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


Dr. Muhamad Saiful Bahri Yusoff
MD, MScMEd






1
Content


INTRODUCTION TO ORGANIZATION AND MANAGEMENT .......................2
EDUCATIONAL MANAGEMENT INFLUENTIAL THEORIES........................8
MANAGERIAL DECISION MAKING ..........................................................16
CONTROLLING & MONITORING..............................................................20
ORGANIZATION & MANAGEMENT OF CLASSROOM...............................26
LEARNING ORGANIZATION.....................................................................30
PLANNING ................................................................................................34
LEADING & INFLUENCING ......................................................................43
HUMAN RESOURCE MANAGEMENT........................................................51
ENVIRONMENT & CORPORATE CULTURE .............................................68
QUALITY ASSURANCE IN HIGHER EDUCATION.....................................72
























2
INTRODUCTION TO ORGANIZATION AND MANAGEMENT


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

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

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

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

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

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

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

5. Management Models
• Management by objectives, MBO












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

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

• Total Quality Management, TQM (Edward Deming)


















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



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

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

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

• Study – study the result or check

• Act – take action to standardized or
improve the process


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
















8
EDUCATIONAL MANAGEMENT INFLUENTIAL THEORIES


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

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

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

11
throw a football, because they can tell by the feel of the act what
the result will produce.
ƒ Adaptation: Skills are well developed and the individual can
modify movement patterns fit special requirement.
ƒ Origination: Creating new movement patterns to fit a particular
situation or specific problem. Learning outcomes emphasize
creativity based upon highly developed skills.

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

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

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

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

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

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







• The use of 6 thinking hats
o Encourage parallel thinking
- White: objective &
factual

- Yellow: merits &
strenghts

- Green: creativity &
growth
- Red: emotion &
intuitive

- Black: demerits &
weaknesses

- Blue: open sky &
overall consideration

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o Encourage full-spectrum thinking
o Separate ego from performance

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













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

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











































16
MANAGERIAL DECISION MAKING


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

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

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

4. Perception affect on decision making





Problems/Agenda Building
Decision
Outcome
PERCEPTION

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

6. Decision making methods
• Weighted pros and cons
o E.g. decision option: should I buy a new car?
Pros
Cons
Comfort (3)
Lower fuel (3)
Better for family use (4)
It will be a load of my mind (5)
Better reliability (2)

Total score = 20
Cost outlay will mean making
sacrifices (5)
Higher insurance (3)
Time and hassle to choose it (2)
Sale or disposal of old car (2)
Scare and upset me (4)
Total score = 16


7. Determine importance of decision by priority matrix:

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

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

9. Problem identification and verification



A
B
C
D
Urgent
Not so urgent
Important
Not so Important

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10. Criteria identification
• Example equipment purchase


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

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

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

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CONTROLLING & MONITORING


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

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

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

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


5. Project Control System

21


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

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


• Listing activities

22


• In figure:




23



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


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

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


Example Gantt Chart with dependence


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

25
practices, philosophies, and performance measure against those of
high-performing organizations anywhere in the world.
• “Improving ourselves by learning from other.”
• Benchmarking is simply about making comparisons with other
organizations and then learning the lessons that those comparisons
throw up.” (source: The European Benchmarking Code of Conduct)
• “Benchmarking is the continuous process of measuring products,
services and practices against the toughest competitors or those
companies recognized as industry leaders (best in class).” (source:
The Xeror Corporation)

































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ORGANIZATION & MANAGEMENT OF CLASSROOM

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























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

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

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

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











• Gaining attention:
o Be friendly to students
o Display enthusiasm
o Be focused on learning
o Provoke curiosity
Instructional Event

Internal Mental Process
1. Gain attention
Stimuli activates receptors
2. Inform learners of objectives
Creates level of expectation for learning
3. Stimulate recall of prior learning
Retrieval and activation of short-term
memory
4. Present the content
Selective perception of content
5. Provide "learning guidance"
Semantic encoding for storage long-term
memory
6. Elicit performance (practice)
Responds to questions to enhance
encoding and verification
7. Provide feedback
Reinforcement and assessment of
correct performance
8. Assess performance
Retrieval and reinforcement of content
as final evaluation
9. Enhance retention a d transfer to the
job
Retrieval and generalization of learned
skill to new situation

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

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



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





















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LEARNING ORGANIZATION


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

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

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

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

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

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

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

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

Items
Definition
Typical example




Strength


Any internal asset (know-how, motivation,
technology, finance business link) which
will help to meet demands and to fight of
threats

