Nursing-Leadership-and-Management.pdf

Nursing Leadership and Management Leadership Effectiveness  the use of one’s skill to influence others  able to accomplish your objectives within the resource...

Nursing Leadership and Management Leadership Effectiveness  the use of one’s skill to influence others  able to accomplish your objectives within the resource parameters Kinds of Influence:  “doing the right things” 1. Assertiveness  related to leadership  standing up for oneself and other’s without violating Efficiency the rights of others  able to accomplish you objectives/ production of results  Ex. You have chosen me as your leader... with minimum waste of time and effort 2. Rationality  “doing the things right”  trying to convince someone by using reason, logic, or  related to management supporting information Management  Ex. We should do this because we need to give to the - Is the process of planning, organizing, directing and patient total quality care controlling human and physical resources and technology 3. Ingratiation to achieve organizational goals / objectives?  making an individual feel important or good before making a request 7 Basic resources of management 4. Exchange 1. Manpower  offering an exchange of favor 2. Money 5. Sanction 3. Machine  coercive authority o bigger equipment; capital expenses; to start a  give punishment for noncompliance or reward for business; costs more compliance 4. Materials 6. Blocking o lesser/minor equipment; operation of  backing up a request with a threat to damage an organization or unit individual’s opportunity for advancement 5. Methods – process  not really the best 6. Moment/Minutes – time management 7. Coalition 7. Market  getting co-workers to back-up a request 8. Upward appeal ADMINISTRATION MANAGEMENT  obtaining formal or informal support of a higher-up - Those at the top level of - Directly responsible to the organization production of services Levels of Leadership - Focus on establishing - Midline and lower levels of - Personhood goals and on integrating hierarchy o Respect work units to achieve the - Directs and guides the o People follow because of what you are and organization’s mission operations of the what you represent organization - People Development Upper level manager: o Reproduction - Primary responsible for establishing organizational goals o People follow because of what you have done and strategic plans for the entire division of nursing for them - Director of Nursing Services, Chairman, Executive Vice- - Production President o Results - 24/7 responsibility o People follow because of what you have done Middle level manager: for the organization - Usually coordinate nursing activities of several units - Permission - Supervisor, coordinator, clinical nurse managers, case o Relationships managers o People follow because they want to - 24/7 responsibility - Position First level manager: o Rights - Directly responsible for the actual production of nursing o People follow because they have to services; acts as links between higher level managers and non-managers Types of Leader - Head nurse (nurse manager), charge nurse (informal), 1. Formal team leader, primary nurse  officially appointed, elected Authority  managers - Legitimate right to give command, to make decisions 2. Informal - Ability to impose his or her with another person or group  chosen by the group Power  those who initiate an action - Ability to get results - Given with authority Management  getting things done Powers a manager/leader may possess  it is the process of getting activities completed efficiently - Legitimate power – based on position given and effectively with and through people; production - Reward power - reward/incentives  is the process of planning, organizing, directing and - Coercive power- give sanctions or punishment controlling human and physical resources - Expert power - Referent power o Charisma – innate personality trait o Connection University of Santo Tomas – College of Nursing / JSV  Nursing Leadership and Management - Self (Personal) power – based on individual’s maturity, LEADERSHIP STYLES credibility, reputation, experience, gender 1. Autocratic - Information power – based on the individual’s access to  Makes decisions alone valued data  Task oriented  Power with coercion Levels of Nurse Managers  Proves useful (even necessary) in crisis situation 1. Upper Level Manager  Authoritarian or exploitative style of leadership  primary responsible for establishing  Satisfaction is low organizational goals and strategic plans for the  Effective when needed for immediate action entire division of nursing  High productivity, less satisfaction of workers  director of nursing service, chairman, executive  2 Types accdg. to Rensis Likert (Systems 4 approach): vice president i. Exploitative-authoritative  nurse executives  Have little trust in employees and exclude  Policy making body of an organization them in decision making  oversee the activities of the