Controlling NCM 119 Lecture PDF

PRNU141: NCM 119 (Lecture) – 4th Year, 1st Semester |By: Alyssa Baldeo CONTROLLING Basic Components of the Control Process 1. establishment of standards, objectives...

PRNU141: NCM 119 (Lecture) – 4th Year, 1st Semester |By: Alyssa Baldeo CONTROLLING Basic Components of the Control Process 1. establishment of standards, objectives, and methods for CONTROLLING measuring performance ▪ It is an on-going function of management 2. measurement of actual performance ▪ It includes assessing and regulating performance 3. comparison of results of performance with standards and ▪ It offers opportunities for improvement and comparing objectives and identifying strengths and areas for performance against standards correction and/ or improvement ▪ The means of good performance and management 4. action to reinforce strengths or successes includes 5. implementation of corrective action as necessary o leadership and commitment o full employee involvement Establishment of Standards for Measuring Performance o good planning 1. Standards on structure o sound implementation strategy, measurement and ▪ Structure Measures are: evaluation, control and improvement, o Relationship exists between quality care and o the achievement and sustenance of standards of appropriate structure. excellence. o It includes resource inputs such as the environment in which health care is delivered. Reasons For Conducting Evaluation o For example, staffing ratios, staffing mix, 1. Evaluation ensures that quality nursing care is provided. emergency department waiting times, and the 2. It allows for the setting of sensible objectives and ensures availability of fire extinguishers in patient care compliance with them. areas 3. It provides standards for establishing comparisons. 2. Process standards 4. It promotes visibility and a means for employees to ▪ Process Measures are: monitor their own performance. o Used to measure the process of care or how 5. It highlights problems related to quality care and the care was carried out. determines the areas that require priority attention. o Relationship exists between the process used 6. It provides an indication of the costs of poor quality. by the nurse and the quality of care provided. 7. It justifies the use of resources. o They tend to be task-oriented and focus on 8. It provides feedback for improvement. whether practice standards are being fulfilled. o Critical pathways and standardized clinical Evaluation Principles guidelines are examples of efforts to 1. The evaluation must be based on the behavioral standardize the process of care standards of performance 3. Outcome standards 2. In evaluating performance, there should be enough time ▪ Outcome measures are: to observe employee's behavior. Usual and consistent o The end results of medical care. behavior should be evaluated o The changes in the patient's health status 3. The employee should be given a copy of the job o What happened to the patient in terms of description, performance standards, and evaluation form palliation, control of illness, cure, or 4. The employee's performance appraisal should include rehabilitation. both satisfactory and unsatisfactory results o What results (if any) occurred as a result of 5. Areas needing improvement must be prioritized specific interventions. 6. The evaluation conference should be scheduled o Examples of outcomes are mortality, 7. The evaluation report and conference should be morbidity, and length of hospital stay. structured positively as a means of improving job performance. Establishment of Objectives and Methods for Measuring Performance Characteristics of an Evaluation Tool ▪ It provides clear direction and communication of ▪ Objectivity expected levels of achievement. ▪ Reliability ▪ There should be full commitment in the form of a ▪ Validity performance contract. ▪ Sensitivity ▪ Objectives should be challenging but attainable. ▪ Performance expectations must be clearly stated and should lie within the individual's scope of control.  PRNU141: NCM 119 (Lecture) – 4th Year, 1st Semester |By: Alyssa Baldeo Commonly used methods for measuring nursing care 11. provide "employee recognition" for accomplishments; ▪ Task analysis 12. inform employees "where they stand." ▪ Quality control - Activities that evaluate, monitor, or regulate services rendered to consumers. Factors Contributing to an Effective Performance Appraisal o Three Steps of the Quality Control Process System 1. The criterion or standard is determined. 1. Compatibility between the criteria for individual 2. Information is collected to determine if the evaluation and organization goals. standard has been met. 2. Direct application of the rated performance to 3. Educational or corrective action is taken if the performance standards and objectives expected of the criterion has not been met. worker. 