NCM 105 Leadership and Management PDF

NCM 105 LEADERSHIP AND MANAGEMENT ORGANIZING  ORGANIZATION signifies an institution or functional group such as business, government agency, or hospital or other healthcare agency with a formal intentional structure of roles or positions ORGANIZATION consists of the structure and pro...

NCM 105 LEADERSHIP AND MANAGEMENT ORGANIZING  ORGANIZATION signifies an institution or functional group such as business, government agency, or hospital or other healthcare agency with a formal intentional structure of roles or positions ORGANIZATION consists of the structure and process which allow the agency to enact its philosophy and utilize its conceptual framework to achieve its goals ORGANIZATION refers to a body of persons, methods, policies and procedures arranged in a systematic process through the delegation of functions and responsibilities for the accomplishment of purpose  FOUR CHARACTERISTICS OF ORGANIZATION ☞a common goal or purpose ☞coordination of effort ☞division of labor ☞established delegation of authority ORGANIZING is identifying the organizational needs from mission statements and objectives and from observations of work performed, and adapting the organizational design and structure to meet these needs  Like planning, organizing is primarily a thinking act  ORGANIZATIONAL STRUCTURE -furnishes the formal framework in which organizing takes place -refers to the process or way a group is formed and its channels of authority, span of control, and lines of communication  ELEMENTS OF ORGANIZATIONAL STRUCTURE ☞Designing jobs ☞Forming departments and work units ☞Creating hierarchy ☞Forming a span of control ☞Coordinating and integrating activities JOB DESIGN – so that both employer and employee understand what is expected and what degree of authority each has DEPARTMENTS AND UNITS – after an organization has determined how to structure various jobs, it must decide how to arrange them into logical departments or units HIERARCHY – a network of reporting relationships, a pattern of reporting relationships throughout an organization SPAN OF CONTROL – defined as the number of persons who report directly to the manager COORDINATING & INTEGRATING ACTIVITIES – needs determined by the extent to which people and groups are interdependent or how much they must rely on one another to get their work done ORGANIZATIONAL CHART is a line of drawing that shows how the parts of an organization are linked ORGANIZATIONAL CLIMATE -a work environment that is conducive to worker satisfaction and productivity is a major concern in every organization  PURPOSE OF ORGANIZATIONAL STRUCTURE 1. It informs members of their responsibilities so that they may carry them out 2. It allows the manager and the individual workers to concentrate on his/her specific role and responsibilities  PURPOSE OF ORGANIZATIONAL STRUCTURE 3. It coordinates all organizational activities so there is minimal duplication of effort or conflict 4. It reduces the chances of doubt and confusion concerning assignments  PURPOSE OF ORGANIZATIONAL STRUCTURE 5. It avoids overlapping of functions because it pinpoints responsibilities 6. It shows to whom and for whom they are responsible  MAJOR PRINCIPLES OF AN ORGANIZATIONAL CHART 1. DIVISION OF WORK - each box represents the individual or sub-unit responsible for a given task of the organization’s work load 2. CHAIN OF COMMAND – lines indicate who reports to whom and what authority  MAJOR PRINCIPLES OF AN ORGANIZATIONAL CHART 3.TYPE OF WORK TO BE PERFORMED - Indicated by labels or descriptions for the boxes 4. GROUPING OF WORK SEGMENTS – shown by the clusters or work groups (departments or single units)  MAJOR PRINCIPLES OF AN ORGANIZATIONAL CHART 5.LEVELS OF MANAGEMENT - indicate individual and entire management hierarchy HIERARCHY – refers to a body of persons or things organized or classified in pyramidal fashion accdg to rank, capacity or authority  PRINCIPLES OF ORGANIZING 1. THE PRINCIPLE OF CHAIN OF COMMAND - denotes centralized authority and corresponding authority this principle states that to be satisfying to members, economically effective, and successful in achieving their goals, organizations are established with hierarchical relationships within which authority flows from top to bottom PRINCIPLES OF ORGANIZING 2. THE PRINCIPLE OF UNITY OF COMMAND - states that an employee has one supervisor/leader and one plan for a group of activities with the same objective  In nursing, primary nursing and case management support