lower levels ii. Benevolent-authoritative 2. Middle Level Manager  Are kind to employees but still do not  usually coordinates nursing activities of several involve them in decision making units  They ask the members  supervisor, coordinator, clinical nurse managers, case managers 2. Democratic  oversee the activities of the lower levels  Involve their followers in decision making 3. First Level Managers  People oriented  directly responsible for the actual production of  Leads to increase productivity and job satisfaction nursing services  There is compliance  acts as links between higher level managers and  Participative/Consultative non-managers  2 Types accdg. Rensis Likert (Systems 4 approach):  head nurse (nurse manager), charge nurse, team i. Consultative-democratic leader, primary nurse  Seek employees advice about decisions ii. Participative-democratic Authority  Value employee involvement, teamwork  legitimate right to give commands, to make decisions and seek advice in decision making Power  ability to get results 3. Laissez-faire  ability to impose his or her will on another person or group  Loose and permissive  Ultraliberal MANAGERS LEADERS  Foster freedom for everyone and wants everyone to Appointment Are appointed May or may not be happy officially to positionhave official  Results in low productivity and employee frustration appointment to  Most beneficial to a staff of highly motivated position professionals Power and Have power and As long as followers Authority authority to enforce are willing 4. Bureaucratic Goals Carry out Influnce others,  Lacks a sense of security and depends on established predetermined either formally or rules and policies policies, rules and informally  Tends to relate impersonality to staff regulations  Avoids decision making without standards or norms for Risk-taking Maintain an orderly, Interested in risk- guidance controlled, rational taking and  Needed when discipline should be imposed and equitable exploring new ideas structure Types of Behaviour Relationship According to their In an intuitive and 1. Passive or Non-assertive with people own roles emphatic manner 2. Assertive – stand for oneself but doesn’t violate rights of Self-reward When fulfilling From personal others organizational achievements 3. Aggressive – violates rights of others missions orgoals THEORIES OF MANAGEMENT Success as If they are May or may not be 1. Frederick Taylor manager reappointed; successful manager manager as long as  “Theory of Scientific Management” appointment holds  Observed people in an electric plant  Time and motion studies  One best way to do the job 7 Basic Skills Required of a Leader/Manager 2. Max Weber 1. Conceptual skills  The ideal form of organization is “Bureaucracy” 2. Technical skills  With hierarchies—with rules and regulations 3. Human relations 3. Luther Gulick 4. Administrative skills  Introduced the 7 activities of management as 5. Communication skills “POSDCORB” - planning, organizaing, staffing, 6. Analytical skills directing, coordinating, reporting. 7. Decision making skills University of Santo Tomas – College of Nursing / JSV  Nursing Leadership and Management 4. Henry Fayol  Rules of Delegation to Unlicensed Staff  Developed the principles management and o Do not delegate the functions of functions of management assessment, teaching, evaluation and nursing judgement  Fayol’s 14 Principles of Management: o Delegate activities that involve i. Division of labor-you should know your job standard, unchanging procedures ii. Authority, responsibility (pure obligation to o Delegate care of stable patients with do the task to the best of your ability), and predictable outcomes; assessment as accountability long as stable iii. Unity of command  Task that may not be delegated iv. Unity of direction – one path, goal, objective o Assessment v. Scalar chain of authority and o Interpretation of data communication-highest to lowest level; o Care of invasive lines channels of communication o Performing triads during emergencies vi. Interest of the whole organization over o Making a nursing diagnosis interest of the individual o IV insertion vii. Equity and justice viii. Order (hierarchy, everything in order, in their  Span of Control place) o Number of persons that the leader can ix. Stability or tenure of personnel – rapid effectively manage turnover would not benefit the organization o If noob-small span of control muna x. Initiative-right to make their own projects,  PODC decisions xi. Centralization- upper level of hierarchy 5. Mary Follet makes decision  Exercise power WITH people rather than power xii. Discipline- follows rules over people xiii. Remuneration - compensation  Participatory management xiv. Teamwork and esprit de corps 6. Elton May  “Hawthorne Effect”  Command responsibility  Tendency of people to perform as expected o Leader responsible for acts of because of special attention subordinate  Should show concern to subordinates to increase o