Key questions:
- What are we good at?
- How are we doing competitively?
- What are our resources?
- Well trained man-
power
- Well established
knowledge base
- Good contact to target
group
- Technology, etc


Weakness


Internal deficits hindering the organization
in meeting demands

Key questions:
- What are we doing badly?
- What annoys our customers most?
- Lack of transport
- Low reputation
- Problems in
distribution of services
or products
- Lack of motivation


Opportunity


Any external circumstances or trend that
favors the demand for an organization’s
specific competence

Key questions:
- What changes of demand do you expect to
see over the next years?
- Increasing purchasing
power
- Development of new
markets for high quality
products
- New technologies that
favor our product


Threat


Any external circumstances or trend which
will decrease the demand for the
organization’s competence
Key questions:
- What do other people do that we don’t do?
- What future changes will affect our
organization?
- Establishment of
strong competitors
- Lack of cash at
household level.
- Governmental
regulation that limit
distribution of our
products


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

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






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PLANNING


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

























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

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

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

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



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

37
ƒ What do you do badly?
ƒ What should you avoid?
ƒ What could you improve?
ƒ What do other people see as your weaknesses?
ƒ Consider form internal and external basis
• What other perceive as your weaknesses
o Opportunities
ƒ Opportunities within the system?
ƒ Favourable trends?
• Changes in technology
• Changes in government policy
• Local events
• Changes in population profiles
ƒ Consider opportunities based on strengths
o Threats
ƒ
What obstacle do you face?
ƒ Do you have cash flow problems?
ƒ Are specifications to your jobs changing?
ƒ Changes in policies?
ƒ Are there risks involved? Æ risk analysis
ƒ Risks analysis
• Definition
o To assess risk
o To determine measures to be taken to minimize disruption
to plans
o To determine strategies to control risks
o Risk = perceived extend of possible loss
o Risk = probability of event x cost of event
• Identify risks/threats
o Human – transfer, illness
o Procedural – system failures
o Nature – floods, epidemic
o Technical – tech failure

38
o Political – regime change
o Financial – reduced budget
• Estimate risks
o Assess likelihood of threat being realized
o Assess possible impact
o Probability x cost project
• Manage risks
o Using available resources
o Contingency planning
o Investing in new resources
• Review risk management
o Post mortem of risk analysis and management exercise
o Test systems and plans
• PEST analysis (external environmental screening)
o Political
ƒ Government policies
ƒ Employment laws
ƒ Environmental regulations
ƒ Political stability
• Local political figure
o Economic
ƒ Budget cuts
ƒ Budget policies
ƒ Economic slowdown
• Cutting down economic deficit
o Social
ƒ Demands
• Demand for short services waiting times
• Accountability in service
ƒ Community demand via media
ƒ Population migration
ƒ Emphasis on safety
ƒ Population growth rate

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• Force-Field analysis













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


6. Establish objectives for processes/tasks













40
7. Communicate plan documents
• A leader is as good as he communicates
• Communication
o Who – to communicate to
o Where – to communicate
o When – to communicate
o What – to communicate
o How – to communicate
• Selling the project plan to different groups – accreditation
o Doctors & specialist
ƒ We Doctors deserve to work in
• A quality environment
• Using dependable equipment
• Assisted by personnel proficient in their jobs
• To achieve this, our roles are…
o Middle managers
ƒ Easier management through guidelines, procedures, protocols
ƒ Not dictated by personal whims and fancies of seniors
ƒ Objective assessment
ƒ Clear goals for achievement
ƒ And our roles for accreditation are…
o Support groups
• When communicating an idea
o Do it everywhere
o As often as possible
o People remember most what they are most often reminded to do.

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

41
o Monitor agreed milestones for progress
o Feedback – positive/negative
o Emphasis on what could be done to improve

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

10. Input for Planning




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


42
ƒ Prioritization
o Allocation of funds
ƒ Monitoring expenditure
ƒ Final accounts
• Machine
o Equipment
ƒ Accessible
ƒ Functioning
ƒ Fit for the purpose
o Materials
ƒ Appropriate quality
ƒ Sufficient quantity
• Method
o Processes
ƒ Processes adopted, technology employed, system used
o Systems
ƒ Procedure adopted to ensure conversion process (input > output)
proceeds efficiently
• Environment]
o Refer to the PEST analysis




