3. Development of behavioral expectations which have Measuring Actual Performance been mutually agreed upon by both the rater and the ▪ It is an on-going, repetitive process worker. ▪ It may be scheduled in advance 4. Understanding the process and effective utilization of ▪ Purpose of measurements should be clarified procedure by the rate 5. Rating of each individual by the immediate supervisor. Comparing results of Performance with Standards and 6. Concentration on the strengths and weaknesses to Objectives improve individual performance. ▪ It is the easiest steps in the control process 7. Encouragement of feedback from the rated employees ▪ It is the matching of performance to standards and about their performance needs and interests. objectives = needs of patients are met 8. Provision for initiating preventive and corrective action and making adjustments to improve performance. Reinforcing Strengths or Successes and Taking Corrective Action As Necessary Methods of Measuring Performance ▪ Positive feedback stimulates motivation, consistently high 1. Essay - The appraiser writes a paragraph or more about performance and growth of the employee. the worker's strengths, weaknesses and potentials. ▪ Corrective actions are applied to improve performance. 2. Checklists - A compilation of all nursing performances expected of a worker. The appraiser's task is to mark the PERFORMANCE APPRAISAL appropriate column whether the worker does or does not ▪ It is a control process in which employee's performance is show the desired behavior. evaluated against standards. 3. Ranking - the evaluator ranks the employees according to ▪ It is the most valuable tool in controlling human resources how he or she fared with co-workers with respect to and productivity. certain aspects of performance or qualifications. ▪ It reflects how well the nursing personnel have performed 4. Rating Scales - includes a series of items representing the during a specific period of time. different tasks or activities in the nurse's job description or the absence or presence of desired behaviors and the A performance appraisal is used to: extent to which these are possessed. 1. determine salary standards and merit increases; 5. Forced-Choice Comparison 2. select qualified individuals for promotion or transfer; ▪ the evaluator is asked to choose the statement that 3. identify unsatisfactory employees for demotion or best describes the nurse being evaluated. 4. termination ▪ The items are so grouped that the evaluator is 5. make inventories of talents within the institution; forced to choose from favorable as well as 6. determine training and developmental needs of unfavorable statements employee 6. Anecdotal Recording 7. improve the performance of work groups by examining, ▪ describes the nurse's experience with a group or a improving, correcting interrelationships between person, or in validating technical skills and members interpersonal relationships. 8. improve communication between supervisors and ▪ The anecdotal record should include (1) a employees and reach an understanding on the objectives description of the particular occasion, (2) a of the jo delineation of the behavior noted including answers 9. establish standards of supervisory performance; to the questions who, what, why, when, where, and 10. discover the aspirations of employees and reconcile these how, and (3) the evaluator's opinion or assessment with the goals of the institution; of the incident or behavior  PRNU141: NCM 119 (Lecture) – 4th Year, 1st Semester |By: Alyssa Baldeo Coaching as Part of the Performance Appraisal Process 8. Peer pressure provides the impetus to effect prescribed ▪ The effective manager and astute leader are aware that changes based on the results of assessment and needed day-to-day feedback regarding performance is one of the improvements on the quality of care. best methods for improving work performance and 9. Reorganization in the formal organizational structure may building a team approach. be required if assessment reveals the need for a different ▪ Reflective Practice or Clinical Coaching - In reflective pattern of health care. practice or clinical coaching, the manager or mentor 10. Collection and analysis of data should be utilized to meets with an employee regularly to discuss aspects of motivate remedial action. their work. Quality Assurance Methods Quality Assurance ▪ Nursing Audit Committee - A nursing audit committee is ▪ Assurance means achieving a sense of accomplishment composed of a represent ative from all levels of the and implies a guarantee of excellence nursing staff: a member of the Training Staff, Supervising ▪ Quality is the degree of excellence Nurse, Head/Senior Nurse, and a Staff Nurse. ▪ Assurance means formal guarantee of a degree of ▪ Patient Care Audits excellence. o A concurrent audit ▪ Total quality management (TQM) - a way to ensure 1) a review of the patients' charts while the customer satisfaction by involving all employees in the patients are still confined in the hospital; improvement of the quality of every product or service. 