Respondeat superior level of performance 7. Kurt Lewin  Principle of Definition  3 phases of behaviour change o Every employee must have a job o Unfreezing-identify what needs to be description changed o Changing – practicing, doing  Principle of delegation o Refreezing- integrating into your daily o Entrusting responsibility to others and to activities create accountability for results 8. Peter Drucker  Delegation  Management by objectives (MBO) o Provides learning opportunities for  Be able to achieve your goals by having subordinates objectives o Increases power 9. Herbert Simon o Cannot delegate total responsibility  2 approaches to decision making o Do not delegate responsibility without o Optimizing-choosing the best possible authorityg alternative; longer time to achieve o Don’t just delegate boring jobs o Satisfying- first workable acceptable  For nurses, delegation is not an option but a solution necessity 10. Henry Mintzberg  Proposed the managerial roles  5 Rights of Delegation  Interpersonal roles o Right Person o Figurehead role o Right Task o Leader role o Right Circumstance o Liaison role o Right Direction/Communication  Informational Roles o Right Supervision o Monitor o Dissemination  Causes of Underdelegating o Spokesman o Waste of time to explain  Decision Roles o Believes that no one else can do the o Entrepreneur job o Disturbance handler o Fear- fear of criticism, fear of failing to o Negotiator get others to follow him o Resource allocator role o The need to control or be perfect o Enjoys the personal satisfaction o Gained from doing the work herself University of Santo Tomas – College of Nursing / JSV  Nursing Leadership and Management MOTIVATIONAL THEORIES  Fiedler’s Contingency theory 1. Maslow’s Hierarchy of Needs o Matches leadership style to situational 2. Douglas McGregor’s Theory X and Y factors  Theory X o Good relationship with subordinates o Man is lazy, dislike work, unmotivated o Knowledge is needed to accomplish a  Theory Y task, use of relationship, power o Man is self-motivated, enjoy their work  Situational Theory by Hersey and Blanchard 3. William Ouchi (Theory Z) o Depends on the situation-may be  Involved workers are key to inc. productivity follower or leader 4. Ferdinand Herzberg o Considers the person’s readiness and  Hygienic factors- working environment willingness  Motivation factors-work itself 4. Path Goal Theory o Give them work they really know  People act as they do because they expect their behaviour to produce satisfactory results Hygenic factors Motivation factors  Leader rewards followers for completing their task (working environment) (work itself) 5. Contemporary Leadership Theory - Adequate salary - Achievement  Collaboration and teamwork - Appropriate supervision - Recognition Transactional Leadership - Good interpersonal - Appropriate  Interaction between leaders and followers are relations responsibility essentially economic- use rewards trade offs - Safe and tolerable working - Opportunity for Transformational Leadership condition advancement and  Focusing on change through its commitment to - Job security achievement its vision - Agency policies and  Empowering the subordinates procedures Servant Leadership Theory (Greenleaf, 1977)  Leaders put serving others as number one priority THEORIES OF LEADERSHIP Shared Leadership/Governance 1. Trait Theories – who the leader is  Several individuals and subordinate share the  Great Man Theory (Aristotelian) responsibility in achieving the organization’s o Leaders are born, not made goals  Charismatic Theory Quantum Leadership  Trait Studies  Should be updated, innovative and creative o integrity, intelligence, initiative, industry  Initiate to update himself o popularity, sociability, dependability Multiple Intelligence 2. Behavioral Theories – what leader can do  Recognizes the different abilities affect  Lewin, Lippit and White leadership o Leadership Styles Emotional Intelligence  Rensis Liker  Understand feelings of others o Systems 4 approach Cultural Bridges  Blake and Mouton  Leaders/managers must become culturally o Managerial Grid sensitive o Country Club-high concern for people, low on results FUNCTIONS/PROCESSES OF MANAGEMENT o Impoverished-low concern for people and results PLANNING o Middle of the road - Deciding in advance what, where, how, when and who is o Authority Compliance-high concern for to do future actions results, low for people - Is a continuous process of assessing, establishing goals and o Team- high concern for people and objectives, implementing and evaluating them which is results subject to change as new facts are known 1,9 9,9 4 Planning modes: Managemen Managemen 1. Reactive Planning – occurs after a problem exists; t t done in response to a crisis Country Club Team 2. Inactivism – a type of conventional planning 5,5 where the person considers the STATUS QUO as Managemen stable environment t 3. Preactivism – utilizes technology to accelerate Middle of the change and is