NLM-MIDTERMS PDF

LEADERSHIP AND MANAGEMENT IN NURSING Effective leadership and management Responsible for overseeing medical team. A. CONCEPTS OF LEADERSHIP AND MANAGEMENT LEADERSHIP – use of one’s skill to influence others. – It is the art of establishing directions. – action of...

LEADERSHIP AND MANAGEMENT IN NURSING Effective leadership and management Responsible for overseeing medical team. A. CONCEPTS OF LEADERSHIP AND MANAGEMENT LEADERSHIP – use of one’s skill to influence others. – It is the art of establishing directions. – action of leading a people. – priviledge to have responsibility to direction actions to others. LEADER Lead Individuals who are out front, taking risks, attempting to achieve shared goals, and inspiring others to action. Those individuals who choose to follow a leader do so by choice, not because they have to DIMENTIONS OF LEADERSHIP: leader – one who directs | follower – rejects or accepts the leader | situation – elements such as work demands, degree of interaction, amount of time. CHARACTERISTICS OF LEADERS: Often do not have delegated authority but obtain their power through other means, such as influence. Have a wider variety of roles than managers. May or may not be part of the formal organization. Focus on group process, information gathering, feedback, and empowering others. Emphasize interpersonal relationships. Direct willing followers. Have goals that may or may not reflect those of the organization. GOALS: ▪ Is the desired aim or condition toward which one is willing to work ▪ Can be short or long term. a. Individual - Personal goals to do task. - Mini goals CJPV  b. Group goals - Org goals in a smaller scale c. Organizational goals - A management goals - Planning for failure KINDS OF INFLUENCE: ARIESBCU 1. Assertiveness – standing up for oneself and others w/out violating the others. 2. Rationality – convincing someone using reason, logic or explanation. 3. Ingratiation – you make an individual feel good, important before making a request. 4. Exchange – offering a favor or sacrifice in exchange of factor. 5. Sanction – coercive authority. Gives punishment for noncompliance. 6. Blocking – cutting of cooperation from future request. 7. Coalition – solidify request to back up workers request. 8. Upward appeal – obtaining formal or informal sipport of the higher up. TYPES OF LEADER: 1. Formal – officially appointed, elected 2. Informal – chosen by the group. Those who initiate an action. LEADERSHIP FLAWS: 1. A lack of energy and enthusiasm 2. Acceptance of their own mediocre performance 3. Lack of a clear vision and direction 4. Having poor judgment 5. Not collaborating 6. Not walking the talk 7. Resisting new ideas 8. Not learning from mistakes 9. A lack of interpersonal skills 10. Failing to develop others COMMON LEADERSHIP ROLES - Decision maker - Priority setter - Communicator - Coach - Evaluator - Counselor - Facilitator - Teacher - risk taker - Critical thinker - Mentor - Buffer - Energizer - Advocate CJPV  - Visionary - Change agent - director - Diplomat - Forecaster - Role model - Influencer - Innovator - Creative problem solver - Encourager MANAGEMENT: Focus on tasks such as planning, organizing, directing and controlling human and physical resources and technology to achieve organizational goals / objectives. MANAGER: Managing people in the organization. Make sure employees know what they are doing and organizational operations run smoothly. 7 BASIC RESOURCES OF MANAGEMENT: Manpower – people/laborers PNCTTMN Money – cost of things to accomplish a goal Machine – bigger equipment, capital expenses, to start a business Materials – lesser/minor equipment, operation of organization or unit Methods - process Moment/Minutes – time managment Manager – responsible for planning. LEVELS OF MANAGEMENT: UMF a. Upper level manager - 24/7 responsibility - Primary responsible for establishing organizational goals and strategic plans for the entire division of nursing - Director of Nursing Services, Chairman, Executive Vice President b. Middle Level Manager - Usually coordinate nursing activities of several units - Supervisor, coordinator, clinical nurse managers, case managers - 24/7 responsibility c. First level Manager - Directly responsible for the actual production of nursing services. - acts as links between higher level managers and non- managers. - Head nurse (nurse manager), charge nurse (informal), team leader, primary nurse - Responsibility depends on their shift. MANAGER: AUTHORITY: legitimate right to give commands, to make decisions POWER: ability to get results | ability to impose his or her will on another person or group. POWER A LEADER/MANAGER MAY POSSESS: LERCERI LEGITIMATE POWER - based on position given CJPV  - given by director - bestowed upon a leader or manager REWARD POWER - reward / incentives - obvious but when abuse (ineffective) COERCIVE POWER - give sanctions or punishment EXPERT POWER - influence thru knowledge possession REFERENT POWER - charisma – innate personality trait - connection INFORMATION POWER - based on the individual’s access to valued data DISTINCTIONS BETWEEN LEADERS AND MANAGERS: Leadership is doing the right thing while management is doing things right. The terms management and leadership refer to the functions and relationships while the terms leaders and managers refer to the actor or agent of leadership and management. The integration of both leadership and management skills is critical to the long term viability of today’s health-care organizations. CJPV B. LEADERSHIP THEORIES 1. Early Leadership Theories The great man theory/trait theories (1900-1940) - The basis for most leadership research until the mid 1940s THE GREAT MAN THEORY: - From aristotelian philosophy, asserts that some people are born to lead, whereas others are born to be led. - suggests that great leaders will arise when the situation demands it. TRAIT THEORY: - assume that some people have certain characteristics or personality traits that make them better leaders than others. - What leader can do. - Mother Theresa and Pope John Pau 2.BEHAVIORAL THEORIES (1940-1980) KURT LEWIN (1951) – ISOLATED 3 PRIMARY LEADERSHIP STYLES 1. AUTHORITARIAN/AUTOCRATIC: - leader has full power. - Group actions are predicatable - Task oriented - Effective only when needed and immediate action Authoritarian Leader is characterized by the ff behaviors: Makes decisions alone Proves useful in crisis situation. High productivity, less satisfaction of workers Others are directed with commands. CJPV  Communication flows downward. Criticism is punitive. 