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Controlling - Management Process
Transcript of Controlling - Management Process
Venzon L. M. and Nagtalon J. M. V. Nursing Management Towards Quality Care, 4th ed., C&E Pblishing Inc. 2010 MEASURING ACTUAL PERFORMANCE It is an on-going, repetitive process with the actual frequency dependent on the type of activity being measured.
The purpose of measurement should be clarified, and the staff should be informed about the tasks and level of care that need attention. Standards are desirable sets of conditions and performance necessary to ensure the quality of nursing care services which are acceptable to those instrumental to or responsible for setting and maintaining them.
Three types: STRUCTURE, PROCESS, OUTCOME Outcome Standards These are designed to measure the results of care provided in terms of changes in the health status of clients served; changes in the level of their knowledge, skills, and attitudes; and satisfaction of those served including the members of the nursing and health team. ESTABLISHMENT OF OBJECTIVES & METHODS FOR MEASURING PERFORMANCE The establishment of objectives provides clear direction and communication of expected levels of achievement. Actions and procedures such as written guides, schedules, rules, records, and budgets are inspected.
It uses tools such as time studies and checklists. Refers to the activities and techniques employed to achieve and maintain the quality of a product, service, or process.
It includes a monitoring activity but is also concerned with finding and eliminating causes of problems so that the requirements of the customers are continually met.
The level of provided nursing care and its effects on the clients are assessed. THE BASIC COMPONENTS OF THE CONTROL PROCESS 1. Establishment of standards, objectives, & methods for measuring performance.
2. Measurement of actual performance.
3. Comparison of results of performance with standard objectives 5. Implementation of corrective action as necessary. 4. Action to reinforce strengths and successes Standards on Structure Those that focus on the structure or management system used by the agency to deliver care.
number and categories of nursing personnel
personal and professional qualities and proficiencies
equipment Process Standards Refers to decisions and actions of the nurse relative to the nursing process which are necessary to provide good nursing care.
plan of care
nursing intervention ESTABLISHMENT OF STANDARDS FOR MEASURING PERFORMANCE Most common used methods for measuring nursing performance:
TASK ANALYSIS, QUALITY CONTROL Task Analysis Quality Control COMPARING RESULTS OF PERFORMANCE WITH STANDARDS & OBJECTIVES If performance matches standards & objectives, managers are assured that the needs of patients are met. However, if performance is contrary to the objectives and standards set, then necessary action should be taken. REINFORCING STRENGTHS OR SUCCESSES AND TAKING CORRECTIVE ACTION AS NECESSARY Positive feedback stimulates motivation, consistent high performance, and growth of the employee. Corrective actions are applied to improve performance. The following are the control measures which may be utilized by the Nursing Service Administrators: Performance Appraisal
Continuous Quality Improvement
Records and Reports
Risk management Purposes Determines job competence.
Enhances staff development and motivate personnel toward higher achievement.
Discovers the employees aspirations and to recognize accomplishments.
Improves the communications between managers and staff associates and to reach an understanding about the objectives of the job and agency. Aids the managers coaching and counselling.
Determines training and developmental needs of nursing personnel.
Make inventories of talents within the organization reassess assignments.
Selects qualified nursing personnel for advancement and salary increases.
Identifies unsatisfactory employees. Purposes Factors Contributing to an Effective Performance Appraisal System Compatibility between criteria for individual evaluation and organization goals. The elements of the performance evaluation system (PES) should be agreed upon at each level of management. Direct application of the rated performance to performance standards & objectives expected of the worker. Predetermined roles for each member of health team & set the goals in terms of behavioral objectives & success criteria Development of behavioral expectations which have been mutually agreed upon by both the rater and the worker. Participation in the formulation of goals motivates workers to work toward their accomplishment. Understanding the process and effective utilization of procedure by the rater. Training in the appraisal process should be provided by the employer through in-service education. Rating of each individual by the immediate supervisor. Appraisal is more accurate when data are gathered and processed by the immediate supervisor which is more familiar with the actual performance of the worker. Concentration on the strengths and weaknesses to improve individual performance. Reinforcement of strengths in performance encourages the worker to further improve. Weaknesses are noted only if these are perceived as threats to safety or if they provide significant deterrents to goal achievement. Encouragement of feedback from the related employees about their performance needs and interests. When the performance appraisal is prepared, the employees are given the opportunity to verify or disagree with anything written about them. Provision for initiating preventive and corrective action and making adjustments to improve performance. The primary goal in the performance of all workers should be to provide quality service to all clients. Methods of Measuring Performance Essay The appraiser writes a paragraph or more about the worker's strengths, weaknesses, and potentials.
