 2,3»6 and
disagree with 1,4 and 5.
Upon completion of results,
disclose to participants
that the quotations are
entirely fictitious and that
the exercise illustrates
that we are all conditioned
by our own inherited
experiences and prejudices
7. (a) Trainer hands out to
participants Exercise 3
(p. 204) and invites each
participant to tick his
choice of answers under
the headings ’Agree’ ’Disagree’
(b) Trainer emphasizes the
importance of judging
individuals on their
own merits
illustrations
8. Trainer summarizes the
benefits of a well
motivated staff and
develops a discussion
on the ’Attitudes’ and
’Actions’ that can enable
management to motivate
their own staff
(pp. 198-200)
44
I 1
V
I
Visuals
Step
q
Comments
trainer to explain that
the exercise is an actual
survey conducted for
industry. Participants
fill in column ’Personal^
Rating’. Time: approx. 10
1minutes
(a) Trainer introduces
Exercise 2 (p. 203)
*
(b) Participants do
exercise
(c) At the completion of the
exercise, trainer
discloses to participants
the actual results of the
survey. Trainer leads
participants in a discussion ,
on reasons why the supervisors
ratings are so often different
from those of their employees,
i.e. lack of knowledge of
individuals' wants, assump
tions, poor communication
The actual results of the
survey are best illustrated
on a iprepared flipchart and
are as follows:
Factors
1
High wages
4
job security
3
Promotion in the
company
2
Good working
conditions
5
Interesting work
6
Personal loyalty
of supervisor
Tactful discipline 7
8
Full appreciation
of work done
Help with personal 9
problems
10
Feeling of being
involved in things
10. (a) Trainer summarizes the
_j of the module
main points
the point
and emphasizes
'
that, motivation is most
• - you
- - , Work at
effective if
period
(p. 200)
it over a i
(b) Trainer draws participants
attention to the points
raised in ’Guide on human
relations’ (p. 205)
(c) Trainer draws participants
attention to ’A guide to
fulfilling the needs of
employees’ (pp. 206,207)
and develops a discussion
on the various points that
are included
I'
1
45
Supervisor Employee.
guide on human
relations
5
2
7
9
6
8
10
1
3
4
Module 14: Perception and Self-development (pp. 209-244)
General
This is another module which requires solid preparation and alertness by the
s
as a main tool for
trainer, Preferably, the trainer will use the exercises
The
trainer
should
be
well prepared for
achieving the session objectives,
and rely mainly on the exercises.
Timing: 150-180) minutes
Process
Visuals
Step
Comments
1. As part of their homework
participants study the reading
materials 1 to 5 (pp» 211—224)
2. Trainer introduces session
objectives
3. (a) Trainer and participants do
Exercise 1 (p. 225)
- trainer to use enlarged
picture
- trainer to use an
alternative picture
(e.g. wine glass)
(b) Trainer and participants
comment on the nature of
perception
4. (a) Trainer introduces Exercise 2
(pp. 226,227)
preferably, trainer to
distribute handouts
of pp. 228 and 229
(b) Participants do exercise
individually or in groups
preferably, partici
pants do the exercise
individually in plenary
to save time
(c) Participants read what they
have written
(d) Trainer and participants draw
conclusions
46
! 1
- handout A - rather
negative description
- handout B - rather
positive description
M
Visuals
Step
5
Comments
i
.....
- Exercise 4 optional
— trainer to distribute
handouts of Personal and
Circulation Worksheets
(pp. 233,234)
•
i Exercises
(a) Trainer introduces
3 (pp7 230-234) and Exercise
4 (pp. 235-237)
r
(b) Participants split into
groups and do the two
exercises
(c) Groups report on their
experience? in
i- doing the
exercises back in
plenary
6-
(d) Trainer summarizes the
OK/Not OK Live Position
figure 5..
p. 235
Trainer
figure 1.»
p. 214
optional
7. (a) Trainer introduces
Exercise 6 (pp- 239-2U3)
■ 3 do exercise
(b) Participants
individually in plenary
the four
orientations
(pp. 219,220)
(c) Trainer introduces
reading material 4
( pp. 219-222)
blackboard/
flipchart
(d) Trainer and participants
calculate the arithmetic
mean for each of the
orientations
arithmetic mean =
scores of all
participants for
each orientation
divided by number
of participants
? and participants
(e) Trainer
interpret these results
!