2. DEMOCRATIC - Involves team members in decision - Members are important - Partially effective - Less efficient Democratic Leader is characterized by the ff behaviors: Less control is maintained. awards are used to motivate. Others are directed through suggestions and guidance. Communication flows up and down. Decision making involves others. Emphasis is on “we” rather than I and you. Criticism is constructive. 3. LAISSEZ-FAIRE - Hands off leadership - Minimal - Non directed leadership - Little or no control - Leader does not care Laissez-faire leadership is characterized by the ff behaviors: Is permissive, with little or no control Motivates by support when requested by the group or individuals Provides little or no direction Uses upward and downward communication between members of the group Disperses decision making throughout the group Places emphasis on the group Does not criticize 3.SITUATIONAL & CONTINGENCY LEADERSHIP: Situational - focuses on adapting to the current situation Contingency -predict and prepares for possible future situation 1.CONTIGENCY LEADERSHIP THEORY: Robert Blake & Jane Mouton (1964) - identifies different styles of leadership based on concern for people versus concern for task production. (managerial grid) CJPV Fred Fiedler (1967) - Leadership style should adapt to the situation at hand and the team. Paul Hersey & Kenneth Blanchard (1977) - Depends on the situation - Considers the person’s readiness and willingness 2.COTEMPORARY LEADERSHIP THEORIES Interactional leadership theory (1970-present) - leadership behavior is generally determined by the relationship between the leader’s personality and the specific situation. - a leader take it upon themselves to include others as much as possible by delegating tasks. Edgar Schein (1970) - Developed culture model - can be used to understand and shape an organization’s culture. Edwin hollander (1978) - Highlights the leader –followership relationship as central to effective leadership. - ‘Doing things with people not to people’ in a 2 way influence relationship Hollander (leadership exchange involves 3 basic elements) 1. The leader 2. The followers 3. The situation William G. ouchi (1981) - Theory z (Japanese style management) - aims to develop a work force that is loyal towards the organization through out it’s career. Rosabeth moss kanter (1977) - A leader must develop relationships with a variety of people and groups within the organization in order to maximize job empowerment and be successful. 3.TRANSFORMATIONAL LEADERSHIP THEORY James mcgregor burns (2003) 2 primary types of leaders in management 1. The transactional leader- the traditional manager, concerned with the day to-day operations. 2. Transformational leader- is committed, has a vision, and is able to empower others with this vision. Transactional leaders focus on tasks and getting the work done. Transformational leaders focus on vision and empowerment. Bass and Avolio (1994) - Leader influence followers and inspire them to perform beyond their perceived capabilities. James Kouzes and barry Posner (2012) - exemplary leaders foster a culture in which relationships between aspiring leaders and willing followers can thrive. Kouzes & posner 5 practices for exemplary leadership: CJPV  - Model the way - Inspire a shared vision - Challenge the process - Enable others to act - Encourage the heart S Gerhard Huber (2015) - collective empowerment. - both the leader and the people they are leading, are working together to achieve a shared goal American Nurses Association (2016) - leaders do more than delegate, dictate & direct - help others achieve their highest potential. 4.SERVANT LEADERSHIP Robert GREENLEAF (1977) - Leaders put serving others as number one priority Bass and Avolio (1993) - a full range leader could apply principles of three specific styles of leadership at any given time: transformational, transactional, and laissez-faire. NURSING LEADERSHIP: The process where the nurse influences one or more persons to achieve specific goals in the provision of nursing care of one or more patients. MANAGEMENT THEORIES 1.EARLY MANAGEMENT THEORIES Traditional management methods - Scientific - Bureaucratic - General administrative Scientific management theory (1900-1930) Frederick winslow taylor (1911) - father of scientific mgt - Conducted Time and motion studies - One best way to do the job/accomplish the task - Result: Productivity and profits rose dramatically MANAGEMENT FUNCTIONS Henri fayol (1841-1925) first identified the management functions of planning, organization, command, coordination, and control. MANAGEMENT PROCESS: Functions 1. Planning 2. ORGANIZING 3. Command 4. Leading CJPV  5. Controlling 1. Bureaucratic management theory Max weber (1846-1920) - (father of modern organization) - The ideal form of organization is “Bureaucracy” - With hierarchies - with rules & regulations to increase efficiency Luther Gulick - expanded on Fayol’s management functions in the “7activities of management” “POSDCORB” - planning, organizing, staffing, directing, coordinating, reporting & budgeting 2. Contemporary management theories Human relations management (1930-1970) - This era developed the concepts of participatory & humanistic management, emphasizing people rather than machines. Participative: Mary Parker Follet (1926) (Participatory management) - The art of getting things done through people Hawthorne effect: ELTON MAYO (1953) - When management paid special attention to people; productivity will increase - More employee participation in decision making Theory x & Y: Douglas Mcgregor (1960) - theorizing that managerial attitudes about employees can be directly correlated with employee satisfaction. - Theory X managers believe that their employees are basically lazy, need constant supervision & direction. - Theory Y managers believe that their workers enjoy their work, are self- motivated, & are willing to work hard to meet personal and organizational goals. Chris Argyris (1964) - supported McGregor (1960) & Mayo (1953) - that managerial domination causes workers to become discouraged and passive. - stressed the need for flexibility within the organization and employee participation in decision making. The human relations era of management science brought about a great interest in the study of workers that contributed to our understanding about worker motivation. CONCEPTUAL PARADIGM OF LEADERSHIP & MANAGEMENT: CJPV CJPV  PLANNING - Is deciding in advance what to do, who is to do it and how, when, and where it is to be done. - First primary function & precedes all other management functions. KFPIVCER LEADERSHIP ROLES IN