MANAGEMENT IN MEDICINE AND SURGERY
Reynaldo O. Joson, M.D.
Introduction
Management and manage are derived from the Latin word,
manus, meaning hand. Manage, therefore, literally means to
handle and management, the handling of.
In the study and practice of medicine and surgery, and in
life and in other professions for that matter, we cannot avoid
encountering situations, problems, and people which and whom we
have to handle or manage. Likewise, we cannot avoid being given
assignments and responsibilities to handle or manage.
Furthermore, we cannot avoid initiating tasks and projects to
satisfy our id, ego, and superego and which, again, we have to
handle or manage.
In the study and practice of medicine and surgery, if we
look at the competencies expected of a physician-general surgeon,
which are to be able to:
1. solve the surgical health problems of a community;
2. be an effective, efficient, and humane physician-
general surgeon in managing patients;
3. be self-directed in continuing surgical education;
4. be an effective and efficient administrator of a
health care unit;
5. conduct surgical health research;
6. conduct surgical health education; and
7. pass the Philippine Board of Surgery examination;
all of them involve management.
Thus, a very basic competency that all physicia-general
surgeons must have is management.
Whether it be management of self (time, ambition); people
(patients, people in an organization or community); projects
(education, research, health care unit, passing the board
examination); and situations and problems, the basic management
processes and principles are the same.
Please take a look at the table below which illustrates the
universal application of management.
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Application of Management
Self
Time
Ambition
Project Health Management
Education Community Health
Research Health Situations Family Health
Health Care Unit Health Problems Individual Health
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Situational Analysis Situational Analysis Situational Analysis
Diagnosis Problem Identification Diagnosis
Diagnosis
Objective Setting Objective Setting Objective Setting
Strategy/Program Strategy/Program Strategy/Program
Implementation Implementation Implementation
Evaluation Evaluation Evaluation
Improving Improving Improving
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PLANNING - IMPLEMENTING - EVALUATION - IMPROVING
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PLANNING - ORGANIZING - STAFFING - LEADING - CONTROLLING -
EVALUATION - IMPROVING
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The only adjustment that you have to make is whether you are
managing
- your own self;
- another individual person (say a patient);
- a group of people (say in a community or an
organization); or
- a project that involves people.
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In managing a group of people or a project that involves
people, the seven processes or functions of management will be
utilized, namely: planning, organizing, staffing, leading,
controlling, evaluating, and improving.
Otherwise, you can just use planning, implementing,
evaluation, and improving.
Below are some definitions of terms used in management as
gotten from the book of Harold Koontz and Heinz Weihrich,
entitled "Management", 9th edition (1989): (Note: this book is
more on the management of people.)
MANAGEMENT - The process of designing and maintaining an
environment in which individuals working together in
groups accomplish efficiently selected aims.
PLANNING - Selecting missions and objectives - and the
strategies, policies, programs, and procedures for
achieving them; decision making; the selection of a
course of action from among alternatives.
OBJECTIVES or GOALS - The ends toward which activity is
aimed - the end points of planning.
EFFECTIVENESS - The achievement of objectives; the
achievement of desired effects.
EFFICIENCY - The achievement of the ends with the least
amount of resources; the accomplishment of objectives
at the least cost or other unsought consequences.
STRATEGIES - General programs of action and deployment of
resources to attain comprehensive objectives.
ORGANIZING - Establishing an intentional structure of roles
for people to fill in an organization.
STAFFING - Filling, and keeping filled, the positions in the
organization structure with competent people. This is
done through (1) defining work-force requirement; (2)
inventorying the people available; (3) recruiting; (4)
selecting candidates for positions; (5) placing
candidates; (6) promoting; (7) appraising; (8) planning
the career of; (9) compensating; and (10) training or
otherwise developing people.
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LEADING - The function of managers involving the process of
influencing people so that they will contribute to
organization and group goals.
CONTROLLING - The managerial function of measuring and
correcting performance of activities of subordinates in
order to assure that enterprise objectives and plans
are being accomplished.
Below is a management framework that I suggest we use:
Goal
M.D.
Self |
Patient |
Student v
Project -----------------------------------> "Specified
Problem Goal"
Situation
Health care unit
Planning
Situational analysis
Specific objectives
Strategies
Working alone Working with people
Organizing
Staffing
Leading
Controlling
Methods of evaluation and
evaluation indicators
Implementing
Using the strategies formulated in the plan
Evaluating
General parameter:
Achievement of objectives and goal
in the most effective and efficient way
possible
Improving
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