NSC 403

NATIONAL OPEN UNIVERSITY OF NIGERIA
FACULTY OF HEALTH SCIENCES
COURSE CODE: NCS403
COURSE TITLE: MANAG EMENT IN NURSING

NCS403 COURSE GUIDE
COURSE
GUIDE
NSC403
LEADERSHIP AND MANAGEMENT IN HEALTH
Course Team Mr. T. P. Olaoye (Developer/Writer) - NOUN

Mr. Kayode S. Olubiyi (Co-developer/writer) - NOUN
Prof. Afolabi Adebanjo (Programme Leader) - NOUN
Mr. Kayode S. Olubiyi (Coordinator) - NOUN

2
COURSE GUIDE
National Open University of Nigeria

Headquarters
14/16 Ahmadu Bello Way
Victoria Island
Lagos
Abuja Office
No. 5 Dar es Salaam Street
Off Aminu Kano Crescent
Wuse II, Abuja
Nigeria
e-mail: [email protected]
URL: www.nou.edu.ng
Published By:
First Printed 2011
ISBN: 978-058-944-9
All Rights Reserved
iii
NCS403 COURSE GUIDE
CONTENTS PAGE
Introduction ............................................................................................ 1
Purpose of the Course ............................................................................1
Course Aims and Objectives .................................................................1
How to Go Through this Course............................................................ 2
Course Materials .................................................................................... 2
Study Units ............................................................................................. 2
Textbooks and References ..................................................................... 3
Course Evaluation ..................................................................................3
Facilitators/Tutors and Tutorials............................................................ 3
Summary ................................................................................................ 3
Conclusion.............................................................................................. 3
4
Introduction
NSC403 Leadership and management in health is a one-semester course. It is a two-unit

course for all students offering B.NSc. programme in the Faculty of Health
Sciences. There are no special background requirements except the normal
entry requirements into the university.
However, students who are already working as nurses in both public and
private institutions will find the course to be of great value.
The essence of Management is to make all human endeavours function

effectively so that defined goals and objectives are efficiently attained.
Therefore, its concepts, principles and theories can be readily observed
and tested out in practice.
This course consists of 13 units which involve marrying the principles of

Management to nursing practice. Some of the units include the definition
of management, nature and purpose of management, the functions of
management, and tools of management, aspects of nursing, the health
delivery system and element in nursing practice as well as the concept of
the Drug Revolving Fund.
Purpose of the Course Guide
This course guide tells you what this course “Leadership and management
in health” is all about, the course materials you will need and how to make
use of the materials. It also provides information on how to go through the
tutor-marked assignments.
Course Aims and Objectives
To give you a broad exposure to the fundamental principles of Management

and their application to health care institutions. The aims will be achieved
by:
• introducing you to the nature, purpose and meaning of

management.
• classifying management as science or art.
• explaining the management functions of planning, organising,
staffing, leadership, control, coordination, innovation and
representation.
• explaining the management tools of communication, budgeting
and control.
• explaining the element in nursing practice.
• explaining the revolving fund concept.
NCS403 LEADERSHIP AND
MANAGEMENT IN HEALTH
How to Go Through the Course
To complete this course, you will have to read the material as contained
in each unit, which has an introduction, unit objectives, the main
content, conclusion, summary and tutor-marked assignments. Youare
expected to attempt the tutor-marked assignment(s) as soon as you
finish a unit. You are equally advised to go through some of the
textbooks recommended in the reference section for additional
information. There is a final examination at the end of this course.
Stated below are the components of this course and what you have to do.
The major components of the course are:
1. Course Guide
2. Study Units
3. Text Books
4. Assignment File
5. Presentation Schedule
Study Units
There are 13 study units in this course grouped into 3 modules as

follows:
Module 1 Introduction to Management
Unit 1 Nature, Purpose and Definitions of Management

Unit 2 Classification of Management and its Functions
Unit 3 Communication and Interpersonal Relationships
Unit 4 Interviewing Skills
Module 2 Management and Control
Unit 1 Human Resources/Services Management

Unit 2 Management and Control of Material Resources
Unit 3 Health Care Delivery Systems
Module 3 Other Issues in Nursing Practice
Unit 1 Quality Assessment in Nursing Practice

Unit 2 Budgeting
Unit 3 Control
Unit 4 Motivation
Unit 5 Leadership
Unit 6 The Drug Revolving Fund
6
These units should be treated sequentially as preceding units act as a

base for subsequent units.
Textbooks and References
Ernest, Dale. (1978). Management Theory and Practice, (4th ed.).

McGraw-Hill.
Nwachukwu, C. C. (2004) Management Theory and Practice. Nigeria:

African First Publishers Ltd.
Olaoye, T.P. (1995). “Lecture Notes on Principles of Management.”

Kwara State Polytechnic, Ilorin: Unpublished.
Course Evaluation
There will be two types of evaluation: Tutor-Marked Assignments and the

Final Semester Examination. As stated earlier, every unit of this course
has an assignment attached to it. Four assignments will be given to you
from the Study Centre out of which 3 will be recorded for you as part of the
evaluation. These assignments attract 30 per cent of the total mark. The
second part is the final semester examination. This comes at the end of the
course and you will be examined in all units -covering all aspect of the
course. The examination attracts 70 per cent of the total marks.
Facilitators/Tutors and Tutorials
Specific dates for particular activities, such as tutorial schedules,

submission of assignments and examination dates shall follow the school
calendar, which shall be made available to you. This will enable you to plan
your activities in the same line. You are therefore advised to work hard in
order not to fall behind schedule
Summary
This course exposes you to the concepts, principles and theories of

Management that will make you better managers of resources in
your various endeavours.
Conclusion
By the time you complete this course, you will find the knowledge you have
gained useful not only in solving management problems, but also in solving
your day-to-day problems.
7
Course Code NSC403

Course Title Leadership and management in health
Course Team Mr. T. P. Olaoye (Developer/Writer) - NOUN

Mr. Kayode S. Olubiyi (Co-developer/writer) - NOUN
Prof. Afolabi Adebanjo (Programme Leader) - NOUN
Mr. Kayode S. Olubiyi (Coordinator) – NOUN
Reviewer Professor Helen Kwanashie -NOUN (2022)
8
9

Headquarters
14/16 Ahmadu Bello Way
Victoria Island
Lagos
Abuja Office
No. 5 Dar es Salaam Street
Off Aminu Kano Crescent
Wuse II, Abuja
Nigeria
e-mail: [email protected]
URL: www.nou.edu.ng
Published By:
First Printed 2011
ISBN: 978-058-944-9
All Rights Reserved
CONTENTS PAGE
10
Module 1 Introduction to Management ........................................... 1
Unit 1 Nature, Purpose and Definitions of Management .............. 1

Unit 2 Classification of Management and its Functions ............... 6
Unit 3 Communication and Interpersonal Relationships ............ 13
Unit 4 Interviewing Skills ……………………………………. 26
Module 2 Management and Control ……………...…………… 32
Unit 1 Human Resources/Services Management ……….….. 32

Unit 2 Management and Control of Material Resources…… 38
Unit 3 Health Care Delivery Systems……………………..… 46
Module 3 Other Issues in Nursing Practice………………….. 65
Unit 1 Quality Assessment in Nursing Practice………….…. 65

Unit 2 Budgeting…………………………………………..… 80
Unit 3 Control………………………………………………… 87
Unit 4 Motivation…………………………………………….. 94
Unit 5 Leadership ....................................................................... 103
Unit 6 The Drug Revolving Fund.............................................. 110
1
1
MODULE 1 INTRODUCTION TO MANAGEMENT
Unit 1 Nature, Purpose and Definitions of Management

Unit 2 Classification of Management and its Functions
Unit 3 Communication and Interpersonal Relationships
Unit 4 Interviewing Skills
UNIT 1 NATURE, PURPOSE AND DEFINITIONS OF

MANAGEMENT
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Nature and Purpose of Management
3.2 Definitions of Management
4.0 Conclusion
5.0 Summary
6.0 Tutor-Marked Assignment
7.0 References/Further Reading
1.0 INTRODUCTION
You might want to ask whether a course in management is necessary in your

field of study. The answer is not far-fetched. This is because, management
is required for effective functioning of all human endeavours, these include:
government establishments, business enterprises, hospitals, cooperative
societies, churches or mosques, profit making or non-profit organisations.
All these organisations exist for predetermined goals and objectives. The
concepts, principles and theories of management are applicable in all
organisations so that the defined goals and objectives are efficiently
attained. Hence, the universality of management.
In this unit, we shall be looking at the nature and purpose of management.

We shall also be looking at various definitions of management from the
perspectives of various authors and professionals. These are necessary for
you to have good understanding of what the term management means and
what its activities entail. Management is about judicious utilisation of
limited resources. As potential heads of health institutions, you need to
understand how apply this knowledge to get desired results at minimum
costs.
1
2.0 OBJECTIVES
By the end of this unit, you should be able to:
• explain the nature and purpose of management

• explain the need for management
• define the word management.
3.0 MAIN CONTENT
3.1 Nature and Purpose of Management
For as long as human beings have learnt to engage in productive efforts in

order to survive, the need to coordinate these activities to achieve desired
results had become imperative. Management has therefore been in
existence from time immemorial. There is no human endeavour that does
not require proper management for its functioning. It is one of the most
important human activities that permeate all organisations. All types of
organisations; government establishments, business enterprises, hospitals,
cooperatives societies, churches or mosques, whether profit making or non-
profit, require management to function effectively and efficiently.
In every organisation, there two types of employees: the ordinary workers;

who engage directly in productive activities or services delivery and the
Management. The management staff are not directly responsible for
production but they are primarily responsible for employing and firing
employees while also taking responsibility for their actions. Complaints
are made to them and they make policies and decisions in an organisation.
The management is concerned with what to do, when to do it, and where to
do it. Management can be described as what the management does. One
answer to the question of what the manager does is that a manager organises
the resources available to him (which include people, money and other
assets such as land and equipment) for the achievement of certain
objectives. His job also usually includes setting of objectives as well.
There is Management based on tradition which involves the crude tactics

of issuing orders and instructions to get things done, but with social
awakening, development of organisations and development of technology,
management has moved away from this simplicity. It has moved to a stage
where it can be described as a process involving so many functions such
as planning, organising, staffing, s e t t i n g o f objectives, coordination
and control, and not just an activity. This type of management is called
scientific management because some scientific principles are applied.
Management is vital for the success of every organisation hence it is
universal and trans-organisational.
2
NSC40 LEADERSHIP AND
3 MANAGEMENT IN HEALTH
SELF ASSESSM ENT EXERCISE

What do you understand by the concept “management”?
3.1.1 The Need for Management
Not all people can manage effectively or aspire to Management position.
Whenever people work together, there is generally a need for the
coordination of efforts in order to attain expected results in reasonable time.
All people who oversee the functions of other people who must work in
subordinate position are managers. Managers are people who are
primarily responsible for achievement of organisational goals.
Any organisation that fails to realise its objectives often blames it on
Management. Thus, management is often accused of lack of initiative,
ineptitude, misconduct or is said to be unqualified and called upon to resign.
The manager is the individual to provide the dynamic force or direction. He
is the person in charge and expected to attain results.
Managers are expected to possess special talents or abilities that are quite
different from those of non-managers. They are a class by themselves,
distinct from ownership and labour. According to Peter Drucker, “rarely if
ever, has a new basic institution or new leading group, a new central
function, emerged as fast as has Management since the turn of the century.”
The manager is expected to get people to put in their best. To do this, the
manager has to understand people, their emotional, physical and intellectual
needs. He has to appreciate that each member of the group has his own
personal needs and aspirations and that these are influenced by such factors
as the ethnic, social, political, economic and technological environment of
which he is a part.
3.2 Definitions of Management

Management has been defined by many authors and scholars. They have
seen management in their own fields and therefore have defined it according
to their various concepts, findings and experiences. The definitions are
therefore as diverse as these scholars and professionals.
Brech defined Management as a process entailing responsibility for the
effective and economical planning and regulation of the operations of an
enterprise in the fulfillment of a given process or task, such responsibility
involving;
(a) judgment and decision in determining plans and in using data to
control performance and progress towards plans, and
(b) the guidance, integration, motivation, supervision of the personnel
composing the enterprise and carrying out its operations.
3
Grovernor Plowman sees Management as a technique by means of which the
purposes and objectives of a particular human group are determined, clarified
and effectuated.
While some see Management as a profession involving a process

demanding performance of a specific function, others see it as an academic
discipline. In this later case, people study the art of managing or
management science.
A more comprehensive definition by the American Institute of

Management sees management as being; used to designate either a group
of functions or the personnel who carry them out, to describe either an
organisation’s official hierarchy or the activities of men who compose it, to
provide antonym to either labour or ownership.
4.0 CONCLUSION
In this unit, we have looked at the nature and purpose of Management with
a view to giving us the background understanding of the course. The
definitions given have been as diverse as the authors and professionals
perspectives. From these definitions, we have been able see the functions
that management is concerned with: what to do, when to do it and where to
it. They are also expected to guide us through the course. We also noted
that management is concerned with setting of an organisation’s objectives
as well as efficient utilisation of resources for the achievement of the set
objectives.
5.0 SUMMARY
We have discussed the nature, purpose and the need for Management. We
also looked at the various definitions by various authors and professionals
of management. This has enabled us to appreciate what management
entails. In our next unit, we shall be looking at the classification of
management and its functions
6.0 TUTOR-MARKED ASSIGNMENT
1. What is the need for Management in an organisation?

2. How do you define Management?
4
7.0 REFERENCES/FURTHER READING

Aldridge, M.D. (2021). “An Open Educational Resource on Leadership and Management in
Professional Nursing Practice, University of Northern Colorado.
Ernest, Dale (1978). Management Theory and Practice, (4th ed.).

McGraw-Hill.
Nwachukwu, C. C. (1988). Management Theory and Practice. African

First Publishers Ltd.
Olaoye, T.P. (1995). “Lecture Notes on Principles of Managements.”

Kwara State Polytechnic, Ilorin. Unpublished.
Weiss, S.A. and Tappen, R.M. (2015). Essentials of Nursing Leadership and
Management (6th ed.). FA Davis company, Philadelphia.
5
UNIT 2 CLASSIFICATION OF MANAGEMENT AND

ITS FUNCTIONS
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Classification of Management
3.2 The Management Functions
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
In the first unit of this course, we looked at the nature, purpose and
definitions of Management. All these were geared towards providing a firm
understanding of the basics of management.
But this may not be enough, and so we need to be able to situate

Management properly, as an art or science. We shall be looking at the
arguments on both sides of the divide and come up with a position.
Also, we shall be trying to resolve the question of what actually the

functions of Management are. In explaining these functions, deeper insight
will be brought to bear in attempting to help in establishing firm
understanding of the scope of management.
2.0 OBJECTIVES
• classify management as either as art or science

• identify and describe the functions of management.
3.0 MAIN CONTENT
3.1 Classification of Management
People often argue whether Management should be classified as an art or

science. We shall therefore be looking at the attributes of both science and
art to enable us draw our conclusion at the end of the lecture.
6
3.1.1 Management as an Art
The application of principles is what is referred to as art. Art requires

technical skill, and conceptual ability. An artist must possess the know-
how in order to create a desired object. To be a successful or creative artist,
one has to understand the fundamental principles governing it. The same
applies to all professionals including doctors, engineers etc. In the same
manner, to be a successful manager, one has to master the art of
managing. Seeing Management as an art makes one to think of creative
ability, and special aptitude to design or effect a desire result.
There are special areas of management that are not subject to the rigours
of science. The manager as a result has to depend on past experience and
judgment instead of depending on any testable technical knowledge as is
the case in engineering, physics or survey. The application of this
knowledge to individual management situation is seen, as the art aspect of
management.
3.1.2 Management as Science
Science, attempts through systematic procedure to establish the

relationships between two variables and the underlying principles. Fredric
W. Taylor, known as the father of scientific Management pioneered efforts
in attacking the traditional approach to management that tended to depend
on intuition, luck or hunches. He was the first to successfully use scientific
techniques to solve managerial problems.
Scientific Management uses the methods of science in making decisions
and evaluating its consequences. Management then becomes science when
it employs systematic procedure or scientific methods to obtain complete
information about a problem under consideration, and the solution is
subject to rigorous control procedures to ensure its correctness and
establish validity.
From the above discussion, it is safe to conclude that both positions are not
mutually exclusive but complementary. A good manager must know the
concepts and principles of Management (management science) and also
know how to apply them in unique situations. A successful manager blends
experience with science in order to achieve a desired result. One decision
could involve both science and art in order to attain the total result desired.
The ability to use both judiciously makes for a successful manager.
3.2 The Management Functions
One question we earlier asked was, what exactly does a manager do? To
this, we answered that a manager organises the resources available to him
for the achievement of certain objectives, and usually sets the
7
objectives as well. To properly grasp the task above, we need a

breakdown of the functions of Management.
The functions have been identified to include, planning, organising,
staffing, leading, directing, control, coordination, innovation and
representation.
3.2.1 Planning
The manager’s first job is to decide what he wants to accomplish; to set

short and long-range goals for the organisation. To do this involves
appraisal and measurement of the prevalent conditions (external and
internal) and decisions concerning courses of action, which are necessary
for the desired results.
Planning is deciding in advance what to do, how to do it, when to do it, and
who is to do it. It bridges the gap between where we are and where we
want to be in future. It strongly implies not only the introduction of new
things, but also sensible and workable innovation. Planning makes it
possible for things to occur that would not otherwise happen.
Planning is a very important and basic element in establishing an

environment for performance by enabling people to know their purposes
and objectives, the tasks to be performed, and the guidelines to be followed
in performing their jobs. If group effort is to be effective, people must
know what they are expected to accomplish.
3.2.2 Organising
The objectives and work that will be necessary to reach them dictate the
number of people needed and the skills that they must possess - that is, the
position to be filled and the qualifications the people who fill them must
possess. In organising, the manager decides what job positions will have to
be filled and the duties and responsibilities attached to each one. But the
work done by members of the organisation will necessarily be interrelated;
hence some means of coordination must be set up.
Activities involved in organising can be broken down as follows:

i. determination of activities required to achieve goals
ii. grouping these activities into department or sections
iii. assignment of such groups of activities to a manager
iv. delegation of authority to carry them out
v. provision for coordination of activities, authority, and
information horizontally and vertically in the organisation.
8
The purpose of an organisational structure is to help in creating an

environment for human performance.
3.2.3 Staffing
In organising, the manager establishes position and decides what the people
who hold them must do. In staffing, he attempts to find the right person for
each job. Simply put, staffing involves filling and keeping filled, the
positions provided for by the organisational structure. The activities
involved in staffing include inventorying, appraising and selecting
candidates for positions, compensating and training or otherwise
developing both candidates and current job holders to accomplish their task
effectively.
3.2.4 Directing/Leading
Management has sometimes been defined as the “Management of people,

not things”; a definition which implies that all the manager needs to do
is to get other people to act as he would like them to. This is however
possible only if he knows what he wants them to do and how they should
act if the organisation is to reach its goal. Leadership involves influencing
people so that they will strive willingly and enthusiastically toward the
achievement of organisational and group goals. It has to do
predominantly with the interpersonal aspect of managing. The most
important problem faced by managers arise from people; their desires and
attitudes, their behaviour as individuals and in group, hence the need for
managers also to be effective. Since leadership implies the existence of
followership and people tend to follow those whom they see as a means
of satisfying their own needs, wishes and desires, it is understandable that
leading involves motivation, leadership styles, approaches and
communication. We shall be taking the subject of communication deeper
in the course of the lecture.
3.2.5 Control
In directing, the manager explains to his people what they are to do and
helps them to do it to the best of their ability. In controlling, he determines
what progress has been made towards the set goals. He must know what is
happening so that he can step in and make changes in procedure if changes
are necessary to ensure that the set objectives are reached.
In other words, controlling is the measuring and correcting of activities of

subordinates to ensure that events conform to plans.
9
The activities involved in control involve:
i. setting specific performing objectives or targets,
ii. measuring performance against plans and goals,
iii. comparing performance with set targets,
iv. taking corrective measures where there are deviations.
Control activities generally relate to the measurement of achievement.
However, whatever means of measuring that is used i.e. budget for

expenses, inspection records and the record of labour hours lost, it must
possess the characteristics of measuring tools, c a p a b l e o f showing
whether plans are working out. If deviations persist, correction is
indicated.
3.2.6 Coordination
Argument abounds as to whether coordination should be a separate function

of a manager or a part of organising function. However, many authors
believe it should be a separate function. Coordination has therefore been
defined as the achievement of harmony of individual efforts towards the
accomplishment of group goals. Each of the managerial function is an
exercise contributing to coordination. Coordination is also a process and in
this process, an executive develops orderly pattern of a group of effort
among his subordinates and secures unity of action to achieve a common
goal. Though of the belief that coordination should be an essential part of
organising, Gulick has described the commonest means of coordination
being, providing common superiors for those whose work is interrelated.
According to him, the first line supervisors will coordinate the work of a
group of rank-and–file employees, and his own efforts will be coordinated
with those of other first-line supervisors by a manager on the next higher
level, and so on, up to the company president who coordinates the activities
of the top level department heads.
3.2.7 Innovation
According to Peter Drucker, “Managing a business cannot be an

administrative or even a policy making job, it must be a creative rather than
an adaptive task” In other words, a real manager is always an innovator. In
a dynamic and competitive environment where organisations operate, a
manager who believes in doing things the usual way will leave the
organisation static, causing it to eventually decline or die. Essentially
therefore, innovation consists of developing new and
10
better ways of doing things. The manager may originate new ideas
himself, combine old ideas into new ones and adapt them to his own
use, or perhaps act as a catalyst to stimulate others to develop and
carry out innovations.
3.2.8 Representation
Finally, the manager’s job includes representing his organisation in dealing

with a number of outside groups. Though this is a public relations
responsibility and most organisations now have a separate department for
this task, the boss is still considered as the number one public relations
officer of his organisation.
List and explain the 8 Management functions.
4.0 CONCLUSION
In this unit, we have examined whether Management is an art or science.