(f) Trainer and participants
draw conclusions
Printing error, p.233
'equal or subordinate
position’ should read
'equal or superior
position’
8. (a) Trainer introduces
Exercise 5 (p- 238)
47
*
a
Visuals
Step
Comments
(b) Participants do the
exercise individually
in plenary
(c) Trainer asks for feedback
from participants (e.g.
target position
as compared with actual
position)
9. Trainer introduces Exercise 7
(p. 244)
10. Trainer and participants
summarize session
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48
n
r
exercise to be done
by individuals back
at home
I
Module 15: Delegation (pp. 245-258)
I
General
During this session participants have an opportunity to
delegation skills.
further develop their
Timing: 120 minutes
Process
Visuals
Step
■1
JU
Comments
trainer to stress that
participants should read
only paper and not to do
any of the exercises
1.
As part of their homework
participants study the paper
’Effective delegation’
(pp. 247-250) in preparation
for this session
2.
Trainer introduces session
objectives
3.
Trainer leads discussion on:
- definition and components
of delegation (pp. 247,248
— steps in the delegation
process
4.
(a) Trainer introduces
Exercises 3 and 4
(p. 245)
(b) Participants split into
groups and do the two
exercises
(c) Groups report their
findings in plenary
5.
(a) Trainer introduces
Exercise 5 (pp. 251-256)
(b) Participants do exercise
individually in plenary
(c) Participants share their
answers with their
colleagues
(d) Trainer and participants
draw conclusions
49
main steps
(p. 248)
Visuals
Step
trainer to invite
participants to use
form back at their
stations
6. (a) Trainer introduces
Exercise 6 (pp. 257»258)
(b) Participants practise use
of the form by doing one
or two tasks and sjiare their
experiences
7.
summary
(p. 250)
Trainer and participants
summarize session
• I
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Comments
I
Module 16: Guidance and Supervision (pp. 259-269)
>1
General
This session is to discuss with participants the importance of a positive
style of supervision and to recognize the benefits which could arise from
such a style. Also included are management’s responsibilities for setting
and maintaining the standards of work and conduct expected from subordinate
staff.
Timing: some 135 minutes
Process
Step
Visuals
Comments
1.
As part of their homework
participants study the paper
'Guidance and Supervision’
(pp. 261-269) in preparation
for this session
2.
Trainer introduces session
objectives
3.
Trainer leads discussion on
Negative and Positive styles
of supervision (pp. 261,262)
and emphasizes the benefits
of a positive style of
supervision
requirements
of positive
supervision
suggested by
participants
trainer to invite
participants to compose their
own list of the requirements
for positive supervision, To
request suggestions from
participants and compile on
blackboard/flipchart. To
compare the list with the
requirements listed in the
manual (pp. 262,263)
4.
Trainer leads discussion on
’Setting Standards of Work’
and emphasizes the 4 guide
lines as described in the
manual (pp. 265-268)
figure 1.>
p. 267
trainer to illustrate the
'Measurement of performance’
shown in figure 1., p. 267.
Participants to suggest
practical examples from
their own work situation
5.
Trainer leads discussion on
the necessity for setting and
maintaining rules for conduct
rules for
rules
(p. 268)
trainer to emphasize the
positive benefits of
involving staff in agreeing
on rules for conduct. Trainer
to emphasize the ’Rules for
rules’ (p. 268)
6.
Trainer leads discussion on
guidelines for conducting
disciplinary interviews
(pp. 268,269)
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092-1-11
N8S
> V /Jf
< /Z
* ■
—-rf
Visuals
Step
7. (a) Trainer introduces
Exercise 1.(a), 1.(b) and
1 (c) (pp. 259,260)
(b) Participants split into
groups and do exercise
(c) Groups report their
findings in plenary
8.
