BMZ2025: ENTREPRENEURIAL MANAGEMENT IN HEALTH CARE
INTRODUCTION TO THE COURSE
Entrepreneurship refers to the process of creating, developing, and managing a new business venture to achieve a profit of
fulfill a specific need in the market.
Characteristics: innovation, pro-activity, creativity, resilience, risk-taking
Entrepreneur in an existing organization intrapreneur
Intrapreneurship (in healthcare) refers to the act of creating new products, services, or processes within an established
organization, with the goal of driving innovation and growth.
Aims of intrapreneurship: improve patient outcomes, increase efficiency, improve processes, and reduce costs.
Intrapreneurs: nurses, physicians and other care staff, administrators, policy officers.
BARRIERS
- Complex organizational structures
- Risk aversion and resistance to change
- Limited resources
- Lacking innovation readiness
LECTURE 1: ORGANIZATION AND MANAGEMENT
What is an organization? “Collective action structured for the pursuit of a common mission”
Structure the pattern of relationships designed to enable its people to take that action together.
SIX BASIC PARTS OF THE ORGANIZATION
Operating core: operators, those people who perform the basic work of producing the
products and rendering the services
Strategic apex: one full-time manager, who oversees the whole systems (as the
company grows more managers of operators, but also managers of managers)
Middle line: hierarchy of authority between the operating core and the strategic apex
Techno-structure: more complex organization group of people, analysts, who
perform administrative duties – plan and control the work of others – often labelled
“staff”
Support staff: add staff units to provide various internal services, like
cafeteria/mailroom/legal counsel/etc.
Ideology: strong culture, traditions and beliefs of an organization (entire system)
KEY PLAYERS:
Operators: deliver the services or produce the products
Support staff: provide indirect services to support operations (cafeteria staff, secretaries, counselors, HR, payroll
Analysts: work to control and adapt organizational activities via planning, scheduling, measuring, etc.
Managers: middle, lower level and high (C-suite) management
,Culture: provides a common frame or reference for all players, belief system
Influencers: external stakeholders who attempt to influence organization
SIX BASIC COORDINATING MECHANISMS
Coordination can be achieved via
Mutual adjustment: achieves coordination of work by the simple process of information communication (informal)
Direct supervision: one person coordinates by giving orders to others, oversees and is responsible for work for others
Standardization
o Work processes: specification – programming of the content of the work directly, the procedures to be
followed. So specifying process and rules
o Outputs: not what is to be done, but of its results. So performance, rather than process
o Skills: as well as knowledge, where the worker is rather specialized than the work or the outputs. So training
specification
o Norms: workers share a common set of beliefs and can achieve coordination based on it. So embedding shared
beliefs to support functioning
THE ESSENCE OF ORGANIZING
To make a movie together, or score a goal, people doing different things have to work together. This is called coordination, and
it is the essence of organizing, following the division of labor.
- Dictated by the mission of the organization (in a restaurant we need a cook, waitresses, bartenders, etc.)
- More division of labor more specialization (and more complexity)
Vertical differentiation = hierarchy
Horizontal differentiation = functionalism
The essence of organizational design is the manipulation of a series of parameters that determine the DoL and the achievement
of coordination:
Job specialization: number of tasks in a given job and the worker’s control over these tasks
Behavior formalization: standardization of work processes by the imposition of operation instructions, job descriptions,
rules, regulations.
o Rely on any form of standardization of coordination bureaucratic (mechanist organization: rigid and tightly
controlled)
o Not organic: highly adaptive and flexible
Training: the use of formal instructional programmes to establish and standardize in people the requisite skills and
knowledge to do particular jobs in organizations
Indoctrination: programmes and techniques by which the norms of the members of an organization are standardized
become responsive to its ideological needs make decisions and take actions
Unit grouping: the choice of the bases by which positions are grouped together into units (usually shown on the
organization chart)
Unit size: the number of positions contained in a single unit
o The equivalent “span of control” is not used here, because sometimes units are kept small despite an absence
of close supervisory control
Planning and control systems: used to standardize outputs
o Action planning systems
o Performance control systems
Liaison devices: devices to encourage mutual adjustment (hoe managers ervoor kunnen zorgen dat binnen het bedrijf
beter gecommuniceerd wordt, door welke structuur van de organisatie, zoals integrating managers)
Decentralization: diffusion of decision-making power. When all the power is in one place it is centralized. So either
vertically or horizontally extent the power of decision-making to more individuals
, THE SITUATIONAL FACTORS
Age and size:
Older more formalized behavior
Larger more formalized behavior, more elaborate structure, the larger the size of its average unit
Structure reflects the age of the industry form its founding
Technical system: instruments used in the operating core to produce the outputs
Environment: various characteristics of the organization’s outside context, related to markets, political climate, economic
conditions, and so on.
Power: per example the greater the external control of an organization, the more centralized and formalized its structure
COORDINATION
Putting parts and players together to produce a seamless experience for the customer requires coordination.
Organizing = creating parts and connections
Managing = coordinating what has been organized (parts, players, etc.)
Managerial functions: planning, organizing, directing, controlling, and managing
A manager: ‘Someone who coordinates and oversees the work of other people so organizational goals can be accomplished
(Robbins & Coulter)
Management/managing: ‘the process of assembling and using sets of resources in a goal-directed manner to accomplish tasks in
an organizational setting’. (Hitt. et al 2013) It is a process that involves a series of activities and operations, such as planning,
deciding, and evaluating.
The act of coordinating what has been organized (parts, players, etc.).
Note: coordination may be seen as the output of managerial functions
HEALTH CARE AS A PROFESSIONAL BUREAUCRACY
- Reliance on professional expertise and skills
- Highly specialized
- Typically organized in functional units
- Clear hierarchy but decentralized power (to professionals)
- Rigid
INTRODUCTION TO THE COURSE
Entrepreneurship refers to the process of creating, developing, and managing a new business venture to achieve a profit of
fulfill a specific need in the market.