future-oriented; do not value Road experience and the past; future is always 1,1 9,1 preferable Managemen Managemen 4. Interactivism or Proactive – considers the past, t t present and future; done in anticipation of Impoverished Authority changing needs compliance 3. Contingency-Situational Theories  Adapts leadership style depending on situation University of Santo Tomas – College of Nursing / JSV  Nursing Leadership and Management Levels of Planning in Nursing:  Budgeting Methods 1. Strategic Planning o Incremental  3-5 years years or more  Flat percentage increase method  In charge of whole organization  Consider the inflation rate (around  CEO, division heads, chief nurse 20%)  Exists farther in the future  Multiply the current year expenses by the inflation rate 2. Intermediate Planning  6 months-2 years o Zero-based  Supervisors, clinical specialist  Requires managers to justify in detail the cost of all programs both 3. Operational Planning and and new  1 week-1 year o Sunset Budget  Managers of nursing units, head nurse, charge  Is designed to self-destruct within nurse, primary care nurse, team leader the prescribed period to ensure cessation of the funder program by Scope of Planning a predetermined date 1. Forecast  Are fixed expenses that cannot be  Estimate the future recovered even if a program is  Short or long range projections cancelled  Vision o Mental image of something not actually *Participation by nursing personnel in planning and visible, dreams, aspirations controlling budget leads to cost consciousness  Mission o Purpose or brief statement identifying  Time Management reasons why organization exists o Making optimal use of available time  Philosophy o More work with less time o Articulates a vision and provides statement o Work smarter not harder beliefs and values that guide one’s practice  3 Steps in Time management  External and Internal Assessment o Establish priorities o SWOT Analysis o Finish one task before beginning another  Know the strength to overcome the o Reprioritize weaknesses; Know the  External Time Wasters opportunities to overcome the o Telephone interruptions threats o Socializing 2. Set Goals/Objectives o Meetings  Goals-broad o Incomplete coworkers o Achieve goals through OBJECTIVES o Paperworks and readings  Objectives- specific  Internal Time Wasters o SMART o Procrastination o Behavioral o Poor planning 3. Develop and Schedule Strategies, Programs, Activities. Set time o Inability to say NO frame. o Failure to set objectives  Strategy o Inability to delegate o Overall plans of the higher management system 5. Establish polices, control standards and evaluation procedures  Programs  First step in evaluation o Series of activities that function together to  Standards facilitate attainment of some desired goals o Indicate the minimal level of achievement 4. Prepare Budget accepted to meet the objectives  Allocation of resources or systematic plan of meeting o Pre-determined level of excellence that expenses serves as a guide for practice  Purpose is TO SET operating cost limits  Types of Standards  Approaches/Systems of Budgeting o Structure o Centralized-upper level makes the budget  Those that focus on the structure or o Decentralized- middle and lower level management system used to managers sets the budget then gives to deliver care including number and upper level management categories of personnel o Process  Types of Institutional Budget  Refers to actual procedure, those o Capital Budget activities engage in to administer  Lands, buildings, major equipments care  greater than 50,00 o Outcome o Operating Budgets  Result of the procedures and  Includes cost of supplies, minor nursing care equipment repairs and overhead  What results (if any) occurred as a expenses result of specific intervention o Manpower Budgets  Salaries and wages University of Santo Tomas – College of Nursing / JSV  Nursing Leadership and Management  Policies o Flat, decentralizaed o Are guides of basic rules that define the  Systematic delegation of power general course and scope of activities and responsibility to middle and  Procedures lower levels of the organization o Step by step guide to action o Matrix  Rules  A second structure overlies the first o Describe the situation that allow only one creating two directions for lines of choice of action authority, accountability and communication ORGANIZING  Involves establishing a formal structure to provide for the FLAT PYRAMIDAL coordination of resources to accomplish objectives Authority Decentralized Centralized # of levels Fewer More Scope of Organizing Span of Control Broad Narrow 1. Organizational Structure Delegation Greater Lesser  Refers to the way a group is formed including its: Control over Lesser More CHANNELS OF AUTHORITY, SPAN OF CONTROL AND subordinates LINES OF COMMUNICATION Type Modern Traditional  Is a mechanism through which work is arranged and distributed among members of the organization to 2. Staffing achieve goals