Planning Notes PDF

RECAP: 4 Management Functions (PODC) Planning Organizing Directing Controlling Management process: (planning) A goal without a plan is just a- wish…. Planning permeates into the other functions which are dependent on it. By forecasting- can estimate the future; by Setti...

RECAP: 4 Management Functions (PODC) Planning Organizing Directing Controlling Management process: (planning) A goal without a plan is just a- wish…. Planning permeates into the other functions which are dependent on it. By forecasting- can estimate the future; by Setting Objectives- results to be achieved can be determined; by developing and scheduling programs- activities needed within a set time frame can be defined; budget- resources can be allocated PLANNING, Defined: As pre-determining a course of action in order to arrive at a desired result. A continuous process of assessing, establishing goals and objectives, implementing and evaluating them, and subjecting these to change as new facts are known. All planning involves choosing among alternatives. ALL PLANNING INVOLVES A CHOICE; A NECESSITY TO CHOOSE AMONG ALTERNATIVES. Planning is proactive and deliberate process that reduce risk and uncertainty. Proactive - is creating or controlling a situation by causing something to happen rather than responding to it after it has happened. Largely conceptual, its results are clearly visible. PRINCIPLES OF PLANNING: Is always based and focused on the vision, mission philosophy and clearly defined objectives of the organization. Is a continuous process. Should be pervasive within the entire organization. Utilizes all available resources. Must be precise in its scope and nature, realistic and focused on its expected outcomes.  Should be time-bound. Projected plans must be documented for proper dissemination to all concerned. Pervasive- spreading widely through out. Documented to all concerned for Implementation and evaluation as to the extent of its achievement. Importance of Planning: It leads to the achievement of goals and objectives. (Workers relate what they do to a meaningful results since plans are focused on objectives) It gives meaning to work. (. Workers experience greater satisfaction if what they do becomes meaningful to them. ) It provides for effective use of available resources and facilities. (. Best use of personnel and material resources prevents wastage.) It helps coping with crises. Hospitals should provide for disaster plans. (Allows the workers to function more clearly and efficiently when the actual emergencies occur.) It is cost effective. (Cost can be controlled for efficient operation.) It is based on past and future activities. (Evaluation, WON successful prevents and reduces the recurrence of problems and provides better ideas in modifying or avoiding them.) It leads to the realization of the need for change. (e.g minor surgeries are also done at the outpatient department so that more hospital beds can be allotted to critically-ill-patient or for those needing specialized services.) It provides basis for control. (Becomes basis for evaluating the accomplishment of the set programs) It is necessary for effective control. (Nurse managers evaluate the environment which they work and make necessary recommendation (for patients and workers) Skills Requirements: Leadership skills such as being visionary and creativity because it is impossible to plan what cannot be dreamed or envisioned. It also requires flexibility and energy (leadership characteristics) It also requires management skills such as data gathering, forecasting and transforming ideas into action. Why managers fail to plan effectively?  Venzon and Nagtalon (2010) stated that they may either lack knowledge of the philosophy, goals and objectives of the agency or lack of understanding of the significance of planning process. They may not know how to manage their time to devote for planning. May lack confidence in formulating plans or may fear that planning may bring about unwanted changes that they are unwilling to undertake or unable to cope with. Scope of Planning (Nursing Service Division : Top management: Nursing Directors, Chief Nurses or Director of Nursing and their assistants. STRATEGIC PLANNING. They set the over-all goals and policies of the organization. Their responsibility covers the over-all management of the organization’s Nursing Service. Middle Management Nursing Supervisors (Clinical Coordinators) Direct the activities to actually implement the broad operating policies of the organization such as staffing and delivery of services to the units. The formulation of policies, rules and regulations, methods and procedures for intermediate level planning for on-going activities and projects is done in coordination with top management and those on the lower level. INTERMEDIATE PLANNING. First-level Management (lower level) Head Nurses or Senior Nurses (including Charge Nurses or Team Leaders) Do the daily and weekly plans for the administration or direct patient care in their respective units. OPERATIONAL PLANNING. Major aspects of planning Planning should contribute to objectives. Seek to achieve a consistent, coordinated structure of operation focused on desired ends. Actions without plans often results in CHAOS. Planning precedes all other processes of management.  