controlling.ana

7/31/2019 Controlling.ana

1/9

CONTROLLING

NATURE AND PURPOSE OF CONTROLLING

Controlling is the last step in the management process. It involves setting of

standards, measuring performance against those standards, reporting the results, and taking

corrective actions. Control should be designed for specific situations and should report

potential or actual deviations promptly enough for corrective action to be effective.

Controlling is an on-going function of management which occurs during planning,

organizing and directing activities. It includes assessing and regulating performance in

accordance with the plans that have been adopted, the instruction issued and the principles

that has been established. (Venzon)

Controlling is the management function in which performance is measured and

corrective action is taken to ensure the accomplishment of organizational goals. It is the

policing operation in management, although the manager seeks to create a positive climate

so that the process of control is accepted as part of routine activity.

Controlling is also a forward looking process in that the manager seeks to anticipate

deviation and prevent it.

The manager initiates the control function during the planning phase, when possible

deviation is anticipated and policies are developed to help ensure uniformity of practice.

Close supervision and a tight leadership style reflect an aspect of control. Through

rewards and positive sanctions, the manager seeks to motivate workers to conform, thus

limiting the amount of control that must be imposed. Finally, the manager develops specific

control tools, such as inspection, visible control charts, work counts, special reports, and

audits.

Principles of Controlling1. Critical few, meaning that fewer people involved in control brings about the best

result2. Point of control or a centralization or decentralization of authority3. Self-control or Discipline which translates to personal acceptance of responsibility

and accountability

Types of Control1. Feed forward Controls It is focus on operations before thy begin. Their goal is to

prevent anticipated problems.

2. Concurrent Controls Concurrent controls apply to processes as they arehappening.

3. Feedback controls it is focus on the results of operations

Steps in Control process

1. Establishment of Standards, objectives and methods for measuring performancea. Standards created when objectives are set during planning process.b. Resource controlc. Financial controls-facilitate achieving the organizations profit motive. One method

of financial control is budgeting.

d. Operations control methods assesses how efficiently and effectively anorganizations transformation processes create goods and services. Methods oftransformation controls include Total Quality Method (TQM) statistical process

control and the inventory management control.e. Just in time System is the timely application of medication for the illness of a

patient and purchased materials just in time to be transformed into parts.Coordination and cooperation are required from supervisors and employees todeliver the smallest possible quantities at the latest possible date at all stages ofthe transformation process in order to minimize inventory costs.

2. Monitor and measure performance of nursing care services and evaluate it against thestandards through records, reports and observations.

pg. 1


2/9

3. Comparison of results of performance with standards and objectives and identifyingstrengths and areas for correction and/or improvement.

4. Action to reinforce strengths or successes5. Implementation of corrective action as necessary

Characteristic of Control Process1. Cyclical

2. Controlling often leads to management expecting employee behavior to change.3. Control is both anticipatory and retrospective4. Ideally, each person in the health care delivery views control as his/her

responsibility.5. Controlling builds on planning, organizing and leading.

I. Quality improvement

Leader:

Envisions high quality care

Models quality care management

Encourages others to be involved in quality standards improvement

Encourages setting high standards

Is proactive versus reactive

Facilitates interdisciplinary quality improvement

Builds a culture of quality

Enables interdisciplinary quality improvement

Fosters development of infrastructure and processes for quality improvement

Encourages use of electronic systems

Communicates the quality findings to others

Acts as role model.

Manager:

Organizes quality-driven service

Monitors quality of care

Selects standards and measures of those with others

Select tools with others

Facilitates collecting and analyzing data

Determines discrepancies between care provided and standards

Facilitates ongoing quality improvement

Evaluates quality of care

Uses the infrastructure and processes with employees for quality improvement

Uses electronic systems for quality control

Assesses the sources of information

Keeps informed about the government, accrediting bodies, and licensingregulations regarding quality improvements.

i. Performance appraisal

Performance appraisal is a method of acquiring and processing information

needed to improve the individuals performance and accomplishments.

The purpose of evaluation is to assess the appropriateness, adequacy

effectiveness and efficiency of checklist, rating scale, and ranking and among

others.

pg. 2


3/9

Tools to evaluate performance:

1. Trait Rating Scale is a method of rating a person against a set standard

which may be the job description, desired behavior and personal trait. It is

also the oldest type of rating scale.

