Study Guide: Pharmacy Administration And Practice

Pharmacy Administration and Practice 2

Study guide P

erformance Management

for the continuous improvement of People & Organizations

Performance Management

Organizations 1: Organizations - their Structure and Environment 2: Ownership of organizations

Management and Leadership 3: Managing organizations successfully

Strategic Management 4: Formulating strategy 5: Implementing strategy 6: Operational Management
Planning Organizing Leading Controlling

Billy Futter
Grahamstown
(Copyright 2006

1 The following are descriptions of why organizations usually fail. Which is not an accurate description of reason? 1. Identity crisis – lack of understanding of its purpose, mission, core competencies. 2. Failure of vision – an aversion to risk taking and grasping opportunities. 3. Unfit for the big squeeze – lack of finances when problems arise. 4. The Glue sticks, and sticks – inefficient managers and staff (resistance to change) 5. Anybody out there? – lack of marketing research on customer preferences. 6. Enemies within – poor employee relations

2. Good performance is a function of the interaction of 4 variables expressed in the following equation P= f(A, W, E, O). Name these variables.

3. Complete the Performance Improvement Framework showing the 4 variables & key words

4. Ability can best be described as: 1. The capacity to perform a task 2. The knowledge a person has 3. The combination of skills and knowledge that would be needed to perform a task 4. The capacity to do something and aptitude to integrate new knowledge 5. The process of learning that results in improved performance

5. Willingness can be best described as 1. The desire to perform a task 2. The enthusiasm displayed by a person who is required to perform a task 3. The ability to sustain enthusiasm for performing the task 4. The level of responsiveness to incentives offered 5. The sustained commitment in the face of difficulties

6. Clear expectations can best be described as: 1. Clear understanding of the organization’s objectives and criteria for measuring its performance 2. Appreciation of the criteria used to measure and evaluate individual and organizational performance relative to its objectives 3. Appreciation of the organization’s SWOT analysis and the role that each person will play in responding to this analysis. 4. Clear understanding of what and how the organization will pursue its objectives and insight into the criteria to be used to measure his / her performance 5. Knows exactly what she/ he has to do.

7. Performance Opportunities can best be described as: 1. Sufficient resources to perform in accordance with expectations. 2. Identified as a result of a SWOT analysis, decisions on strategies depend upon a Cross Impact Analysis 3. The authority to use scarce resources such as time, money & equipment to perform a task 4. Enough resources to perform a task 5. A chance to show what you can do your best

8. Complete the diagram showing the process and structures linked to performance improvement.

2. Organizations in Pharmacy Their Structure & Environment

Educational Objectives

The objectives of this unit are to give learners the opportunity to gain insight into:
1. The different ways of studying pharmacy.
2. The need to integrate the different perspectives in order to achieve a holistic view of the profession
3. The health system, the major role players, the statutory, professional, industrial and commercial organizations which participate in the health system
4. Organizations as entities, since all pharmacists work in one form of organization or another
5. The ownership of organizations as distinct from the management of organizations
6. The different forms of business ownership available for pharmacists who want to create their own organizations or become owners of existing businesses, with others, or on their own.

Learning Outcomes

At the conclusion of this unit, a learner should be able to:
1. Describe the different approaches to studying pharmacy & discuss the need for an integrated approach
2. Identify the statutory, professional, industrial and commercial organizations which form part of the health system
3. Describe the major features of an organization and the environment in which it operates
4. Explain the differences between ownership and management of an organization
5. Describe the characteristics of four forms of business ownership; namely sole proprietorship, partnership, company and close corporation.
6. Compare and contrast these different forms of ownership and assess their suitability for pharmacists seeking to become business owners.
7. Discuss the concept of ownership of pharmacies by pharmacists

The Health System and the major role players involved

Explain the following terms

PSSA, SAAHIP, SAPSF, RUPSA
Pharmacy Council
Private and public sectors
4. The National Drug Policy 1996
5. The Pharmacy Act
6. Systems
6. Open and Closed systems

Complete the following tasks

1. Discuss the seven different approaches that could be used to studying pharmacy. Which, if any, is the most important approach? Give reasons for your choice 2. Describe the major features of an organization. 3. What is the significance of investigating the practice of pharmacy as an open system? 1. List the major statutory organizations that make up the health care system in South Africa. 2. Briefly explain the difference between the roles of the SAPC and the PSSA. 3. What are the names of the professional organizations that represent the pharmacists in hospitals and pharmacists in academic research.? 4. List the all stakeholders who have a stake in the practice of pharmacy and identify their specific goals i.e. what do they expect pharmacists and pharmacy organizations to deliver? 5. Complete the following diagram which represents an open systems model of organization management.

3. Ownership of Organizations - Options for Pharmacists

Explain the following terms:

1. A business enterprise
2. Forms of business ownership
3. Sole proprietor
4. Partnership
5. Private and public companies
6.
7. Close corporation
8.
Limited liability
9. Utmost good faith
10. Legal persona
11. Perpetual succession
12.
Complete the following tasks

1. Explain the three problems that gave rise to the evolution of different forms of ownership?
2. Explain what is meant by the phrases (personally and fully liable(, (joint and several liability( and (limited liability( when discussing different forms of ownership?
3. In what way is lack of continuity a problem with sole proprietors and partnership and how is this problem overcome with close corporations?
1. In what way has the introduction of the Close Corporation altered the personal risk of ownership when compared with the personal risk of partners?
2. What is the meaning of utmost good faith in the context of a partnership?
3. To what extent is utmost good faith required in a Close Corporation and how might this influence the success of this form of ownership?
4. Why is a partnership automatically terminated when there is a change in membership?
5. Compare the different forms of business ownership using the following chart. When you have finished, decide which form of ownership is most appropriate for a community pharmacy, a pharmacotherapy consultant, a pharmaceutical manufacturing organization and explain the reasons for your
choice.

| | | | | |
|Characteristic |Sole Proprietor |Partnership |Company |Close Corporation |
| | | | | |
|Flexibility, speed of response to | | | | |
|change | | | | |
| | | | | |
|Decision making formality | | | | |
| | | | | |
|Ease of Formation | | | | |
| | | | | |
|Personal liability/ risk | | | | |
| | | | | |
|Continuity of business | | | | |
| | | | | |
|Complexity of administration | | | | |
| | | | | |
|Freedom to specialize | | | | |
| | | | | |
|Ease of access to capital | | | | |
| | | | | |
|Expense of administration | | | | |
| | | | | |
|Ease of formation | | | | |
| | | | | |
|Tax advantages | | | | |

Discussion points

1. An important characteristic of a profession is that its members are able to make decisions without being influenced by others who are not bound to a professional code of ethics and whose decisions may be primarily driven by commercial considerations. Prepare a list of reasons for and against the opening up of ownership of community pharmacies to non-pharmacists.
2. It has been forecast that successful community pharmacies of the future will be much larger, more efficient and run on scientific business principles. Discuss the implications this is likely to have for the form of business ownership adopted in the future.
3. How would the choice of ownership form influence the ability of the pharmacist to practice comprehensive pharmaceutical care?