Trainer and participants
summarize the reports
I!
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f1
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Comments
Module 17: Leadership Behaviour (pp. 271-297)
General
' i is similar to that ini Module 10 (Group Working) and
The nature of this module
Once again, the trainer
Module 14 (Perception and Self-development). C
the session objectives.
should rely very much on the exercises to achieve
Timing: 150-180 minutes
Process
Step
1
Visuals
Comments
figure 1.,
p.275
trainer refers also
to cover of manual
As part of their homework
participants study reading
materials 1 to 5 (pp. 273-286)
2. Trainer introduces session
objectives
3. (a) Trainer introduces topic
(b) Participants raise
questions concerning
reading materials
(c) Trainer and participants
answer questions
for Exercise 4,
additional step 3:
Relate individual
answers and group
viewpoint to ’Continuum
of Leadership
Behaviour’, p. 282
printing error, p.282:
delete ’Figure 2.
Check-list of Socio
economic Conditions’
and subtitute with
’Continuum of Leader
ship Behaviour’
4. (a) Trainer Introduces
Exercise 1 (p. 272)
and 4 (pp. 287,288)
(b) Participants split into
groups and do exercises
(c) Participants meet again
in plenary
(d) Groups report on their
findings in plenary
continuum of
leadership
behaviour,
(p. 282)
this step replaces
Exercise 2
(e) Trainer and participants
draw conclusions
53
I ■. •
L
-■ .l ■ - •
»w
......... .
"
Visuals
Step
Comments
optional
(a) Trainer introduces
Exercise 5 (pp. 289*292)
(b) Participants do the
exercise individually
in plenary
(c) Trainer and participants
interpret results
-blackboard/
flipchart
-continuum of
leadership
behaviour,
(p. 292)
figures can be
related to continuum
of leadership
behaviour, p. 292
6. (a) Trainer introduces
Exercise 6 (pp* 293*297)
at this stage not
step 3
(b) Participants do steps 1
and 2 of exercise
individually in plenary
managerial grid,
(p. 286)
(c) 7,
Trainer introduces reading
material 5 (PP* 285.286)
(d) Participants do step 3 of
Exercise 6
» and participants
(e) Trainer
interpret outcome of
exercise
-figure 1., P» 275
-continuum of
leadership
behaviour
(p. 282)
-managerial
-managerial
grid (p* 286)
7. ~Trainer' and participants
summarize session
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54
fl
Module 18: Management of Hospital Outpat^t Services WPS), (pp. 299-303)
General
• * r to apply some
session participants have an opportunity
hospital'outpatient services.
During this
principles of management in the context of 1 .
-- • ’ some 120 minutes (much more time could be allocated
al
Timing:
nnblication Guidelines for the Management o£ Hospital
—..1^^
A
"
of Health'
Administrative Support Unit, 19»^ is
Process
Visuals
Comments
see note on
layout of
Module 3
trainer to encourage
participants to read
their problems from
sheet of paper and not
to refer to problems
already listed on the
blackboard/flipchart
Step
1. Trainer introduces session
objectives
2
I
(a) Trainer introduces
Exercise 1 (p. 249). Trainer
invites participants to
write down on a sheet
of paper 3 important
problems in the management
of hospital OPS
(b) Each participant reads
out his/her problems
(c) Trainer writes each problem
and frequency on blackboard/
flipchart
(d) Trainer and participants
determine priorities in
terms of frequency
see note on
layout of
Module 3
(e) Trainer and participants
indicate whether each
problem is of a resource or
non—resource (managerial)
nature
see note on
layout of
Module 3
(f) Trainer and participants
draw conclusions
55
n
1'
■.