Management is neither purely science nor purely an art, but a scientific
art to increase human efficiency in any organisation.
We did look at the functions of Management as an answer to what it does

in organising the resources available for the achievement of certain
objectives. Management functions begin with goal setting but include
others, which as examined above have provided a framework in for
organization of management knowledge.
A successful manager must be effective in all of these functions to be able

to achieve the goals of his organisation.
5.0 SUMMARY
We have looked at whether Management is an art or science. Having done

that, we looked at what actually are the functions that embody the subject
called management. We identified and explained eight of those functions.
The first two units have tried to provide a foundation on the concept and
nature of management, the understanding of which is pivotal to its
application to our field, Nursing.
In the next one or two units, we shall be looking at the healthcare delivery
system (nationally and internationally).
11
1. Is Management an art or science? Give reasons for your answer.

2. List and explain the functions of Management.

McGraw-Hill,
Nwachukwu, C.C. (1988). Management Theory and Practice, African

Olaoye, T.P. (1995). “Lecture Notes on Principles of Management”.

Kwara State Polytechnic, Ilorin. Unpublished
Micklethwait, J. (2011). Foreword in Wooldridge, A. Masters of management,

NY: Harper Collins.
Aldridge, M.D. (2021). “An Open Educational Resource on Leadership and

Management in Professional Nursing Practice, University of Northern
Colorado.
12
13
UNIT 3 COMMUNICATION AND INTER-PERSONAL

RELATIONSHIPS
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Definitions of Communication
3.1.1 The Communication Process
3.1.2 Importance of Communication
3.2 Types of Communication
3.2.1 Verbal Communication
3.2.2 Non-Verbal Communication
3.2.3 Organisational Communication
3.3 Barriers to Effective Communication
3.4 Ways to Effective Communication
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
The issue of communication has its origin from as far as when m an came
into existence. It is a means by which we convey our emotions, feelings and
beliefs to one another. Relationships are formed and sustained by it. It is
vital for the smooth running of both interpersonal and official relationships.
In business, it is a tool for effective management, the functions of which we
had earlier treated in a previous unit.
In this unit, we shall be looking at the various definitions of communication,

from the different perspectives of authors and professionals. The
importance and types of communication shall also be examined.
Because ineffective communication has been discovered to play a major

role in organisational failure, an attempt is made to highlight the major
barriers to effective communication, with a view to suggesting ways to
avoid it.
We as nurses need to understand how to communicate effectively with the

various stakeholders we interact with on a daily basis. We need to
communicate formally with our employers/employees, patients and with
our colleagues.
14
To help us in this area, this unit will attempt to take us through the
rudiments of this essential tool of conducting interpersonal relationships.
2.0 OBJECTIVES
• define and explain the meaning of communication

• explain the benefits of effective communication
• state the various types of communication
• list the barriers and solutions to effective communication.
3.0 MAIN CONTENT
3.1 Definitions of Communication
Communication is vital in every sphere of human activity. It may even

be described as the life wire of the society. Through communication,
politicians sell their manifestoes to voters, business enterprises sell their
products and services to buyers, preachers propagate their religious
messages, teachers impart knowledge to students, sicknesses and diseases
are diagnosed by doctors, relationships, whether personal or official are
activated, affected, maintained and sustained by it.
The way we communicate may manifest in verbal or in non-verbal form,

and it involves two parties one communicating the other receiving. Good
communication is essential to any group’s or organisation’s effectiveness.
It is however more than imparting meaning, it must be understood.
Communication is universal in nature, and this has led to diverse

definitions of the term. We shall therefore look at a few of these:
1. The word communication is derived from the Latin word communis,

meaning “common”. Thus, when you communicate, you are trying
to establish a “commonness” with someone (William J. Stanton,
1981).
2. Communication is the process by which one person (or a group)

shares and imparts information to another person (or a group) so that
either people (or groups) clearly understand one another. (Rita
Udall and Sheila Udall, 1979:5).
3. Communication is not just the giving of information, it is the giving

of understandable information and receiving and understanding the
message (Eyre, 1983:1).
15
4. The communication process involves all acts of transmitting

messages through channels which link people, to the languages and
symbolic codes which are used to transmit messages, the means by
which messages are received and stored, and the rules, customs,
and conventions which define and regulate human relationships and
events (Frank Ugboajah, 1985:2).
We shall at this juncture look at communication that is focused within the

organisation.
5. At all levels in the organisation, among and between executives,

managers, staff, personnel, supervisors and foremen and employees,
the communication process is continuously in action, conveying
information, ideas, attitudes and feeling among individuals and
among groups of individuals (J. Chruden and W. Sherman.
1978:325).
Putting all these together, we can now define communication as a process

whereby, through the use of verbal or non-verbal symbols, a message is sent
through a channel (by a sender), to a receiver, in an effort to share
information in an understandable form.
3.1.1 The Communication Process
From the various definitions we considered in the last section, it is possible

for us to identify a number of elements constituting the process of
Communication. Fundamentally, communication requires only four
elements – a message, a source of this message, a communication channel,
and a receiver. The information the sending source wants to share must
first of all be encoded into transmittable form, transmitted, and then
decoded by the receiver. Another element to be reckoned with is noise,
which is anything that tends to distort the message at any stage in the
system. The final element in the process – feedback – tells the sender
whether the message was received and how it was perceived by the target.
Sender Transmission Receiver
Feedback
Fig. 1: The Communication Process Model
16
(a) Sender
Communication starts with the sender creating an idea or choosing a fact

to communicate. This is the basis of the message. This idea or fact is then
encoded (organised in a series of symbols) in a way that can be understood
by the intended receiver. It could be in spoken or written words, or perhaps
a gesture of some sort.
(b) Transmission
This encoded message is then linked to the receiver through a channel such
asprint media, a computer, telephone, television or a telegraph. It is the
channel that links the sender with the receiver. In some cases, two or more
channels can be used at the same time. The proper selection of the media
and timing is crucial for effective Communication. The sender also tries
to keep the messages free of barriers or interference, so that they can reach
the receiver and hold his attention.
(c) Receiver
The receiver is the decoder of the message and is to whom it was targeted.
Receivers decode (interpret) the message in the light of their individual
experiences or frames of reference. Effective and reliable Communication
can only be said to have occurred when the receiver and the sender attach
the same or at least similar meaning to the symbols. In other words, the
closer the decoded message is to its encoded form (assuming it was encoded
fully and accurately), the more effective the communication is. A message
coded in English requires a receiver who understands English.
Understanding is in the mind of the receiver; therefore he must have an open
mind and be prepared to receive the message.
(d) Feedback
After the receiver has decoded the message, whether he understands the
message fully or not, he will however, react in some way. His reaction may
be positive or negative depending upon his level of understanding and the
effect the message has on him.
Feedback is essential, because, by evaluating the receiver’s words or

actions, the sender can judge how well the message got through. It also
indicates whether individual or organisational change has taken place as
a result of the Communication.
17
(e) Noise
Noise tends to be present in every stage of the Communication process.

Noise is a technical term for all forms of obstacle to effective
communication. It hinders the sender, the transmission or the receiver. It
also tends to distort the message at any stage in the system.
3.1.2 Importance of Communication
Without Communication, it will not be possible for organisations to achieve

their goals. Managers are the nerve centers of their organisations and
effective communication is the crucial tool a manager has at his disposal for
effective management. It is by means of communication that people are
linked together in an organisation to achieve a common purpose. Group
activities are impossible without communication because coordination and
change cannot be effected.
Communication is essential for the internal functioning of an enterprise. The

manager needs communication for developing and sustaining a smooth
functioning work team. It is through communication that he directs the
employees while coordinating and controlling their activities towards the
accomplishment of corporate goals and objectives, as well as satisfying
the aspirations and expectations of the employees.
Communication has as its ultimate purpose, the integration of management

and employee functions. Furthermore, it is through effective
communication that managers can perform all the core functions of
managing people within the organisation.
Communication also relates to the external environment of the organisation.

It is through communication that organisations interact and conduct
required relationship with stakeholders i.e. customers, shareholders,
communities, governments etc. With this, the organisation becomes an open
system which interacts with its environment.
3.2 Types of Communication
Communication can be classified into two broad categories. They are:

Verbal and Non-Verbal.
3.2.1 Verbal Communication
This is the type of Communication that may take an oral (spoken) form
in which human speech organs are used to produce sounds. This includes
face-to-face discussion and interviews, using the telephone, addressing a
meeting, talking in groups.
18
Verbal Communication may also take a written form in which human

muscles are used to produce symbols (letters of the alphabet and words).
It includes notes, memoranda, letters, notices, statements, orders,
invoices and other types of messages.
(a) Oral Communication
Oral Communication is used in intra-personal, interpersonal and group

communication situations.
(i) Intra-Personal Communication
This is the process of information transfer which goes on within an

individual. Ideas and thoughts that are generated are first of all weighed,
tossed here and there, then we decide how best to put it before we allow
it to escape from within us. During this process, we unconsciously verbalise
(say aloud) what is going on within us. In such situations, no particular
receiver is intended.
(ii) Interpersonal Communication
This is the type of Communication that is often referred to as face-to-face

communication. It is the exchange of ideas and information between two
people - you and your friend, patient, boss, secretary, clerk, doctor, or any
other person. Ideas and thoughts are not kept within one’s self but shared
directly with someone else face-to-face, either by phone or other gadgets
of communication. Face-to-face communication has an advantage of
eliciting immediate response and producing greater impact than the written
word. However, you are left with no record of what has taken place.
(iii) Group Communication
A group is formed when three or more persons come together accidentally

or by design to work towards a common specific goal. We spend a large
part of our lives in groups: the family group, the political group, the self-
help group, the trade union group, the group we are part of at work and
etc. Members within a group share ideas and information with one another.
As a member of a group, you take part in group Communication. It involves
the exchange of ideas and information among members.
(b) Written Communication
This refers to the translation of oral messages into alphabetic symbols.

These symbols are then organised together to convey ideas, messages, or
19
information between those who participate in the Communication

encounter.
Written Communication is normally used in the following situations:
(i) for personal and business letters;
(ii) queries (for disciplinary purposes);
(iii) for writing reports;
(iv) for circulars and memos;
(v) for essays, compositions and all forms of collecting information;
(vi) for questionnaires and forms designed for collecting information;
(vii) telegrams and telexes.
Written Communication is advantageous when the logical presentation

of an argument or directive is needed.
3.2.2 Non-Verbal Communication
This type of Communication is the way we show our feelings through our
movements, gestures and postures. It comprises body movement, the space
or distance put between people and the manner in which we speak. It can
be discussed under the following sub-headings: body language,
paralanguage and distance.
(i) Body Language
Information, ideas, feelings and attitudes can be conveyed by the positions

of our body as well as the movement of some parts of it. Other names for
body language are gestures, body shape, or facial expressions. Body
language does not involve the use of vocal symbols; rather it involves the
use of the whole body or part of it. Sometimes by doing, not doing or
saying anything at all, we can communicate a lot.
(ii) Paralanguage
Ideas, information, altitude and feelings can be conveyed by the way

something is said rather than by what is actually said. A hiss at someone
for example, is a message of scorn or dissatisfaction to him. In
paralanguage, information is conveyed by the tone of the speaker’s voice
and his countenance rather than any specific word choice.
20
(iii) Distance
This refers to the gap created between people. It is used as a means of

Communication in both formal and informal situations. Distance,
territory or space, building design, room and seating arrangements,
artifacts and objects take on unique significance in the context of
organisational communication. Other variants of this type of
communication include: personal distance, business distance, social
distance and public distance. Non-verbal communication often
reinforces verbal communication. It helps to emphasise the point being
made. Also, it can sometimes give a much clearer idea of what we are
thinking and how we are responding than the words we use.
3.2.3 Organisational Communication
Organisation as defined by Rogers and Rogers (1976) “is a stable system of

individuals who work together to achieve common goals, through a
hierarchy of ranks and division of labour.”
The lines of authority which are set up enable workers in an organisation

to chart information and ideas through specific channels. Every organisation
therefore, can be seen as an information processing system in which
message of all sorts are imported, sorted, analyzed and disseminated with a
view to achieving specific pre-determined results.
In all organisations, there are two established systems - the Formal
Communication System and the Informal Communication System. The
size of an organisation, its structure, the quality and attitudes of
management all influence the communication process in the organisation.
A. Formal Communication
Formal Communication is the officially recognised route for task related

messages in organisations. Formal communication may be vertical,
horizontal or semi-vertical, depending on the direction of information flow.
(i) Vertical Communication
This refers to the flow of messages from those at the top of the hierarchy to
the person at the bottom, and from most senior officers to the most junior
workers. It also refers to the flow of messages from those at the bottom to
the persons at the top; hence, Vertical communication could be downward
or upward.
21
Downward Communication Flow
Here information flows from the top management i.e. from the board of
directors, through the general manager, assistant managers and supervisors
to factory hands. Essentially, Downward communication originates from
the person with the greatest authority in the organisation to the person
with the least.
The Communication load carried down usually consists of policies, plans,

targets, directives, queries, instructions and orders. These are necessary
information for task performances as employees work to achieve the goals
set for the organisation.
Upward Communication Flow
This type of Communication refers to that information sent from those at

the bottom of the organisation chart to the higher ranking officers in the
organisation. It is more of a feedback device which supplies information
about how people have reacted or responded to the communication passed
to them by mangers. It is made up of messages containing clarifications and
directives, suggestions on how some activities can be carried out or opinions
of employees on some company plans and policies. Other components of
Upward communication include: comments and objections to plans,
instruction or orders, by employees. As a feedback loop, it enables
management feel the pulse of employees and if encouraged, it can boost
the employees’ confidence and morale as well as enhance productivity.
(ii) Horizontal Communication Flow
This refers to be exchange of messages, ideas and information between

colleagues or workers on the same level or of the same rank, about the tasks
which they perform within their organisation. Horizontal communication
plays a coordinating role as people performing a variety of duties exchange
information about activities in their respective sections. This type of
interaction is often beneficial to the entire organisation. The exchange is
done through face-to-face interpersonal communication, in meetings and
committees as well as through memos. Exchange of this nature often occurs
during informal contact occasions such as in canteens and clubs.
(iii) Semi-Vertical Communication Flow
With the advent of trade unions, a new system of formal Communication

has emerged. Trade unions whether approved by management or not are
recognised by law as the official mouthpiece of the workers and
22
therefore constitute a separate official communication system between

management and the workers.
Unions take up matters concerning the welfare of workers with the

management after consulting with workers. When agreement is reached on
the issue being discussed, they report these directly to the workers without
following the hierarchy as established by the organisational chart.
B. Informal Communication Systems
Organisations also have Informal System of Communication. This type of

communication carries unofficial information about matters within the
organisation or pertaining to it. In other words, it is the unofficial channel
in processing official information.
As noted by Rogers and Rogers (1976:81), Informal communication

structure is determined by proximity and mutual attractiveness of
individuals who interact in work places and in other activities. In the same
way, it is also determined by similarities of values and social characteristics.
Informal communication by-passes all official channels of authority. When

there is information in the channel, it will filter its way through to the
managing director or any other source by a number of means.
The main channels of informal communication are rumour and the
grapevine.
(i) Rumour
This refers to unofficial and unconfirmed information sent through

interpersonal channels. There is no clear-cut evidence to buttress the
message carried nor can anyone pinpoint the source; you will always hear
that somebody else told the person who told you. Rumour is usually
inaccurate and often malicious. Most of the time, it is fabricated and
circulated by persons who are antagonistic to a cause or to the target of the
rumour. Rumour is bad for people and for organisations.
Rumours are signs that human relations within the organisation have for
some reason, degenerated. It is also a sign that there is a gap in
communication between management and employees. It is very important
for management to be sensitive and prevent this situation from arising.
23
(ii) The Grapevine
The Grapevine is the positive side of rumour in an informal communication

system. The grapevine has an origin which is well founded but the person
giving out the information or circulating is not easily found nor will any
person claim responsibility. This information is always related to some
aspects of the life of the organisation. It may also relate to social affairs.
Grapevine information is usually fairly accurate though often incomplete.
Sources of grapevine include:
(a) new information
(b) excitement
(c) loyalty
(d) informal conversation
(e) insecurity
Grapevine information cannot be easily controlled nor stopped and it tends

to spread horizontally.
3.3 Barriers to Communication
Many factors have been found to be responsible for making

Communication not to be effective. These barriers affect the sender,
transmission and receiver - the whole communication process. They
normally arise from structural, human or technological constraints.
(a) Structural Constraints
The architectural plan and location of buildings or plants, the organisation

of physical facilities within each building, and the geographical location of
subsidiary units or departments in relation to the parent company or to the
headquarters are factors that can facilitate or impede the free flow of
communication.
24
(b) Human Constraints
Semantic Barrier
This could arise as a result of a great disparity in the level of language usage
between different categories of workers. It makes information to be
unclear to the receiver due to the symbol used.
Information overload
Too much access to information within a given time makes the worker
forgetful, disorganised and ineffective. Human attitudes, feelings and
biases pose serious communication barriers. People whose experiences are
negative in life have been found to reflect the same about interpersonal
relationship.
Gate-keeping
A Gatekeeper is one who, because of his access to information vets them.

He could impound and suppress information to which he is unsympathetic
or hostile, while allowing that from which he will benefit or to which he
is sympathetic to go through.
Rumours
As earlier discussed, it creates communication problems by adding or

subtracting from what actually is obtained.
(c) Technological Constraints and Departmental Barriers
Specialisation comes with its Communication problems. Each

professional and department develop their jargons, making communication
with other departments and the head office difficult.
The awareness of these barriers is of utmost importance to managers, as
it presents the best opportunity for taking actions that avoid or eliminate
them, thereby enhancing effective communication.
Explain the two established systems of Communication in an organisation.
25
4.0 CONCLUSION
In this unit, we have examined communication in all its ramifications

with a view to presenting it as an effective tool for managers. The
constraints to its effectiveness have been highlighted to help us take
actions that will help in effective communication.
Effective communication is crucial in organisations as it is the means by

which other functions of management are effectively performed.
5.0 SUMMARY
Communication is vital and can rightly be described as the life wire of the
society. In business particularly, it is the tool for effective management, as
managers have been found to spend about 80 per cent of their time
communicating.
The ultimate aim of communication is to integrate employees and

management functions for the attainment of the organisation’s objectives.
It is imperative therefore for managers to cultivate the habit of effective
communication.
1. What does it mean to Communicate? Examine the importance

of communication to an organisation.
2. With the aid of a diagram, identify and examine the process of
Communication.
Stephen, P. Robbins. (2005). Organisation Behaviour, (11th ed.).