2. Job dimension Scale focuses son job requirements and quality work

performance.

3. Behaviorally Anchored rating Scale (ARS) focuses on desired behaviors

to improve performance

4. Checklist is composed of behavioral statements that represent desirable

behavior.

5. Peer Review is a process whereby a group of practicing registered nurses

evaluate the quality of another registered nurses professional performance

6. Self-Appraisal allows the employee to evaluate his own performance.

Common Errors in Evaluation

1. Halo Error is the result of allowing one trait to influence the evaluation of other traits

of rating all traits on the bases of a general impression.

2. Horns Error is the opposite of the halo effect.

3. Contrast Error is produced by the tendency of the manager to rate the nurse

opposite from the way she perceives herself.

4. Logical Error

5. Hawthorne Error

6. Leniency Error

ii. Nursing Audit and Rounds

Nursing Audit consist of documentation of the quality of nursing care in relation to

the standards established by the nursing department.

Objectives of Nursing Audit

To develop openness to change

To provide assurance; meeting evidence-based practice

To improve hospital protocols

To minimize errors or harm patients

To reduce incidents/complaints/claims

Functions of Nursing Audit Committee

To review report and provide recommendation to the board of directors

To provide an open communication among the auditors and the Board of

Directors

Basic Forms

pg. 3


4/9

1. Structure Audit focuses in the setting in which caregivers, organizations, policies,

procedure and medical records.

2. Process Audit implements indicators for measuring nursing care to determine whether

nursing standards are met.

3. Outcome Audit evaluates nursing performance in terms of establishing client

outcomes criteria.

Nursing Rounds pay particular attention to issues of client care and nursing practice. This

will also satisfy needs problems met or unmet.

Basic Forms

1. Charge Nurse Rounds a method of report to incoming nurse

2. Nursing Rounds for Teaching the instructor introduces the client to the student

and they discuss the clients care together

3. Nurse-Physician Rounds- done daily by the nurse and physician to evaluate the

effectiveness of care.

4. Multidisciplinary Rounds-done most commonly to discuss discharge planning or

supplement case conferences.

iii. Variance Report

Types of Budget

1. Operating or revenue and expense budget

-Accounts for the income and expenses associated with day to day activitywithin a department or organization.

- Revenue generation is based upon billable services, and expense associated

with equipment, supplies, staffing, salaries, and other indirect cost.

Personnel estimate the cost of direct labor necessary to meet agencys objectives.

They determine the recruitment, hiring assignment layoff and discharge of personnel.

2. Cash Budget

-Planned to make adequate funds available as needed and to use any extra

funds profitably.

- Nurse Managers estimates the amount of money to be collected from clients

and other sources and allocates that cash to expenditures.

Construction budget developed when renovation or new structure is planned.

Periodic budgetary review

- Managers should review the budget at periodic intervals, compare actual with

projected performance and make necessary changes.

-Managers should review the budget and provide intervals. Compare actual with

projected performances and make necessary changes. It measures whether an

activity is under control or not, if it is not, to what degree is it out of control. It is

the concept that distinguishes normal routine changes in a process from unusual,

abnormal changes that can be attributed to specific causes.

Variance is the difference between the budget and the actual results (Grohar Murvey &

Dicrose, 1997)

pg. 4


5/9

Advantages:

1. Help accountability by assignment or responsibility and authority

2. State goals for all units, offer a standard or performance and stress the continuous

nature of the planning and control process

3. Budget encourage nurse manager to make careful analysis of operations and to basedecisions on careful considerations

4. Weakness of the organizations can be revealed and corrective measures taken.

5. Staffing equipment and supply needs can be projected and work minimized.

Disadvantages:

1. Budgeting converts all aspect of organizational performance into monetary value to

provide single comparable unit of measurement

2. Consequently, only that aspects that are easy to measure be considered and equally

important factors such as organizational development research effort may be ignored.

Budgeting Process:

Establishment of operational goals and policies for the entire agency.

Operational goals must be translated into quantifiable management objectives

for the organizational units

Departmental heads use organizational goals as framework for the

development of departmental goals

Departmental budgets are revised and master budget is prepared

Financial feasibility of the master budget is tested and final document is

approved and distributed to all involved parties.