Previous exam questions on Forms of Business Ownership

1.
Discuss the evolution of the different forms of business ownership with particular reference to their impact on the personal & business risk of owners and the financial needs of the business.
2. You have been offered the opportunity of a partnership with your employers. The senior partner intends retiring within 2 years and expects you to take over the management of the pharmacy. You are keen to pursue the option provided the partnership is converted to a close corporation. Write a letter to the partners which convincingly motivates the arguments in favour of this form of ownership.
3. You are the junior member of a retail pharmacy partnership. You plan to convince your two older colleagues that the partnership should be dissolved and a close corporation formed in its place. What arguments would you use to obtain their support? How would you attempt to overcome their possible resistance to this change?
4. Compare and contrast a partnership and a close corporation as effective forms of business ownership for pharmacists in a turbulent
environment.
5. You and your partner have decided to form a close corporation with three other pharmacists who run their own businesses. In addition to the benefits of a close corporation, it is hoped that the amalgamation of the four pharmacies will reduce fixed costs and fend off the impact of dispensing doctors and recessionary conditions. You have been allocated the task of explaining this change to the staff. a) Draw up a memorandum to distribute to the staff in the pharmacies explaining the changes and attempting to allay fears that these changes may result in staff being dismissed. b) What principles would you observe in implementing these changes?
6. "The days of the one man pharmacy business are over. Success will belong to those pharmacies which are larger, more efficient and run on scientific business principles." Critically evaluate this statement with particular reference to the alternative forms of business ownership available to pharmacists.

Multiple Choice Questions

1. Which of the following statements is not true 1. All shareholders have equal say in the management of a close corporation 2. A partnership must be terminated if utmost good faith is lost 3. Perpetual succession in close corporation follows from its status as a legal persona 4. A close corporation may be formed by one person 5. Profits and losses in a partnership are shared in proportion to the contributions of the partners

1. Which of the following statements is not true? 1. A close corporation is limited to 10 members who must be natural persons 2. A partnership may be terminated if a partner dies 3. A sole proprietor has unlimited liability 4. A partnership has no legal persona status 5. All members of a close corporation retail pharmacy must be registered pharmacists

2. Which of the following statements is not true? 1. A close corporation is limited to ten members who must be natural persons 2. A partnership must have a written agreement in which the percentage contributions of each partner are stated. 3. A sole proprietor has unlimited liability 4. A partnership does not have perpetual succession 5. All members of a close corporation must be registered pharmacists, if it carries out the business of a community pharmacy

3. Limited liability for a close corporation means that: 1. There is a limit to the liability of the corporation for its debts 2. Its borrowing powers are limited 3. Members & not shareholders become liable for debts of the corporation if it goes insolvent 4. The members are not liable for the debts of the corporation beyond their original capital input 5. The members have equal say in the management of the corporation

4. Perpetual succession of a close corporation means that: 1. The business continues to exist, except in the event of insolvency of a member 2. If a member of a retail pharmacy dies, his/her heirs own his/her shares in perpetuity 3. The success of the close corporation ensures its perpetuation 4. A close corporation will continue to exist irrespective of changes in its membership 5. The introduction of a new partner will not effect the continuity of the business

5. A partnership automatically terminates if utmost good faith is lost between partners and: 1. A new partner is admitted 2. One of the partners is declared insolvent 3. The assets of the partnership exceed its liabilities 4. 1 and 2 5. 1, 2 and 3

6. Joint and several liability for partnership debts means that: 1. The partnership has limited liability for its debts but not its members 2. There is a limit to the borrowing powers of the partnership 3. All the partners are personally liable for the debts of the partnership 4. The partners are not liable for partnership debts beyond their original capital input 5. There must be agreement between partners before entering into contracts for which the partnership is expected to accept liability.

7. A close corporation has many advantages over a partnership. Which of the following is one of the advantages? 1. Joint and several liability of its members 2. One owner is the minimum required 3. It is not a legal persona 4. Easier formation 5. Does not rely on utmost good faith

4. Managing Organizations successfully

Educational Objectives
The objectives of this unit are to provide the learner with the opportunity to:
1. come more familiar with the concept of organizations
2. Understand in what ways one organization will differ from another
3. Appreciate the importance of those characteristics of successful organizations
4. Develop an analytical approach to auditing the efficiency and effectiveness of organizations
5. Gain an insight into variety of roles which managers are required to fulfill in organizations

Learning Outcomes
On completion of this unit, the learner should be able to:
1. Describe the primary characteristics which are used to measure the success of an organization
2. Describe the McKinsey 7 S Framework for diagnosing problems within an organization
3. Describe the characteristics of successful South African companies identified by Ball and Asbury.
4. Explain the difference between efficiency and effectiveness and the importance of understanding this difference in the management of organizations
5. Discuss the functions, activities and processes that managers are expected to perform in organizations
6. Describe the different roles played by managers in organizations
7. Describe the different skills required by managers in organizations
8. Distinguish between management work and operating work
9. Distinguish between strategic, functional and operational management
10. Distinguish between managers and leaders
11. Discuss some of the common flaws of managers

The Success of Organizations

Explain the following terms

1. Stakeholders
2. Social responsibility
3. Indicators of organizational survival
4. McKinsey 7S framework
5. The job of managers
6.
7. Management functions, activities, processes and principles
8. Management roles (Mintzberg)
9. Management skills (Katz)
10. Efficiency
11. Effectiveness
12.
Self Test : Short Questions
1. Provide a list of seven indicators which could be used by stakeholders to assess the success of organizations.
1. The following diagram represents a framework used by management consultants to analyse organizational problems. Complete the diagram and provide the title of the framework. What is the significance of the having a central element connected to every other element?