—
Visuals
Step
Comments
3. (a) Trainer introduces
Exercise 2 (pp. 301—303)
-accumulated figures
for arrivals and
patients seen
-figure for waiting =
difference between
arrivals and patients
seen
-stations start at
different times
(b) Trainer and participants
review and discuss the
study form (see task 1
of Exercise 2)
(c) Participants split into
groups and do tasks 2
and 3 of Exercise 2
(d) Groups report on their
findings in plenary
-too many patients
waiting within the
OPS system. Waiting in
the general waiting
area cannot be
avoided. However, once
a patient is being
seen, he/she should
move smoothly through
the different stations
-different start and
break times
-registration of
patients should be
synchronized with
clinical diagnosis
output
4. Trainer and participants
draw conclusions of session
trainer to stress
relationship between
number of patients
and quality of care
!
-1
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11
k
Module 19: Forthcoming Problem-preventing/Solving Activities at Your Station
(p. 305)
General
This is a rather short session,, During this session the teams decide on the
they want to tackle during the forthcoming months. At
two or three problems
]
the same time they indicate the dates for completing the implementation plans.
Timing: some 60 minutes
Process
Visuals
Step
Comments
1. Trainer introduces session
objectives
2. (a) Trainer introduces Exercises
1 and 2 (p. 305)
- trainer to inform
participants to use
their own method,
including criteria,
to select problems
- alternatively, trainer
may advise participants
to use method as
described in Appendix D
- HMTs should also
identify technical
support required
(b) Participants split into their
teams and do the two exercises
(c) Teams report back in plenary
on the two exercises
reports are an
agreement between
HMTs and organizers
(d) Reports are typed and
distributed
57
I!
Appendix A
Comparison of Main Training Techniques
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|Technique
J Comments
’ Useful for
i.
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•jninn
--- --- ----
|Lecture/talk
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Giving background information
Presenting general interest
information
One of the ways of coping
with a very large audience
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_____■ ----
•i
|Group
j instruction
Presenting factual information 1
and ensuring retention
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Not the best method of
developing an understanding
of principles
Not the best method for
changing attitudes
Not suitable for a group of
more than 16 people
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Not suitable where factual
1
information must be put across 1
and retention assured
I
Not suitable for a group of
J
more than 16 people: 10 is the I
optimum
1
Developing understanding
I
Influencing attitudes
!
Giving feedback to the trainer !
I•
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___ nn--- -- --
(’Discussion
1 leading
j
Limited use for developing
understanding or changing
attitudes
1
No guarantee of absorption of I
•
-**
_yj V.
ZS 1
information;
no rfeedback
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(unless the speaker employs
I
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additional techniques)
Use this technique sparingly II
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ICase study
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The case should not be too
I
Providing discussion and
I
remote from the experience
I
understanding of real issues
I
of the trainees
I
rather than abstractions
Giving trainees the opportunity! Care must be taken to bring
of listening to the ideas and 1 out the relevance of the
opinions of their colleagues
I lessons to every trainee in
concerning practical on-the-job 1 his real-life working
problems
! situation. As for the case
Developing role-play situations! study techniques, not
Providing trainees with an
I suitable for a group of more
opportunity to bring out their 1 than 16 people: 10 is the
own similar problems and look i optimum
at them objectively
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Appendix
Choosing the Best Venue
(Setting Priorities by Means of Selected Criteria
*_____ ________ 1--------
r
•
Venue
,
•
.
| Criterion
•Z^t
n
’ j,,..
,,---- —- **• •i44
•I
•
| Venue A
.
»
-i---------- .-----------
---------------- .■■nil.----------
I jr - i-'1---*-
_____________
•
— I JI I
____________
!
First
i
First
•
-__ .
---
J Overall priority
Second
|
•
- - -i—-—
“•** i -
•i
- -----
| Second
|
First
i
i______________
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W aw!
-
Venue D
|
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rr
|
-----
Fourth
,
|
--------
Fourth
— I----Fourth
|
- -
•
!
