Nursing Management Function: CONTROLLING PDF

Nursing Management Function∶ CONTROLLING Prepared by: Ma.Frenie D. Tamano Controlling The fourth and final step in the management process, and like the nursing process, is cyclic, Controlling is not an end in itself, it is implemented throughout all phases...

Nursing Management Function∶ CONTROLLING Prepared by: Ma.Frenie D. Tamano Controlling The fourth and final step in the management process, and like the nursing process, is cyclic, Controlling is not an end in itself, it is implemented throughout all phases of management. Example of management controlling functions includes the… periodic evaluation of unit philosophy, mission, goals and objective measurement of individual or group performance against pre-established or predetermined standards monitoring of expenses and use of supplies auditing of client goals and outcome  During the controlling phase of the management process, performance is measured against predetermined standards and action is taken to correct discrepancies between these standards and actual performance. Employees who feel they can influence the quality of outcomes in their work environment experience higher level of motivation and job satisfaction. Organization also need some control over productivity, innovation and quality outcomes. In nursing, the goal of quality care would be to ensure quality while meeting the intended goals. Controlling According to Fayol,It is verifying whether everything occurs in conformity with the adopted plan, the instructions issued and principle established. It has for its object to point out weaknesses and error in order to rectify them and prevent recurrence. It is assessing / regulating performance in accordance with the plans that have been adopted, the instructions issued and the principles established.  According to Peter Drucker The management function that aims to keep activities directed in such a way that desired results are achieved. It is assessing / regulating performance in accordance with the plans that have been adopted, the instructions issued and the principles established. It plays and important role in identifying opportunities for improvement, comparing performance against set standards and providing information about how well people are doing so that they can be motivated to perform better in the future. The Control Processes Steps in the Control Process It is a continuous flow between comparing, measuring, and taking action Objective of Control: Control is always performed in relation to something like the following: 1. Functions – specific or assigned duties in the performance of a given task. 2. Procedures – these are established as the prescribed way to doing something in a business. 3. Structures – these are activities in various units or departments of business organizations are observed, supervised and made subject to control in the light of the company objective. 4. Personnel – includes the performance of the work force as well as their behavior. 5. Resources – includes objective, machines and material Control Process: 1.Estblish and specify criteria and performance standards a. Standards The control process can be expressed in a formula: Ss+Sa+F+C>I Standards set plus Standard applied plus Feedback plus Correction will yield Improvement STANDARD – is a predetermined level of excellence that serves as a guide for practice. A yardstick for measuring quality care predetermined ( to impose direction beforehand) established by an authority and communicated to and accepted by the people affected by them used a measurement tools (objective, measurable and achievable) b. Resource Controls c. Financial Controls d. Operations Control e. Statistical Process Control 2. Monitors and measures the performance of nursing care services and evaluate it against the standards through records reports and observations  Reasons for Conducting Evaluation: 1. Ensures quality nursing care is provided. 2. Sets sensible objectives and comply with them. 3. Provides standards for establishing comparisons. 4. Provides visibility and a means for employees to monitor their own performance. 5. Highlights quality problems and determines the areas that require priority attention. 6. Gives an indication of the cost of poor quality. 7. Justifies the use of resources. 8. Provides feedback for improvement. Different techniques for monitoring and measuring services a. Nursing rounds particular attention to patient care and nursing practice b. Quality assurance Monitors compliance with established standards Quality Assurance “Quality” – degree of excellence “Assurance” – formal guarantee of a degree of excellence. - it is the estimation of the degree of excellence in patient health outcomes and in activity and other resource outcomes. Quality Circles Introduced by the Japanese. It is a group of workers doing similar works who meet regularly, voluntarily, on normal working time under the leadership of their supervisor, to identify analyze and solve work-related problems and to recommend solutions to the management. Quality circle or continuous quality improvement. ( hallmark of successful Japanese Management) - an individual is the focal element in which production and services depend \ Continuous Quality Improvement Identifying and doing the right thing, the right way, the first time and problem prevention planning lead to quality outcome Never ending process, everything and everyone are subject to continuous improvement effort. No matter how good the product is there is always a room for improvement Quality Control as a Systematic Process/FOCUS PDCA If defining health-care quality is problematic, then the measurement of health-care quality is even more difficult. To make the process more effective and efficient, the collection of both quantitative and qualitative data is used as well as a specific and systematic process. This process, when viewed simplistically, can be broken down into three basic steps: 1. The criterion or standard is determined. 2. Information is collected to determine if the standard has been met. 3. Educational or corrective action is taken if the criterion has not been met. FOCUS PDCA was originally created by Edward Deming to show that people have a greater impact on waste when the entire process is understood rather than just looking at the outcome (Carmody, 2019)..  PDCA allows for a continuous quality improvement cycle to test improvement strategies one by one, in a controlled manner, to measure results and drive further improvements. FOCUS PDCA: A METHOD FOR HEALTH-CARE QUALITY IMPROVEMENT F: Find a process to improve. 