Stages in Organizational Change (Part 2)

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From the course by Johns Hopkins University

Understanding and Strengthening Health Systems

36 ratings

Johns Hopkins University

Understanding and Strengthening Health Systems

36 ratings

Course 1 of 6 in the Specialization Foundations of Global Health

Welcome to our course on Understanding and Strengthening Health Systems for Global Health. During the course we will provide you with an overview of the main elements or building blocks of a health system based on the World Health Organization’s guidance. You will have the opportunity to explore four main areas of health systems in global health with particular reference to low and middle income countries. The first area focuses on understanding health service organizations, the challenges. Our second module looks at WHO’s six major building blocks or health systems components with particular reference to primary health care and the need for community participation in planning, delivery and assessment of these systems components. in our third module we examine the specific systems component of human resource development and capacity building. The fourth area consists of health policy making and advocacy with stakeholders. This course is geared toward learners who are already involved in managing health and development programs on the ground in low and middle income countries or who are preparing for such a management role. The main lectures will span a four-week period with approximately 2-4 hours of viewing learning materials per week. We have one peer graded essay wherein you will use skills in ‘organizational’ diagnosis to better understand a challenge in an organization where you are or have worked. There are also quizzes. We hope you will engage with your fellow learners in discussion forums to learn from each other.

From the lesson

Understanding Organizations and How They Change

Health Systems are human organizations. Organizations have structure, purpose and membership. To remain “Healthy” an organization must adapt to its environment, whether that be funding and policy changes or expectations of its clients. In this module we will focus on diagnosing factors related to the health of organizations and consider strategies to help organizations adapt.

Stages in Organizational Change (Part 1)9:42

Stages in Organizational Change (Part 2)6:27

Meet the Instructors

William Brieger, DrPH
Professor, Health Systems Program of the Department of International Health
Bloomberg School of Public Health

At this point, the organization or if a consultant is brought in,

a consultant together with the organization undertakes an organizational diagnosis.

Five major factors comprise an organizational diagnosis.

Just as we talked about community diagnosis and behavioral diagnosis,

we have organizational diagnosis.

Those five factors include the technical elements, the human element,

the environment which we've talked about a bit, space,

time coordinates and organizational policies.

Briefly, we'll look at each of the five components of an organizational diagnosis.

Technical factors include equipment,

the methods that are used to carry out the organizations function whether

it's laboratory tests or health education posters,

computer use, management information systems, management procedures,

everything from accounting of staff leave procedures,

issues in terms of wages, job descriptions,

quality, assessment of services,

costs of services, financial arrangements, contractual arrangements.

Again, the organization makes contracts with

other organizations in the environment that provide goods and services,

labor arrangements, issues of unions,

contracting again with employees,

specialized skill that are needed by the staff, administrative skills,

technical skills in terms of

epidemiological skills or surgical skills or education or nutritional skills,

and then also how the human resources are deployed.

The adequacy of staffing in different technical jobs.

The human element is concerned about individual personality

as well as the relationships among members of staff.

It looks at communication patterns,

formal communication within the organizational hierarchy,

informal communication among subgroups such as people

who may be from the same town or people who may be of the same profession,

they get together informally and discuss in

the organization's cafeteria issues of job satisfaction and motivation,

looking at the organizational culture, what are the norms,

the accepted behaviors and whether people keep to those,

and what things people value in terms of use of time,

in terms of their promotions.

Space-time coordinates are important especially as organizations get

larger and have branches in different parts of the district or town,

they may be large and have working shifts.

Some people maybe on morning,

some on afternoon and some on night duty,

and it's important also to consider time in terms of seasonalities.

Certain diseases like measles may be more common in the dry season.

Also so as Guinea worm.

And sequencing of activities to ensure that

preventive or treatment measures are in place at the right time and the right location.

Simple example of an immunization program,

we want to make sure that the vaccines are available at all the health outputs,

we want to make sure that people are notified before the vaccines come,

also want to make sure that people are not notified

so far in advance that if the vaccines don't come,

they won't be disappointed.

Sequencing in terms of training of people using

the cold chain properly making sure that equipment's available.

So all this issue of location and sequencing

of activities within the service area is very important.

The issue of decentralization becomes a central element for consideration here.

How much authority and responsibility are given

to the various substations and outreach components of the program.

Organizational policies are specifically the goals that the organization sets for itself,

what it aims to achieve.

These may be written down in terms of directives,

in terms of the bylaws that establish the organization.

There may be policy makers such as

advisory or management boards that actually from time to time set policies.

The policies may focus on issues such as personnel,

their working conditions, their terms of service,

resource management issues and policies that relate to the community,

who can use the service,

who is eligible for discounts,

for free services, relationships with other agencies,

collaborative agreements in terms of

inter agency committees in

the counties or local governments that involve health human services,

social services, transport, education such as that.

So, different kinds of statements by the organization,

in terms of what it hopes to achieve,

and then also statements that indicate how these things will be achieved.

Finally, we have our environmental factors and as indicated,

the organization functions within a community,

it functions within a region or locality,

and part of this broader environment is composed of laws and

regulations that may be passed by a county council or a state or national legislature.

There are community issues such as local culture and beliefs, acceptance of services,

gender issues that affect who can use services and when,

economic factors that would influence the ability of the organization to get resources,

the ability of people to pay for services.

Links again with the other sectors,

links with people who provide resources such as schools that train health workers,

such as companies that supply medicines and drugs.

So the environment, we're concerned about again the interface between

the organization and the community at large.

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