NURSING LEADERSIP AND MANAGEMENT

-CONTROLLING(Group IV)

CONTROLLING Controlling or evaluating is an on-going function of management which occurs during planning, organizing and directive activities. Is the use of formal authority to assure achievement of goals and objectives Action is taken to correct discrepancies between this standards and actual performance

TYPES OF CONTROL Feedforward Control Anticipates problems and prevents it to occur before operations begin within the organization. Concurrent Control Concurrent Control are applied during an ongoing activity within the organization. (inspects, monitors) Feedback Control Feedback controls focus on the results of operations. When an activity is done, evaluation is made.

GUIDELINES FOR DESIGNING EFFECTIVE CONTROL SYSTEMS Control at all levels in the health care delivery system. All nursing units must have a standard control system. Acceptability of those who will enforce decisions. The nurse managers manner of influence to her staff to comply with the policies or procedures. Flexibility of the enforcers and the implementors to enforce decisions based on practical situations. Accuracy. Steps or mechanisms of control must be clear and vivid with significant implications.

Timeliness. Activities are planned with time target set. Cost effectiveness. Resources used are well maintained and enough or adequate to meet thhe needs of the unit. Understandability. Policies and procedures are simple, easy to understand and can be implemented with less difficulty. Balance between objectivity and subjectivity. Theory and practice-based system. Coordinated with planning, organizing and leading.

REASONS FOR CONDUCTING EVALUATION Evaluation ensures that quality nursing care provided. It allows for the setting of sensible objectives with subordinates. It provides standards for establishing comparisons. It promotes visibility and means for the employees to monitor their own performance. It highlights problems related to quality care and determines the areas that require priority attention. It provides an indication of the costs of poor quality. It justifies the use of resources. It provides feedback for improvement.

EVALUATION PRINCIPLE Must be based on the behavioral standards of performance which the position requires. There should be enough time to observe employees behavior. The employee should be given a copy of the job description, performance standards and evaluation. The employees performance appraisal should include both satisfactory and unsatisfactory results with specific behavior instances to exemplify there evaluative comment.

Areas needing improvement must be prioritized to help the worker upgrade his performance. Should be scheduled and conducted at a convenient time for the rater and the employee with ample time for discussion. Should be structured in such a way that it is perceived and accepted positively as a mean of improving job performance.

ESTABLISHING OF THE STANDARDS PERFORMANCE FOR MEASURING Standards are desirable sets of condition and performance necessary to ensure the quality of nursing care services which are acceptable to those instrumental to or responsible for setting and maintaining them.

3 TYPES OF PERFORMANCE STANDARDS STANDARDS ON STRUCTURE Are those that focus on the structure or management system used by the agency to deliver care. PROCESS STANDARDS Refers to the decision and actions of the nurse relative to the nursing process which are necessary to provide good nursing care. OUTCOME STANDARS Are design to measure the results of care provided in terms of changes of health status of clients served, changes in the level of their knowledge, skills and attitudes and satisfaction of those served including the members of the nursing and health team.

ESTABLISHMENT OF OBJECTIVES AND METHODS FOR MEASURING PERFORMANCE Measurable criteria or objectives specific to giving nursing care must be developed to evaluate process and outcome. The establishment of objectives provides clear direction and communication of expected levels of achievement. The greater the participation of the employee, the greater the motivation to achieve. Objectives should be challenging but attainable. The most commonly used methods for measuring nursing care are task analysis and quality control.

Quality control refers to the activities and techniques employed to achieved and maintain the quality of a product, service or process, the level of nursing care provided and its effect to the client are assessed.

MEASURING ACTUAL PERFORMANCE A measurement of performance is an on-going, repetitive process with the actual frequency dependent on the type of activity being measured. For example, nursing care to patients is continuously monitored, whereas, a formal performance appraisal maybe done only twice a year.

Measurements maybe scheduled in advance, maybe done at periodic but unannounced intervals or may occur at random. The purpose of measurement should be clarified and the staff should be informed about the task and levels of care that needed attention.