3. Briefly explain the difference between Strategic management and Functional management.
1. Staude provided a clear perspective of strategic management as a process which answered 4 essential questions about an organization. Briefly discuss each question.
5. Research conducted by Ball and Asbury provided considerable insight into the characteristics of successful companies in South Africa. An important feature was the balance achieved in dealing with issues both internal and external to the organization. Which characteristics dealt with factors external to the organizations?

Discussion Points

1. The Pharmacy profession is a stakeholder in many organizations, for example the South African Pharmacy Council and the Pharmaceutical Society of South Africa. List all the different categories of stakeholders, both pharmacists (eg. retail and hospital) and others (eg. doctors and patients). In what way are the needs of these stakeholders different or similar? Should they be?

2. What criteria would pharmacists use to decide whether those organizations are satisfying their needs? If you were the manager of these organizations, where would your priorities lie?

3. In your opinion, which are the two most important characteristics from the Ball and Asbury list that community pharmacists should seek to imitate if they are to succeed in the new millennium? Give the reasons for your choice.

4. Are community pharmacists more concerned with efficiency than effectiveness? Are hospital pharmacists more concerned with efficiency than effectiveness? Clearly the problems facing both groups are different. What are these problems and what recommendations would you give regarding the improvement of the efficiency and effectiveness of both categories of pharmacist.

Review Exercises

1. Some of the community pharmacies in your area are having difficulties whilst others are doing well. As a member of the PSSA local executive committee you have been asked to assess the success of the community pharmacies in the area. Design a questionnaire (see below) containing not more than 10 questions which, in your opinion, provide a reliable measure of the pharmacy(s chances of survival. There should be 5 answers to each question with points awarded as follows (eg. Very good (+2) , above average (+1), average (0), below average (-1), very weak (-2)). How many points (total) do you think a pharmacy should earn for it to be classified as healthy or in danger of failure?
| | | | | | |
|Questions |Very good (+2) |Above Average (+1) |Average (0) |Below Average (-1) |Very Weak (-2) |
| | | | | | |
|1 to 10 | | | | | |

2. Draw a mind map of the McKinsey 7S Framework. Use a wide range of colours and drawings where appropriate. Provide additional detail which you consider to be relevant.

3. List the Ball & Asbury characteristics of successful South African companies. Compare them with McKinsey mind map. How do they complement each other? What are the key differences?

Case Study : Do-It- Quick Pharmacy CC

Shane Pillay, the manager of Do-it-Quick Pharmacy CC is a worried man. His pharmacy was doing really well until the doctors in the town started dispensing. His patients gradually drifted away and his dispensing volume halved. He asked the patients why they were leaving. The standard answers were (its much cheaper( and (its more convenient.( He tried dropping his prices - that produced lower profits but did nothing to stem the declining sales. In order to address the convenience problem, he established a special patient parking bay, employed a pharmacy technician to reduce waiting time for prescription refills, promoted his delivery service and encouraged more patients to use credit facilities. Still sales continued to fall. Just when he was about to give up he heard that in terms of the National Drug Policy, doctors would be prohibited from dispensing except under special circumstances. The doctors in the town took notice of the policy and decreased their dispensing. But his patients did not return. They started going to the other pharmacy in town. When asked why, some of the answers that he received were (they take time to find out what your needs are(, (they don(t rush you through like a fast food outlet(, (the pharmacist is involved in drug abuse prevention campaigns in the community, so he deserves support(, (they are always offering new services and products(, ( the staff are friendly and really care for you(.
1. Use this case to discuss the difference between efficiency and effectiveness.
2. What indicators show that the other pharmacy is being successfully managed?(use Ball and Asbury characteristics)
3. What advice would you give about the management of the pharmacy and selection of strategies to regain customers?

Self Test : Multiple Choice Questions

1. Excellence is defined as superior competitive performance. It is usually measured by all but one of the following: 1. Profit and Growth 2. Actual quality of management and staff 3. Actual quality of products and services 4. Loyalty of customers 5. Degree of innovation

2. An organization's obligation to its stakeholders, beyond that prescribed by law, is referred to as: 1. Values and ethics 2. Management by objectives 3. Mission statement 4. Social responsibility 5. Corporate culture

3. Which of the following best defines the concept of organizational management? 1. The processes involved in planning, implementing and evaluation 2. Strategic and operational activities and techniques 3. The systematic application of functions & principles to secure results through & with other people. 4. The leadership and motivation of staff and customers 5. The pursuit of profit in times of turbulent change

4. Ball and Asbury identified several characteristics of successful South African companies. Which of the following least accurately reflects those characteristics? 1. Using the strategic planning process to create a corporate culture 2. Identifying and sticking to critical success factors and doing them properly 3. Providing the right kind of leadership which welcomes change, encourages innovation and liberates human potential 4. Managing the relationships with all those who have a stake in the organization 5. Concentrate on giving customers what they want

5. An efficient business organization is one that: 1. Does the right thing 2. Has an external focus 3. Uses its resources productively 4. Creates customer satisfaction 5. Buys at the lowest price

6. An effective business organization is one that 1. Does things right 2. Has an internal focus 3. Does not waste resources 4. Creates satisfied customers 5. Has the lowest costs

The Essentials of Strategic Management 5. Formulating strategy

Educational Objectives
In this section of the course, the aim is to give the learner the opportunity to gain insight into:
1. The concept of strategic thinking as a vital feature of creating a desired future
2. The process involved in producing a strategic plan
3. The importance of clarifying the strategic intent of an organization through envisioning the future and developing an unambiguous, shared mission
4. The role of a situational analysis in identifying the opportunities and threats in the organization and detecting the organization(s strengths and weaknesses
5. The use of a cross impact analysis to match strategic options with SWOTs.
6. The preparation of strategic objectives
7. The concept of a strategic gap, the size of which has a bearing on the strategic choice and resource use
8. The wide range of strategic options that exist to increase the value chain
9. The key features of the generic strategies and the implications of choosing one or another
10. The value of strategic thinking for securing their own desired futures

Learning Outcomes
On completion of this course, the learner should be able to:
1. Describe the sequence of steps in the strategy formulation process
2. Discuss the role of each step in contributing to reaching the best choice situation
3. Describe what is meant by strategic intent, an envisioned future and a BHAG
4. Describe the characteristics of an effective BHAG and quote examples
5. Discuss the 4 elements of the organizational mission, and critically evaluate a business mission in terms of set criteria
6. Describe the components of a Situational Analysis and provide an overview of a SWOT analysis of pharmacy in South Africa
7. Use a matrix approach to prioritise opportunities & threats, identify critical strengths & weaknesses.
8. Discuss the use of a cross impact analysis for providing guidance in choice of strategy
9. Distinguish between strategic, functional and operational objectives
10. Describe the key result areas for which strategic objectives are set
11. Discuss the purpose for gap analysis
12. Describe how to create strategies which will secure a sustainable competitive advantage for the organization, the strategic alternatives and the generic competitive strategies.