and objectives  Assigning people to fill roles designed for the  Organizational Relationship organizational structure o Formal or Reporting-straight line  Process of determining and providing the accepting o Informal or coordinating- broken line personnel to produce a desired level of care to meet the patient’s demand Organization  Steps:  signifies an institution or a functional group with a formal o Recruitment intentional structure of roles or positions o Selection/interview o Hiring Organizational Culture o Induction and orientation  consist of norms and traditions maintained  Complete requirements you  deep rooted assumptions, beliefs and values that are haven’t made handed down from one generation to another  Organizing Patient Care  3 types of culture  5 Primary Means of Organizing Care For Patient o Positive culture Delivery :  Proactive and interactive to meet their 1. Total Patient Care or Case Method satisfaction needs – based on  Oldest mode of organizing patient care humanism, achievement, self-  Nurses assume total responsibility for actualization meeting the needs of all the patients o Passive-agressive assigned  Based on approval, dependent, and avoidance norms 2. Functional o Aggressive-defensive  Evolved as a result of WW2  Based on power, oppositional,  Task-oriented competitive, and perfectionistic norms 3. Team Organizational Climate  Term by RN  is the own perception of characteristics of an organization  Ancillary personnel collaborate in  behaviour, attitudes and feelings of personnel providing care to a group of patients  Types of Organization by nature of Authority  Requires extensive team o Line organization communication and regular team  Each position has general authority planning over the lower position in the hierarchy 4. Modular  Backbone of the organization  Like team nursing, but uses a smaller o Staff/Matrix team (buddy system)  Purely advisory, with no authority to  Pairs professional nurse with ancillary place recommendations to action nurse o Functional  A specialist aid line positions within 5. Primary Care a limited and clearly defined  From admission to discharge scope of authority  As originally designed, requires an all-RN staff  Forms/Patterns of Organizational Structure  24 hours responsibility for planning the o Tall, pyramidal, or Centralized care of one or more patients  Systematic retention of power and  During work hours, the primary nurse responsibility at higher levels of provides direct care to those patients organization University of Santo Tomas – College of Nursing / JSV  Nursing Leadership and Management  Job Title  Managed care – an agency or corporation contracts  Job relationship with a group of providers to deliver specific services  Performance description for a limited cost per enrollee  Case Management DIRECTING  Refers to a service carried out by professionally  Explaining what is to be done, to whom, at what time, how trained individual who provides and or and why coordinates health or social services  Is the issuance of assignments, orders and instructions that  Coordinates care throughout an episode of permit the worker to understand what is expected of him illness  Critical pathways-tools or guidelines that direct Scope of Directing care by identifying expected outcomes  Even before and after discharge 1. Delegation 2. Supervision  Population-based health Care/ Disease Management  Guiding and directing the work to be done, helping  Focus is on the covered lives or populations the individual do his work better of patients with chronic illness rather than on  Assess the capability of the individual if he needs individual illness supervision  Differentiated Nursing Practice 3. Coordination  Delineates nursing roles based on their skills,  Develop linkages/network knowledge, educational level and  Interdepartmental coordination motivation o Medical team o Radiology Dept.  Patient-focused Care  Preparation for a procedure  Is a delivery model that brings all services  Time schedules for special exams and care at the bedside  Proper notification of the nursing service upon complication of  Patient Classification System procedures o A method of grouping patients according to the amount and complexity of their nursing o Lab Services care o Administrative Services o Self-Care- 1.5 hours; patients are capable of  Chief Nurse carrying out ADLs  Recruitment o Intermediate- 3 hours; requires some help  Promotion from the nursing staff with special  Procurement of supplies and treatments, or certain aspects of personal equipment care; IVs, colostomy  Budget preparation o Total Care-4.5 hours; a bedridden patient who lacks strength and mobility to do ADLs o Medical Records o Intensive care- 4.5-6.5; a critically ill patient  Safeguarding who is in constant danger of death or serious  Maintaining injury  Processing medical records  Scheduling o Dietary Service o A timetable showing planned work days and  Notification of new admission shifts of a nursing