43
LEADING & INFLUENCING

1. Leadership definition
• Leadership is the ability to influence a group toward the achievement of
goals – Stephen P. Robins, Organizational Behavior –
2. Leadership vs. Management
• Managers adopt interpersonal attitudes toward goals.
• Leaders adopt a personal and active attitude towards goals.
Abraham Zaleznik, Harvard Business School
• Management copes with complexity, bringing about order
• Leadership copes with change. Leaders develop a vision and establish
direction. They then communicate this vision and inspire followers to
overcome hurdles.
John Kotter, Harvard Business School
3. Leadership theories
• Traits theories
• Behavioral theories
o Ohio state studies
o University of Michigan studies
o The Managerial Grid
o Scandinavia studies
• Contingency Theories
o Fieldler Model
o Hershey and Blanchard’s situational model
o Leader-Member exchange theory
o Path-goal theory
o Leader-participation model
• Attribution theory
• Charismatic theory
3. Traits Theory
• Personality, social, physical or intellectual traits that differentiated
leaders from non-leaders
o Ambition and energy

44
o Desire to lead
o Honesty and integrity
o Self-confidence
o Intelligence and
o Job-related knowledge
o …Born Leaders Æ Margaret Thatcher – charismatic, enthusiastic,
courage.
4. Behavioral Theories


























45
• Theories proposing that specific behaviors differentiated leaders from
non-leaders
o Ohio state studies
o University of Michigan studies
o The Managerial Grid
o Scandinavian studies
o … Leaders can be trained Æ Florence Nightingale
• Leadership style related to situation
o In time of crisis
o In times of peace
















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



46

































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

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


47
6. Critical Factors for Effective Leadership
• Direction setting
o Vision
ƒ A dream for a better organization
• “I prefer to be a dreamer among the humblest, with vision to
be realized, than lord among those without dreams and
desires.” – Kahlil Gibran –
• Martin Luther King, “I have a dream…”
ƒ Visualize in clear term
• “Make sure you visualize what you really want, not what
someone else wants for you.” – Jerry Gillies –
ƒ Loves for the cause
• Nelson Mandela, “If one is to become a leader, one will have to
be in love with ‘the cause’.”
ƒ Clear and focused regarding goals
ƒ Have a plan
• “A good idea is worth a dollar. The plan for implementing is
worth a million dollars.”
• Clear instruction to the staff
• Speak often about this plan at various forums
• Hallway chats
ƒ Be involved directly in the implementation











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• Authority
o Sphere of influence


















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

49
ƒ
‘Maternal Mortality for HKB in 2002 was 9. We must improve this
indicators
ƒ Better way “In 2002, there was 36 children who lost their mothers
through childbirth in Hospital Kota Bharu. We Shall Stop This!!!”
o Marketing skills
ƒ Selling quality to different groups
• Doctors and Specialist
• Paramedic staff
• Support groups
• Task competence
o Knowledge of core business
o Knowledge of related quality activity
ƒ “You cannot support what you do not understand.”
• Diligence
o “There are no office hours for leader.” – Cardinal J. Gibbons –
• Risk taking
o Be willing to look foolish
ƒ Be less concerned with thought such as ‘what will the neighbours
think?’
ƒ “I’m going to build a billion-dollar empire based on a mouse, a
fairy and seven dwarfs. Will you help me?” – Walt Disney –
o The will to get the job done – every problem, a challenge.
ƒ “When you see a problem coming down the road, holler ‘Hello
Problem!’ where have you been? I’ve been training for you all my
life!” – Dr. Norman Vincent Peale –
• People management skills
o Emotional Intelligence (EQ)








50
o Request noble things
ƒ Taxes vs. Donation Æ Donations fund more than taxes fund
o Clearly define work related benefits













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






51
HUMAN RESOURCE MANAGEMENT


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

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










52
3. Recruitment and Selection:
• Recruitment is the process of attracting individuals
o On a timely basis
o In sufficient numbers
o With appropriate qualifications to apply for jobs with an organization
• Recruitment process












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

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



54
• Selection is the process of choosing from group of applicants, the
individual best suited for a particular position
• Selection process









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






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


55
• The employment interview
o Content
ƒ Academic achievement
ƒ Occupational experience
ƒ Personal qualities skills
o Types of interviews
ƒ Structured
• Questions related to worker requirements, job knowledge
• Consistent
ƒ Unstructured
• Open-ended questions, time consuming
o Methods of interviewing
ƒ Group interview
ƒ Board interview
• Personal references checks/ background investigation
o Reference checks
ƒ From previous employers
ƒ Data obtained not objective
ƒ Investigations of previous employment provide better picture
o Background information
ƒ Issues: privacy act
ƒ Applicant to sign waiver to allow employer to contact references
• Selection decision
o Human Resource Manager or supervisor
o Decision best made by one directly responsible for the worker