Discussion points

1. It has been shown that the provision of various antiviral therapies, including AZT, given to pregnant mothers who are HIV positive significantly lowers the rate of transmission to the unborn children. Some have warned of the costs involved with this treatment. The drug costs are high but in addition, mothers would have to stop breast feeding, would have to supplement the infant’s diet, would have to comply with the therapy despite unpleasant side effects, and in addition, tests would have to be conducted to identify mothers with HIV/AIDS. The Government has been criticized for not making AZT available to these mothers. Their argument is that the costs of treating the children who are born with HIV/AIDS would be higher than the cost of the drugs involved. How would you approach this dilemma if you were the Minister of Health?
2. Pharmaceutical care has been proposed by many as the new mission for pharmacists. However, there are a vast and growing number of disillusioned supporters who say that pharmaceutical care is doomed to failure. In the 10 years since its inception it has not really worked anywhere in the world. Furthermore, the developing countries of the world simply cannot afford it.. What is your view? Could this disillusionment be misplaced because of a misunderstanding the purpose of a mission statement? If pharmaceutical care is not an appropriate mission for pharmacists, which would be a better mission?

3. The South African government clearly spelt out its vision and mission with regard to the provision of safe, cost-effective, affordable and accessible health care to the nation. Its ability to deliver has been hampered by a desperate shortage of health professionals in the public sector. The government selected a strategy of requiring newly qualified doctors, pharmacists and others to serve a period of compulsory community service prior to registration to achieve its objective. If you had been the Minister of Health what other strategies would you have considered in order to achieve your objectives?

4. Some would argue that the best option for pharmaceutical industry in South Africa would be to concentrate on the manufacture of generic drugs since both South Africa and Africa are in need of affordable drugs. Others would argue that this segment of the market is not only over-traded, but the competition from Asia and the Far East is far too strong. In their view, industry should concentrate on developing new drugs for new diseases or existing diseases that were becoming drug resistant. What is your opinion?

Self Test: Short Questions

1. The process of formulating strategies is made up of eight steps. What are they?
2. Which four elements make up the organizational mission?
3. Defining the core purpose of the organization helps the strategic manager in three respects. What are they?
4. There is disagreement over the ideal length of a mission statement. On the one hand it should be short, simple and focused; on the other it should be clear enough to lead to desired action. In what way are these criteria in conflict?
5. Mission statements will not achieve their purpose for six reasons. What are they?
1. The relevant environment in which an organization operates is usefully split into the macro and micro environments. In what way are these two environmental segments different and why is this split useful to strategic managers?
2. Not all environmental occurrences, trends or developments have the same priority. Briefly describe a technique that managers could use for allocating priority to these changes.
| | | |
| |Strengths |Weaknesses |
| | | |
|Opportunities | | |
| | | |
|Threats | | |

8. What is the purpose of the Cross Impact Analysis? Complete the following diagram by inserting the appropriate strategic options in the cross impact matrix.

9. Managers have four strategic alternatives of which growth is usually considered to be the best option. When might the other strategies be more appropriate?
1. Some would argue that there are only two strategic competitive options for any organization - to become a low cost producer or to differentiate. Others would disagree saying that all organizations should try and reduce costs and to be different from their competitors. Both these arguments have weaknesses. What are they?
Self Test: Multiple Choice Questions

1. Which of the following statements (or combinations thereof) describes how strategic management differs from operational management? A. Strategic management is more concerned with innovation or reduction rather than routine operational management B. Strategic management is more concerned with long term survival than operational management C. Strategic objectives are more general and difficult to measure than operational objectives 1. A 2. A and B 3. A and C 4. B and C 5. All the above

1. Which of the following statements best describes a mission statement? 1. A statement which describes the ambitions, aspirations, intentions and visions of the organization 2. A statement which conveys broadly what the organization hopes to achieve 3. A broad declaration of the basic, unique purpose and scope of operations that distinguishes the organization from others of its type 4. A statement of performance that clearly specifies what the organization hopes to achieve through its existence 5. A statement which describes the aims, objectives and values of the organization

1. All but one of the following criteria should be met if a mission statement is to be effective. It should be: 1. Concerned with meeting identified market needs 1. Clear enough to lead to desires actions 2. Easy to measure progress 3. An unambiguous promise to all stakeholders 4. In writing to provide stakeholders with a constant visible reminder

1. An analysis of the macro environment will reveal 1. Opportunities and threats 2. Trends in the political, economic, societal and technological environment 3. Trends amongst competitors, suppliers, customers, labour market 4. 1 and 2 5. 1 and 3

2. Strengths are best described as 1. Strategic advantages relative to competitors 2. Developments which provide a superior competitive advantage to the business 3. Areas in which the performance standards needed to meet objectives are being met 4. Exceptional levels of leadership and management 5. All of the above

3. Managers use the following criteria for evaluating an environmental occurrence 1. The focus, impact and timing of the occurrence 2. The probability and magnitude of benefits and risks 3. The resistance to change within the organization 4. 1 and 2 5. 1, 2 and 3

4. When managers evaluate an environmental event they consider the probability of its occurrence and the magnitude of risk/benefits in terms of: 1. The probable reaction of competitors 2. The form of business ownership 3. The strengths and weaknesses of the organization 4. The availability of finance to develop effective strategies 5. Other changes in the macro and micro environments

5. In selecting strategies, the manager is faced with a limited range of generic alternatives in the face of competition. Which, if any, of the following is not considered to be a generic competitive strategy? 1. Low cost 2. Cost leadership 3. Low price 4. Differentiation 5. Focus on differentiation

5. Implementing strategy

Self Test : Short Questions

1. Briefly explain the four steps for implementing a strategy.
2. What criteria would you use to check strategic fit?
3. Use an example to briefly illustrate the difference between a belief, a value and a norm.
4. If you were asked to identify an organization(s culture, explain which characteristics you would investigate?
1. Why is a strong organizational culture usually considered to be an advantage?
2. There are at least two reasons why a strong organizational culture is considered to be a liability. What are they? To what extent do they pose serious barriers to the survival of the organization?
3. The pharmacy “culture” has positive and negative features. Identify those that will facilitate its survival and those that will retard its survival.