London: Pearson Prentice Hall.
Sybil, Janet et al. (1999) Introduction to Communication for Business

and Organisations. Ibadan: Spectrum Books Ltd.
Nwachukwu, C. C. (2004). Management: Theory and Practice. Nigeria:

Olaoye, T. P. (1994). “Lecture Notes on Principles of Management”

Kwara State Polytechnic, Ilorin, Unpublished.
Ali, M. (2018). Communication skills 5: Effective listening and observation. Nursing Times [online],
114(4), 56-57.
Jankelová, N, & Joniaková, Z. (2021). Communication skills and transformational leadership style of
26
3 first-line nurse managers in relation to job satisfaction of nurses
MANAGEMENT INand moderators of this
HEALTH
relationship, Healthcare (Basel), 9(3), 346.
27
UNIT 4 INTERVIEWING SKILLS
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Meaning of Interview
3.2 Types of Interviewer
3.3 Interviewing Techniques
3.4 Problems Associated with Interview
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
In this unit, we shall be looking at one of the tools of Management;

Interview. Generally, interview is always associated with selection of
personnel for employment. Though this may be true, but its applications
goes beyond that. It has general applications.
The main purpose of Interview is to obtain information with the aim of

making a decision on a particular issue. If this is then the aim of interview,
it is very important that one understands the best way of extracting this
information. That is the aim of this unit.
We shall be examining Interview as a tool of Management with emphasis

on its techniques. We shall also look at some bias which some practitioners
and managers have against interview, with a view to helping you to gain
background knowledge of this important management tool.
2.0 OBJECTIVES
• define an interview
• describe the techniques for a successful interview.
28
3.0 MAIN CONTENT
3.1 The Meaning of Interviewing
The word Interview means a face-to-face exchange of information with

a purpose. The purpose of interview is to make a decision. This decision
could be to hire an employee in an employment exercise, to come to
conclusion about a patient’s ailment and so on.
3.2 Types of Interviews
Interviews can be classified into two different broad categories-

classifications by number of participants and classification by techniques.
• Interview by a Number of Participants
An applicant can be interviewed by a group of people. This system is

sometimes known as board interview. Here, the members of a panel ask the
applicant questions. This method is often used for senior staff employment
selection or admission into an institution where there are many candidates
available for the position.
A variation of this method is the group interview. In this instance, a group
of applicants are interviewed together either by a panel or one interviewer.
• Interview by Techniques
In this classification, there are two major interviewing patterns:
(a) Patterned Interview
A Patterned or Structured interview technique is a very structured and well

planned one. This pattern lends itself to the use of detailed checklist of
items that probe the applicant’s background and on other issues believed to
be crucial and essential by the organisation. One of the advantages of a
structured interview is that the interviewer is always in control. The same
question is asked of all applicants and this helps to give some objectivity
and consistency. Time is saved as only important questions are asked. This
interviewing method is very easy to use so that those who are not very
skilled in interviewing could successfully interview applicants.
29
(b) Non-Directive Interview
As the name suggests, the interviewee is in control. The interviewer is

careful not to influence the applicant’s remarks. Open-ended questions
are asked and the interviewer only interferes to keep conversation
going.
Another type of the Non-directive interview is the depth interview. This

method allows some structure. Questions asked are mainly about the
applicant’s life that has a bearing to employment.
There is also a popular interview pattern called the stress interview. The
essence of this method is to put the interviewee in a discomfortable position.
This method admits questions that create stress, such as “I have examined
your poor work record and wonder why you applied for this position?” One
of the things that are done in a stress interview is to give the applicant the
impression that he is most unfit for the job and should not waste the
interviewer’s time. The applicant is evaluated on how he copes with the
stress. Stress interview is best for the selection of key executives and is best
used by professionals.
3.3 Interviewing Techniques
According to the book, Nine Tested Strategies for Accelerated Advancement

in Business, every good interview fits into the framework of nine simple
rules. Whether the purpose of the interview is to get a simple oral report
from a subordinate, or to select the best qualified applicant, the overall
pattern is the same. The rules are identified below:
1. Set Definite Objectives
It is important to set objectives for the interview, and also progressive

results. If the objectives cannot be achieved, there is no point to continue
the interview.
2. Plan the Interview in Advance
Like all Management actions, interview requires advance planning and

careful adherence to plans. Planning the interview is a matter of deciding
which methods to use and how far to pursue them.
30
3. Allow Plenty Time to Accomplish Your Objectives
Once you develop the habit of knowing exactly what you expect from an
interview, you will be able to estimate the time required to fulfill your
expectations.
4. Select the Time and the Place with a View to Results
Choose the time for the interview as you choose the place. When you call
for interviews, announce the time, place and purpose in advance.
5. Establish Mutual Confidence Before You Begin
The first few moments of the interview, whether they are planned or
haphazard, establish the tone of the whole interview. Plan to use them to set
yourself and your interviewee at ease, and you can cut the time of the
interview by half, and double the results.
6. Start Forward, and Keep Moving Forward Towards Your

Objective
Attack your objectives one by one, go on to the next.
7. Meet the Attitude Demands of the Situation
Be pleasant unless pleasantness works against your objectives. Also, be firm

when you must, but be fair.
8. Record the Information You Gain in Useable Form
Don’t trust your memory to keep intact, the information and the impressions
you gain from an interview. Make full notes whenever you can. Summarise
all information obtained and repeat to the interviewee for verification.
9. Stop When You Have Achieved Your Purpose
In addition to the above techniques, some dos and don’ts that make an
interview a success are identified below;
(i) Listen to the interviewee and avoid undue interruptions.
(ii) Remain neutral. Do not offer your opinion or reaction until at the
end of the interview.
31
(iii) Avoid leading questions, this has the tendency of discouraging

initiative and makes the interview session boring.
(iv) Avoid the halo effect, do not be carried away by personal bias or
prejudice.
(v) Avoid Rushing. This gives a very poor image of the organisation
and evidence of lack of preparedness.
3.4 Problems Associated with Interview
Some problems have been identified with interview as selection device.

They are listed below:
(i) many people tend to have preconceptions and prejudice.
(ii) interviewers tend to look for reasons to reject rather than for
reason to accept interviewees.
(iii) halo and horns - The interviewers’ perception of one good or one
bad comment contaminates their perception of other comments.
(v) impressions formed in the first five minutes greatly influence the
selection, but are based on very little information.
(v) it is difficult to assess skills and attitudes in an interview.
List the problems associated with interview and suggest ways they can be
checked.
4.0 CONCLUSION
The interview is the oldest form of selection procedure and usually carries
the most weight. Interview is also useful in getting a simple oral report from
a subordinate or information from a patient about his/her ailment. The main
aim is to secure information to help in decision making.
5.0 SUMMARY
In this unit, we have examined the meaning of interview, the types and
techniques. We have also examined the bias against interview. These issues
have been touched in order for you to appreciate interview as a vital
management function and to get the best from its use.
32
1. Identify and briefly examine the types of Interview you know.

2. Every good Interview fits into the framework of nine simple
rules. Identify and discuss these rules.
Earnes, Dale (1978). Management Theory and Practice, (4th ed.).

McGraw-Hill.

Prentice-Hall Editorial Staff (1963). Nine Tested Strategies for

Accelerated Advancement in Business. London: Heron Books.
Visnath, V.S. (2020). “Lecture Note on Human Resource Management – Nursing Management”,
Department of Psychiatary Nursing, Sherwood College of Nursing, Pradesh, India.
Aldridge, M.D. (2021). “An Open Educational Resource on Leadership and Management in
Professional Nursing Practice, University of Northern Colorado.
33
MODULE 2 MANAGEMENT AND CONTROL
Unit 1 Human Resources/Services Management

Unit 2 Health Care Delivery System
Unit 3 Quality Assessment in Nursing
UNIT 1 HUMAN RESOURCES/SERVICES

MANAGEMENT
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Definition and Meaning of Human Resources
Management
3.2 Human Resources Management Functions
3.2.1 Recruitment
3.2.2 Interview/Selection
3.2.3 Placement
3.2.4 Training
3.2.5 Promotion
3.2.6 Maintenance
3.2.7 Separation
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
Human Resource or Personnel is the most valuable or strategic out of all

the resources employed in organisations. All organisations have their
objectives or purpose, but it is people/personnel that will perform the tasks
that will make these objectives attainable.
People who possess the required skill, knowledge and experience necessary
to perform the task must be employed. They must be appropriately placed
in the area where they are best suited to perform optimally, they must be
trained and developed, they must also be adequately motivated. Not only
that, the personnel, after putting their best in the organisation, must be
properly separated and returned to the society from where they were
originally obtained in good state as much as possible. The main objective
of all these is to secure the best performance of these personnel.
34
All these are the activities involved in Human Resource Management.

They will be engaging our attention in this unit.
2.0 OBJECTIVES
• state the definitions and meaning of Human Resource

Management
• state the functions or activities involved in this Management
function.
3.0 MAIN CONTENT
3.1 Definitions/Meaning of Human Resource Management
In unit one, we defined Management in terms of the functions it performs.

One of these functions is the staffing function which alternatively is also
referred to as Personnel Management or Human Resource Management.
This activity is defined as “filling and keeping filled”, the positions created
in the organisational structure of a firm. This is done by identifying
workforce requirements, inventorying, selecting, placing, promoting,
appraising or developing job holders or candidates, so as to enable them
accomplish their tasks. It involves keeping the jobs filled with people who
have the right Knowledge, Skill and Attitude (KSA).
Staffing is therefore involved in Personnel or Human Resource

Management. The aim of which is the effective utilisation of employee
talents in the attainment of organisational objectives.
For the purpose of this discussion, we shall be using the term Human
Resource Management as synonymous to Personnel Management or
staffing.
Human Resource function is critical to the success or otherwise of an

organisation. Discuss.
3.2 Human Resources Functions
To be able to achieve the aim of Human Resource Management, there are

certain specific tactical activities or core functions that must be performed.
They are discussed below:
35
3.2.1 Recruitment
Recruitment involves all set of activities in identifying, searching and

attracting candidates to fill current and future positions in an
organisation. It is a process of developing and maintaining adequate
sources for filling human resources needs. The greater the number and
variety of sources of personnel, the greater the chances of selecting the
right individual for the job.
Who bears responsibility for recruitment depends on the size of the

organisation. In small organisations for example, recruiting is usually done
by the owner or manager. In large organisations, it is done by the human
resources department and line managers. It is generally a shared
responsibility.
Recruitment is precedented by certain conditions viz.
(i) Confirmation of the need to fill the vacancy
(ii) Reference to the manpower plans
(iii) Completion of an appropriate job analysis process.
Sources of Recruitment
There are two sources for potential employees, the internal and external
sources.
Internal Sources
This is made up of current employees. This is necessary because some jobs

require specialised knowledge that can be obtained only within the
organisation, amongst the current employees. This can be achieved through
transfer, promotion or even upgrading after carefully going through
employee skill inventory.
This method is advantageous because it saves cost and boosts the morale
of employees among others.
External Sources
This is the pool of candidates or potential applicants outside the

organisation. When qualified candidates cannot be found within the
organisation, the external labour market is tapped.
36
External sources include: college graduates, employee referrals,

employment agencies, professional bodies etc.
It is advantageous in the sense that it brings new blood into the organisation
thereby introducing new ideas to enhance performance. However, it is more
expensive compared to internal sources.
3.2.2 Selection/Interviews
The selection process is a match-making one, seeking to evaluate

each applicant and select the most suitable candidates. The aim of
selection is to compare the specification with that person’s qualification.
Essentially, it is to generate information from application that will
reveal and predict their job success, and then hire the candidate
judged to be most successful.
Interview is a two way process, with the candidate assessing the

organisation and vice versa.
The Interview could be structured, in which case the questions and their
sequence should be determined in advance or non-structured in which there
is a general topic to discuss, and the applicant is allowed to talk freely.
Whichever approach chosen, the interview applicant must be put at ease.
The atmosphere must be cordial and friendly.
3.2.3 Placement
Placement follows after successful candidates have been selected. Here, the
candidate or the new employee is matched against the job. Eachdepartment
is responsible for the placement or deployment of the staff posted to it. This
exercise places the candidate to perform specific schedule of duty.
3.2.4 Training
Training is an experience, a discipline or systematical action during which

people acquire new skills, knowledge and pre-determined behaviour on a
particular job or in a schedule of assigned jobs. New employees may require
training to fill job gaps. It is normally intended to make new employees
familiar with their new work environment and may be otherwise known
as orientation training or induction.
Training prepares the employee so that he can move with the

organisation as it develops, changes or grows.
37
Older employees also benefit from training through updating of skills, and
this is very important because the skills and knowledge of today may have
become outdated tomorrow.
Types of Training:
• on-the-job training
• off-the-job training
• apprenticeship training
• simulated training
• executive training
3.2.5 Promotion
Generally, Promotion has to do with moving of the employee to a new

or higher position in which his status, salaries and responsibilities are
increased. This is normally referred to as vertical promotion. There is also
the horizontal promotion where an employee gets more salary without
necessarily being moved up to new a position.
Promotion should be as fair and equitable as possible. Merit should play

a significant role in determining who is promoted and the best candidate
should earn it.
3.2.6 Maintenance
Employee maintenance is a function of human resources management.

Maintenance is needed for retaining a competent, productive and highly
committed workforce. This involves providing various motivational
support, employee welfare and service, wages and salaries, and incentives
to the employees.
Adequate salaries and wages should be given as part of remuneration

package to employees. The main objective is to ensure that the level of
performance and commitment required of employees is maintained.
3.2.7 Separation
Since the first operating function of the human resource management is

procurement, it is logical that the last function should be disengagement or
separation and the return of the employee to the society.
Most people do not die on the job; therefore, the enterprise has to comply
38
3 MANAGEMENT
with certain requirement of “due process” IN HEALTH
of disengagement.
39
The overall objective is to ensure that the returned citizen or exit-worker is

in good shape as much as possible.
4.0 CONCLUSION
The Human Resource Management function is a very critical one that

determines the success or otherwise of organisations. It is people that
perform the task that is needed to achieve the objectives of firms.
Therefore, managers must take extra care in procuring, placing, training,
developing and maintaining employees in order to secure their optimum
performance.
5.0 SUMMARY
We have discussed the Human Resource Management by looking at the core

functions. The main purpose of this management activity is to be able to
secure and bring on board, personnel that have the required knowledge, skill
and attitude (KSA) in the performance of tasks and duties that will ensure
the optimum attainment of organisational goals.
In the next unit, we shall be looking at the management of material
resources.
1. What do you understand by Human Resources Management?

2. Identify and explain the activities involved in Human Resources
Management.

McGraw-Hill.

Africa First Publishers Ltd.
Oloye, Toyin Peter (1995). “Lecture Note on Principles of

Management.” Kwara State Polytechnic, Ilorin. Unpublished.
Visnath, V.S. (2020). “Lecture Note on Human Resource Management – Nursing Management” ,
Department of Psychiatary Nursing, Sherwood College of Nursing, Pradesh, India.
Open Textbook Library (2020). Human Resource Management, University of Minnesota Libraries
Publishing
40
UNIT 2 MANAGEMENT AND CONTROL OF

MATERIAL RESOURCES
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Meaning of Inventory
3.1.1 Types of Inventory
3.1.2 Reasons for Holding Inventory
3.2 Inventory Management and Control
3.3 Relevant Factors in Inventory Control
3.4 Major Types of Inventory Control Systems
3.5 Basic Terms in Inventory Model
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
In this unit, we shall be looking at Management of material resources

otherwise known as inventory management. All organisations hold
inventory for their operations. In other words, the material purchased by a
business in whatever stage of manufacturing can be referred to, either as
stock item, which are taken into store and held until required, or as directly
delivered item to the point of usage.
Inventories are critical and strategic to an organisation’s effectiveness and

efficiency. It constitutes the bulk of asset value of an organisation. But not
holding it in the right quantity can spell significant losses to the
organisation. Hence, the need to effectively control and manage it.
The essence of this unit therefore, is to look at the various aspects
relating to holding inventories and the ways to effectively manage it, in
a way that will achieve a balance on the cost associated withcarrying it.
2.0 OBJECTIVES
By the end of the unit, you should be able to:
• state the meaning of inventory

• explain the costs associated with carrying inventory
• state inventory control techniques or inventory management
systems.
41
3.0 MAIN CONTENT
3.1 Meanings of Material Management
Inventory is of vital issue to all organisations, whether small or large,

product or service oriented (i.e. health institutions) privately or publicly
owned.
A company‟s inventory is made up of purchased and or manufactured items

and jointly, these are referred to as raw materials, work in progress and
finished goods.
Inventory refers to any stock of items within the production system or in

the operation of the business.
Inventory can also be defined as an idle resource that possesses economic

value.
Adequate inventory facilitates production activities and/or operations and

helps to assure customers of regular supply of goods and services. However,
holding it in excess or inadequate quantity create a cost problem to the
organisation. This is so because there are certain cost advantages and
disadvantages associated with every unit of inventory that the firm
maintains.
The inventory problem therefore is to achieve a balance between the risk of

being out of stock and the cost of carrying excess inventory.
3.1.1 Types of Inventories
A convenient classification of the types of inventories is as follows:
(a) Raw Materials: These are materials, components, fuel etc. that
are used in the manufacture of goods.
(b) Work-in-Progress (WIP): Partly finished goods and materials,

sub-assemblies, etc, held between manufacturing stages.
(c) Finished Goods: Completed product ready for sale or

distribution.
The particular items included in each classification depend on the particular

firm. What would be classified as a finished product for one company could
be classified as raw materials for another.
42
3.1.2 Reasons for Holding Inventory
a. To ensure that sufficient quantity of goods are available to meet

anticipated demand.
b. To absorb variations in demand and production.
c. To provide a buffer between production process.
d. To take advantage of bulk purchasing discount.
e. To meet possible shortages in the future.
f. To absorb seasonal fluctuations in usages or demand.
g. To enable production process to flow smoothly and sufficiently.
h. As a necessary part of the production process.
i. As a deliberate investment policy particularly in times of inflation

or possible shortage.
List the major types of inventory control systems.
3.2 Inventory Management and Control
Inventory control can be referred to as the system used in a firm or

organisation to control the firms‟ investment in stock. The system typically
involves recording and monitoring the stock levels, forecasting future
demands and deciding when and how many to order. Since inventory
constitutes the bulk of asset value of an organisation, it needs to be
effectively managed if efficient operation is to be achieved. How inventory
is managed can be a measure of success or failure of an organisation.
Inventory control is therefore concerned with the levels of the inventory that
can be economically maintained. In other words, the objective of inventory
control is to minimize in total the cost associated with it.
43
These costs can be categorised into three groups:
(a) Cost of Holding Stocks
These costs also known as carrying cost include the following:
(i) Interest on capital invested in the stock
(ii) Storage charges (Rent, Lighting, Heating, Refrigeration, etc.)
(iii) Stores staffing, equipment maintenance and running cost
(iv) Handling costs
(v) Audit, stocking or perpetual inventory costs
(vi) Insurance security
(vii) Deterioration and obsolescence
(viii) Pilferage.
(b) Cost of Obtaining Stock (Ordering Cost)
These costs include:
(i) The clerical and administrative costs associated with the

purchasing, accounting and goods received dependents.
(ii) Transportation costs.
(iii) Where goods are manufactured internally, the set up and tooling
costs associated with each production run.
(c) Stock-Out Costs
These are the costs associated with running out of stock. The avoidance of
these costs is the basic reason stocks are held in the first instance. These
costs include the following:
(i) Loss condition through the lost sale caused by the stock out.
(ii) Loss of future sales because customers go elsewhere.
(iii) Loss of customers‟ good will.
44
(iv) Cost of production stoppages caused by stock-outs of WIP or raw

materials.
(v) Labour frustration over stoppages.
(vi) Extra cost associated with urgent, often small quantity

replenishment purchases.
Many of these costs are difficult to quantify but they are often significant.
3.3 Relevant Factors in Inventory Control
Basically speaking, some factors encourage the maintenance of high

inventories while others, the maintenance of lower inventories. However,
what constitutes unnecessary large stocks is a matter of judgment which is
influenced by the following factors:
(a) the amount of capital available for investment in stocks.
(b) the availability of storage space and the cost of storing.
(c) the risk of losses due to such cases as:
(i) deterioration
(ii) evaporation
(iii) obsolescence
(iv) change in taste or fashion
(v) fall in prices
(d) economic ordering quantities
(e) delivery periods.
3.4 Major Types of Inventory Control Systems
There are two broad divisions of inventory control system; The Re- Order
Level and the Period Review system.
• Re-Order Level System
This system is also known as the two-bin system. Its main characteristics
are as follows:
(a) a pre-determined re-order level is set for each item.
45
(b) when the stock level falls to the re-order level, a replenishment
order is issued.
(c) the replenishment order quantity is invariably the Economic Order

Quantity (EOQ).
(d) most organisations operating the re-order level system maintain

stock records with calculated re-order levels which trigger off the
required replenishment order.
Periodic Review System
This system is sometimes called the constant cycle system. The system
has the following characteristics:
(a) stock levels for all parts are reviewed at fixed intervals e.g. every
fortnight.
(b) where necessary, replenishment order is issued.
(c) the quantity of the replenishment order is based upon the likely
demand until the next review, the present stock level and the lead-
time.
(d) the replenishment order quantity, variable quantities are at fixed

intervals as compared with the reorder level system, where fixed
quantities are ordered at variable intervals.
3.5 Basic Terms in Inventory Model
(a) Lead or Procurement Time: This is the period of time expressed

in days, weeks, months, etc. between ordering (either externally or
internally) and replenishment i.e. when the goods are available for
use.
(b) Demand: The demand required by sales, production etc. usually

expressed as a rate of demand per week, month or year. Estimates
of the rate of demand during the lead-time are critical factors in
inventory control system.
(c) Physical Stock: the number of items physically in stock for a given
time.
(d) Free Stock: physical stock plus outstanding replenishment orders

minus unfulfilled requirements.
46
(e) Buffer Stock or Minimum Stock or Safety Stock: A stock

allowance to cover errors in forecasting the lead time or the
demand during the lead time.
(f) Maximum Stock: This represents the quantity above which the item
stock should not rise.
(g) Minimum Stock Level: This represents the level below which stock
should not be permitted to fall. It will be fixed at such a level which
takes safety stock into account.
(h) Re-Order Level: The level of stock at which a further replenishment

order should be placed. The re-order level is dependent upon the lead
time and the demand during the lead time.
(i) Re-Order Quantity: The quantity of the replenishment order.
4.0 CONCLUSION
We have examined the management of inventory, which could be the

inventory of spare parts, of raw materials for production, or of finished
goods like drugs available for sale.
Holding inventory in organisations is very crucial for the effective and

efficient running of operations. There are costs associations with this
holding and the problem of inventory management or control is to achieve
a balance between the risk of being out of stock and the cost of carrying
excess inventory. To achieve the above, inventory control managers
normally develop plans that tend to keep inventories at optimal levels.
5.0 SUMMARY
In this unit, we have examined the various aspects of inventory

management. We examined the meanings of inventory, the types, costs
associated with inventory holding and the control techniques of its
management. The aim of this control is to maintain stock levels at its
optimum - the combined cost of holding are at minimum.
47
1(a) Explain what you understand by inventory management.