Without a plan there would be nothing to organize, direct and control. Planning leads to easy accomplishment of the agency’s objectives. Planning pervades all levels. Encompasses both higher and lower echelons and vice versa and spreads horizontally through peer levels and/or across services and members of the health team. Planning should be efficient.---- It should contribute to the attainment of objectives not only in terms of peso value, man-hours, units of production but should also include individual values and group satisfaction. Fear, resentment and low morale result in low production Characteristics of a good plan (SMARTS) 1. Be precise with clearly-worded objectives, including desired results and methods for evaluation (Specific) 2. Be guided by policies and or procedures affecting the planned action (Measurable) 3. Indicate priorities (Attainable) 4. Develop actions that are flexible and realistic in terms of available personnel, equipment, facilities, and time. (Realistic) 5. Develop a logical sequence of activities. (Time- Bound) 6. Include the most practical methods for achieving each objective (Time Bound) 7. Pervade the whole organization. (Spread) Four Planning Modes: – Reactive planning – occurs after a problem exists. There is a dissatisfaction with the current situation, Planning efforts are directed toward returning the organization to a previous, more comfortable state. Frequently, problems are dealt with separately without integration with the whole organization. Because it is done in response to a crisis, this type of planning can lead to hasty decisions and mistakes. - Inactivism – inactivists seeks the status quo, and they spend their energy preventing change and maintaining conformity. - Preactivism – Preactive planners utilize technology to accelerate change and future oriented. Unsatisfied with the past and present, preactivists do not value experience and believe that the future is always preferable to the present.  - Interactive or proactive planning. - Consider the past, present and future and attempt to plan the future of their organization rather than react to it. is dynamic, and adaptation is a key requirement because the environment changes so frequently. - Proactive planning: An anticipation of changing needs or to promote growth within the organization and is required of all leader-managers so that personal as well as organizational needs and objectives are met. 2 Major types of Organizational Planning Strategic/ Long-Range Planning: extends 3-5 years into the future. An organizational management activity that is used to set priorities, focus energy and resources, strengthen operations, ensure that employees and other stakeholders are working toward common goals, establish agreement around intended outcomes/results, and assess and adjust the organization’s direction in response to a changing environment. Short Range/Operational Planning: Nurse managers are more likely to be involved in this kind of planning, done in conjunction with budgeting, usually few months before the new fiscal year. It develops the departmental maintenance and improvement goals for the coming year. Strategic Planning Process: 1. Analysis or assessment: where an understanding of the current internal and external environments is developed; Where SWOT Analysis comes in. 2. Strategy formulation: where high level strategy is developed and a basic organization level strategic plan is documented 3. Strategy execution: where the high level plan is translated into more operational planning and action items, and 4. Evaluation or sustainment / management phase: where ongoing refinement and evaluation of performance, culture, communications, data reporting, and other strategic management issues occurs. The Planning Process Forecasting Refers to the practice of predicting what will happen in the future by taking into consideration events in the past and present.  It helps managers look into the future and decide in advance where the agency would like to be and what is to be done in order to get there. Includes: environment in which the plan will be executed, who the client will be (customs and belief, language barriers, public attitude, severity of their conditions, kind of care they will receive), number and kind of personnel required, necessary resources. Takes advantages of input from others, gives sequence in the activity, and protects an organization against undesirable changes. Prediction versus Forecasting Prediction involves using historical data to predict a future outcome. Every year for the past ten years your emergency department sees an influx of intoxicated patients on New Year’s Eve. Thus, you can reliably predict that your ER will again see an uptick in intoxicated patients on the next New Year’s Eve. That’s a classic use of prediction. But let’s say that after the most recent New Year’s Eve your city council banned alcohol from sale or consumption within the metropolis. This new variable greatly alters the reliability of your past decade of data. If you rely on prediction to staff your ER in