REINFORCING STRENGTHS OR SUCCESSES AND TAKING CORRECTIVE ACTION AS NECESSARY Positive feedback stimulates motivation, consistently high performance and growth of the employee. Corrective actions are applied to improve performance.
COMPARING RESULTS OF PERFORMANCE WITH STANDARDS AND OBJECTIVES Comparing the results of performance with standards and objectives is one of the easiest steps in the control process. If performance matches standards and objectives, managers are assured that the needs of patients are met. However, if performance is contrary to standards and objectives set, then necessary action should be taken.

RESPONSIBILITY OF THE HEAD/SENIOR NURSE Being at the first level of supervision, the Head / Senior Nurses are in the best position to know whether their staff nurses perform satisfactorily at work. Their influence has an impact on promoting quality care to patients. They have the responsibility to instruct subordinates regarding the appropriate methods and procedures in providing nursing care. They should inform the staff of the likely causes of errors or defects and preventive measure necessary.

They should initiate and facilitate any steps necessary to improve methods, equipment, materials and conditions in the work area for which they are responsible. The feeling of responsibility to render quality performance must be instilled in all employees for them to follow agreed upon written procedures and use materials and equipment correctly as instructed.

PERFORMANCE APPRAISAL It is a control process in which a employees performance is evaluated against standards. It is the most valuable tool in controlling human resources and productivity.

PURPOSE OF PERFORMANCE APPRAISAL Determines salary standards Select qualified individuals for promotion or transfer. Identify unsatisfactory employees for demotion or termination. Make inventories of talents within the institution. Determine training and developmental needs of employees. Improve the performance of work groups by examining, improving, correcting interrelationships between members.

Improve communication between supervisors and employees and reach an understanding on the objectives of the job. Establish standards of supervisory performance. Discover the inspirations of the employees and reconcile these with the goals of the institution. Provide employee recognition for accomplishments. Inform employees where they stand.

TOOLS USED TO EVALUATE PERFORMANCE Trait Rating Scale This is a method of rating a person against a set standard which may be the job description, desired behavior and personal trait. Job Dimension Scales It focuses on job requirements and the quality work performance. Behaviorally Anchored Rating Scale (BARS) This focuuses on desired behaviors to improve performance.

Checklist It is composed of behavioral statements that represent desirable behavior. Peer Review It is a collegial evaluation of the performance done to promote excellence in practice and offer information, support, guidance, criticism and direction to one another. Self- Appraisal This tool allows the employee to evaluate his own performance.

COMMON ERRORS IN APPRAISAL Halo Effect This has a tendency to overrate staff based on the raters first impression of the rate. The evaluation is based on the good traits or good things one sees in a person. Logical Error It is often based on first impression of the rater to the rate. Central Tendency Error This rates the staff as average. This is used by the rater when feedback tools are inadequate.

Leniency Error There is the propensity to overlook the weaknesses and mistakes of the person being evaluated leading too an inaccurate picture of the job performance. Hawthorne Effect The behavior of the ratee changes simply because he is observed by the rater. Horns Effect This occurs when rating an employee very low because of an error committed.

FACTORS CONTRIBUTING TO AN EFFECTIVE PERFORMANCE APPRAISAL SYSTEM Compatibility between the criteria for individual evaluation and organization goals. Direct application of rated performance to performance standards and objectives expected of the worker. Development of behavioral expectations which have been mutually agreed upon by both the rater and the worker.

Understanding the process and effective utilization of procedure by the rater. Rating of each individual by the immediate supervisor. Concentration on the strengths and weaknesses to improve individual performance. Encouragement of feedback from the rated employees about their performance needs and interests. Provision for initiating preventive and corrective actions and making adjustments to improve performance.

METHODS OF MEASURING PERFORMANCE INFORMAL May consist of incidental observation of performance while the worker is engaged in performing nursing care or by responses made by worker during conferences Interaction of worker with clients, their families, visitors and co-workers should also be noted. FORMAL Is accomplished regularly and methodically by collecting objective facts that can demonstrate the difference between what is expected and what was done. This methods include essay, checklist, ranking, rating scale, forced-choice comparison, and anecdotal records.