(b) What are the reasons for holding inventory?
2. Identify the costs associated with holding inventories. How can

they be controlled/managed?
7. 0 REFERENCES/FURTHER READING
Wild, Ray (1980). Essentials of Production and Operations

Management. London: Holt, Rinehart, and Winston.
Earnest, Dale (1978). Management Theory and Practice, (4th ed.).

McGraw-Hill.
Mubaraq, S. & Atedo, M. A. (1999). Foundations in Management Vol.

2. Ilorin: Olad Publishers.
Muller, M. (2011). Essentials of Inventory Management (2nd ed.). American Management

Association.
Chandra Bose D. (2014). Inventory Management (5th ed.). PHI Learning private limited,
Delhi
48
UNIT 3 HEALTH CARE DELIVERY SYSTEMS
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 The Federal or National Ministry of Health
3.2 State Ministries of Health
3.3 Local Government Health Services
3.4 Health Personnel
3.5 Traditional Healers and Medicine
3.6 National Health Insurance Scheme
3.7 Primary Health Care: A Concept for Health Promotion
3.8 Determinants of the Nature and Scope of Health Care
Delivery Systems
4.0 Summary
5.0 Conclusion
1.0 INTRODUCTION
This unit deals with the different levels of health care delivery system in
Nigeria, and those responsible for the organisation and management of
health care services.
2.0 OBJECTIVES
By the end of the unit, you should be able to:
• state the main levels of health services and discuss the functions
of each
• define community health, its components and the factors that
affect the health of any community
• describe the activities of the national health insurance scheme
• define primary health care, its components and function
• identify factors that may militate against primary health care.
3.0 MAIN CONTENT
3.1 Organisation of Nigeria Health Services
There are three hierarchical levels in the organisation of health services in

Nigeria. In such arrangement, a village aide, aid post, dispensary and health
centre will become the point where a patient makes the first
49
contact with a health care system(primary health care). Hospitals will

represent th e second level (adviso y) and teaching hospitals the third tier
(specialised treatment).
The relationship amongst these levels is ideally that of referral. A village

aide or worker at a rendezvous aid camp is expected to refer cases that
cannot be handled to a dispensary or health centers. Similarly, health centers
are to refer difficult cases to hospitals and only cases that will require
specialised treatment and/or use of very sophisticated equipment will be
referred to a teaching hospital.
This means that as one moves from Primary Health Care (PHC) to the third
tier, health workers encountered get more specialised. The assumption
underlying a referral system is that all units are available in all localities
and that patients actually move from one to the other. In practice, there is
no clear-cut pattern of utilisation. A patient who began a course of
treatment at the teaching hospital may later be moved to the house of a
traditional healer or may decide that to cut down on cost, it will be better
to ask an auxiliary health worker in his vicinity to complete the course of
treatment.
3.2 The Federal or National Ministry of Health
This is the executive or top level, headed by the Minister of Health, whois
the top adviser on health problems and policies to health. The ministeris
the top adviser on health problems to the federal government. He is usually
a member of the federal executive council and will liaise with other
government ministers in aiding the country‟s health, social and economic
development.
Functions of the Federal Ministry of Health include:
1. planning a national strategy for health Care.
2. policy making.
3. setting priorities: (e.g. immunisation for 90 per cent of children

against serious infectious disease by the year 2020).
4. collection of health information and statistics.
5. research into the country‟s health problems.
6. liaise with government and other Health Agencies. (e.g. WHO,

UNICEF, Nigeria has asked the WHO to assist to make a national
plan to meet the country‟s health needs).
50
7. Planning for training of doctors, nurses, auxiliary health

personnel, and for provision of buildings, equipment etc.
8. Notification of important epidemiological information to WHO

and other countries.
9. Facilitating importation of essential drugs and equipment, and
encouraging local production of the same.
10. Allocation of monies to states, federal hospitals, medical schools,
research programmes.
3.3 State Ministries of Health
In each state of the federation, the ministry of health of that state handles
the second level of health care delivery, and is responsible for organisation
and management of health care services to people. Functions of the
ministry of health at the state level include:
1. liaising with federal and local departments of health, and providing

the link for exchange of essential information between them
2. carrying out policies of the federal government
3. providing monies, transport and staff for local government health

services
4. provision of health centres, maternities, dispensaries, clinics etc
5. organisation of immunisation programmes
6. selecting, training, promotion and secondment of staff
7. carrying out special programmes to control certain diseases: e.g. TB

and leprosy
8. management of hospitals
9. control of communicable diseases (including notification of diseases

to federal authorities)
10. health education programmes
11. collection of health statistics
51
12. co-operating in project and research programmes e.g.

WHO/UNICEF/Federal G vernment – in supply of safe water
and sanitation
13. organisation of family planning
14. training of traditional birth attendants
15. establishment and control of blood banks
16. provision of essential drugs.
General Hospital and Teaching Hospital
Hospitals can be classified according to size, number of beds, admission

rate and the number of outpatient cases seen. A more remarkable distinction
however, is that based on specialisation and technical sophistication.
General hospitals are usually manned by physicians, a good number of
whom are general practitioners. Together they carry out the functions listed
against the health centre. Teaching hospitals are quite sophisticated; they
are run by consultants and professors. They are expected to cater for patients
who have special cases or ailments which need the attention of specialists.
3.4 Local Government Health Services
These are usually organised and supervised by the state. They form the third
level health services, which provide basic essential health services to the
people where they live. They are responsible for carrying out Primary
Health Care and Community Health Care activities.
Community Health
This consists of all the measures taken to promote the physical, mental and
social well-being of individuals and families and the local community. It
includes the components of Primary Health Care: i.e. enough clean water
and food, breathing clean air, living in a dry and clean house, disposal of
harmful and unsightly wastes, elimination of vermin and bacteria, education
of the young, preventing and curing illnesses, providing for adequate
mental, physical and social recreation.
52
Factors affecting the health of any community include:
water
• pollution
• climate
• prevalent diseases
• sanitation
• roads
• economy
• refuse
• culture
• nutrition
Local Community Health Services
These are usually divided into two branches, which work closely
together. They are:
1. The Environmental Health Services: Under the supervision of the

Public Health Superintendent, Sanitary Inspectors and Assistants.
2. The Personal Health Services: Under the supervision of the Senior

Health Sister (health visitor), Community Nurses and Aides or
Auxiliaries.
3. There may be a Community Health Officer who supervises both the

environmental and personal local government health services.
Environmental Health Services
Environmental health services are concerned with improvement of and

facilitating adequate supplies of safe drinking water to families, refuse
collection and disposal, supervision of housing conditions, (factories,
schools ), prevention and control of communicable diseases, collection
of health statistics, health education. Other services covered include:
Pollutions, public „nuisances‟ and health hazards, provision, and
53
supervision of sanitation, enforcement of regulations concerning health

issues (e.g. food hygiene, slaughter house).
Personal Health Services
These are concerned with:
1. general curative outpatient services
2. maternity care
3. care of the under- fives and immunisation
4. consultative clinics
5. care of school children
6. clinics for special diseases e.g. TB, leprosy
7. care of the elderly and handicapped.
These health services are available at:
1. Health centres which provide a combination of services and

perhaps a few in-patient beds.
2. Maternities provide maternity services and immunisations.
3. Clinics provide some of the above.
4. Dispensaries are staffed by health auxiliaries and assistants,

provide essential basic services and refer more serious cases.
5. Mobile clinics, visit more remote areas usually on a regular basis,

and provide an on the spot combination of some of the above.
6. Home visiting is done routinely and in cases of special need.
Community Services Covers:
a. Health education.
b. The improvement of excreta disposal.
c. The supervision of housing conditions.
54
d. The regulation of food-shops and markets.
e. Campaigns against communicable diseases.
f. The collection of statistics.
Health Personnel
Doctor, Health Sister, Community Nurse/Mid wife and Rural Health

Assistant at the health centres.
The doctor may be based in the community or visit on regular basis e.g. in
hospital‟s mobile clinics.
The Health Sister is a trained nurse and midwife who has a special training
in community health. This enables her to care for the whole family,
including the sick, children, pregnant and lactating mothers, the elderly and
handicapped. She is a „good friend‟, and helpful to the local community,
especially to those in special need. (e.g. the widowed mother, unmarried
mother and those with social problems). She advises on disease control
and prevention. One very important aspect of her job is home visiting.
Here she assesses the particular health needs of families and can give
individual advice and counselling. She also investigates causes of accidents,
neonatal deaths, and visit schools to inspect school children and give health
education. She is usually based at a health centre.
The Community Midwife
Supervises and assesses pregnant women in the antenatal period, delivers

mothers of babies, refers complicated cases, and gives health education and
immunisation at maternities and clinics.
The Community Nurse
The community nurse is a trained nurse who may work in clinics or health
centers.
Rural Health Assistants
These assistants have undergone a basic training course at a certain level to

enable them to give essential, safe health care in the community.
55
Health Aides
This group of health workers usually have “on the spot” in service
training.
Village Aides
This is usually a person who has some knowledge of modern medicine. He

resides in the community where he works and usually acts as the local
representative of health services at this quasi level. Such a person can be a
traditional birth attendant, who can be given some training in sanitary
practices like cutting their nails and washing their hands before delivering
a baby. They are also taught the act of sterilising equipment and can be
given a delivery kit containing a pair of scissors, and a few medicaments.
Some village aides are part-time workers. As an agent of modern health
care, a village aide is regularly visited by mobile teams from the dispensary,
health centre or hospital, (depending on the supervisory body) and
instructed on how to add ress health matters in the locality. The basic
function of the village aide is to educate the people on health practices
(Jolly and King, 1975).
Village Health Workers
Village health workers may be selected by their own communities to do

a basic training course e.g. 3 months, and then return to their village. The
villagers may be responsible for selecting them and employing them after
training. They may be illiterate but can be very effective health workers,
usually being supervised from a distance by the training agency. They
come “from the people” so know the local beliefs and health problems as
well.
SELF ASSESSM ENT EXERCISE 1
Discuss the three hierarchical levels in the organisation of health services

in Nigeria, paying close attention to the different roles they play.
3.5 Traditional |Healers and Medicine Men
Traditional healers are local, known, respected, available, may learned their
skills by knowledge transmitted from their forefathers. They know the local
situation, customs and beliefs.
56
The reasons for consulting traditional healers are:
a. there may be no means of access to modern medical care.
b. beliefs that hospital care is bad or ineffective in treating e.g. measles,

jaundice, chickenpox, etc. or that people with such diseases would
die if taken to the hospital. It is believed that it isa taboo not to be
able to deliver vaginally and delivery by caesarian section is
unacceptable.
Modern medicine deals with the effects of the illness, but not the cause.
People want to know “why me?” Every event must have a cause. They need
an answer that fits in with their beliefs.
Medical problems are seen as part of economic, marital and social problems.
It is not “what is causing my illness” but what is causing my problems,
illness may be due to the attack of something evil on an individual or his
family. He may wonder what will happen next - will his crops or cattle
be attacked? Many healers advise on a wide range of problems. The social
problem may be more important than the medical problems.
Types of Traditional Healers
Herbalist, spiritists, bonesetters, “medical quacks”, ritualists, traditional

birth attendants (who care for the needs of pregnant women).
Methods of Healing
1. The herbalist uses mixtures and concoctions of herbs known as

“native medicine”. Some of the native medicines are medically
useful, while some are harmful. The hospital patient may take native
medicine before, during or after hospitalisation.
2. Bonesetters are popular and do their job well (if the fracture, are
simple closed ones).
3. Ritualists and spiritists find what is causing the problem by

divination, rituals, incantation. They are effective in relieving acute
anxiety. Spiritist may use trances to confront the cause which may
be acceptable to the seekers if it is “an evil spirit” who tells him.
To speak and accept the conflict may be acceptable to all in this
way.
4. Spiritual healing in the churches: The Aladura churches use
57
(a) divination (by prayer and vision).
(b) incubation (sleeping in holy places believing God will visit and
heal them).
(c) Exorcism (removal of harmful spirits).
(d) Holy water and confession. The sacraments of confession, Holy

Eucharist and the sacraments of the sick.
SELF ASSESSM ENT EXERCISE 2
1. List some situations in society that affect (1) physical (2) mental
(3) social (4) spiritual health adversely.
2. A healthy person interacts well with his environment and is

adaptable. Identify some social problems in our present day society
that are also health problems.
3. Make a list of (1) Common beliefs regarding the causes of illness.

(2) Illnesses which it is mistakenly believed are inherited. (3)
Illnesses that carry a stigma. (4) Illnesses for which it is believed
there is no cure.
4. List the factors that determine a person‟s action in the sort of help
he will seek when he is ill.
5. What reasons prevent people from seeking scientific medical care?
6. What reasons make people go to traditional healers?
7. Has traditional healing a place with scientific medicine in curing

today‟s ills?
8. Outline the activities of the Aladura churches healing ministry. Are

there any particular problems?
9. Should the established Christian churches work more closely with

scientific medicine?
10. Describe the traditional healers‟ methods.
58
3.6 National Health Insurance Scheme (NHIS)
Brief Historical Perspective of NHIS
The need to provide access to good health services for the rapidly expanding
and largely rural populations of Nigerians has been a major challenge to
successive Nigerian governments since the country attained independence
in 1960. Successive governments have long perceived NHIS as a strateg y
for improving accessibility of the population to health services. In fact,
the idea of NHIS was first mooted through a bill in national parliament in
1962. The bill was opposed principally because of non-availability of many
providers of quality health services. The idea reemerged in the 80s when
the National Council on Health commissioned a study on the scheme in
1984. The study, which was approved in 1989, led to its first launching in
1997. However, it was not until 1999 that an enabling law for the NHIS was
promulgated through Decree 35 of that year.
3.6.1 Objectives of NHIS
The main objectives of the NHIS are to remove financial barrier to care and
to achieve a more equitable sharing of the financial burden of illnesses. The
scheme also has the objectives of improving the standard, effectiveness and
efficiency of health care delivered to the population.
3.6.2 Organisational Structure of NHIS
The NHIS, with its headquarters in Abuja, has six zonal offices and twelve
area offices located in various parts of the country. For effective coverage
of the entire population, however, the NHIS was structured into six
programmes as follows:
1. Formal sector social health insurance programme: This

programme is designed to cover employees in the public and
organised private sectors and it is mandatory for any organisation
with at least 10 employees to participate in the scheme. Health care
benefits derived from the programme covers a wide range of services
in the fields of curative, rehabilitative and preventive services.
2. Urban self-employed social health insurance programme: This

programme is designed to cover individuals in urban setting who are
members of socio-cultural and occupation-based organisations and
who freely elect to join the scheme by monthly contribution. The
health benefits are to be chosen by the participants based on their
perceptions of their health needs.
59
3. Rural community social health insurance programme: This is

designed to cover rural ommunities and membership of the
scheme is by individuals in the community. This is also bi- monthly
contribution by the individuals and that the health benefits are to
be determined by the community.
4. Children under five social health insurance programme: This is

designed for children under five years of age and government will
pay the contribution.
5. Permanently disabled social health insurance programme:

Under this programme, the disabled person must not engage in any
productive activity and must be resettled in rehabilitation centre to
benefit from the programme.
6. Prisons social health insurance programme: This is for prison

inmates. The health benefits under this scheme cover common
illnesses and they are paid for by the government.
3.6.3 The Mechanism of NHIS
According to the Federal Ministry of Health, the employers will register

their employees with the scheme and affiliate with NHIS-approved Health
Maintenance Organisation (HMO) who, in turn, will provide employees
with a list of NHIS-sponsored health care providers for registration with
them for service provisions.
Healthcare providers will either be paid by capitation, fee-for-services, per

diem or case payment. Capitation is a payment to health care provider by
HMOs on behalf of a contributor for services rendered. Fee- for-service is
a payment made by HMOs to non-capitation-receiving health care
providers who provide services on referral basis from other approved
providers. Per diem fees are payments for services and expenses per day
while case payment is based on a single case rather than a treatment
course.
Of significant to note is the list of recognised healthcare providers, which

include:
Licensed government or private health care practitioners or facilities

registered by the scheme for the provision of services, which can either
be primary, secondary and tertiary health care providers/facilities. These
include private clinics and hospitals, primary healthcare centres, nursing
and maternity homes overseen by a doctor, and outpatient departments of
general hospitals, services provided by specialist doctors, pharmacists,
nurses and midwives, physiotherapists, etc.
60
3.6.4 Implementation Strategy
The scheme will be implemented in phases. The first phase of the

scheme will start with federal government emplo yees and later expanded
to cover the employees in the organised private sector. The second
major component will cover the informal sector, i.e. the urban self-
employed and the rural communities.
3.6.5 Appraisal of the Scheme
There are many problems facing the implementation of the scheme. The
scheme may not be able to address the current inequality in access to
qualitative health services that exists between the rich and the poor because
rather than decreasing the cost of health care services, it may actually lead
to its increase. For example, WHO noted that heavy spending on drugs has
been the bane of health insurance in developing countries, which often limit
access of the majority of the population to the scheme.
There is an erroneous belief that the NHIS will serve primarily as a

mechanism for recourse mobilisat ion and therefore reduce the burden of
government spending on health. It should be realised that health insurance
is a mechanism for sharing risks and not primarily a mechanism for
resource mobilisation. The government spending on health should
increase rather than decrease under the scheme if qualitative and
comprehensive health services are to be provided for the population.
Although it was argued that NHIS will allow for more resources to be
devoted to preventive and promotive care, while high cost hospital- based
cares will be covered by the insurance, it is doubtful whether this will be the
case. On the contrary, the scheme is likely to draw away human resources
from the preventive and promotive care unless urgent and remedial action
is taken to provide more incentives for those working in these areas.
3.7 Primary Health Care: A Concept for Health Promotion
Primary health care came into focus as a result of the health for all
movement which was launched in 1997 with a resolution adopted by the
30th World Health Assembly. The resolution is attainment by all
citizens of the World by the year 2000 A.D., a level of health that will
permit them to live a socially and economically productive life. This
resolution was reaffirmed and amplified by the declaration of Alma-Ata
which defined primary health care as:
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“Essential Health Care based on practical, scientifically sound and

socially acceptable methods and technology made universally accessible
to individuals and families in the community through their full
participation and at a cost that the community and society can afford to
maintain at every stage of their development in the spirit of self reliance
and self determination.”
Thus, primary health forms an integral part of the country’s health system
of which it is a central function and main focus and for the overall social
and economic development of the community. It is the first level of contact
of individuals, the family and community with the national health system
thereby, bringing health care as close as possible to where people live and
work, while constituting the first element of a continuing process.
3.7.1 Aims of Primary Health Care
• To promote health
• To prevent diseases
• To cure diseases
• To rehabilitate (help people to live normal lives after an illness or

disability)
3.7.2 Components of Primary Health Care
The essential components of primary health care are as follows:
1. Education concerning prevalent health problems and the methods

of preventing and controlling them:
• promotion of food supply and proper nutrition