this scenario, you will be making decisions based on unreliable data. Instead you must move to forecasting, in which you factor new dynamics like the alcohol ban into your decision-making. Forecasting allows you to use data as well as intuition to model several possible future outcomes and then choose the best or most likely option. Because there are Changes in technology, payment structures and resource availability…… If the manager is unwilling or unable to forecast accurately…It will impede the organization’s efficiency and unit’s effectiveness. There is an increased competition… Changes in government reimbursement… Decreased hospital revenues…. Because of this… it reduces the intuitive managerial decision making. To avoid disastrous outcomes when making future professional and financial plans… Managers need to stay well informed about the legal, political, and socioeconomic factors affecting health care. Managers who are uninformed about the legal, political, economic, and social factors affecting health care can result to planning errors and may have disastrous implications for their professional development and the financial viability of the organization Healthcare Forecasting Being Used To project patient demand, disease trends, costs and other variables, Healthcare financial professionals make forecasts by modeling potential outlooks and scenarios using multiple data sources. Healthcare forecasting can improve a provider’s planning and budgeting for patient volume, care-delivery expenditures, staffing and the other fundamentals of running a Healthcare organization. SWOT ANALYSIS: strengths, weaknesses, opportunities, and threats Albert Humphrey at Stanford University in 1960’s and 1970’s is a framework used to evaluate a Health care’s Competitive position and to develop strategic planning. It pulls information from internal sources (strengths or weaknesses of the specific company) and external forces that may have uncontrollable impacts on decisions (opportunities and threats). designed to facilitate a realistic, fact-based, data-driven look at the strengths and weaknesses of an organization, initiatives, or within its industry. works best when diverse groups or voices within an organization can provide realistic data points rather than prescribed messaging. often synthesized to support a single objective or decision that a company is facing. SWOT ANALYSIS: Components: Strengths: it describe what an organization excels at and what separates it from the competition: Weaknesses: those that stop an organization from performing at its optimum level. Areas where the Healthcare Institution needs to improve to remain competitive Opportunities refer to favorable external factors that could give an organization a competitive advantage. Threats refer to factors that have the potential to harm the healthcare institution. Application to Healthcare Institution Internal Strength or weaknesses: may include management development, qualifications of staff, medical staff expertise, abundance or scarcity of staff, financial situation, cash flow position, marketing efforts, market share, facilities, location and quality of services.  Opportunities: may include nurse and physician recruitment, referral patterns, new programs, new markets, diversification, population growth, improved technology and new facilities. Threats: may include shortage of nurses, decrease in patient satisfaction, decrease in insured patients, increase in accounts receivable, decrease in demand for services, competition, regulations, litigation, legislative changes, unionization and loss of accreditation. Setting the Vision, Mission, Philosophy, Goals and Objectives: Vision statement: Outlines the organization’s future role and function; gives the agency something to strive for. Mission Statement: Outlines the agency’s reason for existing, who the target clients are and what services will be provided. Philosophy: describes the vision; It is the sense of purpose of the organization and the reason behind its structure and goals. It explains the beliefs that shape how the mission or purpose will be achieved. It gives direction towards the attainment of the set goals and objectives. Philosophy of nursing service dovetails with the philosophy of the agency. Goals and Objectives: Goals are more general and they cover a broad area while Objectives tend to be more specific and concrete. They are action commitments through which an organization’s mission and purpose will be achieved and the philosophy or belief sustained. Stated in terms of results to be achieved and should focus on the production of health care services to the patients. POLICIES AND PROCEDURES are means for accomplishing goals and objectives. Example of Vision Statement: To be the UNPARALLELED LEADER in patient care, clinical outcomes, research, and education. (St. Luke’s Hospital) Transforming medicine to connect and cure as the global authority in the care of serious or complex disease. (Mayo Clinic Rochester- #1 Hospital in the world Ranking) An Audacious Christ-Centered institution in the Province of Capiz, Providing Quality Educational and Healthcare Services System which respond to the needs of persons living in poverty situations and of GOD's creation. (SACH) An exemplary hospital providing the highest standard in holistic care through our culture of authentic caring and social responsibility. (CDH) Example of a Mission Statement: We provide COMPASSIONATE, PATIENT-CENTERED experience guided by excellence and innovation. (St Luke’s Medical Center)  Inspiring hope and promoting health through integrated clinical practice, education and research. (Mayo Clinic Rochester) Inspired by the Spirit of Saint Vincent de Paul and St. Loiuse de Marillac, we commit ourselves to: 1. Vigorously provide value-innovative educational and healthcare services rooted in Christ. 