ORGANIZATIONAL PLANNING Knowledge into vision & insights to foster goal attainment Forecasting Inspires proactive planning Influences & inspires team to be involved in planning Value clarification to self awareness, thru active listening & feedback Communicates & clarifies organizational goals and values to subordinates Encourages involvement in policy formation Receptive to new ideas KUPCDDP MANAGEMENT FUNCTIONS IN ORGANIZATIONAL PLANNING Knowledge on legal, political, economic & social factors affecting health-care planning Uses appropriate techniques in planning Provides opportunities to participate in organizational planning Coordinates planning with organizational goals Determine available resources for planning Develops, articulates, reviews & revises unit goals and objectives, policies & procedures, unit philosophy to meet the unit’s changing needs Participates in planning, defining & operationalizing plans at the unit level DCP4 PRINCIPLES OF PLANNING Deciding in advance Choosing among alternatives Proactive & deliberate process 4 planning modes RIPP 4 PLANNING MODES 1.Reactive - past oriented, predicts the future. - can lead to nasty decisions and mistakes - Occurs after a problem exists - Aim to return to a previous & more comfortable state 2.Inactivism - present oriented. - preserves the present and fears the future - Seeks to maintain the status quo & prevent change  3.Preactivism - future oriented. - future is always preferrable for the present - Utilizes technology to accelerate change & is future oriented 4.Proactive - create the future - Consider the past, present & future to plan the future of the organization rather than react to it PEGED CHARACTERISTICS OF PLANNING Precise with Objectives PWO EC Guided by policies & procedures GBPP EE Develop actions that are flexible DATAF Evaluation checkpoints Employee engagement PLANNING PROCESS Assessment - involves gathering of data Diagnosis - problem are identified Planning - develops strategies Implementation - plan that is put into action Evaluation - assessing the outcomes of the plan TYPES OF PLANNING ❖ Strategic planning - Is an organization’s process of defining it’s strategy or direction & making decisions on allocating it’s resources to attain strategic goals. long range plan. Strategic planning tools: - upper level of management SWOT analysis - developed by Albert Humphrey at Stanford University in the 1960s and 1970s. A tool frequently used to conduct environmental assessments such as new equipment & technology, escalating cost and prestige of the company & it’s impact to society. Strengths - internal attributes that help an organization to achieve its objectives. Weaknesses - internal attributes that challenge an organization in achieving its objectives. Opportunities - external conditions that promote achievement of organizational objectives. Threats - external conditions that challenge or threaten the achievement of organizational objectives. Balanced scorecard - developed by Robert Kaplan and David Norton in the early 1990s  Able to translate strategy into action It is an effective tool for translating an organization’s strategic vision into clear and realistic objectives. ❖ Operational planning - Pertains to activities in specific departments of an organization & focuses on timetables, actions & resources - first level: unit level ▪ GANTT CHART - one of the common tools that managers use to create operational plans. Useful for planning and scheduling projects. FVMPGPP ELEMENTS OF PLANNING - Forecasting - involves trying to estimate how a condition will be in the future. - Vision - used to describe future goals or aims of an organization.  ▪ Ex: County Hospital will be the leading center for trauma care in the region. - Mission - identifies the organization’s constituency and addresses its position regarding ethics, principles & standards of practice. ▪ Ex: County hospital is a tertiary care facility that provides comprehensive, holistic care to all state residents who seek treatment. The purpose of County Hospital is to combine high- quality, evidence-based care with the provision of learning opportunities for students in medicine, nursing, and allied health sciences. - Philosophy - flows from the purpose or mission statement o Describes the set of values and beliefs that guide all actions of the organization. o The basic foundation that directs all further planning toward that mission ▪ NURSING SERVICE PHILOSOPHY - address fundamental beliefs about nursing & nursing care; the quality, quantity & scope of nursing services & how nursing will meet organizational goals. ▪ INDIVIDUAL PHILOSOPHY & VALUES - values have a tremendous impact on the decisions that people make. MCNALLY’S 4 CHARACTERISTICS THAT DETERMINE A TRUE VALUE o It must be freely chosen from among alternatives only after due reflection. o It must be prized and cherished. o It is consciously and consistently repeated (part of a pattern). o It is positively affirmed and enacted. - Goals - the desired result toward which effort is directed o It is the aim of the philosophy ▪ Objectives - more specific and measurable than goals because they identify how and when the goal is to be accomplished. ▪ 2 focus of objectives: Process Objectives - methods to be used o Ex: “100% of staff nurses will orient new patients to the call-light system, within 30 minutes of their admission, by first demonstrating its appropriate use and then asking the patient to repeat said demonstration.” Result-focused objectives - specify the desired outcome o Ex: “95% postoperative patients will perceive a decrease in their pain levels following the administration of parenteral pain medication.” - Policies - plans reduced to statements or instructions that direct organizations in their decision making. ▪ 2 types of policies: Implied - neither written nor expressed verbally Expressed - verbally or in writing - Procedures - plans that establish customary or acceptable ways of accomplishing a specific task and delineate a sequence of steps of required action RULES AND REGULATIONS - Plans that define specific action or nonaction - Describe situations that allow only one choice of action BUDGET Fiscal year - keeping an organization running efficiently within its allocated budget - is a financial plan that includes estimated expenses as well as income for a period of time. CLASSIFICATIONS OF EXPENSES Fixed - predicatable, one pricing. Ex: rents - easier to plan and is usually stay the same over time Variable - nagbabago yung pricing. Materials used in hospi like meds - unpredictable Controllable - can be controlled. Ex: staff mixing of RN and NA Non-controllable - cannot be controlled. STEPS IN BUDGETARY PROCESS 1. Assess what needs to be covered in the budget 2. Diagnosis 3. Develop a budget plan 4. Implementation 5. Evaluation TYPES OF BUDGET: Personnel - The largest of the budget expenditures is the workforce or personnel budget because health care is labor intensive. Operating - reflects expenses that change in response to the volume of service, such as the cost of electricity, repairs and maintenance, and supplies. Capital - plan for the purchase of buildings or major equipment, which include equipment that has a long life. BUDGETING METHODS: 1. Incremental budgeting - the simplest method for budgeting by multiplying current year expenses by a certain figure. Budget for the coming year may be projected. 