• an adequate supply of safe water and basic sanitation
• maternal and child health care, including family planning
• immunisation against the major childhood infections and diseases
• prevention and control of locally epidemic diseases and injuries
• provision of essential drugs
• treatment of common minor ailments
• community mental health
• community dental health
• community eye care
62
Environmental Hygiene: Housing, Water,

Personal Hygiene Sanitation, Pollution, Refuse Disposal.
Available curative health services
and their use.
Cultural Beliefs and customs
Climate/Prevalence of
Disease,Vectors.
Family Size. Family
Spacing
Road Communication
HEALTH Antenatal Care
Family Income
Traditional Birth
Budgeting Poverty
Attendants Maternity
State of Nutrition eating Services.
habits available food
Under -five clinics
production marketing
economy Immunisation/State of
Ignorance about Immunity
Health
Age
Health Education Occupation
Level of Education Literacy
Fig. 2: Targets of Primary Health Care
3.7.3 Principles of Primary Health Care
The five basic principles of primary health care are:
1. Accessibility of health services to all populations.
2. Maximum individual and community involvement in the

planning and operation of health services.
3. Emphasis on services that are preventive and promotive rather

than curative services.
4. The use of appropriate technology.
5. The integration of health development with total overall social

and economic development.
3.7.4 The Role of the Nurse in Primary Health Care
Central to the implementation of activity to provide and extend primary

health care is the role of the nurse. The role of the nurse in primary health
care becomes much more relevant because of:
a. Advances in medicine, science and public health are consequent

to reorientate nursing practice and training.
60
b. Professional nurses who have to function at their maximum level of

capability in order to make health care efficient and effective.
c. The adoption by World Health Organisation (WHO) in 1977 on

Primary Health Care (PHC) and in 1978 of the goal of health for
all by the year 2000 A. D., necessitating changes in the training
and function of nursing systems based on primary health care
approach.
However, the modalities for achieving this is shaped by a number of factors;

among which are the climatic conditions, the amount of funds available, for
health services and the political ideology or will of a country. Let us now
examine the operations of each of these factors in some details.
3.8 Determinants of the Nature and Scope of Health Care

Delivery Systems
3.8.1 Climatic Condition
The pattern of medical care or health care delivery of a country can be

determined by the types of diseases that are prevalent in such countries. For
example, some countries are situated in the temperate regions of the world,
while others are located in the tropics. It is known that some diseases that
are spread by vectors need warm climate to thrive. Examples of such
diseases are cholera, lassa fever, worm infestations, yellow fever,
schistosomiasis, trypanosomiasis, malaria and onchocerciasis. Since the
vectors, which cause these diseases hardly survive in the temperate
regions of the world, they are usually not transmitted there. The implication
of this for health care delivery systems is that for effective control,
countries that are located in the tropical axis of the world should ideally
develop a health care system which emphasises preventive measures.
3.8.2 Funds
The amount of resources a nation has or is willing to devote to health care,

directly influence the pattern of health care delivery of such nation. In the
past, all nations were poor and diseases like plague, tuberculosis, cholera,
rabies, small pox, measles, leprosy, kwashiorkor and others which have
their roots in poverty were quite prevalent. However, as a result of industrial
revolution, most Euro-American societies have been able to raise the
standards of living of their people and to reduce or virtually eliminate
poverty induced diseases.
61
In contrast, most developing nations of today are still very poor. There is
shortage of everything needed for effective health care delivery. Aside
from shortage of physicians, lack of adequate funds, inadequate hiring
and training of all other categories of health workers, there are no drugs,
available facilities are breaking down from lack of maintenance and the
sites are littered with abandoned projects. Worse still, the people
themselves are poor and this further limits access to health care. Health
services financing has to compete with other needs of a nation. Where
this amount is small, it invariably follows that not much can be
achieved.
3.8.3 Political Ideology/Political Will
This variable finds expression in the operations of health care delivery

services. The pertinent questions here are: should individuals or the state
fund health care delivery services? What category of people should a
particular health programme cover? Although this may not be a conscious
policy, we find that whatever health care system a particular country
adopts is not completely divorced from its political ideology. As indicated
by the Americans, the United States health policy is highly influenced by
laissez-faire. Efforts to socialize medical care is usually blocked by medical
practitioners who contend that, it will be grossly unfair to adopt such
measures in a society which believes so much in market forces.
Arguably, health care organisations can be placed on a continuum. At one

extreme, are liberal democracies and capitalist societies like America where
the sense of individual is so strong. In the United States, health care funding
is mostly in the hands of individuals who reserve the right to shop
wherever they like. Under such arrangement, the poor is usuallyat the
mercy of the private insurance companies which exist to cover diverse
range of health services, as the most sophisticated or quality care is
reserved for the highest bidders.
Liberal democracies like Britain, Sweden and Japan are at the middle of
the continuum. In these countries, the governments even while
acknowledging the strong sense of individuals have established national
insurance schemes that have gone a long way towards ensuring a reasonable
health status for their citizenry.
Lastly, countries like Russia, China, Cuba and other socialist/communists

societies can be located at the end of the continuum. These countries
emphasize the state rather than individuals. It is believed that the state is
more than the summation of the individuals that make it. Accordingly, the
state owns and directly interferes in the running of health services. Private
practice and private insurance
62
companies are not tolerated. The remaining part of this chapter will be
devoted to the organisation of orthodox medicine and its operations in
selected countries.
3.8.4 Urbanisation
With development, many people are migrating to the towns where rapid
increase of population has not been planned, so the existing “infrastructure”
or services are inadequate. There is a shortage of housing, rents are high,
residences overcrowded, with poor cooking facilities and a lack of basic
sanitation. Young people find a high level of unemployment, jobs are
scarce, food expensive and there is no available land to farm. Slums and
squalor exist and with the lack of personal and environmental hygiene, poor
health results and social problems (e.g. drug abuse, alcoholism, violence
increase). There is no extended family in the rural areas to give support and
help in difficult times and many families experience poverty and
disillusionment. A decent life for the family is hard to maintain under such
circumstance.
4.0 CONCLUSION
There are three hierarchical levels of health care delivery systems. In such
arrangement, a village aide, aid post, dispensary and health centre will
become the point where a patient makes the first contact with a health care
system (primary health care). Hospitals will represent the second level
(advisory) and teaching hospitals the third tier (specialised treatment). The
relationship amongst these levels is ideally that of referral. The assumption
underlying a referral system is that all units are available in all localities and
that patients actually move from one to the other.
5.0 SUMMARY
Primary health care is the first level of contact of individuals, the family and
community with the national health system, bringing health care as close as
possible to where people live and work and constitute the first element of a
continuing process.
The main objectives of the NHIS are to remove financial barrier to care and
to achieve a more equitable sharing of the financial burden of illnesses.
Describe the factors that can influence patients’ utilization of the three
levels of health care.
63
7.0 REFERENCE/FURTHER READING
Barbara, Kozier & Glenora, Erb. Fundamentals of Nursing, Concepts and

Procedures. (2nd Ed.).
64
MODULE 3
Unit 1 Quality Assessment in Nursing Practice

Unit 2 Budgeting
Unit 3 Control
Unit 4 Motivation
Unit 5 Leadership
Unit 6 Dealing with Conflicts
Unit 7 The Drug Revolving Fund
UNIT 1 QUALITY ASSESSMENT IN NURSING

PRACTICE
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Concept of Quality Assessment
3.2 Elements of Quality Assessment
3.3 Components of Quality Assessment
3.4 Framework of Quality Assessment
3.5 Steps to Quality Assessment Review
3.6 Methods of Nursing Assessment
3.7 The Roles of the Nurse in Quality Assessment
4.0 Conclusion
5.0 Summary
7.0 Reference/Further Reading
1.0 INTRODUCTION
Assuring good service is an ethical obligation of health care providers.

Over the years, there have been concerted efforts to improve the quality of
health care. In view of this, services are being scrutinised more than ever
before for evidence of quality care and their effect or outcome. The essence
is to ensure that the products meet set standards and consistently achieve
customer satisfaction.
2.0 OBJECTIVES
• define quality assessment

• explain the aim and objective of quality assessment
65
explain the framework of structure, process and outcome in
quality assessment
describe the steps in quality assessment
• describe the types of nursing audit.
3.0 MAIN CONTENT
3.1 Concept of Quality Assessment
Williamson (1962) defined quality assurance as “the measurement of the

actual level of the service provided, plus efforts to modify, when necessary,
the provision of these services in the light of the results of the
measurement.” Smith and Hibberd (1998) also described quality
assurance as the systematic process wherein there is a data-based,
judgmental appraisal of a selected element of care and subsequent
improvement. These definitions show that there is a commitment to respond
positively to results obtained from an assessment of services provided.
However, assessment of services without effort to improve it is not quality
assurance activity. So in quality assurance, actual practice is assessed
against given standards, deficiencies are identified and actions are then
taken to remedy and prevent them from recurring in the future.
Aims and Objectives of Quality Assessment Programme
1. To assess the quality of performance in provision of nursing care and

management of other services within patient’s environment.
2. To provide nursing personnel with information on their level of

performance in relation to set standards in the organisation.
3. To serve as a tool to increase awareness on medico-legal

implications of nursing practice.
4. To identify specific needs for additional in-service-training of

personnel and staff development.
5. To provide statistical data concerning the management process of

organised nursing services and utilisation of resources (human and
material).
3.2 Elements of Quality Assessment
Quality assurance ensures that health care provided to patient is

consistently of good quality. However, the quality of care the patient
receives in any situation is determined by certain variables. Four of the
principal elements are:
66
1. The provider i.e. the people who give the care. This takes
cognizance of the education, intelligence and experience of health
professionals.
2. The standards that are maintained in the agency providing care.
3. The environment, or setting in which the care is given.
4. The recipient of care, i.e. the patient.
3.3 Components of Quality Assessment
Modern approaches to quality assurance are depicted as a triangle,

comprising of: quality design, quality control, and quality improvement.
The three are essential, interrelated, and mutually reinforcing components
of quality assurance.
1. Quality Design: This is a planning process within which goals are

set, resources allocated and standards of service delivery set.
2. Quality Control: This consists of monitoring, supervision and

evaluation of care to ensure that standards are met and good quality
is consistently maintained. It ensures that a programme of activities
take place as designed, more importantly it may uncover flaws in
design and thus point to changes that could improve quality. For
effective good quality control, the following must be present:
(i) Measurable indicators of quality
(ii) Timely data collection and analysis
(iii) Effective supervision.
Quality Improvement: This is directed at increasing quality and

raising standards by continually solving problems and improving
processes.
Give reasons why quality assessment is crucial in nursing.
3.4 Framework for Quality Assessment
There are different frameworks that can be utilised to set standards. Among
these, the “ Donabedian structure, process and outcome” have
67
been mostly adopted by the nursing profession. In this framework, the

structure describes the resources in the systems that are required to meet
the standards (for example, the quality and number of staff, who, and
what is needed). The process describes how the service is to be carried
out, and the outcome standard describes the desired results to be
achieved. The formulation of structure, process and outcome criteria
which was aimed at, helps to epitomise the desired quality
improvements. Table 1 below shows the type of information required for
quality assurance.
Table 1: Types of Information Required for Quality Assessment
Structure
The attributes of settings in which care occurs (physical and
organisational tools and resources). The structure includes:
material resources (e.g., facilities, equipment, money);
human resources (e.g., number and qualifications of personnel); and
organisational structure (e.g., medical staff organisation, peer-review

methods).
Process
What is actually done in giving and receiving care (the activities that
occur between client and provider). The process includes:
patient’s activities in seeking care and carrying it out; and
practitioner’s activities in making a diagnosis, and recommending or

implementing treatment.
Outcomes
The effects of care of the health status of patients and populations (the
changes in status attributable to antecedent health care). Outcomes include:
improvements in a client’s knowledge;
changes in a client’s behavior; and
degree of client satisfaction with care.
Source: Adapted from A. Donabedian, “Evaluating the Quality of

Medical Care,” Milbank Quarterly, 44 (Supplement, 3, 1996), pp. 166–
203.
68
3.5 Steps to Quality Assessment Review
A variety of techniques have been proposed to perform the quality

assurance review. Presented here is the problem-solving model used by
the American Nurses Association (ANA). Its eight steps include the
following:
1. Identify values
2. Identify standards and criteria
3. Measure degree of attainment of standards and criteria
4. Interpret strengths and weaknesses
5. Identify possible courses of action
6. Select a course of action
7. Take action
8. Re-evaluate.
Each of these steps is discussed as illustrated below:
1.
8. Identify values
Reevaluate
2.
Standards and criteria
7.
Take action
3.
Collect data
6.
Action plan
4.
5. Interpret data
Identify possible
courses of action
Fig. 3: Steps to Quality Assessment Review
Topics for quality assurance reviews are generally placed in some order
69
of priority based on their frequency and their real or potential impact on
70
patient care. Impct is usually gauged by whether efficiency or

effectiveness of patient care is affected. Efficiency is generally defined
in terms of accomplishing a task with a minimum of resources (time,
money, personnel); effectiveness is defined in terms of accomplishment
of predetermined goals. The focus for the evaluation may be the nurse,
the unit or institution, the nursing care, or a combination of the three.
If the focus of the evaluation is the nurse, it can include the actions of a
single nurse or of all the nurses in a department, and any area of nursing
activity can be examined. For example, is the nursing staff satisfied with the
nursing programme instituted 3 months ago? What criteria do the nursing
staff use to determine the frequency of vital sign monitoring in the
immediate post-operative period? Are the nursing standards for
administration or intravenous therapy being adhered to?
If the nursing unit or institution is the focus of the quality assurance review,
it might examine the administrative structure, the physical plant and
equipment, or staffing. For example, a review could be implemented to
determine whether required educational records for nurses in the critical
care units are up to date. When nursing care or a nursing care problem is the
focus of the review, it is generally best to limit the scope to a certain
population (for example, patients with certain diagnoses, surgical
procedures, nursing care problems, or degree of all the variables to be
considered.
It is critical to remember that the perspective of the consumer must be

considered in any evaluation. In selected instances, such as using patient
outcomes or in attempting to validate patient care plans with patients
themselves, consumer input is essential.
Steps in Quality Assurance Review
Step 1: Identify Values
Before the implementation of the quality assurance model, there must be an

examination of the societal, professional, and individual values that guide
the health care in the respective agency. The very word quality implies that
someone somewhere has determined that certain outcomes have more value
than others. As applied to nursing care, the individual nurse, nursing unit,
hospital, and community will interact to influencethe development of
criteria to be used in the review process.
Step 2: Identify Standards and Criteria
A standard is the desirable or achievable level or range of performance

of a certain criterion, or a framework against which performance is
71
compared. An example of a standard is, “Every patient will have an

admission assessment by a registered nurse.” A criterion measure is that
variable believed to be the indicator of the quality of care, for example, “The
assessment form will be completed by the admitting nurse within 8 hours
of admission.”
The standards for nursing practice are generally developed by clinical

nursing leaders in the institution, using their professional expertise as well
as professional research and literature. The standards are made operational
by construction of the criterion elements. These criteria, which are the
actual evaluation criteria, are generally developed by a quality assurance
committee, the nursing practice committee, or some similar group.
The actual criteria that are developed can be three types: structure, process,
and outcome.
Structure criteria describe the environmental elements, setting, and

conditions within which the nurse-patient relationship occurs. It includes
the philosophy and objectives of the institution; its fiscal resources,
equipment, physical facilities, management structure, accreditation, and
licensure; and the quality and characteristics of the professional and
technical employees. Examples of structure criteria include, “Hospital beds
must be 3 feet apart.” “All patients must sign the required consent form
before any invasive or surgical procedure.” “The current license number of
each registered nurse must be on file in the main nursing office.”
Process criteria describe the nature and sequence of nursing care activities.
For example, process criteria might describe the nursing plan for a patient
who demands pain medication every 1½ hours, or a teaching plan for a
diabetic patient.
Outcome criteria focus on the results of the processes of health care. Many
experts consider them to be the ultimate indicators of the quality of patient
care. For the patient, the outcome should be measurable in terms of change
in health, knowledge, or functional status. After the criteria have been
written, they must be validated, generally by “consensus among peers.”
The rationale for this validation step is to ensure that all criteria are correct
and relevant and reflect nursing practice at the particular institution.
Usually, nurses most expert in the selected clinical areas are chosen to do
the review.
The final step in the criteria writing process is the establishment, by the
quality assurance committee and the “nurse experts,” of a specific and
observable level of performance for each criterion measured. For
72
example, for the outcome criterion, “Patient or significant other is able to

demonstrate proper technique in insulin administration,” at least 90 per
cent compliance might be expected.
Step 3: Measure Degree of Attainment of Standards and Criteria
Multiple methods are available to collect data to assess the attainment of the
standards and criteria. The degree to which the actual practice exceeds,
meets, or falls below the validated criteria provides the data necessary to
evaluate the strengths and weaknesses of the nursing care programme. Data
collection methods might include questionnaires, staff interviews, patient
interviews, self-assessment questionnaires, performance evaluation,
utilisation review, audits, patient or staff complaints, and direct observation.
Whatever the method selected, the data should be easily accessible, and
questions of efficiency and accuracy should be considered.
Data collected are tabulated, and the results indicate whether the percentage
of Yes/No responses correspond to the previously established level of
performance (per cent compliance) for each criterion. If the level of
performance does not achieve expectations, the criterion element has not
been met.
Step 4: Interpret Strengths and Weaknesses
The degree to which the levels of performance have been met serves as the
basis for describing the strengths and weaknesses of the nursing care
programme. However, it is essential that certain subtle factors not be
overlooked before final judgments are made.
Consider the following: One of the outcome criteria for a patient with a
pacemaker is, “The patient or significant other is able to take a pulse.” A
retrospective nursing audit was done on patients with pacemakers to
determine whether the outcome was being met. On nursing Unit A, 95 per
cent of the patients could take their pulse, whereas on nursing Unit C, only
65 per cent of the patient data revealed that. In general, patients on Unit C
were older, had fewer significant others, and were frequently discharged to
extended care facilities. Comparing the two units on these factors provided
insights into reasons for their differences that may have been missed if the
evaluator had not questioned these differences.
Step 5: Identify Possible Courses of Action
After identifying the strengths and weaknesses, possible courses of action

to correct the weaknesses are developed. The goal of the action plan is
elimination of the weaknesses and reinforcement of the strengths
73
of the existing programme. Some consideration should be given to how

best to motivate the nursing staff to implement the desired changes.
Generally, the best results will be obtained when those staff most
affected by the quality assurance review is involved in the planning of
subsequent courses of action.
Solutions to the identified problems can be numerous and can include

administrative changes, further clinical research into the problem,
continuing education, changes in practice, environmental changes, a reward
system for improved compliance, or even the organisation of peer
pressure. Each of the possible solutions has advantages and disadvantages,
and the peer group will have to weigh each one.
Step 6: Select a Course of Action
After examination of the alternatives, the peer group selects the courseof
action, based on such considerations as the identified problem, available
resources, and organisational structure. How the decision is implemented
will vary among institutions. For example, if it involves a nursing practice
change, it may have to be reviewed by the director of nursing.
Step 7: Take Action
Improving the quality of nursing care implies change, and sooner or later
some action must be taken. Implementation of the selected action generally
includes time frames, persons responsible for overseeing each step of the
plan, and selection of a date of re-evaluation. This action step is critical to
the success of the quality assurance review.
Step 8: Re-evaluate
After the action has been taken, the cycle begins again. If a change has been
made, it must be re-assessed to determine its effectiveness in improving the
quality of care.
3.6 Methods of Nursing Assessment
In addition to the problem-focused quality assurance reviews, a varietyof

methods have been devised for ongoing assessment of the nursing. Some of
the more frequently used methods are described here.
3.6.1 Incident Reports
Whenever an untoward event occurs involving a patient, nurse, or visitor,

an incident report must be completed. Generally, these are
74
compiled by the hospital and/or the hospital insurance carrier. Increases

in certain types of incidents such as, medication errors or patient falls,
would be a signal to the quality assurance committee that a review of either
of these two areas may be indicated.
3.6.2 Nursing Audit
The nursing audit is a method of evaluating the quality of client care. The
purpose of the nursing audit is to examine nursing care that has been
given to clients and to verify that acceptable standards are being met. The
audit is conducted during or after care has been provided and is a method
of accounting for outcomes achieved. Audits are usually based on the
assumption that when expected client outcomes are achieved, nursing
process criteria are also met.
The nursing audit team compares pre-determined criteria with the
documentation found in the patient record.
Types of Nursing Audit
There are two types of audit: retrospective and concurrent.
The Concurrent Audit
This has also been called the open chart audit, because it occurs while a
client is receiving care in a health care facility. A concurrent audit is a
critical examination of the patient’s progress towards a desired health status
(outcome) and patient care management activities (processes) while the
care is in progress. The purpose of the concurrent audit is to assess the past
and present care given to a client. This type of audit can provide information
to care givers that may alter a particular client’s care plan. Patient
questionnaires, interviews, and observation and review of the patient record
are possible sources of data for a concurrent review. Concurrent review has
the advantage of providing opportunities for making changes in the
ongoing care programme.
Retrospective Audits
A retrospective audit is a critical examination of nursing actions, with a

view toward improvement in practice. A retrospective review is done after
the patient has been discharged. The reviewer has the advantage of using
data from the patient’s entire stay from admission to discharge, and of
evaluating the results for a large series of comparable patients. The
retrospective is also called a closed chart audit. It occurs after client care
has been completed, that is, after discharge or termination of the relationship
with the health care facility. Retrospective audits are less costly than
concurrent audits and usually requires less time to complete
75
because records are used as the database. Usually, its purpose is to

assess how well the group provided care to a particular type of client.
One advantage of retrospective audit is that practitioners gain
impressions from single cases in which they are personally involved.
The care of clients whose charts are audited is not influenced by the
outcome of a retrospective audit. However, other clients may be helped,
since group members can improve the quality of care given based on the
results of the audit. When a record is unclear, the retrospective auditor
must assume that the criteria have not been met, while the concurrent
auditor can seek more information.
Nursing Audit Team
The Nursing Audit is often conducted by a nurse or a team of nurses not

directly involved in the care of the patient being examined. This is done
in order to give objectivity to the process. The membership strength
should be between twelve and fifteen, and should include a representative
of all categories of nurses in the hospital. It is important that in selecting
members, each Nursing Unit is also represented. A typical audit committee
should consist of:
1. Head of Nursing Research Unit or Continuing Education Unit –