2. Humanely deliver quality educational and healthcare services to customers especially those living in poverty situations. 3. Proactively respond to take care of GOD's creation. 4. Ardently sustain and improve educational and healthcare services viability. 5. Interdependently accelerate leadership through continuous training, research and intensive Vincentian formation. We recognize the value of every person and are guided by our commitment to excellence, leadership in healthcare and a tradition of caring, and thus we put you – our patient at the center of everything that we do by: Dedicating ourselves to unparallel passion for quality in patient care; Providing an unrelenting attention to clinical excellence; Fostering social responsibility in healthcare; Promoting institutional culture where each person is valued, respected and is given opportunity for personal or professional growth; Strengthening complementary and integrated services with other healthcare and educational institutions. Examples of Philosophy/Values: VALUES: Integrity Healthcare Excellence Accountability Responsibility Teamwork (IHEART) – St Luke’s Medical Center Our institutional primary value: The needs of the patient come first. Our core values: Respect, integrity, compassion, healing, teamwork, innovation, excellence and stewardship. Our values-driven culture. (Mayo Clinic Rochester) Core Values: Social Commitment, Solidarity, Simplicity , Advocacy to person living in poverty situation, Compassionate Services, Commitment to Vincentian Excellence, Co- responsibility and Respect for Human Dignity. Policies and Procedures POLICIES : plans reduced to statements or instruction that directs the organization in their decision making; a statement of expectations that sets boundaries for action taking and decision. – Expressed Policies: Delineated verbally or in writing. Readily available to all people and promote consistency of action. Uniform policies through collaboration is critical. E.g formal dress code, policy for sick leave. – Implied policies: neither in writing or expressed verbally; developed over time and follow a precedent. E.g hospital may have an implied policy that employees should be encouraged and supported in their activity in community, regional and national health care organizations. Procedures: Plans that establish customary and acceptable ways of accomplishing a specific task and delineate a sequence of steps of required action. It supply a more specific guide to action. Procedure Manuals: provide a basis for orientation and staff development and are ready reference for all personnel. Establishing Nursing Standards, Policies and Procedures Some institutions develop their own standards of nursing practice. Standards of Nursing Practice and Nursing Service Administration formulated by a joint committee of the Association of Nursing Service Administrators of the Philippines (ANSAP) and the Philippine Nurses Association, is a good reference. Nursing Service Policies Policies are broad guidelines for the managerial decisions that are necessary in an organizational and departmental planning. General areas in nursing that require policy formulation: – Areas in which confusion about place of responsibility might result in neglect or malperformance of an act necessary to patient’s welfare. – Areas pertaining to the protection of patients and families’ rights (e.g Privacy, property etc) – Areas involving personnel management and welfare. Basis for future actions and decisions, help coordinate plans, control performance and increase consistency of action by increasing the probability that different managers will make similar decisions when independently facing similar situations. Purpose of the policy must be considered, it should be examined carefully so that they facilitate the goals of the department, should also take into account the constraints within the situation. Characteristics of Good Policies It should be written and understandable and known by those who will be affected by them. It should be comprehensive in scope, stable, flexible, so that they can be applied to different conditions. It should be consistent to prevent uncertainty, feeling of bias, preferential treatment and unfairness. It should be realistic and prescribe limits. It should allow for discretion and interpretation by those responsible for it. Nursing Service Policy Manual Manual is an effective tool for orienting new employees, a reference when unexpected problems arise, a basis for developing administrative