Disadvantage: Essays touch on different aspects of a worker's performance. May also concentrate on those areas of performance for which the appraiser has strong feelings. Checklist It consists of a list of performance criteria with corresponding blanks wherein the evaluator is asked to indicate, for each criterion whether the nurse has or has not the desired or approved behavior. Ranking It requires the evaluator to rank the employee according to who he/she fared with his/her coworkers with respect to certain aspects of performance. Rating Scale It includes series of items representing different activities or tasks included in the nurse's job description or the absence or presence of desired behaviors and the extent to which these are possessed. Forced-choice Comparison The evaluator is asked to choose the statement that best describes the nurse being evaluated. The items are so grouped so the evaluator is forced to choose from favorable as well as unfavorable statements and to encounter the tendency towards leniency by some evaluators. Anecdotal Recording It describes the nurse's experience with a group or person, or in validating technical skills and interpersonal relationships.
description of a particular occasion
a delineation of the behavior noted
including answers to the questions who, what, why, when, where & how
the evaluator's opinion or assessment of the incident or behavior Miss A was on her way to take her lunch. She passed by a patient who was reaching for her food tray but was having hard time as this was placed on her left side. Her right hand had an intravenous site. Miss A stopped, positioned the food tray comfortably and assisted the patient to eat although she herself was late for lunch. Miss A acted in a commendable manner. Example Select the statement that best describes the nurse being evaluated and the statement that least describes him/her.
1 - Respects the ideas of others
2 - Limited communication ability
3 - Even-tempered
4 - Capable of enduring long hours of hard work
5 - Tends to be a loner Example On a scale of 1 to 5, indicate the degree of the nurse's skill in assessing the patient's condition where each of the corresponding number means:
5 - Excellent
4 - Very Satisfactory
3 - Moderately Satisfactory or Average
2 - Minimal Satisfactory
1 - Unsatisfactory Example RECORDING & REPORTING Essential Points in Keeping Records Should be accurate, adequate, and up-to-date.
Should be clear, brief, and concise.
Should provide relevant facts for evaluation and study.
Should be filled chronologically by subjects to facilitate accessibility and effective use of data.
Records and reports may be temporarily or permanent and policies should be provided for their disposition.
Record forms must be maintained at all times.
Must be kept in dry storage areas.
Confidential records and reports should be safeguarded. The word "confidential" should either be stamped or written preferably in red ink.
A properly-trained responsible person should be in-charge of records and reports. Personal Record (Form 201) copy of the personal data
staff and professional activities
confidential information Master Staffing Pattern Daily assignment of the nursing personnel which will help the Chief Nurse visualize the coverage of all nursing units.
actual number of nursing staff
nursing staff on sick leave
staff on-the-job training
nursing staff on study leave Daily Census of Patients Includes detailed list of actual patients in the different in-patient and the total census for 24 hours. Daily Time Records or Bundy Cards These indicate the time each personnel reported to and from duty. Nursing & Hospital Policies These may refer to policies, admissions, discharges, transfers for regulation, time and work schedules, charging of patients, etc. directives are dated and signed by the sender. Manual of Procedure A set of standards operating procedures such as:
for carrying out oral/telephone orders for medications
errors in medication
omission of treatment
arrangement of the patient's clinical chart
transcribing of doctor's order Continuous Quality Improvement Program Conducted Nursing Audits Records of Staff Development Programs Conducted Outreach Program
Nursing Leadership and Management Training
Continuing Education Program Nursing Affiliation Record approved affiliation contract with the list of students including the date and time for affiliation and the clinical instructors
record of payments provides the number of students; date and length of affiliation, and payments each with corresponding receipt number and the date such were paid
Quarterly Report of Affiliation
Performance Evaluation Record of Affiliation Record of Nursing Researches Conducted Minutes of the Nursing Department Meetings Minutes of meetings with in the Nursing Service Manual, are kept on file for ready reference. Policies, rules and regulations are discusses for infirmity of interpretation and implementation. (for training & teaching hospital) CONFLICT MANAGEMENT Defined as a struggle or contest between people with opposing needs, ideas, values or goals. Primary Categories of Conflict Intergroup Conflict Interpersonal Conflict Interpersonal Conflict intrapersonal interpersonal intergroup It involves an internal struggle to clarify contradictory values or wants.