Chairman.
2. Representatives from all cadres of nurses – members.
3. A representative of the professional Nursing Association –

member.
4. Representatives of other hospital professionals e.g. Medical

Record Officers/Librarian – Consultants.
5. Director of Nursing Services – Ex-officio member.
This is important because as experienced professional nurses in a particular

specialty, they are in a better position to write the outcome criteria to
evaluate performance in their specialty area.
The team must have a proven integrity bordering on honesty, dedication and
truth. They should be objective in their thinking, skillful, knowledgeable,
and experienced and exhibit competencies in nursing practice.
Nursing audit must be mounted regularly by nurses. This programme are

planned to maintain quality nursing care while also controlling the cost to
the patient. These concepts can be equated with industry’s
76
“efficiency and effectiveness”. A nursing department is efficient if it

observes cost containment, and wise use of resources. It is effective if it
can at the same time deliver quality patient care, which is its reason for
existence.
3.6.4 Peer Review
Nursing peer review occurs when nurses establish standards and criteria and
evaluate the quality of patient care among themselves. The peer review
process may be performed within a single unit or by specialty, for
example, orthopedic nurses. Clinical nurse specialists also frequently have
a peer review group to monitor their practice.
3.5.5 Patient Satisfaction Questionnaire
A patient satisfaction questionnaire is generally used when written data

regarding a patient‟s perceptions of his or her hospitalization are needed,
for example, by hospital management or a nurse researcher. Many hospitals
routinely distribute these questionnaires to all patients and request that they
complete them. Other hospitals have patient ombudsmen who visit
patients, question them regarding their hospitalisation experience, answer
any questions they may have, and intervene on their behalf, if necessary.
3.5.6 Staff Satisfaction Surveys
In staff satisfaction surveys, either questionnaires or interviews, are used

by the administration to assess general employee satisfaction or to test
responses to certain program changes.
3.5.7 Utilisation Review
The utilisation review programme was mandated by the Joint Commission

on Accreditation of Healthcare Organisations Standards (JCAHO) in 1978.
Its primary goal is the appropriate allocation of hospital resources. This
programme does not focus primarily on nursing, but it does provide data
that may require nursing involvement in a more thorough evaluation.
3.5.8 Infection Control Reports
Because nurses are involved in the direct care of patients, they may at times
be included in infection surveillance and infection control programs. Even
when the nursing staff is not involved directly, they should be familiar with
the monthly report of nosocomial infections on their respective units.
Questions can be raised about nursing procedures and practices that may
affect the infection rate on the unit.
77
3.7 The Role of the Nurse in Rendering Quality Nursing

Care
The nurse has a significant role to play in rendering quality nursing care
through the following functions:
1. Provision of Therapeutic Ward Milieu
To facilitate the provision of quality nursing care, the nurse must ensure
a therapeutic ward environment. The physical, social and psychological
environment of the patient must be conducive. Both the hospital and ward
environments must be neat and the nursing staff must demonstrate kindness
and understanding in rendering the care needed by the patient/client.
2. Staffing
It is the responsibility of the nurse to ensure that the hospital/ward/unit

is adequately staffed with nursing staff of relevant cadre and specialty to
render quality nursing service. The nurse should be able to project into the
future in respect of the hospital need for nursing staff, hence the need to
ensure enough hands to provide the quality nursing care.
3. Delegation of Responsibility
Since the nurse cannot do all the work, she has to delegate responsibilities
to subordinates considering their knowledge, skill and attitudes. The nurse
must use his/her authority to delegate responsibility in such a way to enlist
the full co-operations, commitment and loyalty of the staff. The nurse takes
the blame for a delegated work that is not satisfactorily executed; hence the
need to give appropriate guidelines for carrying out delegated
responsibilities.
4. Leadership Style
In order to enlist optimal performance from subordinates, the nurse needs

to adopt different leadership style depending on the knowledge, skill and
attitude of the followers that will enhance high productivity and provision
of quality nursing care. The nurse needs to be dynamic in relating with
subordinators. It is assumed that lazy, dependent, irresponsible,
unimaginative and short sighted worker will function well with autocratic
leadership style, whereas, active and independent function well under a
democratic leader.
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5. Discipline/Control
Quality nursing care demands that the nurse should have a good control
of staff and the activities in the unit/ward/hospital. He/she should be
able to evaluate both the activities and the staff to answer the question:
“ Do the nursing actions meet the objectives?” Monitoring of staff to
ensure that jobs are performed according to specifications. Thus the
nurse needs to be firm, just, knowledgeable and hardworking in order
to ensure a good control of the subordinates.
6. Staff Development
Knowledge update is a key to provision of quality nursing care. The nurse

should take advantage of opportunities for continuing education programme
through continuing training, reading of professional journals, financial,
political and international literature. The nurse in-charge arranges or
sponsors subordinates for conferences, seminars and courses.
7. Motivation
This is a process of ensuring that the best is obtained at all times from every
worker. The need to motivate subordinates for quality nursing care to
patients cannot be over emphasised. Different things motivate different
workers. The nurse must be conversant with different theories of
motivation such as satisfaction theory, incentive theory, intrinsic theory,
Hertzberg’s dual-factor theory, McClelland three factor theories, Theory X
and Y etc.
In addition, the nurse must be ready to give appropriate reward to ensure

high productivity from his subordinates through recognition of good
performance.
8. The Use of the Nursing Process
It is through the use of Nursing Process that nurses can render quality
nursing care. It is also through it that nursing assessment can be made, to
identify patients’ need, plan and implement appropriate nursing activities
so as to take care of identified need, and then evaluate the nursing action
implemented to ensure the achievement of good goals earlier formulated.
To provide adequate nursing care, the nurse must ensure full
implementation of nursing process in rendering care at his
unit/ward/hospital. She should use her position to cover the constraints that
may militate against the provision of logistic support.
79
4.0 CONCLUSION
Quality assessment ensures that health care provided to patients is

consistently of good quality. Retrospective and concurrent reviews each
have their own advantages, and may be used singly or together in a quality
assurance review.
5.0 SUMMARY
Structure, process and outcome criteria are used to set standards.

Nursing audit is a method of quality assessment. Components of
quality assessment include quality design, quality control and
quality improvement.
Describe methods by which nursing activities can be evaluated for

quality assessment.
7.0 REFERENCE/FURTHER READING
Kozier, B. and Glenora, E. Fundamentals of Nursing Concepts and

Procedures (2nd Ed.). Philadelphia.
Folse, V. N. as adapted by Wong, C. (2015). Managing Quality and Risk. In P. S. Yoder-

Wise, L. G. Grant, & S. Regan (Eds.), Leading and managing in Canadian nursing
(pp. 391-410). Toronto: Elsevier.
Weiss, S.A. and Tappen, R.M. (2015). Essentials of Nursing Leadership and
Management (6th ed.). FA Davis company, Philadelphia.
80
UNIT 2 BUDGETING
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Definitions of Budget
3.1.1 Types of Budget
3.1.2 Objectives of Budgeting
3.2 Budgeting Techniques
3.2.1 Line-Item Budgeting
3.2.1 Performance Budgeting
3.2.3 Zero-Base Budgeting
3.2.4 Programme Budgeting
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
All organisations plan by setting goals and objectives to be achieved in a

given period of time. The resources to attain these goals and objectives are
not usually unlimited hence, the need for budgeting. Budgets are normally
part of the 81rganizational plans that translate company intentions into a
series of assignments and provide the money to carry them out.
As nurses, the knowledge of budgeting is very important, because it is an

important tool for allocating the scarce resources available to the
organisation and also for controlling expenditure. More recently, with
corporate governance, it has become increasingly popular as a tool to
promote accountability and effectiveness in the management of
organisations.
We shall therefore, in this unit be looking at the meaning of budgeting

or profit planning, the types and objectives, as well as the techniques
available in budgeting. All these are done with a view to giving you
theoretical background knowledge of the topic so as to become better
mangers of various institutions.
81
2.0 OBJECTIVES
By the end of this unit, you should be able to state:
• the meaning of budgeting and the types

• the techniques of budgeting.
3.0 MAIN CONTENT
3.1 Definitions of Budgeting
In organisations, objectives and policies are set and laid out as quantitative
data through budgeting. Budget is therefore nothing but a quantitative
aspect of planning. A budget is a statement, usually expressed in financial
terms of the desired performance of an organisation in the pursuit of its
objectives in the short-term (one year). It is an action plan for the
immediate future representing the operational and tactical end of the
corporate planning chain.
Budgets are sometimes referred to as business plans or profit plans. The

budget and budgetary control form the backbone of any control system.
Budgetary control takes the targets of desired performance as its standards,
then systematically collates information relating to actual performance
(usually on a monthly or four weekly period basis) and identifies the
variances between target and actual performance.
The budget of an organisation whether government (which we are all very

familiar with), corporate, private organisation etc. can be surplus or deficit.
List and discuss the various techniques used in budgeting.
3.1.1 Types of Budget
Basically, budgets are of two broad types: Capital and Expense.
The Capital Budget
Capital spending is investment and it may provide the single most important
way for an organisation to increase the sales share of the market. The capital
investment has a longer time horizon; it can make it possible for the
company to produce a new product or a better product, serve customers
quicker or to reduce prices.
82
Since no company has unlimited funds, of course, nor can it call an

unlimited credit or always sell new equities at the price it would like to get,
it must therefore set or adopt some criteria or priority for new investment
that must be undertaken.
In capital budgeting, the criterion for judging among projects is the rate
of return on investments over the long-term.
Expense Budget
Expense budgets allot the money to be expended for various operational

activities. Some of these amounts will be fixed while others will depend on
the level of operations planned for i.e. the amount of production, the sales
effort to be expended, the amount of advertising to be done. Budgets in
this category include the cash budget.
3.1.2 Objectives of Budgeting or Profit Planning
The following are the main objectives of budgeting or profit planning:
(a) to ensure by means of an overall plan, that available resources are

utilised to the maximum advantage.
(b) to ensure that sufficient cash required to finance the proposed scale
of activity is generated internally or will be available from
additional capital loans and overdraft.
(c) to approve major items of capital expenditure specifically, and to

fix all other limits for minor items.
(d) to fix target for current income and expenditure.
(e) to have a detailed basis for comparing performance throughout the

year with estimates.
3.2 Budgeting Techniques
In government and the corporate world, budget is being talked about as

a tool to promote accountability and effectiveness, rather than simply
as a vehicle for allocating resources and controlling expenditure. The
response has therefore been that of reforming their budgetary practices
and techniques. The techniques are discussed below:
83
3.2.1 Line-Item Budgeting
The Line-Item or incremental budgeting represents the most commonly

used budget. Each category of activity is afforded its separate appearance.
It assumes the continuation of present programmes. Here, previous year’s
actual spending is extrapolated for next year by adding a percentage
increase (for inflation). The main advantage of the line-item budget is the
ease of its preparation; it makes a simple comparison of performance from
one fiscal period to another fiscal period.
The main disadvantage of this approach is the difficulty of relating the line
budgeting to the goals of the present organisation.
3.2.2 Performance Budgeting
Performance Budgeting (PB) is a system where the managers are provided

with the flexibility to utilise department or organisation’s resources as
required, in return for their commitment to achieve certain performance
results. It is a system of planning, budgeting and evaluation that emphasizes
the relationship between money budgeted and result expected. The primary
disadvantage associated with a PB is the emphasis on quantity, not quality
of the activity being monitored.
3.2.3 Zero-Base Budgeting
Zero-Base budgeting (ZBB) is a budgeting method for a corporation or

government in which all expenditures must be justified afresh each year and
not just amounts in excess of the previous year, like in the line-item or
incremental budget. Every time, the mangers are supposed to start from
scratch or on a “clean slate”.
ZBB is claimed to be a new technique of planning and decision-making. It

reverses the working process of traditional budgeting. In traditional
budgeting, departmental managers need to justify only increases over the
previous year’s budget. This means what has been already spent is
automatically sanctioned. While in ZBB, no reference is made to the
previous level of expenditure. Every departmental function is reviewed
comprehensively and all expenditures rather than only increases are
approved.
ZBB is a technique by which the budgeting request has to be justified in

complete detail by each division manager, starting from the zero-base.
The zero-base is indifferent to whether the total budgeting is increasing
or decreasing.
84
Benefits of ZBB
(i) Elimination of obsolete and non-relevant decision packages.
(ii) Increased or decreased levels of funding for some decision packages

and addition of new packages.
(iii) ZBB encourages budget participation at the operating level. As a

result, managers and employees become focused.
(vi) Results in efficient allocation of resources as it is based on needs and

benefits.
(v) Useful for service department where the output is difficult to

identify.
(vi) Increases communication and co-ordination within the

organisation.
(vii) Managers and employees learn more about the organisation

activities and problems.
Possible Problems of ZBB
(i) Increase in paper work and time consuming.
(ii) In certain areas of the organisation, it is difficult to define decision

units and decision packages.
(iii) It forces the managers to justify everything related to expenditure.

Sometimes, certain departments like R&D may be threatened while
production department would benefit.
(iv) In the first year, cost of training, paper work and implementation of
ZBB may go up because without its proper understanding, it cannot
be successfully implemented.
(v) Organisation may face some resistance from the employees and their
unions.
(vi) Difficult to administer and communicate the budgeting because more

managers are involved in the process. Since ZBB threatens certain
position of the managers and executive they may play games and
politics.
85
3.2.4 Programme Budgeting
Under programme budgeting system, department or agency budget

requests not only include the funding that it would like to receive, but
also the outputs and outcomes they expect to produce as a result of the
funding. The legislature then establishes performance targets for
outcomes and outputs in the implementing act to the appropriation act.
Departments or agencies then report their actual performance in their
long-range programme plans and budget requests for the following fiscal
year.
Agencies may be given incentives for performance that exceeds standard or

disincentives for performance that falls below standards. These incentives
and disincentives can be monetary or non-monetary. By its nature, a
programme budget focuses on the output services that the programme
provides to its users. It also more readily, relates to overall organisational
goals and objectives.
4.0 CONCLUSION
We have in this unit considered budgeting. We have defined it as expressing

plans/objectives in quantitative terms in writing for definite period of time
- a year/month. All organisations find budgeting useful, not only as a
vehicle for allocating resources and controlling expenditures, but now also
as a tool to promote accountability and effectiveness.
5.0 SUMMARY
This unit has examined the meaning of Budgeting (otherwise known as

profit planning), the types and objectives of budgeting. We have also
looked at the various techniques of budgeting i.e. traditional budgeting, the
incremental budgeting and the increasingly popular modern one like the
zero-base budgeting. These issues have been highlighted in order to
appreciate the place of budgeting as a tool for resource allocation and
controlling expenditure in organisations.
1. Examine what you understand by Budgeting. Why the need for

budgeting?
2. Identify the various budgeting techniques you know. Examine
fully, the ZBB techniques of budgeting.
86
Cole, G. A. (2004 ). Management Theory and Practice, (6th ed.).