6. Operational management

Educational Objectives

The objectives of this unit are to provide the learner with insight into how managers do the things they are expected to do, more specifically:
The tasks that managers do on a day-to-day basis
The guiding principles to use to get things done (which have been tested and shown to work)
The processes that, if followed, will increase the chance that things will happen as intended
The techniques used to make sure things work
The activities that have to be performed in order to achieve a desired outcome
How all these different aspects of management can be applied to any situation - from self-management, to patient management to disease management, in addition to the more traditional management of organizations

Learning Outcomes

On completion of this unit the learner should be able to describe how to conduct the following management activities in accordance with good management practice:
1. Prepare operational objectives from strategic objectives
Forecast future events
Prepare operational plans to achieve identifiable performance based objectives
3. Create policies, standard operating procedures, programmes and schedules and resource budgets to implement these plans
Develop an organization structure to carry out these plans
Delegate work to others
Recruit and select staff for the present and future
Communicate effectively with all stakeholders
Direct, train, develop and motivate staff
Make effective decisions
Establish performance standards
Introduce quality control, quality assurance, quality improvement systems
Measure and evaluate performance of people and operating units
Identify discrepancies and take corrective action
14. Audit the operational management of a community pharmacy and recommend changes in strategy to improve quality and access, and reduce cost.
15. Prepare, implement and evaluate a management plan for himself/ herself to improve the efficiency and effectiveness of his/her activities to achieve his/her goals.
16. Prepare and describe how to prepare, implement and evaluate a pharmaceutical care plan for a patient.

Prescribed Text: WT Futter. (I(m thinking of buying a pharmacy(
Recommended reading WT Futter. (The three roles of the pharmacist(

Self Assessment : Planning

Explain the following terms: Planning 1. Principle of flexibility 2. Principle of stability 3. Principle of resistance to change 4. Investigating and forecasting 5. Principle of cause and effect 6. Principle of gradual change 7. 8. Setting objectives 9. Programmes 10. Schedules 11. Policies 12. Procedures 13. Budgets

Complete the following tasks 1. Explain why proactive planning is important for business success? 2. Describe the barriers to planning 3. Describe three principles that should be taken into consideration when planning 4. Explain how to go about investigating and forecasting 5. What guidelines should be taken into consideration when investigating and forecasting 6. Explain why setting objectives is so important 7. Describe the guidelines for setting objectives 8. Explain the importance of programming and scheduling for contributing organizational success 9. Describe the guidelines to observe when programme and scheduling
10. Discuss the process to follow when developing a programme and a schedule
11. Describe the circumstances in which a programme and schedule might fail
12. Explain why Policies are so important
13. Describe the guidelines for follow when formulating policies
14. Describe the circumstances in which a policy is likely to
15. Explain why procedures important for business success
16. Describe the guidelines to follow for developing procedures which will increase the efficiency and quality of work in an organization
17. Describe those circumstances in which procedures are likely to fail
18. Discuss the guidelines for effective budgeting
19. Describe the circumstances in which budgets are likely to fail
20. Complete the time management matrix proposed by Stephen Covey.

| | | |
| |Urgent |Not Urgent |
| | | |
|Important |1 ACTIVITIES |2 ACTIVITIES |
| | | |
| | | |
| |3 ACTIVITIES |4 ACTIVITIES |
|Not important | | |

21. Explain which of the following matrices represents the best balance of activities for a manager to achieve.

| | | | | | |
| |Urgent |Not Urgent | |Urgent |Not Urgent |
| | | | | | |
|Important |I Activities |2 Activities |Important |I Activities |2 Activities |
| | | | | | |
| | | | | | |
| | | | | | |
|Not important |3 Activities |4 Activities |Not important |3 Activities |4 Activities |

Do the following:

1. Visit a pharmacy. Discuss with the pharmacist how much time he/she devotes to planning. Ask whether there is a staff policy and procedure manual and what contribution the staff make to policy development. 2. Start a scrap book in which you keep copies of newspaper cutting regarding the trends and developments which influence the practice of pharmacy in South Africa.

Multiple Choice Questions:

1. Managers resist planning because it is frustrating, time consuming, they lack the skills and 1. they prefer functional activities 2. the environment is predictable 3. plans provide too much flexibility 4. they are reluctant to ask the staff to participate 5. they have an undeveloped MIS

2. Policies differ from rules in that: 1. They are flexible 2. They allow managers to delegate discretionary authority 3. Infringement does not usually result in disciplinary action 4. 1 and 2 5. 1, 2, and 3

3. Which of the following guidelines are least useful in helping managers to formulate effective policies? 1. Policies should deal with problems of significance rather than trivial issues 2. Policies should be fixed and inflexible to ensure a consistent response to recurring situations 3. Policies should be written down to ensure that staff do not have to rely on their memories 4. Policies should be definite and understandable 5. Policies should be reviewed regularly to take into account changing situations

1. Effective time management presupposes that managers are able to set priorities in terms of the importance and urgency of their activities. Which one of the following activities is classified as being important but not urgent: 1. Pleasant activities 2. Deadline driven projects 3. Popular activities 4. Prevention 5. Time wasters

5. Communicating by telephone is a key feature of pharmacy practice. An . . . pharmacy will have a . . . which explains how to use the telephone, a . . . regarding its use for private calls and . . . against which to assess patient satisfaction. 1. Efficient, programme, policy, objectives 2. Effective, programme, policy, performance standards 3. Efficient, procedure, programme, objectives 4. Effective, policy, procedure, performance standards 5. Effective, procedure, policy, performance standards