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

56
o Diplomatic feedback
ƒ “There does not appear to be a proper match between your
qualification and our needs.”
o Deeper into process, greater the trauma

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

57
ƒ …lack of external controls such as training boards which
recognized training activities in organizations.
ƒ …drop in staff turnover, which drastically reduced initial training
and induction.
ƒ …lack of commitment towards training especially on the part of
personnel managers.
• Successful companies
o Xerox
ƒ …over 300 million a year spent on training and retraining its
employees
o Motorola, Federal Express, Corning and Singapore Airlines
ƒ 3% of payroll cost on training
• Training and Development objectives
o To increase productivity
o To prevent obsolence (declination) of skill at all level of the
organization
• Matter must be considered in training and development
o Identify training needs
ƒ For different groups of employee
o Develop training objectives
ƒ Organizational goals
o Match trainees with resources available for training
o Methods of training
o Conducting training
o Evaluation of training
• Identifying training needs
o Based on request
o Job performance
o Organizational change
o Technological development
o Career development
o Credentialing and privileging
• Types of organizational training

58
o Management skills
o Computer skills
o Communication skills
o Technical skills
o Customer relations
o Labor relations
o Sales skills
o Secretarial skills
o New methods/procedures
• Training methods
o Conference
ƒ Lectures and discussion
ƒ Used by companies and universities
ƒ In house – university
ƒ Expert Æ professional conference (according to the needs) Æ
conference
o Lectures
ƒ Most common method
ƒ Classroom style teaching
ƒ Audience usually homogenous
ƒ In-house and invited lectures
ƒ Part of continuous professional education
ƒ Integral part of short and long courses
o Group discussion
ƒ Forum an important training method
ƒ Members interact with one another
ƒ Share experiences and update
ƒ Especially useful when facilitated by senior staff
o Simulation
ƒ An approach that uses a training set up that is identical to a live
setting
ƒ Vestibule training used by pilots in a mock-up cook-pit is a type
of stimulation training

59
ƒ CPR
• The correct technique in applying pressure in Cardiac Arrest is
important, in order to achieve optimum results, without
injuring the rib cage
ƒ Light indicators for correct technique
ƒ Uses in Emergency Medicine
• Disaster drills
o Training is provided to staff on action to be taken, in the
event of a disaster e.g. plane crash or a natural disaster
involving a large number of victims needing medical
assistance
o In collaboration with:
ƒ Police
ƒ Fire brigade
ƒ The army
ƒ The Red Crescent
ƒ St. John’s Ambulance
ƒ HUSM
o E.g. of a scenario
ƒ A crash is simulated with victims at crash site.
• Students nurses role play the part of victims are
triaged (screened)
• Vehicles in the form of ambulances and helicopters
and public vehicles from various agencies rush to the
site and ferry patients to various hospitals.
ƒ At the hospital
• In-house disaster drill is set in motion
• All relevant departments on alert
• Operations and media rooms set up
• Warts and spaces cleared for management of survivor
of the crash
o Apprenticeship

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

61
• Shorten periods of institution based learning
• Provides JIT medical knowledge and practice guidelines at
point of care
• Electronic textbooks, local and international databases,
electronic medical journal, linkages to medical/health
websites, etc.
• Training methods should match
o The organization
o Staff
ƒ Category
ƒ Skill level
o Available resources


Training Methods
Manager
Technical staff
Conference
O

Job rotation

O
Lectures
O
O
Simulation

O
Apprenticeship

O
On the job training

O
Computer based training
O
O
Group discussion
O
O


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

62

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

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

63
o The appraisal interview
o Legal implication
• Uses of performance appraisal
o Human Resource Planning
ƒ For placement based on ability identified
ƒ Staff with potential for consideration for promotion
o Recruitment and selection
ƒ Based on favorable appraisal reports
ƒ Used as reference
o Human resource development and career planning
ƒ Identification of training needs
• Computer skills
• Course of disciplinary procedures for managers
• Subspecialty training for specialist
ƒ To assess employee potential for activities
• Specialist for quality activities
o Compensation program
ƒ Excellence in service cash award
o Internal employee relation
ƒ Basis for
• Promotion
• Transfers
• Counseling
• Termination
• Process of performance appraisal
o Identify goals
ƒ Organization wide
ƒ Department wide
ƒ Individual
o Establish job expectation
ƒ Sasaran kerja tahunan
o Examine work performance