Characteristics: innovation, pro-activity, creativity, resilience, risk-taking
Entrepreneur in an existing organization intrapreneur
Intrapreneurship (in healthcare) refers to the act of creating new products, services, or processes within an established
organization, with the goal of driving innovation and growth.
Aims of intrapreneurship: improve patient outcomes, increase efficiency, improve processes, and reduce costs.
Intrapreneurs: nurses, physicians and other care staff, administrators, policy officers.
BARRIERS
- Complex organizational structures
- Risk aversion and resistance to change
- Limited resources
- Lacking innovation readiness
LECTURE 1: ORGANIZATION AND MANAGEMENT
What is an organization? “Collective action structured for the pursuit of a common mission”
Structure the pattern of relationships designed to enable its people to take that action together.
SIX BASIC PARTS OF THE ORGANIZATION
Operating core: operators, those people who perform the basic work of producing the
products and rendering the services
Strategic apex: one full-time manager, who oversees the whole systems (as the
company grows more managers of operators, but also managers of managers)
Middle line: hierarchy of authority between the operating core and the strategic apex
Techno-structure: more complex organization group of people, analysts, who
perform administrative duties – plan and control the work of others – often labelled
“staff”
Support staff: add staff units to provide various internal services, like
cafeteria/mailroom/legal counsel/etc.
Ideology: strong culture, traditions and beliefs of an organization (entire system)
KEY PLAYERS:
Operators: deliver the services or produce the products
Support staff: provide indirect services to support operations (cafeteria staff, secretaries, counselors, HR, payroll
Analysts: work to control and adapt organizational activities via planning, scheduling, measuring, etc.
Managers: middle, lower level and high (C-suite) management
,Culture: provides a common frame or reference for all players, belief system
Influencers: external stakeholders who attempt to influence organization
SIX BASIC COORDINATING MECHANISMS
Coordination can be achieved via
Mutual adjustment: achieves coordination of work by the simple process of information communication (informal)
Direct supervision: one person coordinates by giving orders to others, oversees and is responsible for work for others
Standardization
o Work processes: specification – programming of the content of the work directly, the procedures to be
followed. So specifying process and rules
o Outputs: not what is to be done, but of its results. So performance, rather than process
o Skills: as well as knowledge, where the worker is rather specialized than the work or the outputs. So training
specification
o Norms: workers share a common set of beliefs and can achieve coordination based on it. So embedding shared
beliefs to support functioning
THE ESSENCE OF ORGANIZING
To make a movie together, or score a goal, people doing different things have to work together. This is called coordination, and
it is the essence of organizing, following the division of labor.
- Dictated by the mission of the organization (in a restaurant we need a cook, waitresses, bartenders, etc.)
- More division of labor more specialization (and more complexity)
Vertical differentiation = hierarchy
Horizontal differentiation = functionalism
The essence of organizational design is the manipulation of a series of parameters that determine the DoL and the achievement
of coordination:
Job specialization: number of tasks in a given job and the worker’s control over these tasks
Behavior formalization: standardization of work processes by the imposition of operation instructions, job descriptions,
rules, regulations.
o Rely on any form of standardization of coordination bureaucratic (mechanist organization: rigid and tightly
controlled)
o Not organic: highly adaptive and flexible
Training: the use of formal instructional programmes to establish and standardize in people the requisite skills and
knowledge to do particular jobs in organizations
Indoctrination: programmes and techniques by which the norms of the members of an organization are standardized
become responsive to its ideological needs make decisions and take actions
Unit grouping: the choice of the bases by which positions are grouped together into units (usually shown on the
organization chart)
Unit size: the number of positions contained in a single unit
o The equivalent “span of control” is not used here, because sometimes units are kept small despite an absence
of close supervisory control
Planning and control systems: used to standardize outputs
o Action planning systems
o Performance control systems
Liaison devices: devices to encourage mutual adjustment (hoe managers ervoor kunnen zorgen dat binnen het bedrijf
beter gecommuniceerd wordt, door welke structuur van de organisatie, zoals integrating managers)
Decentralization: diffusion of decision-making power. When all the power is in one place it is centralized. So either
vertically or horizontally extent the power of decision-making to more individuals
, THE SITUATIONAL FACTORS
Age and size:
Older more formalized behavior
Larger more formalized behavior, more elaborate structure, the larger the size of its average unit
Structure reflects the age of the industry form its founding
Technical system: instruments used in the operating core to produce the outputs
Environment: various characteristics of the organization’s outside context, related to markets, political climate, economic
conditions, and so on.
Power: per example the greater the external control of an organization, the more centralized and formalized its structure
COORDINATION
Putting parts and players together to produce a seamless experience for the customer requires coordination.
Organizing = creating parts and connections
Managing = coordinating what has been organized (parts, players, etc.)
Managerial functions: planning, organizing, directing, controlling, and managing
A manager: ‘Someone who coordinates and oversees the work of other people so organizational goals can be accomplished
(Robbins & Coulter)
Management/managing: ‘the process of assembling and using sets of resources in a goal-directed manner to accomplish tasks in
an organizational setting’. (Hitt. et al 2013) It is a process that involves a series of activities and operations, such as planning,
deciding, and evaluating.
The act of coordinating what has been organized (parts, players, etc.).
Note: coordination may be seen as the output of managerial functions
HEALTH CARE AS A PROFESSIONAL BUREAUCRACY
- Reliance on professional expertise and skills
- Highly specialized
- Typically organized in functional units
- Clear hierarchy but decentralized power (to professionals)
- Rigid