—. i——
-■
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KEY
First
Second
i
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_ri_ I
_ •( .l.i. -ni-------
____—
•
t .1.. ri
____ —„mi-i-----
Third
Second
Second
I First
Venue C
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I First
______ I
|
■'
|Hotel management
1
I .1
1
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—11
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■■■-"■ | JI-
]Accommodation/board I Fourth
'
Venue B
jSecond — I-----
1
’(Training facilities I Third
1
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*. . .
best satisfies a given criterion
second best; etc.
Third
1
Third
II.----------
1
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•
Third
>—I1
|
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Fourth
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_____ - —---(1mmrnr-,
|Technique
•-
____ _i-—
i ™rnrn'
'■
IRole playing
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| Comments
Useful for
_________
! If trainees
are _paired off
I| aiiu
and each Hpair
an --observer !
ax*' has —
whn will
will afterwards give
I
|• who
| constructive criticism, care ii
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| must be taken in the
selection and briefing of the i
Ii
| observer
i
| One trainer cannot handle
i
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| more than 12 trainees using
i
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| this technique
i
Developing communication and
interactive skills
Feedback helps the trainee to
see himself as others see him
(partially at least)
Enabling the trainer to give
advice and criticism based on
behaviour in a simulated
situation
Building trainee confidence
in dealing with similar reallife situations
•
i
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i
Putting trainees under pressure
in simulated situations and
giving them practice in coping
Helping trainees to sort out
their priorities
Developing an understanding of
the different kinds of action
we can take (adaptive,
corrective, interim, preventa
tive, contingency)
•
__ 1 ——-—
, J-IH"
! Programmed
|learning
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|Management
|games
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F1
Learning factual information
When trainees have to work at
their own pace, usually alone,
and probably at odd times
When trainees find reading too
passive, or when their atten
tion might wander
m,
(,,,
_____
•
__ ___ _—
___
1
Learning factual information
When trainees have to work at
their own pace, usually alone,
and probably at odd times
When trainees find reading too
passive, or when their atten
tion might wander
—mi— —-
|Individual
!study
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•
_______
I .it
.
■nr------------- ---
Giving supervisors practice in
... supervisory
---- ---dealing with
problems in practical ways
; Be, sure that the exercise and
| context are relevant to the
| kinds of priorities and
| pressures to which they are
! subject
J Optimum number: 10
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.... —
| Not suitable when group work
| is needed
| But programmed instruction
| can provide a useful prelude
| to group work
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| Not suitable when group work
i
| is needed
j But can provide a useful
| prelude to group work
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Appendix C
BRIEFING NOTES
r STRENGTHENING THE MANAGERIAL PERFORMANCE
OF HEALTH MANAGEMENT TEAMS
THREE-DAY EVALUATION WORKSHOP 26-28 NOVEMBER, 1984
TABLE OF CONTENTS
PAGE
1.
PURPOSE OF BRIEFING NOTES
1
2.
BACKGROUND
1
3.
OBJECTIVES OF THE WORKSHOP
2
4.
WORKING APPROACH
2
5.
AGENDA
3
6.
PARTICIPANTS
4
7.
VENUE
4
8.
DATES
4
9.
PREPARATORY WORK
4
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1
1.
PURPOSE OF THE BRIEFING NOTES
The purpose of these Briefing Notes is to provide some
information on the rationale for this forthcoming Evaluation
Workshop; the objectives of the workshop; working approach;
the agenda; participants; venue and workshop participants.
2.
BACKGROUND
The Ministry of Health is recently spending much effort on
imp1ementating the 'Integrated Rural Health and Family Planning'
(IRH & FP) project. As you know, one of the Project components
is 'Strengthening the Managerial Performance of Health Management
Teams (HMTs).' A two-pronged approach is being applied which
consists of: i. Innovative problem-preventing/solving tasks;
and ii. A series of training activities in health management.