Being self-aware and conscientiously working to resolve intrapersonal conflict as soon as it is first felt is essential to the leader's physical and mental health. It happens between two or more people with different values, goals, and beliefs. It occurs between two or more groups of people, department or organizations. LATENT CONFLICT PERCEIVED CONFLICT FELT CONFLICT MANIFEST CONFLICT CONFLICT RESOLUTION CONFLICT AFTERMATH Implies the existence of antecedent conditions
Conditions are ripe for conflict, although none has actually occurred and may never occur.
As managers, the organization must be examined more closely for antecedent conditions to prevent or reduce the conflict Also known as SUBSTANTIVE CONFLICT
It is recognized logically and impersonally by the person as occurring
Sometimes conflict can be resolved at this stage. Also referred to as AFFECTIVE CONFLICT
Occurs when conflict is emotionalized
Felt emotions include: HOSTILITY, FEAR, MISTRUST and ANGER
It is possible to perceive conflict and not feel it
A person can also feel the conflict but not perceive the problem Also called as OVERT CONFLICT
Action is taken.
May be to withdraw, compete, debate or seek conflict resolution. It encompasses the use of nonviolent resistance measures by conflicted parties in an attempt to promote effective resolution It may be more significant than the original conflict if the conflict has not been handled constructively
If managed well, people involved will believe that their position was given a fair hearing.
If managed poorly, the conflict issues remain and may return later to cause more conflict. DISCIPLINE It is regarded as a constructive and effective means by which employees take personal responsibility for their own performance and behavior. Steps of Progressive Discipline COUNSELLING & ORAL WARNING WRITTEN Reprimand SUSPENSION DISMISSAL BEST given in private and an informal atmosphere
The employee is given a fair chance to air his/her side
The employee is then counseled regarding: expectations of improved behavior/performance
ways of correcting the problem
warning that a repetition of the same offense may warrant further disciplinary action Preceded by an interview similar to the oral warning
This includes: the statement of the problem
identification of the rule which was violated
consequences of continued deviant behavior
employee's commitment to take corrective action
any follow-up action to be taken It is given after an evidence of oral and written warnings
Suspension rather that dismissal is applied when management feels that the employee can still be rehabilitated
Accurate documentation of oral and written warnings including suspension, if done, are necessary evidences of due process. It is invoked only when all other disciplinary efforts have failed.
The 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 (private firm employees), or those contained in the Civil Service Rules & Regulations and the Codes of Conduct (government employees).
A review is usually done by higher management (private), or by their respective departments and final affirmation by the Civil Service Commission (government). Factors That Influence Discipline A strong commitment to the vision, philosophy, goals, and objectives of the institution. It results in cohesion and teamwork which in turn encourage greater conformity to expected norms of conduct within the organization. Laws that govern the practice of all professionals and their regulations of the agency. Civil Service Rules & Regulations as provided for PD807 and the Code of Conduct for Public Officials RA6713, are also to be complied with. All employees are oriented on the rules, regulations, and policies of the agency. Understanding the rules and regulations of the agency. An atmosphere of mutual trust and confidence. The subordinates can consult their superiors about their problems without fear. They can trust that their superiors will be fair and just in decisions concerning their welfare.
The superiors trust their workers will do their best performing their jobs well. Pressure from peers and organization Social pressures from co-workers and the organization demand that workers perform their jobs to the best of their abilities. QUALITY IMPROVEMENT A continuous, on-going measurement and evaluation process that includes structure, process and outcome. The team establishes criteria, identifies relevant information, collects and analyze data, judges quality, takes corrective actions, reevaluates and does public reporting. Establish Criteria Developing Standards Setting Benchmarks Standards are written value statements that define a predeterined level of expected performance.