0: Organize a team that knows the process. C: Clarify current knowledge of the process. U: Understand the variability and capability of the process. S: Select a plan for continuous improvement. P: Plan. D: Do. C: Check. A: Act. Total Quality Management TQM A continuous quality improvement, is a philosophy developed by Edward Deming. TQM is one of the hallmarks of Japanese management systems. It assumes that production and service focus on the individual and that quality can always be better. It is identifying and doing the right things, the right way, the first time, and problem-prevention planning— not inspection and reactive problem solving—lead to quality outcomes. TQM is based on the premise that the individual is the focal element on which production and service depend (i.e., it must be a customer- responsive environment) and that the quest for quality is an ongoing process c. Nursing audit Consists of the documentation of the unity of nursing care in relation to the standards established by the nursing department Nursing Audit Committee It is composed of all levels of the nursing staff – Training Staff, Supervising Nurse, Head/Senior Nurse, and a Staff Nurse. 1. Patient Care Audits a) Concurrent audit – patient care is observed and evaluated. It is given through: 1. review of patient’s chart while still admitted 2. observation of staff as patient care is given 3. inspection of patient and/or observation of the effect of patient care where the focus is on the patient. This is done during rounds or patient interview. b) Retrospective audit – patient care is evaluated through: 1. review of discharged patient’s chart 2. questionnaire sent to or interviews conducted on discharge patients 3.Compare performance with standards, models or criteria to determine devotions and differences a. Program Evaluation and Review Technique b.Benchmarking -seeks out the best so s to improve its performance 4. Enact remedial measures or steps to control devotions or errors a. Corrections of deviations and errors b.Master control plan c.Take necessary action Responsibility of the Head / Senior Nurses 1. Instruct subordinates in the appropriate methods and procedures in providing nursing care. 2. Inform likely causes of errors or defects and the preventive measures necessary. 3. Initiate and/or facilitate any steps necessary to improve methods, equipment materials & condition in the work area for which they are responsible. CONTROL PROCESSES Performance Appraisal It is a control process in which employee’s performance is evaluated against standards. Purpose of Performance Appraisal 1. To determine salary standards and merit increases 2.Select qualified individuals for promotion or transfer 3. Identify unsatisfactory employees for demotion or termination 4. Make inventories of talents within the institution. 5. Determine training and development needs of employees 6. Improve the performance of work groups by examining, improving, correcting interrelationships between members. 7. Improve communication between supervisors and employees and reach an understanding on the objective of the job. 8. Establish standards of supervisory performance 9. Discover the aspirations of employees and reconcile these with the goals of the institution. 10. Provide “ employee recognition “ for accomplishment 11. Inform employee “ where they stand “. Factors Contributing to an Effective Performance Appraisal Methods of Measuring Performance a) Informal appraisal – incidental observation of performance while workers engaged in performing nursing care or by responses made by the worker during conferences, as well as, interacting with clients, their families, visitors and co-workers. b) Formal appraisal – accomplished regularly and methodically by collecting objective facts that can demonstrate the difference between what is expected and what was done. These method would include 1. Essay Appraiser writes a paragraph or more about the worker’s strengths, weaknesses and potentials. 2. Checklist A compilation of all nursing performances expected of a worker. 3. Ranking Evaluator ranks the employees according to how he/she fared with co-workers with respect to certain aspect of performance or qualifications. 4. Rating Scales It include series of items representing the different tasks or activities in the nurse’s job description or the absence or presence of desired behaviors and the extent to which these are possessed 5. Forced-Choice Comparison Evaluator is asked to choose the statement that best describe the nurse being evaluated. 6. Anecdotal Recording It describes the nurse’s experience with a group of persons, or in validating technical skills and interpersonal relationship Sentinel report It examines serious, unexpected events, like severe harm or death in healthcare, to find the root causes, such as medical errors or system failures. Leadership plays a key role in responding, ensuring clear communication, effective crisis management, and preventive strategies Variance The different styles and approaches leaders use based on their goals, environment, or team dynamics. Leaders may choose a transformational style to inspire innovation or a transactional style to focus on task management and stability. It also includes how theymanage resources, make decisions, and approach change. Management by Objective A performance appraisal method. It is n excellent tool for determining an individual employees progress because it incorporates both the employees assessments and the organization. Peer Review When peers rather than supervisors carry out monitoring and assessing work performance The 360 Degree Evaluation Includes an assessment by all the individuals within the sphere of influence of the individual being appraised Discipline It is an employer’s actions against an employee for violation of company policies or rules. It connotes rigid obedience to rules and regulations, the violation of which result to punitive actions. Today, discipline is regarded as a constructive and effective means by which employees take personal responsibility for their own performance and behavior. This is termed as self-discipline. Factors influencing self-discipline: Strong commitment to the vision, philosophy, goals and objectives of the institution. Laws that govern the practice of all professional and their respective Codes of Conduct. Understanding the rules and regulations of the agency. An atmosphere of mutual trust and confidence. Pressure from peers and organization.  Objective of Establishing Good Discipline a) Its purpose is not retribution or vengeance but to impress upon the employee the need to do things in a prescribed manner b) Its serves as a warning to other employees that the company will not tolerate any willful violation of its rules and regulations or proper conduct and behavior. c) To ‘educate’ the employees in the fundamental standards of behavior and performance. Its aim is to “correct” or “reform” the employee, not to penalize them. “Effective discipline is a by-product of positive and intelligent leadership and of the willing cooperation by subordinates.” General Guidelines: 1. Be sure of the facts. 2. Listen. 3. Control your feelings. 4. Avoid entrapment. 5. Keep records. 6. Know your authority. 7. Keep others advised. Disciplinary Approaches Develop a sound disciplinary program tailored to the objective of the institution/organization. These should include: 1. A set of disciplinary policies and procedure. 2. Uniform application of discipline rules. 3. A disciplinary committee. 4. An orientation program for all new employees where expectations of appropriate performance and behavior are emphasized.