Periodic performance reporting by responsibility center during the budget

period.

Cost Containment

Goal of cost containment is to keep costs within acceptable limits for volume,

inflation and other parameters.

Involves awareness, monitoring, management, and incentives to prevent,

reduce and control cost

Cost awareness focuses on the employees attention of cost

Cost monitoring-on how much will be spent, when, where and why

Cost management focuses on what can be done by whom to contain cost

Cost incentives motivate cost containment and reward desired behavior

Cost avoidance means not buying supplies, technology and services

Cost reduction spending less for goods and services

Cost control making effective use of available resources through careful

forecasting, planning, budgeting, reporting and monitoring.

pg. 5


6/9

Cost effectiveness method of economic evaluation that ranks program by the

cost of achieving the objective

Cost benefit analysis procedure that determines the cost of installing and

operating program converts that into monetary amount.

Example of operating budget for medical unit (Zobeds, 2007)

Statistics Actual Budget Variance

Pt. days 870 720 180

Full time equipment 79.2 71.4 7.8

Revenues in patient

revenue

1,287,000 1,085,700 201,300

Operating expenses,

salaries wages, benefits

372,780 246,450 126,330

Contract employees

OT

Supplies

Repairs

Travel

Continuing Education

3,720

7,712

17,200

1,000

650

1,750

2,000

8,640

14,700

1,200

600

2,000

1,720

928

2,500

200

80

250

Total expenses 404,812 275,590 129,222

Variance analysis compares the budgeted to actual then tries to explain any differences

between the two

Reasons for differences between the budget and actual

1. There is less than or more than no. of patients to be cared for than were predicted in

the budget

2. The intensity of care required by patients is more than or less than predicted by the

budget

3. The efficiency of the staff in providing care in more than or less than predicted

4. The cost of personnel is more or less than the predicted.

iv. Benchmarking is a process of identifying best practices and comparing themwith the agencys practice to improve performance.

Tool for identifying desired standards of organizational performance.

Process of measuring products, practices and services against best

performing organizations.

pg. 6


7/9

Management tool for seeking out the best practices in ones industry so as

to improve performance.(Swanburg,1996)

The process is as follows:

1. Identify the benchmark team

2. Identify what to benchmark

3. Gather information through search for the literature

4. Survey benchmark partners through written or telephone surveys or site visits.

5. Compare benchmark data with organizations current practices and outcomes.

6. Borrow ideas from the best and adapt them to important processes within

organization

7. Monitor the results (Rousel,Swanburg,&Swanburg,2006)

v. Accreditation/Certification

Accreditation- is the standardize program for the evaluation of health care

organizations. It is based on established minimum standards for quality health care.

The accreditation process is voluntary; however, the distinction offers benefits to the

provider. The public perception of a health care institution is related to the seal of quality

awarded by the accrediting body.

The Joint Commission on Accreditation of Healthcare Organization (JCAHO) is the current

national organization that develops standards and accredits health care organizations.

This accreditation is important to hospitals because it is one of the ways hospital can becertified to receive federal government Medicare reimbursement for delivery of patient

care services.

All hospitals and long term care organizations seeking JCAHO accreditation monitor

patient outcomes and use a performance measurement system to provide data about

these patient outcomes and other indicators of care.

Hospital Accreditation Standards

Patient-Focused Functions

patient rights and organization ethics

assessment of patient care of patient

education

continuum of careOrganization-Focused Functions

improving organizations performance

leadership

management of the environment of care

management of human resources

management of information

surveillance, prevention and control of infectionStructure with Functions

governance

management

medical staff

nursing

Certification is a validation of clinical or administrative skills. The process of certificationgenerally requires a license nurse, a set of amount of year or hours in practice in a specific

pg. 7


8/9

specialty and documented continuing education hours. A major benefit of professionalcertification is the recognition that certified nurses apart. (Tina Marcelli)

The process by which a non-governmental agency or association certifies that anindividual licensed to practice a profession has met certain standards specified by thatprofession for practice.

Many certifications last up to 5 years and the nurse may recertify by either retesting or

completing the needed member of continuing education contact hours.