They are typically about structure, process or outcomes "All nurse managers will have a master's degree in nursing." "Every patient will have a discharge plan before being discharged." "No more than 20% of patients with specific diagnosis will be readmitted for that diagnosis within two months of discharge." Benchmarking is measuring what exists against the best practice.
The indicator allows for comparison of data. Accrediting body standards, professional organization standards, and laws can be sources of standards.
An indicator is the tool used to measure the standard. Identify Relevant Information Collect
Information NURSING AUDIT is a basic form of data collection. Structure Audits a checklist that can note:
presence/absence of policies, procedures, medical records, physical facilities, equipment
caregiver's knowledge and experience
patient's ability to reach call lights, food and water Process Audit related to care such as:
implementing the physician's order
observation of symptoms
implementation of nursing procedures
appropriate charting Outcome Audit may be related to:
physical health status
mental health status
utilization of services
satisfaction with the service received Retrospective Audit Concurrent Audit It is done after the patient is discharged.
Usually done by examining the medical records of discharged patients. Then comparisons are made among cases. Recommendations were made based on experience of patients with similar care problems. It is conducted while the patient is receiving care.
Care can be modified if observations indicate the need to make changes. Peer Reviews Done when practicing nurses determine the standards and criteria they believe indicate quality care and assess the performance of nurses against those standards. Analyze
Information Bar Graph a series of bars representing successive changes in the value of a variable of different data sheets Cause-and-effect Diagram or Fish bone Diagram Check Sheet Decision Matrix Histogram Pie Chart Radar Chart used to identify the root cause of a problem or outcome can be used to collect and classify raw data
good tools for monitoring key performance indicators
the data can be used to generate histograms & other charts a grid that helps prioritize options - that are evaluated and eliminate unfeasible options, leaving viable alternatives a bar graph that can be used to compare patterns of occurrence over time
can be used to identify trends and analyze variations compares the relative size of different data sets in a circle instead of as bars on graphs are circular displays of before-and-after data to demonstrate progress made or lost Judge Quality, Take Corrective Action, & Monitor The implemented plan needs to be evaluated to determine if the outcome standard was met. If not, revisions may be needed.
The interdisciplinary teem may need to meet periodically to reassess the outcomes & make adjustments if necessary. Public Reporting Stakeholders should also be informed of the evaluation results
Results can be disseminated through mass media, computer announcements, department meetings, and discussion groups Controlling or evaluating is an ongoing function
of management which occurs during planning,
organizing, & directing activities. CONFLICT MANAGEMENT FLOWCHART thank you! RISK MANAGEMENT It involves the development and implementation of strategies to prevent partial injury, minimizes financial loss, and preserves agency assets. RISK
IDENTIFICATION ANALYSIS IMPLEMENTATION EVALUATION FOLLOW-UP For potential or actual risks for accidents, injury, and financial loss. Patient falls, medication errors, infections, operative & post operative complications, equipment failures Done after data collection to determine the frequency and severity of problems. Review of policies and procedures, equipment safety, consents, and laws & regulations Corrective and preventive actions should be taken. Education, formulation or revisions of new policies and procedures., changes to systems, new equipment, counseling/disciplinary action The results should be evaluated and reported. Risk management programs should include customer satisfaction, safety & security, continuous quality improvement, and liability control. To assess need for further analysis and implementation of other ways to prevent or minimize the risk. Regularly checking of incident reports, observation The team should identify relevant information from major regulatory and accrediting bodies that control health care organizations Department of Health (DOH)
Philippine health Insurance Corporation (PHIC)
Joint Commission International (JCI)
Joint Commission on Accreditation of Health Organization (JCAHO)
ISO 9001 Certification Professional Regulatory Commission (PRC)
Specialty Certification from Individual Specialty Societies (Philippine College of Physicians - Affiliate, Diplomate, Fellow) Quality Improvement Process 1. Understand the meaning of controlling.
2. Describe the different components of the Control Process. Objectives: At the end of the discussion the class will be able to: 3. Understand and define different control measures Nurse Managers utilize. a. Performance Appraisal
b. Quality Improvement
c. Records and Reports
e. Conflict Management
f. Risk Management