2) observation of the staff as patient care is given; ▪ Continuous quality improvement (CQI) - a process of 3) inspection of patients and/or observation of continuously improving a system by gathering data or the effects of patient care where the focus is on performance and using multi-disciplinary team to analyze the patient. the system, collect measurements, and propose changes. o A retrospective audit o The four main principles are 1) a review of discharged patients' charts 1. customer focus, 2) questionnaires sent to or interviews 2. the identification of key processes to improve conducted on discharged patients. quality, ▪ Peer Review 3. the use of quality tools and statistics o Patient care audits may be done by peers 4. and the involvement of all people in problem (employees of the same profession, rank and solving. setting) evaluating another's job performance ▪ Benchmarking against accepted standards. o The process of measuring products, practices, or o Peer review has the potential for increased services against best-performing organizations. professionalism, performance, and professional o Organizations can determine how and why their accountability among practicing staff and is gaining organization differs from these exemplars and then popularity in the United States and internationally. use the exemplars as role models for standard ▪ Quality Circles development and performance improvement. o introduced by the Japanese. o a group of workers doing similar work who meet Principles Underlying Quality Assurance Efforts regularly, voluntarily, on normal working time, 1. All health professionals should collaborate in the effort to under the leadership of their supervisor, to identify, measure and improve care. analyze, and solve work-related problems and to 2. Coordination is essential in planning a comprehensive recommend solutions to management. quality assurance program. 3. Resource expenditure for quality assurance activities is Control of Resources appropriate. ▪ the periodic review of the utilization of materials and 4. There should be focus on critical factors such as functions supplies in the various nursing units and activities ▪ Consumption of supplies and materials should be 5. Quality patient care is accurately evaluated through proportionate to the number of patient served adequate documentation. ▪ A high turnover rate is desired 6. The ability to achieve nursing objectives depends upon ▪ Preventive maintenance is important the optimal functioning of the entire nursing process and its effective monitoring. 7. Feedback to practitioners is essential to improve practice.  PRNU141: NCM 119 (Lecture) – 4th Year, 1st Semester |By: Alyssa Baldeo Self-Discipline McGregor’s (1967) Hot Stove Rule ▪ The process by which rules are internalized and become Four elements must be present to make discipline as fair and part of the person’s personality. growth-producing as possible: ▪ Highest and most effective form of discipline. 1. Forewarning 2. Immediate consequences Factors that influence self-discipline 3. Consistency 1. A strong commitment to the vision, philosophy, goals and 4. Impartiality objectives of the institution 2. Laws that govern the practice of all professionals and Four Common Steps in Progressive Discipline their respective Codes of Conduct 1. Counseling/Informal reprimand or verbal admonishment. 3. Understanding the rules and regulations of the agency 2. Formal reprimand or written admonishment. 4. A atmosphere of mutual trust and confidence 3. Suspension from work without pay. 5. Pressure from peers and organizations 4. Termination. Strategies to Create an Environment of Self-Discipline The Disciplinary Conference 1. Clearly written and communicated rules and regulations. 1. State problem clearly. 2. Atmosphere of mutual trust. 2. Ask employee why there has been no improvement. 3. Judicious use of formal authority. 3. Explain disciplinary action to be taken. 4. Employee identification with organizational goals. 4. Describe expected behavioral change. 5. Get agreement and acceptance of the plan. Rule Breaking ▪ Most common reason for discipline. Performance Deficiency Coaching ▪ If rule is consistently broken, need to ask: ▪ May be ongoing or problem-centered. 1) Whose rule is it? ▪ Manager actively brings areas of unacceptable behavior 2) Do we still need the rule? or performance to the attention of the employee and ▪ Think back to rule breakers you have know: works with him or her to establish a plan to correct o Were they a majority or minority in the group? deficiencies. o How great was their impact on group behavior? o What characteristics did they have in common? The Termination Conference o Did the group modify the rule breaker’s behavior or 1. State the facts of the case and the reason for termination. did the the rule breaker modify the group’s 2. Explain the termination process. behavior? 3. Ask for employee input and respond calmly and openly. 4. End the meeting on a positive note, if possible. Destructive Discipline ▪ Use of threats and fear to control behavior. Termination ▪ Employee always alert to impending penalty or ▪ Should always be the last resort when dealing with poor termination. performance, but is necessary for employees who ▪ Arbitrarily administered and either unfair in the continue to break rules despite repeated warnings. application of rules or the resulting punishment. ▪ Is always difficult for the employee, manager, and unit; however, the cost in terms of managerial/employee time Constructive Discipline and unit morale of keeping such an employee is ▪ Helps the employee to grow. enormous. ▪ Is carried out in a supportive, corrective manner. ▪ Employee is reassured that punishment is given because of actions and not because of who he or she is as a person. ▪ Primary focus is to assist the employee to behave in a manner that allows him or her to be self-directed in meeting organizational goals.