Certification samples:ACLS- Advance Cardiac Life SupportBLS - Basic Life SupportCEN - Certified Emergency NurseNRP - Neonatal resuscitation ProgramPALS - Pediatric Advanced Life SupportCCRN - Critical Care registered Nurse

Specialty CertificationMany healthcare organizations encourage their staff to become certified. Nearly all

nursing specialties now offer board certification exams to validate expert knowledge of that

particular discipline. Successfully passing a certification exam is another measure ofprofessional growth and offers the benefit of national recognition of ones credentials

Examples of Specialization:Community Health NurseMedical Surgical NurseNursing Care ManagementPediatric NursingPerinatal NursePsychiatric or Mental health Nurse

II. Standards in Nursing Practice

A prime element of the management of nursing services is a system for evaluation

of the total effort, including evaluation of the management process, the practice ofnursing and all nursing care services.

Evaluation requires standards that can be used to gauge the quality and quantityof services.

Standards are desirable sets of conditions and performance necessary to ensurethe quality of nursing care services which are acceptable to those responsible forsetting and maintaining them. Also, standards are established criteria ofperformance, planning goals, strategic strategic plans, physical or quantitativemeasurement, units of service, labor hours and speed cost revenue.

Performance Standards can be used for individual performance and criteria can be

developed for collective evaluation of patient care.

3 Types of Performance Standards1. Standard on structure - It is focus on the structure or management used by the

agency to deliver care.2. Process Standards - Prefer to decisions and actions of the nurse relative to the

nursing process which are necessary to provide good nursing acre.3. Outcome Standards - Designed to measure the results of care provided in terms of

changes in the health status of clients served, changes in the level of their knowledge,skills and attitudes and satisfaction of the served including the health team

Nursing Care Standard - is a descriptive statement of desired against which to evaluate

nursing care given to a patient.

Purposes:-To improve the quality of nursing-Decrease the cost of nursing care-Provide a basis for determining nursing negligence

Sources of Nursing Care Standards (Philippines)DOH PRCPNA ANSAP

pg. 8


9/9

Sources of Nursing Care Standards

American Nurses Association (ANA)

Joint Commission on Accreditation of Healthcare Organization (JCAHO)

Institutional Policies & procedures

Nursing Literature

Physicians order

American Medical Association National Joint Practice Committee (NJPC)

Graduate Nursing programTypes of Nursing Care Standards

1. Normative Standard- Practices considered good or ideal2. Empirical Standard Practices actually observed in a large no. of patie3. Structural4. Process5. Outcome

All managers exercise control by:1. Knowing or establishing the standards that relate to a particular course of action.2. Measuring actual performance against the standards

3. Correcting deviations from standards.

Standards by the American Nurses Association

Standard I The division of nursing has a philosophy and structure that insure the delivery

of high quality nursing care and provide means resolving nursing practice issues throughout

the health care organization.

Standard II - The division of nursing is administered by a qualified nurse executive who is a

member of corporate organizations.

Standard III - Policies and practices of the division of nursing provide for quality and

continuity of nursing services that recognized cultural, economic and social differences

among patients of the health care organizations.

Standard IV - The division of nursing ensures that the nursing process is used to design andto provide nursing care to meet the individual needs of the parents/clients in the context of

their families.

Standard V The division of nursing provides an environment that ensures the effective of

nursing practice.

Standard VI The division of nursing ensures the development of educational programs to

support the delivery of high quality nursing care.

Standard VII The division of nursing initiates utilizes and participates in research studies

or projects for the improvement of patient care.

III. Implications to Nursing Care

Controlling is implemented throughout all phases of management. Quality control gives employees feedback about their current quality of care as well as

how their care can be improved.

Quality control evaluates monitors and regulates services rendered to consumers.

In quality control, clients must also be actively involved ( Hughes,1987)

Clinical practice guidelines provide diagnosis-based step by step interventions fornurses to follow in an effort to promote high quality care and yet control resourceutilization and costs.

Process audits are used to measure the process of care on how care was carried out.

Structure audits monitor the structure or setting in which patient acre occurs.

As direct givers, staff nurse are in an excellent position to monitor nursing practice byidentifying problems and implementing corrective actions that have the greatest

impact on patient care.

pg. 9

controlling.ana

Documents