Bookpower.
Pandy, I. M. (2005). Financial Management, (9th ed.). Vikas Publishing

House PVT, Ltd.
North Dakota Public Health Training Network (2020). (Video). Basic

budgeting concepts – leadership and management.
Smyth, D. (2021). How to develop an operating budget for a nursing

unit. Chron.
87
UNIT 3 CONTROL
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Definition and Meaning of Control
3.1.1 What do we Control?
3.1.2 Elements of Effective Control
3.2 Requirements for Effective Control
3.3 Control Techniques
3.4 Wining Acceptance for Control
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
The first of the management functions we identified and discussed was

planning. We defined it as setting goals and objectives to be pursued by
an organisation over a period of time. It is however not enough to set goals
and pursue it, but it is important to monitor the activities (performance)
towards achieving the objectives from time to time.
This is necessary because as managers, we need to know whether we are
working towards achieving the plans or not. There is no cause for
concern when performance is according to plans, but there is, whenever
there is deviation. Management has to intervene by instituting
corrective measures early enough to forestall the high cost of deviation.
The aim of this unit therefore, is to look at control as a supervisory
function of management, and examine the various control techniques or
tools at their disposal. We shall also be looking at the various ways by
which acceptance for control could be achieved amongst the
organisation’s members.
2.0 OBJECTIVES
• define control
• state what can be controlled
• specify the requirements for control and
• list the control techniques available.
88
3.0 MAIN CONTENT
3.1 Definitions and Meaning of Control
Control is a management function that is vital for the success of all

organisations in attaining the goals of the firm.
Many authors and professionals have expressed their opinion of what

control is, and we shall be looking at these diverse definitions. Control is
a process constituting many positive functions. Traditional control is
checking the results.
A positive control is a process constituting setting the standard and checking

the results and comparing the results with the set standard. Some
authorities are of the opinion that control is just another way to describe
effective management to guide and direct subordinates to attain the desired
objectives. It is the determination of progress towards objectives in
accordance with the predetermined plan.
McFarland has defined Control as “that function of a system which provides

direction in conformance to the plan” and or “the maintenance of
variations from system objectives within available limits”. Control is
determining what is being accomplished, i.e. performance, evaluating the
performance and if necessary, applying corrective measures so that
performance takes place according to the plan.
In the opinion of Henri Fayol, Control is seen as follows: “in an undertaking,

control consists of verifying whether everything occurs in conformity with
the plan adopted, the instructions issued and principles established. It points
out weaknesses and errors in order to rectify them and prevent their re-
occurrence. It operates on everything and on every action”. Control is a
managerial or supervisory function, and it is a sort of follow up which
helps to ascertain that what is desired and planned is achieved, and various
corrective measures are taken when required.
There is a general consensus that planning and control go hand in hand -

without planning, there could not be control. Control cannot take place in
a vacuum; for effective control, there should be set targets, which can only
be done through planning.
89
3.1.1 What Do We Control?
Any activity concerning the following areas could be controlled:
(a) Quality
(b) Quantity
(c) Time
(d) Cost
(e) Profit
3.1.2 Elements of effective control
For effective control, the following steps are necessary:
(a) Fixing of the target
(b) Measuring the performance
(c) Comparing the performance with set targets
(d) Taking corrective measures where there are deviations
3.2 Requirements for Effective Control
For effective control to take place, the following requirements must be in

place
3.2.1 Control should focus on the results or targets set in

the plan
3.2.2 Control must reflect the nature and needs of activity
The mechanism of control should be directly linked to the activity to be

controlled.
3.2.3 Control should report deviations promptly
The management should know the activity and performance in the

organisation. This is essential for comparison with fixed targets which will
show deviations if any for corrective measures to be taken in time.
90
3.2.4 Control should be understandable to everyone in the

organisation
Especially to those whose actions, activities and progress are being

controlled.
3.2.5 Control should be objective
It should not be based on sentiments and should be difficult to manipulate.
3.2.6 Control should be clear, determinable and flexible
3.2.7 Control should reflect the organisational pattern
Control in a democratic or open organisation must reflect same, and should

not be otherwise.
3.2.8 Control should be economical
The amount spent on control should be justifiable.
3.2.9 Control should lead to corrective measures
Control should be able to show corrective actions to be taken.
3.2.10 Control must be acceptable by all members of the

organisation
Discuss the elements of effective control in organisations.
3.3 Control Techniques
A variety of tools and techniques have been used over the years to help
managers control the activities of organisations. Some of the techniques are
identified below.
3.3.1 Budgets
A budget is a planning and a control tool. Budgeting has been exhaustively

discussed in a previous unit.
91
3.3.2 Financial control
This is a very good instrument for the control of resources. It entails the
use of quantifiable measures to monitor deviations.
3.3.3 Inventory control
Inventory management or control is a form of administrative control that is

particularly essential in all manufacturing, wholesale and retail
establishment. The essence of all inventory control is to have the right
quantity at the right time and place. This topic has been fully discussed in
a previous unit.
3.3.4 Auditing is a very important control system
The auditor examines records and statements and expresses an opinion

regarding their fairness and accuracy.
3.3.5 Break Even Point analysis (BEP)
The Break-Even Point analysis is another control technique that is often

used in some organisation. Every profit making organisation is anxious
to know at what level of operation the volume of total revenue will be
greater than total costs. The break-even point is that level of volume at
which the total revenue equals total expenses. At this point, the company
makes no profit and suffers no loss.
3.3.6 Traditional non-budgetary control devices
There are many traditional control devices not connected with budget,
although, some may be related to, and used with budgetary controls. Among
the most important ones are the use of statistical data of many aspects of the
operation, special reports and analyses of specific areas and personal
observation such as managing by walking around.
3.3.7 Time-event network analysis
Another Planning and control technique is a time-event network analysis

called the Program Evaluation and Review Techniques (PERT)
3.4 Wining Acceptance for Control
Control is not an easy task as it seems, but a tedious one for management.
This is because nobody wants to be controlled in the organisation no matter
their status.
92
It is therefore the duty of the management to ensure acceptance of

control by the subordinates in the organisation. For this to be achieved, the
following steps are necessary:
(i) The management should have an awareness of the personnel

needs and pressure.
(ii) Develop mutual interest in achieving the objectives of the

organisation.
(iii) Explain controlling mechanism to workers.
(iv) Needed changes should be automatic in the control.
(v) Controlling policies should be kept constant.
(vi) Adequate authority should be given to the person in charge of

control.
(vii) There must be wholehearted cooperation from the top

management for control.
(viii) For best results, comparison and controlling should be on a

continuous basis
4.0 CONCLUSION
We have examined control as a managerial and supervisory function of

managers. Planning and control are interrelated, while planning is setting
targets, control is checking the performance towards the set goals.
For control to be effective, certain requirements must be present in the

organisation, and where combined with the appropriate control techniques,
success is certain.
5.0 SUMMARY
In this unit, we have given diverse definitions of control by various authors

and professionals, each expressing their experience. They all point to the
same direction by defining control as having to do with setting targets and
measuring performance against these targets.
Control process can be applied to all factors in a firm. These include:

quantity, quality, cost etc. Control must be targeted against plans, timely,
objective and economical amongst others.
93
Because control may not be easily acceptable by organisation’s

members some suggested ways of winning acceptance have been
identified.
1(a) Define Control in your own words.

(b) What are the elements of Control?
(c) Identify the requirements for effective Control you know and
explain 5 of such.
2. How can Control be undertaken in an organisation?
Weihrich, H. & Koontz, H. (2005). Management A Global Perspective.

Tata McGraw Hill.
Nwachukwu, C. C. (2004). Management: Theory and Practice. African

Earnest, Dale (1978). Management Theory and Practice, (4th ed.).

McGraw-Hill.
Olaoye, Toyin Peter (1995). “Lecture Notes on Principles of

Management” Kwara State Polytechnic, Ilorin, unpublished.
Özen Bekar E, Baykal Ü. (2020). Investigation of the Control Process in Nursing Care Management:
A Qualitative Study. Florence Nightingale J Nurs. 28(1):61-70.
Sullivan, E.J. (2013). Effective leadership and leadership and management in health. USA: Pearson;
pp. 11–55.
94
UNIT 4 MOT IVATION
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Meanings of Motivation
3.2 Theories of Motivation
3.3 Motivational Techniques
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
In our discussion on staffing/human resource management, we described
staffing as filling positions with personnel that have required knowledge,
skills and attitudes, in order for the organisation to achieve its objectives.
But the responsibility of management does not end there. Continuously,
management must ensure that the personnel performs his tasks to the
maximum and remains committed to the organisation while meeting his
personal objectives.
The responsibility to ensure this conducive working environment for

optimal performance rests with the leadership. The leadership has to
maintain a good interpersonal relationship with his subordinates. This way,
he would be able to understand the needs that drive them to goal attainment.
This is motivation, and that is what we shall be discussing in this unit.
We shall be looking at a comprehensive meaning of motivation, motivation

process, characteristics of motivation, some theories that have helped to
explain motivation and some motivational techniques.
The proper understanding of this unit is expected to enrich the management

skill of the student and managers alike, to secure optimal performance from
their employees.
2.0 OBJECTIVES
• state the meaning of motivation

• discuss the various theories of motivation
• describe the various motivational techniques.
94
3.0 MAIN CONTENT
3.1 Meanings of Motivation
One of the challenges of management in the process of managing

organisations is to ensure that the employees contribute their maximum
effort towards the attainment of the organisation’s objectives. It is therefore
of paramount importance for management to determine the needs that drive
their employees towards certain goals achievement. This drive is known
as motivation. This is done by managers, through building into every
possible aspect of the organisation’s climate, those things which will cause
people to act in the desired ways.
Motivation can be defined as individual needs, desires and concepts that

cause people to act in a particular manner. Motivation has been linked with
urges, instinct, purposes, goals, and desires involving the physiological and
social aspects of human beings. It is that energising force that induces or
compels and maintains behaviour.
Our interest is however, in work motivation i.e. how to make the individual
employees put in extra effort willingly and enthusiastically in the work
setting.
Motivation as a function of leadership involves directing individuals so

that they can satisfy their needs as much as possible, while they strive to
accomplish organisational objectives.
3.1.1 Characteristics of motivation
Motivation as an internal psychological process whose process is inferred

from observed performance has three basic characteristics:
i. It is sustainable - it can be maintained for a long time until satisfied.
ii. It is goal directed - it seeks to achieve an objective.
iii. It results from a felt need - it is an urge directed towards a need.
3.1.2 The motivation process
A need creates a tension in the individual who moves in a certain direction

in order to achieve the desired objective which reduces tension. A satisfied
need does not motivate, conversely, an unsatisfied need motivates.
95
Need Tension Goal Reduction

Motivating oriented of tension
Behaviour Behaviour satisfaction
of need
Fig. 4: The Motivation Process
3.1.3 Types of motivation
There are two basic types of motivation viz:
a. Intrinsic
b. Extrinsic
Intrinsic motivation
This is the motivation that is within the individual i.e. internal and not
manipulatable (controllable) by anyone apart from the individual e.g.
hunger, sleep etc.
Extrinsic motivation
This is the motivation that is external. It is not within the individual to

control. It is therefore controllable. Example is incentives. It relates to the
work environment, therefore it can be influenced or changed.
3.2 Theories in Motivation
For adequate understanding of motivation and workers, we shall examine

a number of theories of motivation as propounded by the following people:
1. Abraham H. Maslow
2. Douglas McGregor
3. Frederick Hertzberg
4. V.H Vroom
5. Chris Argyris
96
3.1.2 Abraham Maslow
Abraham Maslow was a psychologist who developed the theory of

human motivation and classified human needs into five hierarchical
forms. As lower need is satisfied, the individual shifts his concern to the
next higher one.
The five needs according Maslow are discussed below:
i. Physiological need: These are survival needs such as food, shelter,

sleep, sexual satisfaction etc. They are basic needs that must be met
before others.
ii. Safety and security needs: These needs include actual safety and
the feeling of being safe and protected from both physical and
emotional injuries, threat and deprivation, protection against danger.
iii. Belongingness and love needs: The first two needs center primarily
on interaction with others for the purpose of giving and receiving
affection. This is the need for association for love, acceptance,
giving and receiving friendship.
iv. Esteem and status: This is the need for self respect and regard. It
is based on the notion that people want to be esteemed in terms of
their living standards and others. It is the need to gain approval and
to achieve, the need for self confidence, knowledge, competence and
expertise.
v. Self-actualisation needs: This represents the highest needs level.

It is man’s craving to become what he is capable of becoming. It
takes into account the individual’s own goals and potentials. This need
is seldom met by human beings.
3.2.2 Douglas Mcgregor - Theory X and Theory Y
Mc Gregor’s Theory X and Theory Y are essentially sets of assumptions

about behaviour. In his publication “The Human Side of the Enterprise”,
he refers to the theoretical assumption of management that underlies its
behaviour. He sees two different sets of assumptions made by managers
about their employees.
Theory X
Theory X regards employees as being inherently lazy, requiring coercion

and control, avoiding responsibility and only seeking security.
97
This is the theory of scientific management, with its emphasis on the

control of extrinsic r ewards.
Theory Y
Here, the assumptions see man in a more favourable light. Employees are
seen as liking work, which is as natural as rest or play, they do not have to
be controlled or coerced, when committed to organisation’s objectives.
Under proper conditions they will not only accept but also seek
responsibility More rather than less, people are able to exercise imagination
and ingenuity at work.
3.2.3 Fredrick Hertzberg Two-Factor Theory
Fredrick Hertzberg’s studies centered on satisfaction at work. In His

initial research, some two hundred engineers and accountants were asked
to recall when they had experienced satisfactory and unsatisfactory
feelings about their jobs. Following the interviews, Hertzberg’s team came
to the conclusion that certain factors tended to lead to job satisfaction,
while others led frequently to dissatisfaction. The factors giving rise to
satisfaction were called motivation, while those giving rise to
dissatisfaction were called hygiene factors. These studies were later
extended to other groups.
The following were the most important motivators:
i. Achievement
ii. Recognition
iii. Work itself
iv. Responsibility
v. Advancement
These factors were intimately related to the content of work.
The hygiene factors were as follows:
i. Company’s policy and administration

ii. Supervision – the technical aspect
iii. Salary
iv. Interpersonal relations
v. Working conditions
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There are certain distinctions beween motivators and hygiene factors. While
motivators brought about positive satisfaction, the hygiene factors served
to prevent dissatisfaction. If motivators are absent from the job, the
employee will experience real dissatisfaction. However, even if the hygiene
factors are provided for, they will not in themselves bring about job
satisfaction. Medically put, hygiene, in other words does not positively
promote good health, but can act to prevent ill-health.
This work has led to the job enrichment movement (adding motivators to
jobs) and more recently to the quality of working life movement.
3.2.4 Chris Argyris Theory
Professor Argyris research was on the relation between people’s needs and
the needs of the organisation. He suggests that the reason for so much
employee apathy is not because of laziness, but rather, because people are
being treated like children. This led to his so called immaturity-maturity
theory which suggests that the human personality develops from immaturity
to maturity in a continuum, in which a number of key changes take place.
These are as follows:
Immaturity Maturity
Passivity Activity
Dependence Relatively independent
Behave in few ways Behave in many ways
Erratic, shallow interest Deeper interest
Short-time position Equal or superior position
Lack of Awareness Awareness and control of self
From the above theory, Argyris sets the features of the typical classical
organisations, task specialisation, chain of command, unity of direction and
span of control. The effect on the individual is that they are expected to
be passive, dependent and subordinate i.e. individuals are expected to
behave immaturely.
For individuals who are relatively mature, the environment is a major

source of frustration at work, and could lead to difficulties such as
creating informal organisation which work against the formal hierarchy.
Argyris is of the opinion that the more we understand human needs the
more it will be possible to integrate them with the needs of the
organisation. If the goals of both individual and the organisation can be
99
brought together, the resulting behaviour will be cooperative, rather than

defensive or antagonistic.
3.2.5 V.H. Vroom expectancy theory
This theory attempted to study the process of motivation. It was developed

by V.H. Vroom in the United States of America in 1964. The key point to
note is that an individual’s behaviour is formed not on some sense of
objective reality, but rather on his own perception of reality i.e. how he
actually sees the world around him.
The perception is based on three things: efforts, performance and reward.

The strength of the attraction of particular outcomes or rewards for an
individual is termed “valence”.
The degree of belief that a particular act will produce a particular outcome
is termed “expectancy”. Valence and expectancy depend on the individual’s
own perception of a situation.
3.3 Motivational Techniques
There are three basic motivational techniques employed by management in

motivating employees. They are: money, behaviour modification and
participation. We shall consider them one after the other.
3.3.1 Money
Money plays an important factor in motivating workers. It could be in form

of wages, pay rise, granting bonuses or any other things that may be given
to people for improved performance. Managers and union leaders have
tended to place money high on the scale of motivators, while the
behavioural scientists tend to place it low.
Money is most important to people as it is a means of meeting basic needs

of life. Money is also a means of keeping an organisation adequately staffed
to attract and hold employees.
3.3.2 Behaviour Modification
This approach holds that individual can be motivated by properly designing

the work environment. Good performance is rewarded while poor
performance is punished. Specific goal are set with workers participation
and assistance, point and regular feedback of result is made available and
performance improvement are rewarded with recognition
10
and praise. Where the set targets are not met by the workers, ways are
found to help people and praise them for the good things they do.
3.3.3 Participation
People are more motivated through the use of participation of people in the
management of an organisation. People are more motivated by being
consulted on action affecting them. As those people in the center of the act
will have in-depth knowledge of the problem and can easily proffer a
solution which can lead to organisation’s success.
Participation is a means of recognition. It appeals to the need for affiliation

and acceptance and finally it gives people a sense of accomplishment.
Though participation does not mean that the manager should abandon their
authority to their subordinates, but rather, they should call subordinates on
matters that affect them for advice, while taking the final decision.
4.0 CONCLUSION
We have considered the various theories and techniques of motivation. The

implication of our discussion is that any of the theories or techniques of
motivation could be employed in motivating employees at work. What is
important is to consider the peculiar circumstance prevalent in the
organisation before choosing a particular type.
5.0 SUMMARY
In this unit, we have considered the meanings of motivation, types, and

characteristics of motivation. We have also considered the theories of
motivation and the techniques to employ in motivating employees. It is
important for managers to understand their subordinates very well and
work out appropriate motivational packages, depending on the
circumstance, that will make the employees work willingly and
enthusiastically towards attainment of organisation’s objectives.
1. What do you understand by motivation?

2. Mention and discuss the characteristics of motivation.
3. How can employees be motivated?
10
Nwachukwu, C.C. (2004). Management: Management and Practice.

Nigeria: African First Publishers Ltd.
Cole, G.A. (1997). Personnel Management: Theory and Practice, (4th

ed.). Gosport: Ashford Colour Press.
Ernest, D. (1984). Management: Theory and Practice, (4th ed.).

McGraw-Hill.
Mubaraq, S. & Adebo, M.A. (1999). Foundation in Management

(Vol.2) Ilorin: Olad Publishers & Printing Enterprises.
Olaoye, T.P. (1995). “Lecture Notes on Organisational Behaviour,”

Kwara State Polytechnic, Ilorin. (Unpublished).
Akintola O. & Chikoko G. (2016). ‘Factors influencing motivation and job

satisfaction among supervisors of community health workers in marginalised
communities in South Africa’, Human Resources for Health 14(54), 2–3.
Breed, M.., Downing, C. & Ally, H. (2020). ‘Factors influencing motivation of nurse
leaders in a private hospital group in Gauteng, South Africa: A quantitative
study’, Curationis 43(1), a2011.
10
UNIT 5 LEADERSHIP
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Definitions of Leadership
3.2 Classification of Leadership Style
3.2.1 Trait Theory
3.2.2 The Situational Theory
3.2.3 McGregor Theory
3.3 Qualities for Effective Leadership
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
As earlier identified in the early unit of the study, Leadership/Directing is

one of the core functions of Management. It is useless, to plan wisely,
organize for efficiency, and hire people who seem to have the requisite
skills, if the people themselves are unable or unwilling to perform their tasks
as they should.
The above underscores the relevance of leadership in organisations. It

includes, not only telling people what to do, but ensuring that they know
what is expected of them in each situation and helping them to improve their
skills. Most of all, perhaps, it includes the development of good morale to
ensure that the subordinates want to do their best, not merely work well
enough to get by.
In this unit, we shall be examining various definitions of leadership, types

and theories that have explained the issue of leadership. We shall also be
examining the qualities required for a leader to be effective.
2.0 OBJECTIVES
• state the meaning and functions of leadership

• discuss theories of leadership
• state the qualities of effective leadership.
.
10
3.0 MAIN CONTENT
3.1 Definitions of Leadership
A leader is a person who leads and leadership is a scientific art of leading.
Leaders and leadership have been variously defined within different

situations. We shall look at a few of these definitions.
According to Cecil A. Gibb, in his book, The Principles and Traits of

Leadership, four definitions of a leader were given, viz:
• An individual in a given office.
• The central person of a group, whose personality is incorporated

in the “ego ideals” of his followers.
• The person considered most to advise the group towards its goals,
and
• The person who is most effective in creating a structure or

consistency in the interaction of the group members.
Gibb was of the opinion that in some groups, one person may satisfy all the
five definitions, while in other groups; the status of a leader may be
attributed to as many as five different persons according to the definitions.
To Mooney and Relly, leadership is the supreme coordinating power. It

is the activity of influencing people to strive willingly for group activities.
It is important to note that leadership is something more than just

personality or accident or appointment, but intimately linked with human
behaviour. It is essentially a human process at work in organisations. Hence,
it can be described as a dynamic process in a group whereby one
individual influences or induces others to contribute voluntarily to the
achievement of group tasks in a given situation.
Discuss the different theories of leadership.
10
3.2 Classification of Leadership Style
Leadership style is the way in which a manager or leader exercises his

leadership role. Leadership style can be classified into four categories.
(a) Authoritarian: This depicts the leader who behaves like a dictator
and is constantly harassing his staff and using orders with little or no
explanation.
(b) Benevolent: While sometimes taking into account the views of his
subordinates, this type of leader likes to consider that he knows
what is best for his staff and usually takes all the decisions himself.
(c) Consultative: This leader tends to explain his action to staff and
invite discussions however, this can create problems because, this
approach may end up in disagreement because the manager’s view
may be contested.
(d) Participative: This involves the manager in sharing the decision

making process with his staff in the fullest sense. He invites staff
to put forward their ideals.
It should be recognised that leadership styles are not necessarily classified

into water tight compartments. The different styles perhaps fall between
two main extremes;
• being only interested in achieving the goal, irrespective of the view

and feelings of the staff concerned, or
• being only concerned with being nice and understanding to staff,

possibly at the expense of achieving the goals or tasks.
The choice of style of leadership depends on a number of factors, including:
(i) The goal to be achieved.
(ii) The nature, personality and background of the leader.
(iii) The nature, personality and background of the staff or group who
must undertake the work to achieve the goal.
(iv) The environment.
10
3.3 Theories of Leadership
We shall be looking at two basic theories to explaining leadership viz:
(i) The trait theory,
(ii) The situational theory, and
(iii) The McGregor contribution.
3.3.1 The Trait Theory
Early studies in the field of leadership attempted to split leadership ability

into its components by identifying the traits of character and personality
that make the leader. If it could be shown that all leaders possessed certain
traits in common, then it might be concluded that those traits added up
to natural leadership ability.
The exponents of this theory are of the opinion that leadership is inherent
and there are certain qualities which are necessary to make a person a leader,
and those qualities and characteristics are; honesty, loyalty, ambition,
initiative, drive, etc. They believe that these qualities are inborn.
Traits are carried in genes and the persons endowed with leadership traits
could only become leaders and lead others in a better way. It then means
that leadership is a quality that cannot be acquired and that leaders are
born, not made.
The major drawback of this theory is the reality that not all leaders possess
all the traits, and many non-leaders may possess most or all them, and
hence it was not a successful theory to the question of leadership.
3.3.2 The Situational Theory
The unsuccessful research for universally agreed qualities of leadership led

to the Situationist Approach. This school of thought is of the opinion that
leadership is purely situational. The circumstances and the situations in
which leaders work make them what they are. In other words, leadership
is purely a function of the environment or the society around which the
leader is working.
Critically, both the traits and situational theories failed to appreciate that
leadership is a complete process which neither trait nor situational
10
theories could cover comprehensively. A harmonising view is provided

in the next section.
3.3.3 The McGregor Contribution
McGregor had come out with a conclusion which harmonises both the trait
and situational theories. He was of the opinion that leadership is a
relationship having the following as its main variables:
(i) The characteristics of the leader,
(ii) Attitudes, needs and personal characters of the followers,
(iii) Characteristics of the organisation, such as its basic purpose, habits,

custom, structure and nature of the tasks performed.
(iv) Social, political and economic conditions.
To McGregor, all the above variables combine to make a leader.
3.4 Qualities for Effective Leadership
For leadership to be effective, the following qualities are a must:
(i) Leadership must be full of energy. This is the power of doing

mental and physical work and the stamina to work under a normal
condition. Spiritual energy is also necessary.
(ii) Emotional Stability: He should be free from violence, anger,

resentment, fear and other negative emotions and reactions.
(iii) Knowledge of Human Relations: He must know his subordinates

and the relationship existing between them. This is necessary for him
to be able to respond constructively to their behaviors.
(iv) Empathy: He must have the ability to look at things and understand
them from others’ point of view. He should not take decisions solely
at his own level. He must look at things objectively from the
subordinate’s point of view.
(v) Objectivity: Leaders should be objective in all their doings, words

and actions.
(vi) Personal Motivation: A leader must have drive and initiatives.