The training which was carried out in 1983 and 1984 included a
series of three activities for the following HMTs:
Nyanza Province
Kisii, Kisumu, Nyanza Provincial General Hospital, Municipality
Kisumu, RHTC Chulaimbo
Workshop on problem-preventing/solving; planning, Kakamega,
4-13 May, 1983
Workshop on health management, Kisumu, 8-12 August 1983
Follow-up workshop, Kakamega, 1-3 February 1984
Homa Bay, MTC, Nyamira, Nyanza Provincial General Hospital,
Municipality Kisumu, Siaya
I
Workshop on problem-preventing/solving; planning, Kakamega,
8-17 June 1983
Workshop on health management, Kakamega, 5-9 September,
1983
Western Province (Alupe, Bungoma, Busia, Kakamega, MTC, Port
Victoria, RHTC Mbale)
Workshop on problem-preventing/solving; planning, Kakamega,
18-27 May 1983
Workshop on health management, Kakamega, 22-26 August 1983
I
Follow-up workshop, Eldoret, 7-9 February 1984
2
a
'■AM
3.
OBJECTIVES OF THE WORKSHOP
3.1
Evaluation Objectives
1
■■■Wil J
The main objectives of the workshop are:
a. To assess the adequacy of the two-pronged approach
of problem-preventing/solving tasks and a series of
training activities to strengthen the managerial
performance of HMTs;
b.
To assess the adequacy of the learning process and
the learning materials;
c.
To list innovative problem-preventing/solving
activities which have been carried out by the HMTs
and their members.
d.
To assess any changes in behaviour of the HMTs and
their members back on the job/
e.
To assess any impact - increased efficiency, improved
staff morale, patients’ satisfaction, better health
services;
f.
To suggest alternative strategies and actions to
strengthen the managerial performance of HMTs in
future.
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3.2
r
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Educational Objectives
■
In addition to the evaluation objectives the workshop has
the following educational objectives:
a.
At the end of the workshop, participants should:
-
b.
i.
Have strengthened their knowledge of and skills
in problem-solving;
ii.
Be able to manage their time more effectively.
i.
iiI-
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Upon returning to their working settings, participants
should:
'"if
Be able to apply the knowledge and skills they
have acquired in the workshop;
Be motivated to share their knowledge and skills5
with their colleagues and staff.
• :•
«
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■
4.
WORKING APPROACH
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During the forthcoming workshop the participants will be the
main actors. They are responsible for achieving the evaluation
objectives by working together both in groups and in plenary.
nlenarv.
The organizers of the workshop - the Provincial HMT and AMREF
will act as facilitators and provide guidance if necessary. •
The workshop will also provide an opportunity to discuss and
elaborate on creative approaches to problem-solving and1
'
effective time management.
■ FW
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5.
AGENDA
Session
Date
r
Monday
26.11.84
8.30
9.00
9.00 - 10.30
10.30
11.00
11.00
13.00
1.
Opening Session
2.
Adequacy of two-pronged
approach of problempreventing/solving and
training activities; and
learning process and
learning materials
Coffee Break
Continuation of session 2.
Luncheon
13.00 - 14. 1 r>
r
14. 15
16. 30
8. 15
10. 30
3.
Creative approaches to
problem-solving
4.
Innovative problem preventing/solving
activities; change in
behaviour; impact
t'
1
Tuesday
27.11.84
Coffee Break
10.30 - 11.00
Continuation of session 4.
11.30 - 13.00
Luncheon
13.00 - 14.15
14.15 - 16.30
5.
Effective time management
8.15- 10.30
6.
Alternative strategies and
actions to strengthen the
managerial performance of HMTs
M.
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Wednesday
28.11.84
Coffee Break
10.30 - 11.30
Continuation of session 6.
11.00 - 12.00
12.00 - 13.,'^0
B
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------------
7.
Closing session
4
6.
PARTICIPANTS
The workshop will be attended by some 32 participants from
Nyanza and Western Provinces: two representatives of each
HMT.
The selection of the workshop participants is most important.
The participants have to satisfy the following requirements:
7.
a.
Participants should have attended at least two of the
three workshops on problem-preventing/solving and
planning; health management; follow-up workshop;
b.
Participants should be interested in the effort to
strengthen the managerial performance of HMTs;
c.
Participants should have participated in some problempreventing/solving activities in their station;
d.