Assess yourself: Organizing

Explain the following terms: 1. Organizing 2. Developing an organization structure 3. Principle of the objective 4. Principle of busyness 5. Principle of maximum span 6. Principle of minimum levels 7. Principle of specialization 8. Delegating 9. Position 10. Responsibility 11. Authority 12. 13. Accountability 14. Principle of control limits 15. Principle of commensurate authority 16. Principle of complete accountability 17. Principle of unity of command 18. Principle of willingness and ability 19. Technique of completed work 20. Technique of loyal opposition 21. Establishing relationships 22. Line relationship 23. Staff relationship 24.
Complete the following: 1. What are the three activities that managers perform when they arrange and relate work so that it can be done most effectively by people? 2. Describe the five stages through which organizational structures develop and the problems that usually arise as growth occurs. 3. If you were asked to diagnose whether or not an organization had a growth crisis, what symptoms would you look out for? 4. Explain why an organization needs an structure. 5. Discuss the advantages and disadvantages of using specialization as an organizational principle. 6. Describe the process to follow when developing an organizational structure. 7. Discuss the differences between a bureaucratic structure and an adhocracy. 8. Describe the type of structure you would develop in a community pharmacy and explain the principles that your would observe in developing this structure. 9. Explain why managers resist delegating work to subordinates and comment on the extent to which these reasons may apply to pharmacists not wanting to delegate work to assistants or technicians.
10. Describe the type of tasks that should and should not be delegated by managers.
11. Discuss the guidelines that managers should use when delegating work to subordinates. Explain how these guidelines relate to the use of pharmacy assistants by pharmacists who are providing pharmaceutical care
12. Discuss the guidelines that managers should use when developing relationships amongst the people with and for whom they work.

Do the following: 1. Speak to a community and a hospital pharmacist and find out their opinions regarding the use of pharmacy technicians and assistants in the dispensary. Find out the difficulties they have experienced, the benefits they have derived and their fears and concerns.

2. Speak to a pharmacy owner/ manager about the organization structure that he/she employs, and the extent to which he/she is able to delegate work to subordinates. Did you get the impression that the staff were given enough authority to discharge the responsibilities that were allocated to them?

Multiple Choice Questions:

1. The key objective for developing an organization structure is to: 1. Minimize duplication of work and increase the efficiency of the work force 2. Reduce uncertainty and frustration 3. Delegate authority commensurate with responsibility and create accountability for the results to be achieved 4. Create conditions necessary for the mutually cooperative efforts of people 5. Identify and group all the work to be performed so it can be accomplished most effectively by people

2. Indicate which of the following statements is least accurate: 1. The greater the levels within the limits of maximum span, the greater the potential effectiveness of the people involved 2. Establish effective controls before assigning responsibility and authority 3. If a person reports to more than one boss on the same responsibility, conflict may result 4. Without necessary authority, difficult to discharge responsibility 5. Only individuals, not groups, can be assigned complete accountability

3. Which of the following statements is not an advantages of work specialization? 1. It leads to more efficient use of the worker 2. It allows workers to concentrate skills on a wide range of work 3. It facilitates the achievement of complex goals 4. It contributes to better consistency of quality in products and service 1. It facilitates the selection and training of workers to perform identifiable activities

8. A bureaucratic structure has all but one of the following advantages over an (adhocracy( 1. Consistent performance standards are ensured through close supervision 2. It promotes stability and efficiency 3. Since it relies on division of labour, it promotes efficiency through specialization 4. The extensive use of committees promotes communication and increases flexibility 5. Relatively limited authority in the hands of individuals reduces the risk of errors

1. When delegating, certain principles are useful if the delegation is to be effective. Which of the following principles is least likely to contribute to effective delegation? 1. Establish effective controls after assigning responsibility and authority 2. The greater the number of superiors to whom a subordinate reports, the greater the potential for conflict 3. Without necessary authority, it is difficult to discharge responsibility 4. Do not assume that the most willing staff members are the most able 5. Only individuals, not groups, can be assigned complete accountability Assess yourself : Leading

Explain the following terms

1. Leading 2. Giving direction 3. Position power 4. Personal power 5. Decision making 6. Principle of problem definition 7. Principle of evidence 8. Principle of identity 9. Principle of procrastination 10. Principle of success 11. SOAP note 12. Communicating 13. Principle of line loss 14. Principle of emotional appeal 15. Principle of application 16. 17. Principle of noise 18. Motivating 19. Inspire 20. Encourage 21. Impel 22. Principle of recognition 23. Principle of information 24. Principle of challenge 25. Principle of participation 26. Staffing the organization 27. Selecting 28. Principle of potential 29. Principle of job satisfaction 30. Principle of future characteristics 31. Developing people 32.
Complete the following:

1. Describe the power bases available to leaders and the types of responses to each. 2. Describe which type of response is preferred and explain why some of the power bases are unlikely to achieve that response 3. Describe the normative model of decision making and discuss its weaknesses 4. List the major steps involved in the decision making process. 5. Discuss what is involved in categorizing facts and diagnosing the real problem. 6. Describe the four phases in the communication process 7. Explain the meaning of ALLCU-TCU in relation to elements of the communication process 8. Describe 3 guidelines that managers should observe to improve communication with their staff 9. Explain what is meant by (management barriers to communication(. Your answer should include examples to illustrate the barriers concerned.
10. Pharmacists who seek to practice pharmaceutical care should pay particular attention to overcoming communication barriers. In your opinion, which five barriers are the most important - explain the reasons for selecting these barriers, and provide an example of each.
11. Describe the contents of the 2K 5G(s formula for improving communication.
12. In one word, what is it that the management process of motivation is intended to achieve?
13. Describe the hierarchy of needs proposed by Maslow giving examples which are relevant to the motivation of university students
14. (Happy workers are not necessarily motivated workers.( Explain this statement by referring to Herzberg(s two factor theory of motivation.
15. Describe the guidelines for managers to observe when promoting participation by subordinates in the decision making process.
16. Discuss the steps that a manager could take to improve the motivation of his/her staff.
17. List the sequence of steps that a manager should follow when selecting staff.
18. Explain the difference between training and development.
19. Describe the prerequisites for a successful development programme.
20. Describe the process for developing staff.

Do the following:

1. Interview any store manager about the amount of time he/she devotes to the training and development of the staff. Eg. do they shut early or open early for regular training? are staff sent on courses etc? To what extent does staff promotion depend on whether they do the training. Then, with permission, interview a staff member and ask about their attitudes towards training, their frustrations, whether it makes a difference to their promotion.

2. Ask any staff member in any organization about the communication channels with management - check on the extent to which any of the listed communication barriers exist.

What do people want from their jobs?

Rank the following items from 1 to 10 in terms of how you think supervisors and workers would rank them (1 is the highest and 10 the lowest in importance).

| | | |
| |Supervisor(s ranking |Worker(s ranking |
| | | |
|Good working conditions | | |
|Feeling (in( on things | | |
|Tactful disciplining | | |
|Full appreciation for work done | | |
|Management loyalty to workers | | |
|Good wages | | |
|Promotion and growth in the company | | |
|Sympathetic understanding of personal problems | | |
|Job security | | |
|Interesting work | | |
|Interesting members of staff | | |
|Excellent holidays and leave benefits | | |

True or False
Identify which of the following statements are true or false?