2. Zero-based budgeting - this method does not automatically advice to be of a program that has been funded in the past. Should be continued to be funded. 3. Flexible budgeting - budget that flex up and down depending on the volume 4. Performance budgeting - budget allocated for the performance of the employees. Emphasizes outcomes and results 5. directed at specified goals and objectives 6. must be flexible and allow for readjustment as unexpected events occur 7. The manager should include in the planning process all people and units that could be affected by a plan 8. specific, simple, and realistic  9. Know when to plan and when not to plan 10. A final evaluation should always occur at the end of the plan ORGANIZING - Follows planning as the second phase of the management process - Relationships are defined, procedures are outlined, equipment is readied & tasks are assigned. - Involves establishing a formal structure to provide for the coordination of resources to accomplish objectives. ORGANIZATION Henri Fayol (1949) Organization is formed when the number of workers is large enough to require a supervisor. Organizations are necessary because they accomplish more work than can be done by individual effort. ORGANIZATIONAL THEORY & BUREAUCRACY Max Weber (1920s) - Bureaucracy as an institutional method for applying general rules to specific cases, thereby making the actions of management fair & predictable. CHARACTERISTICS OF BUREAUCRACIES Clear division of labor Well-defined hierarchy of authority must exist Impersonal rules and impersonality of interpersonal relationships. System of procedures for dealing with work situations System of rules covering the rights & duties of each position must be in place. Selection for employment & promotion is based on technical competence. ORGANIZATION CHART Max Weber (father of organizational theory) Credited with the development of the organization chart to depict an organization’s structure. ORGANIZATIONAL STRUCTURE - Refers to the way in which a group is formed, its lines of communication, and its means for channeling authority and making decisions. 1. FORMAL STRUCTURE o Emphasis is on organizational positions and formal power o Roles & functions are defined & systematically arranged o Different people have differing roles o Rank and hierarchy are evident 2. INFORMAL STRUCTURE o Focus is on the employees, their relationships & the informal power that is inherent within those relationships o Often result in a more immediate response from individuals, saving people’s time & effort o People rely on informal structure if the formal structure has stopped being effective o The informal structure also has its own leaders. o Also has its own communication channels, often referred to as the grapevine. DIVISION OF WORK: each box COMPONENTS OF ORGANIZATIONAL STRUCTURE represents an individual or sub-unit responsible for a given task. 1. Relationships & chain of command CHAIN OF COMMAND: lines indicating who reports to whom and by what authority. o Defines formal relationships within the institution o Formal relationships, lines of communication & authority are depicted on a chart by unbroken or solid lines o These line positions can be shown by solid horizontal or vertical lines. o Solid horizontal lines represent communication between people with similar spheres of responsibility and power but different functions. o Solid vertical lines between positions denote the official chain of command, the formal paths of communication & authority. o Those having the greatest decision-making authority are located at the top o Those with the least are at the bottom. o The level of position on the chart also signifies status and power. o Dotted or broken lines on the organization chart represent staff positions.  TYPES OF WORK SEGMENTS: shown by clusters of work group. o Unity of command is indicated by the vertical solid line between positions on the organizational chart. 2. Span of control o Can be determined from the organization chart o The number of people directly reporting to any one manager represents that manager’s span of control and determines the number of interactions expected of him or her 3. Managerial levels - indicating hierarchial relationships o In large organizations, several levels of managers often exist ▪ Top level manager external influences ▪ Middle level manager integrating unit level w/ org needs ▪ First level manager day-to-day needs at unit level 4. Centrality o Refers to the location of a position on an organization chart where frequent and various types of communication occur. Types of organizational structures - The type of structure used in any health-care facility affects communication patterns, relationships & authority. o Line structures ▪ Bureaucratic organizational designs are commonly called line structures or line organizations. ▪ found frequently in large health-care facilities and usually resemble Weber’s original design for effective organizations ▪ In these structures, authority and responsibility are clearly defined, which leads to efficiency and simplicity of relationships. o Ad hoc design ▪ Modification of the bureaucratic structure and is sometimes used on a temporary basis to facilitate completion of a project within a formal line organization. ▪ Ad hoc structures use a project team or task approach & are usually disbanded after a project is completed. o Matrix structure ▪ Has a formal vertical and horizontal chain of command o Service line organization ▪ Sometimes called care-centered organizations ▪ Smaller in scale than a large bureaucratic system  ▪ Service line would decide on the processes to be used to achieve the goals. o Flat designs ▪ An effort to remove hierarchical layers by flattening the chain of command & decentralizing the organization SHARED GOVERNANCE/ORGANIZATIONAL DESIGN FOR THE 21ST CENTURY One of the most innovative & empowering organization structures Developed in the mid-1980s A flat type of organizational structure is often used to describe shared governance Governance is shared among board members, nurses, physicians & management. Thus, decision making and communication channels are altered. ORGANIZATIONAL CULTURE - the total of an organization’s values, language, traditions, customs and behaviors that contribute to the unique social and psychological environment of an organization STAFFING  The third phase of the management process An especially important phase of the management process in health-care organizations The leader/manager recruits, selects, places, & indoctrinates personnel to accomplish the goals of the organization. STAFFING PROCESS 1. Determine the number & types of personnel needed to fulfill the philosophy. 