ESSAY The appraiser writes a paragraph or more about the workers strengths, weakness and potentials. CHECKLISTS A compilation of all nursing performances expected of a worker. The appraisers task is to mark the appropriate column whether the worker does or does not show the desired behavior. RANKING The evaluator ranks the employees according to how he/she fared with co-worker with respect to certain aspects of performance or qualifications.

RATING SCALES Includes a series of item representing the different task or activities in the nurses job description or the absence or presence of desired behaviors and the extent to which these are possessed. FORCED-CHOICE COMPARISON The evaluator is asked to choose the statement that best describes the nurse being evaluated. ANECDOTAL RECORDING It describes the nurses experience with a group or a person, or in validating technical skill and interpersonal relationship.

QUALITY ASSURANCE ASSURANCE Means achieving a sense of accomplishment and implies a guarantee of excellence. QUALITY Is the degree of excellence.

QUALITY OF CARE Exist to the degree that service is efficient, well executed, effective and appropriate. QUALITY ASSURANCE Provision of health care services by health workers. QUALITY IMPROVEMENT PROGRAM Is the umbrella program that extends the many areas for the purpose of accountability to the consumer and payor. SENTINEL EVENT INDICATORS Measures low volume but serious undesirable and often avoidable process or outcome such as falls and medication errors.

BENCHMARKING Is a tool to assists in quality of care decision making. BEST PRACTICE Is service, function or process that has been fine tuned, improved and implemented to produce superior outcomes. TOTAL QUALITY MANAGEMENT Is a way to ensure customer satisfaction by involving all employees in the improvement of the quality of every product or service. CONTINUOUS QUALITY IMPROVEMENT Is a process of continuously improving a system by gathering data or performance to analyze the system, collect measurements, and propose changes.

QUALITY ASSURANCE METHODS Purpose is to measure and improve the quality of nursing care delivered in the agency. DEVELOPING QUALITY ASSURANCE CRITERIA Structure, process and outcome or any combination of these, are common approaches to evaluation.

Structure Approach Includes physical setting, instrumentalities and conditions through which nursing care is given such as the philosophy and objectives, the building, organizational structure, financial resources, and equipment. Process Approach Includes the steps in the nursing process in compliance with established standards of nursing practice. Outcome Approach Identifies desirable changes in the patients health status.

NURSING AUDIT COMMITTEE Is composed of a representative from all levels of the nursing staff A member of the training staff Supervising Nurse Head/Senior Nurse Staff Nurse

PATIENT CARE AUDITS CONCURRENT AUDIT Inspection of patients and observation of the affects of patient care where the focus is on the patient while the patient is still confined in the hospital. RETROSPECTIVE AUDIT Questionnaires sent or interviews conducted on discharged patients.

PEER REVIEW Patient care audits may be done by employers of the same profession, rank and setting. QUALITY CIRCLES A group of workers doing similar work who meet regularly on normal working time, under the leadership of their supervisor, to identify, analyze and solve work related problems and to recommend solutions to management. UTILIZATION OF RESULTS The Nursing Staff Unit is given feedback on the results of the quality assurance study.

CONTROL OF RESOURCES Part of the control process is the periodic review of the utilization of materials and supplies in the various nursing units. DISCIPLINE It is regarded as constructive and effective means employees take personal responsibility for their own performance and behavior.

PROBLEM SOLVING An effective supervision aids supervisor is analyzing the work problems of their subordinates. DISCIPLINARY ACTION Any employee charged for breach of the rules and regulations, policies, norms of conduct shall be given due process.

Counseling and Oral Warning The employee is given a fair chance to air his/her side. Suspension Suspension over minor violation is given after an evidence of oral and written warnings. Suspension is applied when management feels that the employee can still be rehabilitated.

Dismissal Dismissal is invoked only when all the other disciplinary efforts have failed. Written Warning The employee must be told after the interview that he will be given a written warning this include the statement of the problem, identification of the rule which was violated, consequences of continued deviant behavior, the employees commitment to take correction action, and any follow up action to be taken.

THANKYOU VERY MUCH!!!