the principle of unity of command Although employees may interact with many different employees in the performance of their duties, they should be responsible to only one superior PRINCIPLES OF ORGANIZING 3. THE PRINCIPLE OF SPAN OF CONTROL - the number of workers that a supervisor can effectively manage should be limited, depending upon the pace and pattern of the working area this principle is flexible because the more trained an employee is, the less supervision is needed, while those still under training need more supervision to prevent mistakes PRINCIPLES OF ORGANIZING 4. THE PRINCIPLE OF SPECIALIZATION - the concept of division of labor or the differentiation among kinds of duties, springs from this principle. This principle states that each person should perform a single leading function  LINE AND STAFF RELATIONSHIPS ☞LINE AUTHORITY – is the authority that entitles a supervisor to direct an individual’s work. is the simplest and most direct type in which each position has general authority over the lower positions in the hierarchy  ORGANIZATIONAL TYPES OF AUTHORITES ☞STAFF AUTHORITY – Staff authority in positions created to support, assist, recommend, and generally reduces the supervisors’ informational responsibilities  EXECUTIVE DIRECTOR ASSIST. EXECUTIVE DIRECTOR HRD DIRECTOR OF DIRECTOR OF OPERATIONS PURCHASING Unit 1 MANAGER Unit 2 MANAGER OPERATIONS OPERATIONS Purchasing HUMAN RESOURCES  TYPES OF ORGANIZATION ☞LINE ORGANIZATION ☞ INFORMAL ORGANIZATION ☞ STAFF ORGANIZATION ☞ FUNCTIONAL ORGANIZATION ☞LINE ORGANIZATION – is the simplest and most direct type of organization in which each position has general authority over the lower positions in the hierarchy ☞INFORMAL ORGANIZATION – refers to horizontal relationships rather than vertical. This is composed of small groups of workers with similar interests ☞STAFF ORGANIZATION – is purely advisory to the line structure with no authority to put recommendations into action ☞FUNCTIONAL ORGANIZATION – is one where each unit is responsible for a given part of the organization’s workload. There is clean delineation of roles and responsibilities which are actually interrelated HIERARCHICHAL STRUCTURE is commonly called LINE STRUCTURE ☝ this is the traditional structure and is associated with the principle of chain of command, bureaucracy, vertical control and coordination, levels differentiated by functions and authority, and downward communication  HOSPITAL DIRECTOR CHIEF NURSE ASSISTANT CHIEF NURSE NURSE SUPERVISOR SENIOR STAFF NURSE STAFF NURSE Traditional Hierarchal structure  DECENTRALIZATION ☝ refers to the degree to which authority within the organization is delegated downward to its divisions, branches, services, and units  ☝ DECENTRALIZATION of AUTHORITY includes delegation of all management components of planning, organizing, leading, and controlling  STAFFING ☝ filling, and keeping filled, positions in the organization structure through defining workforce requirements, inventorying workforce, appraising, selecting, compensating, and training  STAFFING ☝ Staffing is the use of recruitment, selection, and development of personnel to assign competent people to the roles designed for the organizational structure  FACTORS AFFECTING STAFFING 1. The type, philosophy, and objectives of the hospital and the nursing service 2. The population served or the kind of patients served whether pay or charity 3. The number of patients and severity of their illness – knowledge and ability of nursing personnel are matched with the actual care needs of patients  FACTORS AFFECTING STAFFING 4. Availability and characteristics of the nursing staff, including education, level of preparation, mix of personnel, number and position 5. Administrative policies such as rotation, weekends and holiday off-duties  FACTORS AFFECTING STAFFING 6. Standards of care desired which should be available and clearly spelled out 7. Layout of the various nursing units and resources available within the department such as adequate equipment, supplies and materials  FACTORS AFFECTING STAFFING 8. Budget including the amount allotted to salaries, fringe benefits, supplies, materials, and equipment 9. Professional activities and priorities in nonpatient activities like involvement in professional organizations  FACTORS AFFECTING STAFFING 0. Teaching program or the extent of staff involvement in teaching activities 1. Expected hours of work per annum of each employee 2. Patterns of work schedule – traditional 5days/wk, 8 hours per day….  