personnel  Patient transfers  Discharges  40 hour per week load (RA 5901) – less than 1,000,000  Specialty items for VIP admissions but more than 5,000 they can be required for 48 hours and employees o 8 hours X 5 days o 10 hours X 4 days o Medical Social Services o 12 hours X 3 days  Patient’s record  Health education for patient,  Types of Scheduling: relatives and watchers o Centralized – upper level schedule  Referrals for patients in need of o Decentralized-senior nurses schedule blood, medicine, financial and o Cyclical/Block- 2 week period same material assistance schedule. With off for a weekend o Permanent Shifts- o Pharmacy o Variable-floaters  The pharmacy should provide the nursing service with the established  More nurses in the morning. 45%, 37% and 18% hospital Drug Formulary including effective and administration of 3. Job Descriptions medicines through the Unit drug  Are specifications of duties, conditions and Dose System (UDDS) requirements of a particular job, also called performance description University of Santo Tomas – College of Nursing / JSV  Nursing Leadership and Management  Principles:  Categories of Conflict o Responsbilities of each dept./ service should o Interpersonal be clearly defined and understood by all  Also known as horizontal violence o Policies, guidelines, SOPs on or bullying interdepartmental relationships should be o Intrapersonal made available to all o Intergroup o Schedules of different dept. should be  Conflict Resolution Outcomes synchronized and adhered to o Win-win 4. Communication o Win-lose  Process by which a message is sent, received and o Lose-lose understood as intended  Ensuring common understanding  Ways of Resolving Conflict  Flow of Communication o Avoiding o Downward-highest to lowest  Parties are aware of a conflict but  Memos choose not to acknowledge it or  Directives attempt to resolve it o Upward-lowest to highest  Lose-lose  Incident reports o Compromise o Horizontal- peer groups  Each party gives up something it  Endorsement wants  Types of Communication  Lose-lose o Formal o Competing  passes through the hierarchy  One party pursue what it wants o Informal regardless of the cost to others  no agenda needed  Win-lose o Verbal o Accommodating  Conferences  One party sacrifices his beliefs and  Endorsement wants to allow the other party to  staff meetings win  change of shift reports  Lose-win o Written o Smoothing  patient’s chart  An individual attempts to reduce  memos the emotional component of the  directives conflict  manuals of operation  Win-lose o Grapevine (Informal) o Majority Rule  effective nurse manager uses the  Trying to resolve conflict by majority grapevine advantageously by rule maintaining an open and trusting  Win-lose relationship through the use of o Dominance and Suppression formal communication channels  One side is forced to give way to and by giving pertinent information the other side to liaison, influential or key people  Loser is left feeling angry and  Tell one then it the one told will tell frustrated another  Win-lose  Risk for distortion of message; o Collaborating correct immediately  An assertive and cooperative means of conflict resolution  Barriers to Effective Communication whereby all parties set aside their o Physical Barriers- environmental factors original goals and work together a  Distance supraordinate or common priority  Noise goal.  Ventilation  Win-win o Social-psychologic- from judgements, emotions and social values of people such  Organizational Stresses as lack of trust and respect o Task demands  Transference of patients  Are associated with the specific  Emotionally unstable task o Interpretation of meanings and semantics  A nurse called during cardiac  Oral arrest  Written- POS o Role demands  Repeat order to doctor in  Stress may result when there is role telephone orders ambiguity o Physical demands 5. Management of Conflict  Back strains, feet problems, allergy  Conflict to some solution o The internal or external struggle as a result of o Interpersonal demands differences in ideas, values, or beliefs of two  Associated with relationships within or more people organizations University of Santo Tomas – College of Nursing / JSV  Nursing Leadership and Management  Benchmarking 6. Staff Development o Is a technique whereby an organization  In-service training programs seeks out the BEST PRACTICE in its o Orientation industry to improve its performance o Skills training o Leadership training 2. Monitor and evaluate nursing care services utilizing various o FREE methods  Continuing education programs  Quality Assurance o Seminars o Monitoring compliance with established o Workshops standards o Symposiums  Total Quality Management o Specialty nursing trainings o Also referred to as continuous quality o Given by other accredited agencies improvement  PNA, Heart Centre o Doctor Edward Deming o With payment from nurse o Focus is on doing the doing the right things, the right way, the first