2. Recruit, interview, select & assign personnel based on established job description performance standards. 3. Use organizational resources for induction & orientation. 4. Ascertain that each employee is adequately socialized to organization values & unit norms. 5. Use creative & flexible scheduling based on patient care needs to increase productivity & retention. RECRUITMENT - Process of actively seeking out or attracting applicants for existing positions and should be an ongoing process INTERVIEW - Verbal interaction between individuals for a particular purpose - Frequently accepted as the foundation for hiring PURPOSE OF SELECTION INTERVIEW 1. The interviewer seeks to obtain enough information to determine the applicant’s suitability for the available position 2. The applicant obtains adequate information to make an intelligent decision about accepting the job, should it be offered 3. The interviewer seeks to conduct the interview in such a manner that regardless of the interview’s result, the applicant will continue to have respect & goodwill toward the organization. SELECTION - The process of choosing from among applicants, the best qualified individual or individuals for a particular job or position. o Involves verifying the applicant’s qualifications o Checking his or her work history o Deciding if a good match exists between the applicant’s qualifications & the organization’s expectations. o Educational & Credential Requirements o Reference Checks & Background Screening  o Preemployment Testing o Physical Examination as a Selection Tool o Making the Selection o Finalizing the Selection PLACEMENT - Assigning a new employee to a position within his or her sphere of authority, where the employee will have a reasonable chance for success. INDOCTRINATION - refers to the planned, guided adjustment of an employee to the organization & the work environment. PHASES OF INDOCTRINATION 1.INDUCTION First phase of indoctrination, takes place after the employee has been selected but before performing the job role. Includes all activities that educate the new employee about the organization, employment & personnel policies & procedures. Provides the employee with general information about the organization 2. ORIENTATION Activities are more specific for the position. Organizations may use a wide variety of orientation programs. WEEK ORIENTATION SAMPLE STAFFING NEEDS - Managers must be certain that adequate numbers & an appropriate mix of personnel are available to meet unit needs & organizational goals. PREDICTING STAFFING NEEDS - A crucial management skill because it enables the manager to avoid staffing crises. MANAGERS IN PREDICTING STAFFING NEEDS - Know the source of their nursing pool - The number of students enrolled in local nursing schools - The usual length of employment of newly hired staff - Peak staff resignation periods - Times when the patient census is highest - Consider the patient care delivery system in place - The education and knowledge level of needed staff - Budget constraints - Historical staffing needs and availability - Diversity of the patient population to be served STAFFING NEEDS 1. CENTRALIZED o staffing decisions are made by personnel in a central office or staffing center 2. DECENTRALIZED o the unit manager is often responsible for covering all scheduled staff absences o reducing staff during periods of decreased patient census or acuity o adding staff during periods of high patient census or acuity, preparing monthly unit schedules, preparing holiday & vacation schedules. SKILLS MIX  - Refers to the combination of different levels of nursing staff, such as registered nurses (rns), licensed practical nurses (lpns) & nursing assistants within a healthcare setting. - This mix is crucial for delivering high-quality patient care and optimizing healthcare resources. Key points of Skills mix: 1. Impact on patient outcomes 2. Cost efficiency 3. Challenges 4. Strategies for optimization SCHEDULING - A timetable showing planned work days and shifts of a nursing personnel - Regulatory requirements - Will be followed as mandated by r.A. 5901 (40 hours week law) STAFFING & SCHEDULING OPTIONS 10 or 12 hour shifts Premium pay for weekend work Part-time staffing pool for weekend shifts & holidays. Cyclical staffing, which allows long-term knowledge of future work schedules because a set staffing pattern is repeated every few weeks. Job sharing Allowing nurses to exchange hours of work among themselves Flextime Use of supplemental staffing from outside registries & float pools Staff self-scheduling shift bidding, which allows nurses to bid for shifts rather than requiring mandatory overtime DIRECTING - The fourth phase of the management process - May be referred to as coordinating or activating - “Doing” phase of management, requiring the leadership and management skills necessary to accomplish the goals of the organization. - In planning and organizing, leader-managers attempt to establish an environment that is conducive to getting work done. - In directing, the leader-managers sets those plans into action. - Creating a motivating climate is a critical element in meeting employee and organizational goals. ELEMENTS OF DIRECTING DELEGATION – simply as getting work done through others or as directing the performance of one or more people to accomplish organizational goals. TCPDL 5 RIGHTS OF DELEGATION 1. RIGHT TASK – one that is delegable for a specific patient 2. RIGHT CIRCUMSTANCES – appropriate patient setting, available resources and other relevant factors considered 3. RIGHT PERSON – is delegating the right task to the right person to be performed on the right person. 