NURSING CARE HOURS PER PATIENT PER DAY ACCORDING TO CLASSIFICATION OF PATIENTS BY UNITS CASES/PATIENTS NCH/Pt/day Prof to Non Prof Ratio General Medicine 3.5 60:40 Medical 3.4 60:40 Surgical 3.4 60:40 Obstetrics 3.0 60:40 Pediatrics 4.6 70:30 Pathologic Nursery 2.8 55:45  NURSING CARE HOURS PER PATIENT PER DAY ACCORDING TO CLASSIFICATION OF PATIENTS BY UNITS CASES/PATIENTS NCH/Pt/day Prof to Non Prof Ratio ER/ICU/RR 6.0 70:30 CCU 6.0 80:20  PATIENT CARE CLASSIFICATION SYSTEM -is a method of grouping patients according to the amount and complexity of their nursing care requirements and the nursing time and skill they require CLASSIFICATION CATEGORIES LEVEL I – SELF CARE OR MINIMAL CARE - patient can take a bath on his own, feed himself, feed and perform his ADL Average amount of NCH/pt/day – 1.5 Ratio of Prof to Non-Prof – 55:45 CLASSIFICATION CATEGORIES LEVEL II – MODERATE CARE OR INTERMEDIATE CARE - patient need some assistance in bathing, feeding, or ambulation Average amount of NCH/pt/day – 3 Ratio of Prof to Non-Prof – 60:40 CLASSIFICATION CATEGORIES LEVEL III – TOTAL, COMPLETE OR INTENSIVE CARE - patient are completely dependent upon the nursing personnel Average amount of NCH/pt/day – 6 Ratio of Prof to Non-Prof – 65:35 CLASSIFICATION CATEGORIES LEVEL IV – HIGHLY SPECIALIZED CRITICAL CARE - patient need maximum nursing care Average amount of NCH/pt/day – 6-9 Ratio of Prof to Non-Prof – 80:20  CATEGORIES OF LEVELS OF CARE OF PATIENTS LEVELS OF CARE NCH/Pt/day Prof to Non Prof Ratio LEVEL I 1.5 55:45 Self Care or Minimal Care LEVEL II 3.0 60:40 Moderate or Intermediate Care  CATEGORIES OF LEVELS OF CARE OF PATIENTS LEVELS OF CARE NCH/Pt/day Prof to Non Prof Ratio LEVEL III 4.5 65:35 Total or Intensive Care LEVEL IV 6-9 70:30 Highly Specialized or 80:20 Critical Care  PERCENTAGE OF NURSING CARE HOURS -also depends on the setting in which the care is being given  PERCENTAGE OF PATIENTS AT VARIOUS LEVELS OF CARE PER TYPE OF HOSPITAL TYPE OF MIN. MOD. INT. HIGHLY HOSPITAL CARE CARE CARE SPC.CARE Primary Hosp. 70 25 5 Secondary 65 30 5 Tertiary Hosp. 30 45 15 10 Special Tertiary 10 25 45 20 COMPUTING FOR THE NUMBER OF PERSONNEL NEEDED -when computing for the number of nursing personnel in the various nursing units of the hospitals, one should ensure that there is sufficient staff to cover all shifts, off duties, holidays, leaves, absences, and time for staff development program  40-HOUR WEEK LAW (REPUBLIC ACT 5901) – employees working in hospitals with 100-bed capacity and up will work only 40 hours a week -less than 100-bed capacity will work 48 hours per week  TOTAL NUMBER OF WORKING AND NON-WORKING DAYS AND HOURS OF NURSING PERSONNEL PER YEAR RIGHTS AND PRIVILEGES WORKING HOURS PER WK GIVEN EACH PERSONNEL PER YEAR 40 HOURS 48 HOURS VACATION LEAVE 15 15 SICK LEAVE 15 15 LEGAL HOLIDAYS 10 10 SPECIAL HOLIDAYS 2 2 SPECIAL PRIVILEGES 3 3 OFF DUTIES/RA5901 104 52 CONT. ED. PROG. 3 3  TOTAL NUMBER OF WORKING AND NON-WORKING DAYS AND HOURS OF NURSING PERSONNEL PER YEAR RIGHTS AND PRIVILEGES WORKING HOURS PER WK GIVEN EACH PERSONNEL PER YEAR 40 HOURS 48 HOURS TOTAL NON-WORKING DAYS/YEAR 152 100 TOTAL WORKING DAYS/YEAR 213 265 TOTAL WORKING HOURS/YEAR 1704 2120 RELIEVERS NEEDED To compute for relievers needed, the ff should be considered: 1. Average number of leaves taken each year… 15 a. Vacation leave …………….10 b. Sick leave …………………. 5 2. Holidays …………………………………. 12 3. Special Privileges as per CSC MC#6 ….… 3 4. Continuing Education Prog. for Profl. ….… 3 Total Average Leaves 33  To determine the relievers needed, divide the average number of days an employee is absent per year by the number of working days per year that each employee serves 33 / 213 = 0.15/person (40 hours/wk) 33 / 265 = 0.12/person (48 hours/wk) Multiply the computed reliever per person by the computed number of nursing personnel. 