He must have new ideas that he wants to put into
10
practice. The leader must always have enthusiasm and be a self-

starter.
(vii) Communicative Ability: He should be good in both oral and written

communication.
(viii) Teaching Ability: He should know many things about the work his
followers will do and he should point/show the way out for achieving
results.
(ix) Social Skill: This is the ability to work, associate and interact with
others. He should be friendly and approachable.
(x) Technical Competence: An effective leader must know his job

thoroughly. He should have sufficient knowledge and insights on
the work operations under his guidance and supervision. He should
be able to plan, coordinate, lead and control.
4.0 CONCLUSION
From our discussion in this unit, it is clear that no matter how good plans
are, how skillful the personnel of an organisation are, there is a need for
an arrow head - the leader who must influence the personnel to willingly
and enthusiastically strive towards the attainment of the organisation’s
objectives.
5.0 SUMMARY
This unit lets you appreciate the place of leadership as a core function of
management. We have examined diverse opinions as to what it is, various
types, and theories that have tried to explain what leadership entails.
However, effective leadership entails certain qualities, a number of which

been discussed.
1. Critically examine the trait and situational theories of leadership.

2. Identify and discuss the qualities of effective leadership.
10
7.0 REFERENCES/FURT HER READING
Drucker, P. F. (1954). The Practice of Management. London:

Heinemann.
Ubeku, A.K. (1975). Personnel Management in Nigeria. Nigeria:

Ethiope Publishing Corporation.
Earnest, D. (1984). Management: Theory and Practice, (4th ed.).

McGraw-Hill.
Koontz, H. & O‟Donell, C. (1968). Principles of Management, (4th ed.).

McGraw-Hill.
Olaoye, T.P. (1995). “Lecture Notes on Principles of Management”.

Kwara State Polytechnic, Ilorin. Unpublished.
Sullivan, J. (2016) Effective Leadership and Management in Health Services.

Giourda Publications Athens.
Kourkouta L, Kaptanoglu AY, Koukourikos K, Iliadis C, Ouzounakis P, et al. (2021) Leadership and
Teamwork in Nursing. J Health Commun Vol. 6: No.2:2
10
UNIT 6 DEALING WITH CONFLICTS
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Contents
3.1 Conflict
3.2 Possible causes of conflict in the work place
3.3 Steps in resolving conflict
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
The possibility of occurrence of face-offs or disagreements among workers

in a work environment cannot be ruled out. Conflict may negatively affects
the ability of workers to work together as a team towards the achievement
of the set goals of an organisation. However, if well handled, it may result
in strengthening cooperation and mutual understanding among workers. It
is therefore important for the management of an organisation to be equipped
with the necessary skill set for amicable resolution of conflicts that may
arise among workers in the in the work environment.
In this unit, we shall be looking at the concept of conflict, the possible

causes of conflict in a work environment as well as ways of resolving
conflict and restoring trust among conflicting individuals.
2.0 OBJECTIVES
• explain the concept of conflict in a work environment

• identify the common causes of conflict among workers
• explain the steps for resolving conflict among workers.
3.0 MAIN CONTENT
3.1 Conflict in a Work Environment
Conflict is a state of disagreement, misunderstanding or opposition between two

individuals or groups of people usually, due to difference in ideas, interests, attitude
or thought process. It is a common daily occurrence that takes place when groups of
people try to work together in the same wok environment over a given period of time.
Conflict can have either constructive or destructive effect on the process of
10
achievement of the goals of an organization, depending on the way it is being

handled. If it is allowed to linger, it may increase work stress, hostility, sleep or
relationship disorders and also reduce overall job performance of an individual
worker or group of workers.
3.2 Causes of Conflict Among Workers
There are several factors that have been identified to cause conflict among
workers in a work environment. These are:
3.2.1 Scarcity of resources
Unavailability of adequate work-related resources which may include equipment,

disposables or even work space is likely to trigger competition and a struggle to gain
control of such limited resources by one worker before another. If such situation is
not well handled with effective communication and good understanding, it may result
in conflict between individual or group of workers.
3.2.2 Increased work demand
An increase in a health worker’s work load may also increase the stress level of such
individual. It may also trigger a sense of impatience and resentment if such an
individual perceives that he/she is being treated unfairly compared to other workers.
3.2.3 Competition between workers
Unhealthy rivalry among workers may occur due to several factors such as: poor
work attitude, scarcity of resources, favouritism, etc.
3.2.4 Differences in cultural beliefs
Cultural differences may result in communication challenge among workers; this may
also result in conflict in the work place.
3.2.5: Multiple job roles
Assignment of multiple work roles to an individual may create an atmosphere of

confusion and disagreement among workers.
3.3 Steps for Resolving Conflict
The following steps can be taken to resolve a conflict situation in a work place so as
to arrive at a constructive outcome:
j. Identification of the cause of conflict
The first step towards resolving conflict among workers is to find out the root
cause of the disagreement. This may involve digging beyond emotional
resistance of the individuals involved in the conflict.
ii. Development of possible solutions
10
upon identification of the cause of the conflict, members of the management

should generate possible solutions towards resolving the conflict. The
individuals involved in the conflict should also be carried along in the
process of proffering solutions to the problem.
iii. Implementation of the best solution
The best of the suggested solutions should be selected and implemented.
iv. Evaluation of the situation
After the best solution has been implemented, the situation should be
evaluated to see whether it has been solved or not. This may involve taking
feedbacks from the concerned individuals and also from other workers.
v. Repeat the process
If the conflict is not resolved by the first attempt of proffered solutions, the
process should be repeated with greater attention until it is eventually
resolved.
SELF ASSESSMENT EXERCISE
Explain the concept of conflict in relation to a work environment
4.0 CONCLUSION
In this unit, you have been exposed to the concept of conflict as it relates to a work
environment, the possible causes of conflict among workers as well as the steps that
can be taken to resolve a conflict situation in the workplace.
5.0 SUMMARY
Conflict is a common occurrence in every workplace. It may result from various

factors such as competition, increased workload and limited resources etc. If conflict
is well handled, it will yield a constructive outcome. Conversely, if poorly handled, it
may reduce staff performance and oppose the achievement of organizational goals.
1. Outline the causes of conflict in a work environment

2. What are the steps that can be taken to resolve conflict in a work
environment.
Isosaari, V. (2011). Power in health care organizations. Journal of Health

Organization and Management, 25(4), 385–399.
McChrystal, S. (2012). (Quoted by R. Safian). Secrets of the flux leader. Fast

Company, 170, 105.
10
Laschinger, H., Wong, C., Regan, S., Young-Ritchie, C., & Bushell, P. (2013).
Workplace incivility and new gradate nurses’ mental health: The protective
role of incivility. The Journal of Nursing Administration, 43(7/8), 415–421.
10
UNIT 7 THE DRUG REVOLVING FUND (DRF)
CONTENTS
1.0 Introduction
2.0 Objectives
3.4 Main Contents
3.5 The Drug Revolving Fund Concept
3.6 The Drug Revolving in Nigeria
3.7 The Objectives of the Fund
3.8 Condition for Cost Recovery Objective
3.9 Benefits of the Concept
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
One of the major challenges in health care delivery in developing nations

like Nigeria is high cost of drugs and its unavailability. Apart from this,
there is the uneven distribution of these drugs between the urban and rural
areas of the country.
The situation above has thus created a scenario in which the health care
delivery at all levels is poor. It is in recognition and determination to find
a lasting solution to these challenges that the Alma Atta resolution was
passed by the World Health Organisation (WHO) in 1978. It was at this
session that the august body resolved that all member nations should
endeavour to make essential drugs accessible at all levels of their health care
delivery service. It was to implement this resolution that the concept of
drug revolving fund evolved.
In this unit, we shall be looking at the concept of this fund. The meaning
and modus-operandi will be examined with a view to providing a theoretical
knowledge of the workings of the fund.
2.0 OBJECTIVES
• explain the meaning of the drug revolving fund concept

• state the conditions for its realisation
• list the benefits of the concept.
11
3.0 MAIN CONTENT
3.1 The Drug Revolving Fund Concept
The Drug Revolving Fund concept is essentially a component of the

Essential Drug Programme (EDP). It had long been approved by the World
Health Organisation (WHO) Assembly at Alma Atta in 1978. The main
resolution at the assembly was that all member nations should endeavour
to make essential drugs available/accessible at all levels of the health care
delivery service. The first model list of drugs was produced in 1977 by the
World Health Organisation (WHO).
Essential drugs are defined as those drugs that satisfy the health care needs
of the majority of the population. It was an attempt to implement the
essential drug programme that the drug revolving fund scheme emanated.
3.2 The Drug Revolving Fund Concept in Nigeria
Drug sales programme in which consumer/patient contribution covers the

cost of drugs received are frequently conceptualised as “revolving funds”.
Start-up money in form of capital is provided to purchase an initial supply
which is then sold. The cycle can be repeated indefinitely without further
financier’s contribution/allocations as long as the funds recovered from
sales are sufficient to purchase replacement stock.
The concept entails that after an initial capital investment, drugs supplies
are replenished with monies collected from the sale of drugs.
3.3 The Funding of the Fund in Nigeria
The federal government of Nigeria is a signatory to the Alma Atta protocol.

In realisation that the quality of health care system the government could
provide is closely linked with availability of drugs, and discovering that
the initial capital outlay to entrench the policy is beyond governments at all
levels, the federal government approached the World Bank to provide
loanable funds for the states as well as the Federal Ministry of Health’s
(FMoH) scheme.
The Federal Government of Nigeria, the states and the local governments
are partners in this venture and are therefore expected to make counterpart
funding available. This counterpart contribution is to enable the project to
set in place such things that are part of the conditions precedent to loan
effectiveness and loan drawn-down, and to make available seed stock to
states and local governments to update the medical stores and those of
health institutions in readiness for receiving the drugs.
11
3.4 The Objectives of the Fund
There are two main objectives of the fund:
(i) To ensure that the public has access to a sustainable supply of safe,
effective and affordable drugs and
(ii) To establish cost recovery mechanism at all levels of health care

system that could guarantee that the fund so recovered are retained
in order to, on continuous basis, guarantee the replenishment of
depleted stock.
3.5 Conditions for the Realisation of the Second Objective
For a full realisation of the objective of a cost recovery system (whose

aspiration is to put back into the system for the purpose of sustaining the
scheme) funds generated, there must be firm policy decisions on the
following from the onset viz:
(i) Amount to be invested
(ii) Percentage of cost to be recovered
(iii) Availability of exemption
(iv) Price determination
(v) Operational policies
(vi) Accounting/control mechanism
(vii) Monitoring/reporting to facilitate feedback
3.5.1 Amount to be invested
What is required here is the “working capital”, a sum for initial stocking.
It should take into account of the following:
(i) Potential market: e.g. Number of clinics/population to be served.
(ii) Drugs cost i.e. basic drugs cost plus related requisition cost such as
freight, insurance, duties, port charges and etc.
(iii) Operating cost: salaries, distribution cost, allowances for

expiration, pilferage, breakages, spoilage and etc.
11
(iv) Lead time analysis: i.e. the interval between the decision to
order stock and medical stores indication that the stock is
available for distribution.
(v) Drug supply “pipeline” i.e., the time it takes for drug to flow to
facilities and the flow of funds back to the central procurement unit.
Without the return of funds, new procurement cannot be made,
supply then becomes erratic, and the system soon fails.
3.5.2 Percentage (%) of cost to be recovered
Unlike a commercial pharmaceutical distributor who must recover all his

expenses and make some profit, a publicly sponsored DRF can be designed
with the objective of recovering any of the following combination of costs:
(i) All costs including repayment of the capital invested.
(ii) Drug and operating costs only.
(iii) Drug costs only, while public service, and contribute to pay
operating expenses.
(iv) Partial drug costs.
3.5.3 Will there be exemption?
If the scheme is to be run on commercial basis, there should be no room for

exception. Since an element of social service must be reflected in all that
government does, however, where exception orders are made, there should
be some budgetary allocation to cover cost of such exempted patients. An
advance deposit must be made for settling exempted patient’s drug bills.
3.5.4 Price determination
A standard selling price must be established for each drug. The price should
cover replacement cost of the drug, plus other expenses of getting it to
warehouse and distribution/sale centres. For government institutions
however, the drug price should not be higher than those obtainable in the
open market and/or elsewhere. In fixing the price, the following must be
taken into consideration:
(i) Cost to be recovered

(ii) Effective procurement policies
(iii) Dynamics of pricing
11
There are, however, two types of pricing that may be chosen from:
Cost plus certain percentage (%)
• Percentage (%) below market price
3.5.5 Operational policies
The operation of DFR must be self-sufficient, demand-led trading accounts,

using the principle of “Cash and Carry” for sales and retaining all proceeds
from drug sales fully separated from government finances.
3.5.6 Accounting/Control mechanism
DRF scheme should be self-accounting and its fund should not to be mixed
up with any other. It has to maintain therefore, separate accounting records
that are capable of providing fast, the cost, revenue and consumption
data necessary for management decisions.
Stock–Keeping and cash responsibility must be separated. Double-entry

system of accounting is considered most ideal for the financial record of the
scheme.
3.5.7 Monitoring and reporting
The establishment of drug revolving fund puts a greater demand on

accounting and stores staff to maintain accurate and comprehensive records
of both the drug inventory and monetary transactions. There is also the need
to from time to time, check performance or output against set goals and
ensure that required actions proceed as planned. This is necessary as a
prelude to taking timely and appropriate measure to correct deviations
and/or defaults.
3.6 Benefits of the Concept
Revolving funds are attractive because the concept:
• is theoretically self-financing, once start-up cost have been

provided.
• has particular appeal to foreign-aid donors because of the ease of
maintenance once commenced.
• offers the guarantee of regular supplies of high quality drugs to
the populace.
• drugs are cheaper.
• encourages transparency and accountability in drug management.
11
Outline the benefits of the Drug Revolving Fund and suggest ways of
sustaining the programme in Nigeria.
4.0 CONCLUSION
In this unit, you have been exposed to the Drug Revolving Fund concept
with a view to understanding its basics. The drug revolving fund concept is
a novel idea to provide drugs and medical supplies to the generality of the
populace, through cost recovery mechanism. For the cost recovery objective
to be sustained however, certain decisions must be considered. Though this
scheme is a lofty one, the practical application may be fraught with
problems, if adequate monitoring and reporting system is not put in place.
5.0 SUMMARY
The Drug Revolving Fund concept has been discussed. Effort has been
made to trace the history of the fund in Nigeria. We have discussed the
meaning, funding, and the modus-operandi of the scheme. Conditions that
will make for the cost recovery objective of the scheme have also been
highlighted as well as the benefits of the scheme.
3. What do you understand by the Drug Revolving Fund concept?

4. What are the firm decisions to be taken for the
realisation of thecost recovery objective of the
scheme?
5. What are the benefits of the concept?
Essential Drug Project (EDP), 1992 Workshop on Drug ManagementUnder

the Drug Revolving Scheme, Ministry of Health (MOH), Ilorin.
Essential Drug Programme (EDP), 1997 Workshop on Drug Revolving

Fund Management, Ministry of Health, Ilorin.
Obuaku, C. (2014) Essential Medicines in Nigeria: Foregrounding access

to affordable essential medicines. African Sociological Review, vol
18(2):42-52.
Stopstoctouts initiative (2013) what are essential medicines?

http://stopstockouts.org/stop-stock-outscampaign/what-are-
essential-medicines/
11

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NATIONAL OPEN UNIVERSITY OF NIGERIA

FACULTY OF HEALTH SCIENCES

COURSE CODE: NCS403

COURSE TITLE: MANAG EMENT IN NURSING

Course Team Mr. T. P. Olaoye (Developer/Writer) - NOUN

NATIONAL OPEN UNIVERSITY OF NIGERIA

National Open University of Nigeria

First Printed 2011

All Rights Reserved

NSC403 Leadership and management in health is a one-semester course. It is a two-unit

The essence of Management is to make all human endeavours function

This course consists of 13 units which involve marrying the principles of

Purpose of the Course Guide

Course Aims and Objectives

To give you a broad exposure to the fundamental principles of Management

• introducing you to the nature, purpose and meaning of

How to Go Through the Course

The major components of the course are:

There are 13 study units in this course grouped into 3 modules as

Module 1 Introduction to Management

Unit 1 Nature, Purpose and Definitions of Management

Module 2 Management and Control

Unit 1 Human Resources/Services Management

Module 3 Other Issues in Nursing Practice

Unit 1 Quality Assessment in Nursing Practice

These units should be treated sequentially as preceding units act as a

Textbooks and References

Ernest, Dale. (1978). Management Theory and Practice, (4th ed.).

Nwachukwu, C. C. (2004) Management Theory and Practice. Nigeria:

Olaoye, T.P. (1995). “Lecture Notes on Principles of Management.”

There will be two types of evaluation: Tutor-Marked Assignments and the

Facilitators/Tutors and Tutorials

Specific dates for particular activities, such as tutorial schedules,

This course exposes you to the concepts, principles and theories of

Course Code NSC403

Course Team Mr. T. P. Olaoye (Developer/Writer) - NOUN

NATIONAL OPEN UNIVERSITY OF NIGERIA

National Open University of Nigeria

First Printed 2011

All Rights Reserved

Module 1 Introduction to Management ........................................... 1

Unit 1 Nature, Purpose and Definitions of Management .............. 1

Unit 4 Interviewing Skills ……………………………………. 26

Module 2 Management and Control ……………...…………… 32

Unit 1 Human Resources/Services Management ……….….. 32

Module 3 Other Issues in Nursing Practice………………….. 65

Unit 1 Quality Assessment in Nursing Practice………….…. 65

MODULE 1 INTRODUCTION TO MANAGEMENT

Unit 1 Nature, Purpose and Definitions of Management

UNIT 1 NATURE, PURPOSE AND DEFINITIONS OF

You might want to ask whether a course in management is necessary in your

In this unit, we shall be looking at the nature and purpose of management.

By the end of this unit, you should be able to:

• explain the nature and purpose of management

3.0 MAIN CONTENT

3.1 Nature and Purpose of Management

For as long as human beings have learnt to engage in productive efforts in

In every organisation, there two types of employees: the ordinary workers;