4. RIGHT DIRECTION/COMMUNICATION – clear, concise description of the task, including its objective, limits and expectations 5. RIGHT LEVEL OF SUPERVISION – appropriate monitoring, evaluation, intervention, as needed and feedback. MOTIVATION – is the force within the individual that influences or directs behavior. - Creating a motivating climate is a critical element in meeting employee and organizational goals. - Why are some managers or employees more motivated than others - How do demotivated managers affect their subordinates? - What can manager do to help the employees who is demotivated? EMPLOYEE ENGAGEMENT - an employee’s emotional commitment to the organization and its goals - This emotional commitment means engaged employees actually care about their work and their company - They don’t work just for a paycheck, or just for the next promotion, but work on behalf of the organization’s goals. - The extent to which employees feel passionate about their jobs, are committed to the organization, and put discretionary effort into their work. INTRINSIC MOTIVATION – comes from within the person, driving him or her to be productive. - From within the individual - Often influences by family unit and cultural values EXTRINSIC MOTIVATION – comes when individuals are motivated to perform a behavior or engage in an activity to earn a reward or avoid punishment - From outside the individual CJPV  - Rewards and reinforcements are given to encourage certain behaviors or levels of achievement MOTIVATIONAL THEORY – guided organizational efforts and resource distribution for the last 100 years. MASLOW (1970) / HIERARCHY OF NEEDS – believe that people are motivated to satisfy certain needs, ranging from basic survival to complex psychological needs, and that people seek a higher need only when the lower needs have been predominantly met. SKINNER B. F. (1953) / OPERANT CONDITIONING AND BEHAVIOR MODIFICATION - Skinner’s research on operant conditioning and behavior modification demonstrates that people can be conditioned to behave in a certain way based on a consistent reward or punishment system. FREDERICK HERZBERG (1987) / MOTIVATION - HYGIENE THEORY - Herzberg maintained that motivators or job satisfiers, are present in the work itself and encourage people to want to work and to do that work well. - Hygiene or maintenance factors keep the worker from being dissatisfied or demotivated but do not act as true motivators for the workers. MOTIVATION-HYGIENE THEORY OR TWO-FACTOR THEORY VICTOR VROOM (1964) / EXPECTANCY MODEL - Expectancy model says that a persons expectations about his or her environment or a certain event will influence behavior MCCLELLAND DAVID MCCLELLAND (1971) - People are motivated by three basic needs: achievement, affiliation, and power. Achievement-oriented – people actively focus on improving what is; – They transform ideas into action, judiciously and wisely, taking risks when necessary. Affiliation-oriented – people focus on their energies on families and friends; CJPV  –their overt productivity is less because they view their contribution to society in a different light from those who are achievement oriented. Power-oriented – people are motivated by the power that can be gained as a result of a specific action. –they want to command attention, get recognition and control others. SAUL GELLERMAN (1968) - States that most managers in organization overmanage, making the responsibilities too narrow and failing to give employees any decision – making power or to stretch them often enough. STRETCHING - involves assigning tasks that are more difficult than what the person is used to doing. - this includes personal and professional development in areas of vocational knowledge, skills, and expertise. - giving people responsibility often causes them to rise to the challenge. MCGREGOR DOUGLAS MCGREGOR (1960) / THEORY X & THEORY Y - How the manager views and treats the worker will have an impact on how well the organization functions. CREATING A MOTIVATING ENVIRONMENT - Worker empowerment - Incentives & rewards - Relationship between employees & supervisor Worker empowerment – process of allowing employees to have input and control over their work and the ability to openly share suggestions and ideas about their work and the organization as a whole Incentives & Rewards – many organizations use incentives or rewards to foster a motivating climate. Relationship between employees & supervisor – feeling valued, being treated fairly, receiving feedback and direction and having a strong working relationship between an employee and his or her manager that is based on mutual respect is predictive or strong employee engagement with their manager. CJPV PROMOTION ; A MOTIVATIONAL TOOL - Promotions are reassignments to a position of higher rank - Include a pay raise - Include increased status, title changes, more authority and greater responsibility. DECISION MAKING - A complex, cognitive process often defined as choosing a particular course of action - The though process of selecting a logical choice from the available options Problem Solving - is a part of decision making and is a systematic process that focuses on analyzing a difficult situation - problem solving always included a decision-making step. MANAGERIAL DECISION MAKING MODEL 1. Determine the decision and the desired outcome (set objectives) 2. Research 3. Compare and identify options contrast these options and their consequences 4. Make a decision 5. Implement an action plan 6. Evaluate results. CONFLICT MANAGEMENT - Conflict defined as the internal or external discord that results from differences in ideas, values, or feelings between two or more people. CATEGORIES OF CONFLICT - INTRAPERSONAL CONFLICT – occurs within the person. It involves an internal struggle to clarify contradictory values or wants - INTERPERSONAL CONFLICT – happens between two or more people with differing values, goals, and beliefs. (Ex. Horizontal violence or bullying) - INTERGROUP CONFLICT – occurs between two or more groups of people departments, and organizations. (Ex. Two political affiliations with widely differing or contradictory beliefs or nurses experiencing intergroup conflict with family and work issues) CONFLICT RESOLUTION STRATEGIES Compromising o each party gives up something it wants CJPV  Competing o used when party pursues what it wants at the expense of the others. o Managers may use competing when a quick or unpopular decision needs to be made. Cooperating / Accommodating o one party sacrifices his or her beliefs and allows the other party to win. Smoothing o occurs when one party in a conflict attempts