procedures and a firm basis for discussion when difference occur. It must reflect the policies of the hospital, hence it should be carefully made to define the scope of departmental responsibility within the hospital. Periodic review is necessary to evaluate their effectiveness and workability. Implementation problems and verification if followed. Changes: personnel should be informed. – Example: Accidents, Admissions, Autopsies, Breakage, Bulletin Boards, committees, complaints, consent, death, discharge, Dos, equipment and supplies, fire regulation, Nursing Care, reports, meetings. Interdepartmental Policies: Are developed in keeping with over-all hospital policies, thus ensuring unity and harmonious relationship among departments. Requires understanding of how these services can be carried out smoothly for the betterment of all concerned. Nursing Procedures: Two areas where procedures are needed: 1. Those that are related to job situations (e.g reporting complaint or disciplinary instances) 2. Those involving patient care (Should consider  the safety of the patient, comfort, proper care, use of supplies and equipment, good workmanship on the part of the person doing it) Nursing procedure manuals: should be available in each unit to familiarize nurses with the common nursing procedures utilized in the unit. (Complete, up-to-date, properly indexed). Developing and Scheduling Programs Programs are determined, developed and targeted within a time frame to reach the set goals and objectives. Kron has developed a planning formula which may be used for daily duties, or for short and long range projects. KRON’s PLANNING FORMULA: WHAT- what has been done? What should be done? What equipment and supplies have been used or are needed? What steps are necessary in the procedure? What sequence of activities was previously used? What other efficient methods may be used? WHEN- When should the job be done? When was it formerly done? When could it be done? WHERE- Where is the job to be done? Where does an activity occur in relation to those activities immediately preceding and following it? Where could supplies be stored, cleaned and so forth? HOW- How will the job be done? What are the steps to be followed in doing the procedure? How will the time and energy of personnel be used? How much will it cost? How much time will it require? WHO- Who has been doing the job? Who else could do it? Is more than one person involved? WHY- Why is it necessary? Why is this done this way, in this place, at this time and by this person? CAN- Can some steps or equipment be eliminated? Can this activity be efficiently combined with other operations? Can somebody else do it better? Can we get a machine to Help? Can we get enough money? Time Management: It is a technique for allocating one’s time through the setting of goals, assigning priorities, identifying and eliminating wasted time and using managerial techniques to reach goals efficiently. “Work smarter, not harder” Time Management: Davies et.al states the following symptoms of time mismanagement: Rushing chronic vacillation between unpleasant alternatives fatigue and listlessness with hours of non-productive activity constantly missed deadlines insufficient time for rest and/or personal relationship Feeling overwhelmed by details and demands Time Management Principles Planning anticipates the problems that will arise from actions without thought (PLAN YOUR ACTION) Tasks to be accomplished should be done in sequence and should be prioritized according to importance. Set deadlines and adhere to it. Prevent procrastination. Delegate. Time-saving techniques/devices/ methods to better use of time: Conduct an inventory of your activity. Set goals and objectives and write them down. With the use of calendars, planners, log/journals, write what you expect to accomplish yearly, monthly, weekly or daily. Break down large projects into smaller parts. Devote a few minutes at the beginning of each day for planning. Organize your work space so it is functional. Close your door when you need to concentrate. Learn to delegate. In a meeting, define the purpose clearly before starting.  Take or return phone calls during specified time. Develop effective decision making skills Take rest breaks and make good use of your sparetime. Preparing the Budget: Budget is defined as a written financial plan aimed at controlling the allocation of resources. It is the annual operating plan, a financial “roadmap” and plan which serves as an estimate of future costs and a plan for utilization of manpower, material and other resources to cover capital projects in the operating programs. Nursing Budget: plan for allocation of resources based on preconceived needs for a proposed series of programs to deliver patient care during one fiscal year. Part of the hospital budget Hospital budget: a financial plan to meet future service expectations- derived from the best judgment of the needs of the community. Whole budget. The Budgetary Process It is complex and requires the completion of several complicated documents. A typical budget process ties into overall strategic and managerial planning. The multiple steps of a budget process can be grouped into the following three phases: – Establishing the basis for budget preparation: strategic plans and program budgets need to be prepared. – Preparing the first draft: Unit and department managers use the gathered data to prepare budget documents for their areas. – Reviewing and re-budgeting: As budget documents go through serial review and flow to top administration. This necessitates review, adjustment, and appeal. There may be multiple iterations of re-budgeting before the final budget is approved. The Budgetary Process in the Nursing Service: Budget committee must be well-defined (for timely and orderly development of the budget).