Managers should follow these guidelines to allow for staff participation in decision making
1. The participation should be flexible and take place on an ad hoc basis
2. If staff come up with a good idea, then they should become accountable for the idea
3. Make it clear to staff that there is no guarantee that any of their suggestions will be accepted and/or will be implemented.
4. If a proposal is made, managers must either do it or explain why it will not be done
5. Participation should take the form of an official meeting with minutes to avoid misunderstandings

Multiple choice questions:

1. A leader is able to influence others because he/she possesses: 1. Authority 2. Communication skills 3. Good organizing ability 4. Power 5. 1, 2, and 3

1. Management has traditionally relied on the use of all but one of the following to motivate behaviour: 1. Increase pay 2. Job security 3. Good working conditions 4. Recognition for achievement 5. Promotion

2. Complete the sentence. Power is the capacity to affect the behaviour of others. -------------- power is based on the capacity to control the incentives, whilst ----------- power is based on the possession of expertise that is valued by others. 1. Coercive, referent 2. Reward, expert 3. Legitimate, referent 4. Coercive, expert 5. Reward, referent

1. Effective communication means that the receiver: 1. Hears the message of the sender 2. Listens to the message of the sender 3. Correctly interprets the message of the sender 4. Trusts the expertise of the sender 5. Provides feedback to the sender

2. The minimum human qualities necessary to perform a job are formulated in a: 1. Manpower analysis 2. Job analysis 3. Job description 4. Job specification 5. All of the above

Assess yourself : Controlling

Define the following terms in your own words:

1. Controlling 2. The 80:20 principle 1. Principle of point of control 2. Principle of diagnosis not post mortem 3. Establishing performance standards 4. Standards 5. Dimension of quality 6. Elements of health care quality 7. Quality control 8. 9. Quality assurance 10. Total quality management 11. Structure 12. Process 13. Outcome 14. Measuring performance 15. Evaluating performance 16. Management by exception 17. Taking corrective action

Complete the following: 1. Describe the management control process 2. Explain why managers tend to avoid setting standards 3. Describe the elements of quality and identify five features which are vital to the success of pharmacy as a profession 4. Describe the elements of health care quality and discuss two elements on which you feel that community pharmacists and hospital pharmacists need to concentrate 5. Explain the difference between efficacy and effectiveness and the reason why understanding this difference is important for pharmacists 6. Describe the guidelines to follow when selecting criteria to measure 7. Explain the significant differences between quantitative and qualitative criteria 8. Discuss the dilemma that managers have in measuring outcomes to assess quality 9. Explain how structure and process are used as indicators of quality
10. Describe the guidelines to follow in developing standards
11. Describe the guidelines to follow for effective reporting
12. Describe the guidelines for evaluating performance reports
13. Explain the difference between operating and managing correction. What are the consequences for managers who concentrate only on correcting operational problems.
14. Select five of the most important (control diseases( and explain each with the aid of examples.

Do the following 1. Compare the standards of behaviour that are unacceptable in a few sports clubs and cultural organizations. For example, what have you got to do to be thrown out the organization? Do the same standards apply to the profession of pharmacy? 2. Ask pharmacists what they feel is an acceptable level of stock-outs in a week. How would you feel as the affected patient?

Case study
You have selected the following range of indicators for your community pharmacy. At the end of the month, you compile this report. Which variances would you concentrate on addressing? Why?
| | | |
|Indicator Report |Standard |Actual performance |
| | | |
|Number of prescriptions received per day |120 |105 |
|Sales per staff member per day |R1 500 |R 1 450 |
|Number of times prescription medicine out-of-stock each month |3 times |2.75 times |
|Daily sales turnover per day |R15 000 |R 15 500 |
|Amount of credit owed by customers |R 60 000 |R 75 000 |
|Number of complaints received per staff member per month |5 |6 |

True or False Questions
Indicate which of the following descriptions of health care quality are true or false.
Acceptability means identifying and meeting the expectations of patients
2. Accessibility means providing appropriate knowledge and skills, seamless care and services which are convenient.
3. Appropriateness means that health care is adjusted to fit in with the age, knowledge, abilities and social needs of patients.
Effectiveness means that scarce resources are used productively and not wasted
Efficiency means that the health care has been tested to work in controlled conditions.
Equity means that the health care provided is the same for all people, irrespective of their rance gender or disability

Multiple Choice Questions
The sequence of functions in the control process is: 1. Establishing standards, comparing performance with standards and taking corrective action 2. Setting objectives, comparison of performance with standard, and taking corrective action 3. Establishment of standards, comparison of performance with standard and re-evaluation 4. Establishment of goals, comparison of goals and taking corrective action 5. Establish the point of control, focus on the critical few, take corrective action

Three critical areas of the control process are: 1. Establishment of standards, comparison of performance to standards, taking corrective action. 2. Setting objectives, recording and reporting performance and comparison of performance to standard 3. Establishment of standards, implementation and evaluation of performance 4. Establishment of goals, comparison of goals and taking corrective action 5. Establish the point of control, focus on the critical few, take corrective action

Controls are more likely to be effective if the following principles are applied: 1. Establishment of standards, comparison of performance to standards, taking corrective action. 2. Setting objectives, recording and reporting performance and comparison of performance to standard 3. Establishment of standards, implementation and evaluation of performance 4. Establishment of goals, comparison of goals and taking corrective action 5. Establish the point of control, focus on the critical few, take corrective action

All but one of the following reasons are given as to why managers tend to avoid setting standards: 1. The environment is turbulent and unpredictable 2. Objectives do not clearly specify the standards expected 3. It is difficult to decide what is an acceptable standard 4. They have not been trained in setting standards 5. It is difficult to communicate what is good, average or below standard 7. Managing Change and Situational Leadership

Educational Objectives

1. The objectives are to give the learner the opportunity to :
2. Appreciate the importance of change and the need to manage it effectively
3. Reflect on the magnitude of changes facing the pharmacy profession
4. Reflect on emotional changes that people experience when faced with new situations and the need to alter their routines
5. Consider the processes that are involved when managing change
6. Develop the confidence to design a plan to facilitate successful change which incorporates the principles that have been shown to increase the success of that change.