to pacify the other party or to focus on agreements rather than differences. o Managers often use smoothing to get someone to accommodate or cooperate with another party. Avoiding o The parties involved are aware of a conflict but choose not to acknowledge it to attempt to resolve it. o Those who actively avoid conflict frequently have low esteem or hold a position of low power o Avoidance may be indicated in trivial disagreements, when the cost of dealing with the conflict exceeds the benefits of solving it, when the problem should be solved by people other than you, when one party is more powerful than the other, or when the problem will solve itself. Collaborating o An assertive and cooperative means of conflict resolution that results in a win-win solution o In collaboration, all parties set aside their original goals and work together to establish a supraordinate or priority common goal. o In doing so, all parties accept mutual responsibility for reaching the supraordinate goal. CHANGE MANAGEMENT - The process of making changes in a deliberate, planned and systematic manner. - Important for nurse leaders and nurse managers to remember a few key points about change management - Employees will react differently to change, no matter how important or advantageous that change is purported be. - Basic needs will influence reaction to change, such as the need to be part of the change process, the need to be able to express oneself openly and honestly, and the need to feel that one has some control over the impact of change. - Change often results in a feeling of loss due to changes in established routines. Employees may react with shock, anger, and resistance, but ideally with eventually accept and adopt to change. CJPV  - Change must me managed realistically, without false hopes and expectations, yet with enthusiasm for the future. Employees should be provided information honestly and allowed to ask questions and express concerns. LEWIN’S CHANGE TEHORY OF UNFREEZING, MOVEMENT AND REFREEZING Unfreezing – occurs when the change agent convinces members of the group to change or when guilt, anxiety, or concern can be elicited. Thus, people become discontent and aware of a need to change. Movement – the change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces. Refreezing – the last phase, the change agent assists in stabilizing the system change so that it becomes integrated into the status quo. STAGES OF CHANGE AND RESPONSIBILITIES OF THE CHANGE AGENT STAGE 1 – UNFREEZING 1. Gather Data 2. Accurately diagnose the problem 3. Decide if change is needed 4. Make others aware of the need for change; often involves deliberate tactics to raise the groups discontent level; do not proceed to stage 2 until the status quo has been disrupted and the need for change is perceived by the others STAGE 2 – MOVEMENT 1. Develop a plan 2. Set goals and objectives 3. Identify areas of support and resistance 4. Include everyone who will be affected by the change it its planning 5. Set target dates 6. Develop appropriate strategies 7. Implement the change 8. Be available to support others and offer encouragement through the change. 9. Use strategies for overcoming resistance to change 10. Evaluate the change 11. Modify the change, if necessary STAGE 3 – REFREEZING 1. Support others so that the change continues TIME MANAGEMENT – technique for allocating ones time through the setting of goals, assigning priorities, identifying & eliminating wasted time & using managerial techniques to reach goals efficiently. Process: Allow time for planning and establish priorities -> complete the highest priority task whenever possible and finish one task before beginning another -> reprioritized based on the remaining tasks and on new information that may have been received. SUPERVISION - Guiding and directing the work to be done - Helping the individual do his work better CJPV  - Assess the capability of the individual if he needs supervision. CONTROLLING - The fifth and final step in the management process - Because the management process like the nursing process – is cyclic, controlling is an end in itself ; it is implement throughout all phases of management - Assessing & regulating performance - Process of seeing that actual expenditures and activities conform to plan EXAMPLES OF MANAGEMENT CONTROLLING FUNCTIONS INCLUDE: - The periodic evaluation of unit philosophy, mission, goals and objectives - The measurement of individual and group performance against preestablished standards - Auditing of patient goals and outcomes EVALUATION MECHANISM CONTINUOUS QUALITY IMPROVEMENT Total Quality Management (TQM) o Is a philosophy developed by Dr. W. Edward Deming o Also referred to as continuous quality improvement (CQI) o It assumes that production and service focus on the individual and that quality can always be better o Identifying and doing the right things, the right way, the first time, and problem prevention and reactive problem solving – lead to quality outcomes Quality Control o A specific type of controlling o Refers to activities that are used to evaluate, monitor, or regulate services rendered to consumers. HALLMARKS OF EFFECTIVE QUALITY CONTROL PROGRAMS ▪ Support from top level administration ▪ Commitment by the organization in terms of fiscal and human resources ▪ Quality goals reflect search for excellence rather than minimums ▪ Process is ongoing or continuous. QUALITY CONTROL PROCESS ▪ The criterion or standard is determined ▪ Information is collected to determine if the standard has been met ▪ Educational or corrective action is taken if the criterion has not been met AUDIT - A systematic and official examination of a record, process, structure, environment, or account to evaluate performance. - Auditing in health care organizations provides managers with a means of applying the control process to determine the quality services rendered. THE AUDITS MOST FREQUENTLY USED IN QUALITY CONTROL INCLUDE: CJPV  OUTCOMES – reflect the end result of care or how the patient’s health status change as a result of an intervention PROCESS AUDITS – to measure the process of care or how the care was carried out and assume that a relationship exists between the process used by the nurses and the quality of care provided. STRUCTURE AUDITS – assume that a relationship exists between quality care and appropriate structure. o Are often set by licensing and accrediting bodies, ensure a safe and effective environment o Includes resource inputs such as the environment in which health care is delivered. o Includes elements that exist prior to form the interaction