time, all 7. Decision Making the time and problem prevention,  Decision-making tools planning, not inspective and reactive o Gantt chart problem solving  tool used to visualize multiple tasks  Nursing Audit that need to be done o Method for assuring documentation of o Decision tree quality of nursing care in keeping with  graphic tool to visualize established standards alternatives available, chance o Types: events and probable  Open chart review or concurrent consequences process- patient is still in the o CPM (Critical Path Method) hospital; check charting;  calculate time estimate for observation of patient care activities  Closed chart review or o PERT (Program Evaluation and Review retrospective process- patient is Technique)- identifying key activities in a discharged project, sequencing activities in a flow diagram  Performance Appraisal  Review previous activities before o Evaluated by supervisors moving forward o Method of evaluating accomplishments to help employees improve his work CONTROLLING methods  Assessing/regulating performance o When done correctly, it is one of the  Process of seeing that actual expenditures and activities greatest tools an organization has to conform to plan develop and motivate staff  Quality Control o When done poorly, it has the potential o Activities that evaluate, monitor, or regulate to discourage and demotivate services rendered to consumers  Types of evaluation responses Total Quality Management o Free Response Report Management  Comment in writing on the Quality Improvement quality of the nurse’s Improvement performance Quality Assurance o Performance Checklist Prevention  Indicate in a checklist the Quality Control behaviour desired in the Inspection performance o Simple Ranking Scope of Controlling  Employee is ranked in relation to his co-workers 1. Establish standards for measuring performance o Graphic Rating  No one set of standards fits all organization  Use graph or a numerical  Standards must be SMART scale  Criteria/Indicators of Standards o Forced-choice Comparison o Characteristics used to measure  Choose from a group of performance weighted descriptive  Audits Frequently used in Quality Control statements those that best o Structure Audit describe the nurse o Process Audit o Outcome Audit  Common Errors of Evaluation o Halo error  Good things done overshadow errors University of Santo Tomas – College of Nursing / JSV  Nursing Leadership and Management o Horn’s  Poor performance  Four Common Steps in Progressive Discipline overshadowed good 1. Informal reprimand or verbal performance admonishment  underrated 2. Formal reprimand or written o Logical error admonishment  First impression 3. Suspension from work without o Central tendency error pay  All treated as average 4. Termination o Leniency error  Given mercy rating 4. Meeting change confidently  Planned Change  Quality Program Evaluation o Overt-one that people are aware of o FOCUS-PDCA model o Covert- hidden or occurs without the o Provides a systematic method to study individual’s awareness. a work process for improvement. It  May be gradual or sudden includes:  Find a process to improve  Unplanned Change  Organize a team that knows o Is an alteration imposed by external the process events or persons and occurs when  Clarify current knowledge of unexpected event, force or reaction the process  All major change brings feelings of achievement,  Understanding causes of loss and stress process variation  Select the process  Change Agent Strategies improvement o Empirical-rational  Plan the improvement  People are willing to adapt or  Do data collection, data change if it is justified and if analysis and improvement they are shown how they can  Check data process benefit from the change improvement and costumer o Normative-reeducative outcome  Are based on the assumption  Act to maintain and continue that people act according to improvement their commitment to socio- cultural norms 3. Employee discipline  Staff development through  Is the process of generating employee training groups compliance with the institutional rules and o Power-coercive regulations  When you comply to the  Problem employees: rule breakers, marginal plans, direction of the more employees (working but do not exert effort to powerful improve), and chemically or mentally impaired  Strikes, sit-ins, negotiations  Principles of disciplinary action o Have a positive attitude 5. Legal and ethical control  If they are treated as suspects they are more likely to provide the trouble that the manager anticipates o Investigate carefully o Be prompt o Protect privacy o Focus on the act o Enforce rules carefully. Use extreme caution in instituting disciplinary measures o Be flexible o Take corrective, constructive actions o Should be progressive in nature preceded with counselling  Counselling  Verbal reprimand  Written reprimand  Short suspension  Long suspension  Dismissal/Discharge University of Santo Tomas – College of Nursing / JSV