0.15 x _______ = ________ 0.12 x _______ = ________ This will give the total number of relievers needed DISTRIBUTION BY SHIFTS 45% - MORNING SHIFT 37% - AFTERNOOIN SHIFT 18% - NIGHT SHIFT  STAFFING FORMULA 1. Categorize the number of patients according to the levels of care needed. Multiply the total number of patients by the percentage of patients at each level of care  FIND THE NUMBER OF NURSING PERSONNEL NEEDED FOR 250 PATIENTS IN A TERTIARY HOSPITAL 25O (pts) x.30 = 75 pts needing minimal care 25O (pts) x.45 = 112.5 pts needing moderate care 25O (pts) x.15 = 37.5 pts need intensive care 25O (pts) x.1 = 25 pts need highly specialized care 250  STAFFING FORMULA 2. Find the number of nursing care hours (NCH) needed by patients at each level of care per day. Get the sum of the nursing care hours needed at the various levels 75pts x 1.5(NCH needed at level I) = 112.5 NCH/day 112.5pts x 3(NCH needed at level II) = 337.5 NCH/day 37.5pts x 4.5(NCH needed at level III)=168.75 NCH/day 25pts x 6(NCH needed at level IV) = 150. NCH/day TOTAL 768 NCH/day  STAFFING FORMULA 3.Find the actual number of nursing care hours (NCH) needed by the given number of patients. Multiply the total nursing care hours needed per day by the total number of days in a year. Find the total NCH needed by 250 patients per year. 768.75 x 365 (days/yr) = 280,593.75 NCH/yr  STAFFING FORMULA 4. Find the actual working hours rendered by each nursing personnel per year. Multiply the number of hours on duty per day by the actual working days per year 8 (hrs/day) x 213 (working days/year) = 1,704 (working hours /yr)  STAFFING FORMULA 5. Find the total number of nursing personnel needed. a. Divide the total number of nsg care needed/yr by the actual number of working hours rendered by an employee/year b. Find the number of relievers c. Add the number of relievers to the number of nursing personnel needed Find the total number of nursing personnel needed. a. Total NCH/yr = 280,593.75 = 165 Working hours/year = 1,704 b. Relief x Total Nsg Personnel = 165 x 0.15 = 25 c. Total Nsg Personnel needed = 165 + 25 = 190  STAFFING FORMULA 6. Categorize to professional and non-professional personnel. Multiply the number of nursing personnel according to the ratio of professionals to non-professionals  Ratio of prof to non-prof in a tertiary hospital: 65:35 190 x.65 = 124 professional nurses 190 x.35 = 66 nursing attendants  STAFFING FORMULA 7. Distribute by shifts. 124 nurses x.45 = 56 nurses on AM shift 124 nurses x.37 = 46 nurses on PM shift 124 nurses x.18 = 22 nurses on NIGHT shift 124 nurses 66 nsg attendants x.45 = 30 NA on AM shift 66 nsg attendants x.37 = 24 NA on PM shift 66 nsg attendants x.18 = 12 NA on NIGHT shift 66 nursing attendants  Find the number of nursing personnel needed for a 120 bed capacity Salus Infirmorum Hospital and Medical Center  It should be noted that the computation for personnel are only for in-patients. Therefore additional personnel should be hired for those in supervisory and administrative positions  PLACEMENT OF STAFF -managers should consider some factors when assigning employees to a position or area where these employees have very good chances for success Proper placement fosters: -Personal growth -Provides a motivating climate for the employee -Maximizes productivity and organizational goals Inappropriate placement often results in: -Frustration -Poor quality of work -Reduced organizational efficiency -Rapid turn over -Poor image for the agency Factors to consider in placement of staff: 1. Past experience and training of the employee 2. Culture of the clientele 3. Decision-making skills 4. Communication skills  SCHEDULING A SCHEDULE is a timetable showing planned work days and shifts for nursing personnel Scheduling must function smoothly in terms of: 1. Ability to cover the needs of the unit 2. Quality to enhance the nursing personnel’s knowledge, training, and experience 3. Fairness to the staff 4. Stability 5. Flexibility  TYPES OF SCHEDULING 1. CENTRALIZED SCHEDULE – one person, usually the Chief Nurse or her designate, assigns the nursing personnel to the various units of the hospital. This includes the shifts on duty and off-duty  TYPES OF SCHEDULING 2. DECENTRALIZED SCHEDULE – the shift and off-duties are arranged by the Supervising Nurse or Head or Senior Nurse of the particular unit  TYPES OF SCHEDULING 3. CYCLICAL SCHEDULE – covers a designated number of weeks called the cycle length and is repeated thereon. It assigns the required number of nursing personnel to each nursing unit consistent with the unit’s patient care requirements, the staff’s preference, their education, training and experience  ADVANTAGES OF CYCLICAL SCHEDULE 1. It is fair to all. Favoritism is minimized 2. It saves time as the schedule does not have to be redone every week or two ADVANTAGES OF CYCLICAL SCHEDULE 3. It enables the employees to plan ahead for their personnel needs preventing frequent changes in schedule 4. Scheduled leave coverage such as vacation, holidays, and sick leaves are more stable 5. Productivity is improved  EMPLOYMENT PROCEDURES 1. RECRUITMENT - to recruit nurses, one can fill vacancies from within the facility, hire