Participants should be ready to carry out several tasks
in preparation for the forthcoming workshop.
VENUE
Venue of the workshop is Golf Hotel, P.O. Box 118, Kakamega,
telephone 20460, which will provide the working and training
facilities and full board.
8.
DATES
The workshop will start on Monday, 26 November 1984 and end
on Wednesday 28th November 1984 after luncheon.
All participants are expected to arrive on Sundayy 25 November
1984 in the late afternoon.
All participants are responsible for their own travel
arrangements. If necessary, travel expenses will be
reimbursed during the workshop.
IMPORTANT;
9.
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PREPARATORY WORK
In preparation for the workshop the two participants of each
HMT will have to carry out together and in consultation with
other members of their team the following assignments:
-5-
Nature of assignment
Comments
a.
An assessment of the adequacy
of the two-pronged approach of
problem-preventing/solving and
training activities to
strengthen the managerial
performance of HMTs
approx. 0.5-1 page
b.
Assessment of the learning
process as applied during the
series of three workshops
approx. 1 page
c.
Illustrations of problempreventing/solving tasks
which have been carried out
at least 1 illustration,
preferably 2 illustrations.
For each illustration
approx. 1 page.
Illustration should be
structured as follows:
1.
2.
3.
4.
5.
6.
d.
c.
■
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Assessment of impact,
e.g. change in
behaviour of HMT,
individual members,
yourself; staff morale;
patients' satisfaction; better health
services; others
Alternative stategies
to strengthen the
managerial performance
of HMTs
Problem Statement
Underlying Cause(s)
Intervention
Status of implementing
Intervention
Impact
Constraints Met
approx. 1-2 pages
approx. 1-2 pages
Appendix g
RANK PROBLEMS IN ORDE1R OF PRIORITY
USING CRITERIA
STEP
NO.2
EVALUATION
CRITERIA
r
1.
2.
3.
4.
Frequency of Occurence
(Score high if frequent; low if
infrequent)
1
2
3
4
5
Severity of tie Problem
(Direct effect on management of
health service. Score high if
severe; lew if not severe)
1
2
3
4
5
Consequence s/ Implications
(If problem is not prevented or
solved. Score high if of great
conseqence; low if little)
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Is Problem Preventable/Solvable?
(Its vulnerability or feasibility.
Score high if resources telow are
avail able or not needed; lo.v if not
available)
i
Internal, ly:
(a) . Cost (money)
(b) . Technology (skills/knowledge)
(c) .
Facilities
1
2
3
ZL
5
(d) .
(e) .
Supplies
1
2
3
4
5
Transport
1
2
3
4
5
Authority
1
2
.3
3.
4
5
(f) .
(g) .
Actors (me/we)
2
1
5
4
Externally:
5.
(a) .
(b) .
Cost (money)
Technology (skills/knowledge)
1
2
3
4
5
1
2
3
4
5
(c) .
Facilities
1
2
3
4
5
(d) .
Supplies
1
2
3
4
5
(e) .
(f) .
(g) .
Transport
1
2
3
A
5
Authority
Actors (they)
1
1
.2
.2
3
3
4
4
5
5
1
2
3
4
5
Implementat ion
(Ease of implementation. Score liigh
if easy; low if Inrd)
.../cont’d
JU
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EVALUATION
CRITERIA
6.
Other:
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
CALCUATE TOTAL SCORE:
Add: All numbers
•Divide: By number of criteria used
Result: Average score for all criteria
Note re: Scoring Criteria:
This is an unweighted score.
In arriving at a final ranking, the DHMT
should consider the inpact of certain key criteria such as cost and
availability of resources. For exanple, no matter hew good (high) the
score, if the cost is prohibitive, or if there is no practical way to
obtain essential personnel, then you will want to give the recommendation
i
a lew rank.
It will help you to identify these key criteria by going back
over the list and drawing a line under them.
Use this score as a general guide only.
Compare the scores for the
different problems and the underlined criteria to help you in arriving at
a rational decision.
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- Media
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