between the patient and the health-care workers such as staffing rations, staffing mix, emergency department wait times & the availability of fire extinguishers in patient care areas. (Ex. Call lights, bf rooms) THE JOINT COMMISSION - An independent, not-for-profit organization that accredits healthcare organizations and programs has historically had a tremendous impact on planning for quality control in acute-care hospitals - JC was the first to mandate that all hospitals have a QA program in place by 1981. These QA programs were to include a review of the care provided by all clinical departments, disciplines and practitioners; the coordination and integration of the finding of quality control activities; and the development of specific plans for known or suspected patient problems CERTIFICATIONS - In the Philippines, ISO certification is becoming increasingly common for hospitals - Many Hospitals are now looking to achieve ISO certification in order to improve their quality management systems - ISO Certification provides a hospital with an internationally recognized quality management system - This can help to improve the quality of care and increase patient satisfaction - In addition, ISO certification can also help to reduce costs and improve efficiency. SOME OF THE BENEFITS OF HAVING ISO CERTIFICATION INCLUDE: 1. Improved quality of care – iso certified hospitals must meet strict quality standards, which leads to improved patient care 2. Increased patient satisfaction – patients are more likely to be satisfied with the care they receive at an iso certified hospital 3. Greater staff satisfaction – employees of iso certified hospitals report higher job satisfaction rates 4. Lower costs – iso certified hospitals tend to have lower costs due to their streamlined processes and improved efficiency. THE FOLLOWING IS A LIST OF SOME OF THE ISO CERTIFIED HOSPITALS IN THE PHILIPPINES: 1. Manila Doctors Hospital 2. Makati medical center CJPV  3. St. Lukes Medical Center – Global City 4. Asian Hospital and Medical Center 5. The Medical City NURSING AUDIT – method for assuring documentation of quality of nursing care in keeping with established standards. TYPES OF NURSING AUDIT 1. Retrospective audits – are performed after the patient received the service. 2. Concurrent audits or open chart review – are performed while the patient is receiving the service, check charting, observation of patient. PERFORMANCE APPRAISAL - Evaluated by supervisors - Method of evaluating accomplishments to help employees improve his work methods - When done correctly, it is one of the greatest tools an organization has to develop and motivate staff - When done poorly, has the potential to discourage and demotivate EVALUATION - Plays an important role in quality and productivity improvement for several reasons: o Ensures quality nursing care is provided o Allows for setting of sensible objectives and ensures compliance o Provides standards for establishing comparisons CJPV  o Promotes visibility & means for employees to monitor their own performance o Highlights problem related to quality and care & determines the areas that require priority attention o Provides and indication of the costs or poor quality o Justifies the use of resources o Provides feedback for improvement TYPES OF EVALUATION PROCESS: Checklists ▪ A compilation of all nursing performances expected of a worker ▪ Appraisers task is to mark the appropriate column whether the worker does or does not show the desired behavior Ranking ▪ The evaluator ranks the employees according to how he fared with co- workers with respect to certain aspects of performance. (Ex: Educational requirements, clinical proficiency) Rating Scale ▪ Includes series of items representing the different tasks or activities in the nurses job description Free Response Report ▪ Comment in writing on the quality of the nurses performance Forced – Choice Comparison ▪ The evaluator is asked to choose the statement that best describes the nurse being evaluated COMMON ERRORS OF EVALUATION Halo error ▪ Based on the good traits one sees in person, good things done overshadow errors. Horn’s effect ▪ Poor performance overshadowed good performance Logical error ▪ First impression ▪ First encounter may provide the rater the qualities or specific traits which serves as bars to the quality of performance of the ratee Central Tendency error ▪ All treated as average, used by the rater when feedback tools are adequate & when there’s insufficient time for the rater to observe the ratee Leniency Error ▪ Given mercy rating CJPV BENCHMARKING - Technique where by an organization seeks out the best practice in its industry to improve its performance DISCIPLINE - Part of the controlling process in management - Regarded as a constructive & effective means of by which employees take personal responsibility for their own performance and behavior. PRINCIPLES OF DISCIPLINARY ACTIONS 1. Have a positive attitude 2. If they are treated as suspects they are more likely to provide the trouble that the manager anticipates 3. Investigate carefully 4. Be prompt 5. Protect privacy 6. Focus of the act 7. Enforce rules carefully. Use extreme caution in instituting disciplinary measures 8. Be flexible 9. Take corrective, constructive actions 10. Should be progressive in nature preceded with counselling. DISCIPLINARY ACTIONS 1. Counseling & oral warning 2. Written warning 3. Suspension 4. Dismissal Counseling & Oral Warning - Given in private & in an informal atmosphere - Employee is given a fair chance to air his side - The relevant facts are analyzed & evaluated against his performance - Employee is then counseled regarding expectations of improved behavior/performance, ways of correcting problem and a warning that a repetition of the same offese may warrant further disciplinary action Written Warning - Second step in the disciplinary action - The employee must be told after the interview that he will be given a written warning - Includes the sop, identification of the rule which was violated, consequences of continued behavior, employee’s commitment to take corrective action and any follow up action to be taken Suspension - Given after an evidence or oral & written warnings - Suspension rather than dismissal is applied when management feels that the employee can still be rehabilitated Dismissal/Discharge CJPV - Invoked only when all the other disciplinary efforts have failed - Disciplinary committee should be very sure that the cause for dismissal conforms with the criteria of a major discipline violation as contained in the policy manual. CJPV