graduates from schools and colleges, place advertisements and announcements, and use professional and private nurse employment agencies, both national and international  EMPLOYMENT PROCEDURES EXPERIENCED NURSES - nurses who have practiced for a number of years and have become experts in their fields carry more clout with recruiters  EMPLOYMENT PROCEDURES SUPPLEMENTAL STAFFING - involves the use of nurses who are available and on-call at their homes or who are employed by nurse registries APPLICATION FORM should include: -personal history -educational background -work experience -and other pertinent information APPLICATION FORM is used to: -Determine whether the applicant meets hiring requirement -Furnish background data useful in the selection interview -Obtain names of references who may be contacted for further information -Collect information for personnel administration, such as SSS, TIN  EMPLOYMENT PROCEDURES 2.SELECTION OF NURSING PERSONNEL - responsibility for staffing an organization with nursing personnel rests with every manager at every level  EMPLOYMENT PROCEDURES 3. INDUCTION AND ORIENTATION - INDUCTION consists of those formal procedures an employee follows immediately after being hired ORIENTATION is the formal process of familiarizing the new employee with the organization and his or her place in it STAFF DEVELOPMENT includes all training and education undertaken by an employer to improve the occupational and personal knowledge, skills, and attitudes of employees  STAFFING PROCESS EFFECTS OF ABSENTEEISM – studies in the workplace have been conducted over the past three decades and have shown that individual needs, relationships with co-workers and supervisors, working conditions, work policies and compensation affect the extent to which an individual is gratifies or fulfilled in his or her work  STAFFING PROCESS STAFF BURNOUT - burn out has been associated with three composite factors: a. emotional exhaustion, or feeling overextended and worn out from work b. depersonalization, or lack of appropriate responses to the nurse’s efforts, c. a diminished sense of personal accomplishment Researchers has began to investigate variables that reduce or buffer burnout. “PERSONAL HARDINESS” Three personality characteristics determine hardiness: Commitment, Control, Challenge COMMITMENT – involves a strong sense of dedication to self and others CONTROL – having control means that a nurse can influence the course of events in his or her life CHALLENGE – a challenging career offers opportunities to use one’s abilities, energies and resources or provides an opportunity to attempt what one believes he or she can accomplish  JOB DESCRIPTION ☞ is a statement that sets the duties and responsibilities of a specific job  JOB DESCRIPTION is also a contract that includes the job’s functions and obligations and tells the person to whom the worker is responsible  CONTENTS OF JOB DESCRIPTION ☞ IDENTIFYING DATA Position Title: Staff Nurse Department: Nursing Supervisor’s Title: Head/Senior Nurse  CONTENTS OF JOB DESCRIPTION ☞ JOB SUMMARY – this includes the essential features of the job that distinguish it from the others ☞ QUALIFICATION REQUIREMENTS – educational preparation, training and experience necessary to fill the position  CONTENTS OF JOB DESCRIPTION ☞ Job Relationships – source of workers ☞ Specific and Actual Functions and Activities  USES OF JOB DESCRIPTION ☞ for recruitment and selection of qualified personnel ☞ To orient new employees to their jobs ☞ For job placement, transfer or dismissal ☞ As an aid in evaluating the performance of an employee ☞ For budgetary purposes JOB SPECIFICATION – are the enumeration of necessary and desirable personal qualities that an applicant should possess in order to execute the job satisfactorily  USES OF JOB DESCRIPTION ☞ for determining departmental functions and relationships to help define the organizational structure ☞ For classifying levels of nursing functions according to skill levels required ☞ To identify training needs ☞ As basis for staffing  JOB DESCRIPTION are being discussed with the nursing personnel to enable them to see the extent to which their jobs contribute to patient care, their place in the nursing team and the hospital as a whole  JOB EVALUATION JOB EVALUATION is needed in creating a sound wage salary and career ladder systems -it requires job analysis and job description JOB EVALUATION is defined as systematic method of appraising the work of each job in relation to all other jobs in organization