- It can assist the budget officer in budget preparation and in monitoring the budget. Chief nurse or assistant is usually a member of the budget committee. Within the nursing service , Chief Nurse works with supervisors and head nurses in preparing the budget for the nursing service. Factors should be considered in Budget Preparation:  – Assurance of standards according to the philosophy and objectives of the hospital and the Nursing Service. – Past experiences in the unit – Anticipated needs of the unit. – Percentage of unit occupancy. Estimation of staff for each unit should be based on the number of patients, number of nursing care hours needed, the provision of leaves and holidays and the average number of absences per staff member per year. Components of Budget Cash Budget: Forecasts the amount of money received. Consist of Beginning cash balance, estimates of the receipts and disbursements and the estimated balance for a given period corresponding to that of the operating and capital budgets. Operating Budget: deals primarily with day- to-day service delivery operations. Nurse managers typically prepare three major aspects of the operating budget: (1) the expense budget for personnel; (2) the expense budget for costs other than personnel; and (3) the revenue budget. Capital Expenditure Budget: consists of accumulated data for fixed assets that are expected to be acquired during the budgeted period. – Any proposal for Capital Equipment must be accompanied by a complete description of the item, a statement as to the reason of purchase (addition, improvement or replacement), Classification item’s prioritization The Budgetary Process in the Nursing Service Ascertain the amount and kind of supplies needed for the operation of each nursing unit. Requests for the replacement of capital equipment must be supported with documented justification. Chief Nurse compiles and completes the final draft of the budget and presents this to the Budget Officer or Hospital Administrator. PLANNED CHANGE CHANGE: Planned Change: it results a well thought-out and deliberate effort to make something happen. It is the deliberate application of knowledge and skills by a leader to bring about a change. It occurs because of an intended effort by a change agent to deliberately move the system. Change Theory: Developed by Kurt Lewin (1951) He identified three phases through which the Change Agent (CA for brevity) must proceed before a planned change becomes part of the system: – Unfreezing stage: CA unfreezes forces that maintain the status quo. Thus, people become discontented and aware of a need to change “People must believe that change is needed” – Movement: CA identifies, plans and implements appropriate strategies, ensuring that driving force (forces that push the system toward the change) exceeds restraining forces (Forces that pull the system away from the change). As Change is a complex process- it requires a great deal of planning and intricate timing. Recognizing, addressing and overcoming resistance may be a lengthy process. – Refreezing: CA assists in stabilizing the system change so it becomes integrated into the status quo. If it is incomplete- change will be ineffective and the pre-change behaviors will be resumed. Change Strategies Described by Bennis, Benne and Chin (1969) Rational-Empirical Strategies: give current research as evidence to support change. Assumption: resistance comes from ignorance and superstition. “That humans are rational beings who will change when given factual information documenting the need for change”. Normative re-educative strategies: it use group norms to socialize and influence people so change will occur. Assumption: Humans are social animals- more easlily influenced by others than by facts. Power-Coercive strategies: based on the application of power by legitimate authority, economic sanctions, or political clout of the change agent. Resistance: The expected response to change Because it disrupts the homeostasis/status quo. Level of resistance generally depends on the type of change proposed. – Covert: delaying tactics or passive-aggressive behavior – Overt: openly refusing to follow a direct command Instead of wasting time and energy trying to eliminate opposition, contemporary managers immerse themselves in identifying and implementing strategies to minimize or manage this  resistance. Encourage subordinates to speak openly so options can be identified to overcome objections. Enumeration, Identification through a Word Bank, Situational Multiple Choice, Essay/Illustration.