64
ƒ Documented proof of achievement
ƒ Evidence based
o Appraise performance
o Discuss appraisal with employee
• Responsibility for Performance Appraisal
o Immediate supervisor
ƒ Able to observe daily activities
ƒ Responsible for output of unit
o Subordinate
ƒ Evaluate the effectiveness of the superior
ƒ Popularity
ƒ Anonymity
o Peer appraisal
ƒ Participative culture
ƒ Selection of excellence award candidates
o Group appraisal
ƒ Assessing subordinates as a team
ƒ Senior staff providing feedback on staff performance
ƒ Improve disciplines
ƒ Vertical job enrichment for senior officer
o Self-appraisal
ƒ Staff appraise himself and discusses with superior ob gaps in
evaluation
ƒ Self-evaluation in accreditation of hospitals
o Combination
ƒ Peer appraisal + group appraisal
ƒ Self-appraisal + group appraisal
ƒ Subordinate appraisal + superior appraisal
• Appraisal Period
o Annually
o Six monthly
ƒ Revision of target
o Four monthly

65
ƒ Housemen
ƒ Attachment
• Appraisal Method
o Rating scale
ƒ Judgement of performance recorded on a scale (5-7).
(outstanding, average, unsatisfactory)
ƒ Job related factors and personal characteristics for evaluation
ƒ Popular – simple, allow for quick assessment
o Critical incident methods
ƒ Good event write up
ƒ Unfavorable event write up
ƒ Used along with other records for assessment
o Essay
ƒ Difficult to assess
ƒ Used as reference. Self appraisal + Group appraisal
ƒ Subordinate appraisal + superior Appraisal
o Work standard
ƒ Assesses performance of staff against a predetermined standard
• Record officer: % medical reports made available within one
month of application
o Ranking
ƒ Numerical
ƒ Best… worst
o Forced distribution
ƒ Based on normal frequency distribution
o MBO – management by objective
ƒ Set objectives
ƒ Monitor performance
ƒ Keep communication channels open
ƒ Discuss achievement and issues at appraisal meeting
o BARS – behavioral anchored rating scale
ƒ Set statements to define performance with different weight given
to each statement

66
ƒ Assessment factor: ability to absorb and interpret policies
ƒ For example:









• Problem related to performance appraisal
o Halo error
ƒ High or low ratings based on a single criterion
• Sensitivity to personal characteristics
o Leniency/strictness
ƒ Too generous – undeserved high ratings
ƒ Too strict/critical
o Central tendency
ƒ Playing safe
ƒ Avoiding high/low rating which require explanations
o Lack of objectivity
ƒ Personal characteristics
ƒ Poor goal setting
ƒ Poor job related performance indicators
o Personal bias
ƒ Assessment based on own rating by assessor’s supervisor
ƒ Bias toward staff
o Recent behavior bias
ƒ Based on events/behavior during immediate period before
assessment
• Characteristics of effective appraisal
o Job related criteria
1. This officer could serve as an information source for other in
the department concerning USM policies and procedure Æ 10

2. …….. Æ 8

3. …….. Æ 6

4. ……. Æ 4

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

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




























68
ENVIRONMENT & CORPORATE CULTURE


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

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


69
3. Assessing Corporate Culture
• Understanding and assessing your organization’s culture can mean the
difference between success and failure
• Around here what is really important?
• Around here who get promoted?
• Around here what behaviors get rewarded?
• Around here who fits in and who doesn’t?
• “Hail the Chief”!
• “The lower the rung, the greater the flak” – blame and fault-finding –
• Why assess culture?
o To analyse the gap between the current and desired culture
o To maximize its ability to attain its strategic objectives
o To understand if the prevailing culture supports and drives the
actions necessary to achieve its strategic goals
o You may need to change some of its practices and secondary values
while keeping a few precious and non-negotiable core values intact.

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

70
o Slogans
o Clothing
o Logos
o Brochures

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

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

71
• Corporate Culture in Kementerian Kesihatan Malaysia
o Professionalism
• Appearance
• Conduct
• Knowledge
• Working in a quality environment
• Performance
o Teamwork
• Horizontal team – with colleagues
• Vertical team –with superior (boss) and subordinate
o Caring service
• External clients
• Hotline/pusat informasi
• Suggestion box
• Walk-in compliant system
• Incident reporting
• Siaran mesra
• Tabung kebajikan pesakit
• Handling patient
• Bedside manner
• Teaching self-reliance
• Health education
• Managing relatives
• Dignity of patient
• Decorum
• Privacy
• Respect

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


72
QUALITY ASSURANCE IN HIGHER EDUCATION


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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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