Learning outcomes

On completion of this section, you should be able to :
1. Define organizational change and explain the forces for change
2. Describe the characteristics of change that managers should take into consideration
3. Describe the sequence of four change activities that must be performed in order for change to be successful
4. Explain the techniques managers can use to facilitate the initiation of change in organizations
5. Define sources of resistance to change
6. Explain the ten stages that people go through when they are required to change
7. Explain force field analysis and other implementation tactics that can be used to overcome resistance to change
8. Develop a plan to bring about successful change based on a five phase model

Test yourself

Explain the following using your own words:

organizational change learning organization transitional change transformational change operational change patient change characteristics of change external forces for change internal forces for change

performance gap emotional stages of change resistance to change readiness to change force field analysis driving forces restraining forces

Discuss the following:

1. Describe the findings of Ball and Asbury regarding the way in which successful companies respond to change
2. Explain what is meant by organizational change and how the concept of a learning organization is related to organizational change.

3. Discuss some of the major characteristics of change which managers should investigate before deciding how to manage change
4. Outline the features of a basic 4 step change model. Briefly describe the differences between the four stages.
5. List the 10 stages of emotional response to change identifying the most appropriate strategies to use during each stage
6. Discuss the applicability of these stages to a patient who is diagnosed as being HIV positive and for whom anti-retroviral therapy has been prescribed. To what extent does an understanding of these emotional stages provide you with insight into how to deal with this patient?
7. Explain what is meant by resistance to change and describe the reasons why people resist change.
8. Booysens identified barriers to change which are particular to health care field. Discuss the extent to which these apply to pharmacists in a hospital setting as opposed to a community setting.
9. Describe how you would conduct a force field analysis prior to introducing the concept of pharmaceutical care into a hospital setting. What the driving and restraining forces might you expect to find?
10. Describe a process for introducing change which would have the greatest chance of success and the least chance of resistance.

Do the following:

1. Pharmaceutical care is the new philosophy which is guiding the practice of pharmacy It is service centred and encourages pharmacists to apply their professional and clinical skills rather than merely count tablets. Nevertheless, there is considerable resistance to change. Reflect on what you have learned in this section and then list those reasons which you think explain this resistance. What advice would you give to the Pharmacy Council with regard to overcoming this resistance?

2. (The success of Rhodes University is derived from the perceived security of its residential campus. Any attempt to introduce distance education would seriously disrupt the Rhodes student profile and ultimately lead to its demise.( This is the topic of a debate. Do you agree? How would you predict the progress of the debate? Do you think that Rhodes will ever change?

3. The South African Government steadfastly deferred making decisions to introduce anti-retroviral therapy to reduce the risk of vertical HIV transmission from mother to child. Refer to the 5 phase change model and indicate which feature(s) is/are missing - i.e. preventing the change taking place. If you were an AIDS activitist what aspect would you have concentrate on to bring about a change in government policy?

Situational Leadership

Educational Objectives

The major educational objectives are to provide students with learning opportunities to:
1. Become familiar with the concept of leadership
2. Understand the various roles that leaders undertake in formal and informal organizations
3. Gain some insight into the development of leadership theories
4. Be able to use one leadership model to guide them in the selection of leadership styles

Learning Outcomes

On completion of this unit you should be able to:
Explain what is meant by (leadership theories(
3. Explain the differences between trait, relationship and situational approaches to leadership
4. Describe four management styles identified by behaviourists
5. Describe the managerial grid designed by Blake and Mouton
6. Explain the 3 principles used by Hersey & Blanchard to build their Situational Leadership Theory
7. Explain the difference between task behaviour and relationship behaviour in the context of situational leadership theory
8. Describe how one would distinguish between the various levels of maturity of followers in situational leadership theory
9. Discuss the four different leadership styles upon which the situational leadership theory is based.
10. Explain how a leader should achieve an appropriate match between follower maturity/ readiness and leadership style. Use examples to illustrate your explanation.
11. Apply the Situational Leadership model to individual and group situations

Test yourself

Explain the meaning of the following in your own words:

Leadership
Power
Traits approaches
Relationship approaches
Situational approaches
Leadership styles

Managerial grid
Situational Leadership
Task behaviour
Relationship behaviour
Follower maturity
Matching style to maturity

Complete the following:

1. Explain the meaning of leadership theories
2. Explain the differences between trait, relationship and situational approaches to leadership
3. Describe four management styles identified by behaviourists
4. Describe the managerial grid designed by Blake and Mouton
5. Explain 3 principles upon which Hersey and Blanchard base their Situational Leadership Theory
6. Explain the difference between task behaviour and relationship behaviour in the context of situational leadership theory
7. Describe how one would distinguish between the various levels of maturity of followers in situational leadership theory
8. Discuss the four different leadership styles upon which the situational leadership theory is based.
9. Explain how a leader should achieve an appropriate match between follower maturity/ readiness and leadership style. Use examples to illustrate your explanation.

Do the following

Use the Situational Leadership model to suggest leadership strategies which will be effective in the following situations.

1. A new pharmacy intern has joined your staff. Although very keen, the intern does not know where the products are kept, is not familiar with the brand names, is rather shy and unable to communicate with patients.

Your best front shop staff member is at the receiving end of unjustified criticism from a member of the public. She had to accept loud public recriminations from an irrate customer. The problem arose with a misunderstanding in the accounts office and she has received all the blame on behalf of the pharmacy. After the event she comes to your office to explain what has happened and bursts into tears.

Your new intern has been doing extremely well but has made a serious error with a prescription by putting the wrong label on a medicine container.

the Pharmacy Council is adamant that all pharmacists should practice pharmaceutical care. A survey shows that most pharmacists are keen to change towards a more clinical role but do not feel that they have the necessary training, time, infrastructure nor financial incentives to do so. A small minority are adamant that they have been practising pharmacy all their lives, know what to do and see no reason for change.

You are the newly elected president of RUPSA. Describe the leadership style that you would use to achieve the objectives of RUPSA and explain the reasons for your choice.
Ends/ wtf
03 May 2005
Next year - list all the learning points/ lessons from the principles into a true and false situation

Organizations: Ownership, Management and Leadership
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1. Performance Management and Continuous Improvement

Performance

Four Variables of Performance

9.

Organizational structure

o
4

5.

6.

1.

2

8

7

3.

Context

Performance Improvement Framework

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