Leadership and ManagementMa. Irma C. Bustamante, RN, PhDDefinitionsLeadership is the ability to influence people.Management is the process of getting work done through others.Comparison

LEADER MANAGER May not have

delegated authority. Obtains power

through influence Possess a wide

variety of roles May not be a part of

the formal organization

Focus on group process, information gathering, feedback, & empowering others.

Emphasize interpersonal relationships

Direct willing followers

Have goals that may or may not reflect the formal organization

Have assigned position within organizations

Obtain power through delegated authority

Expected to carry out specific functions

Always a part of the formal organization

Emphasize control, decision making, decision analysis & results.

Manipulate people and resources to achieve goals

Direct willing and unwilling subordinates

Have greater formal responsibility & accountability for control

14 Management PrinciplesHenri Fayol1. Division of work: allows specialization. Individuals

build up experience and improve their skills making them more productive.

2. Authority: right to command balanced with responsibility and accountability

3. Discipline: employees will only obey orders if management play their part by providing good leadership.

4. Unity of command: there should only be one boss with no conflicting lines of command.

5. Unity of direction: people engaged in the same kind of activities must have the same objectives in a single plan.

6. Subordination of individual interest to general interest: the goals of the firms are always paramount.

7. Remuneration: payment is an important motivator.8. Centralization or Decentralization: this depends

on the condition of the business and the quality of its personnel

9. Scalar chain/line of authority: refers to the number of levels in the hierarchy. It should not be over stretched and consist of too many levels

10. Order: both material order (minimizes lost time & useless handling of materials) and social order (achieved through organization and selection) are necessary.

11. Equity: a combination of kindness and justice is needed. Employees should be treated well to achieve equity.

12. Stability of tenure of personnel: job security and career progress are important for employees to work better. High turnover affects the organization adversely

13. Initiative: allow personnel to show their initiative, it may be a source of strength for the organization.

14. Esprit de corps: management should foster the moral of employees. There is a need to coordinate effort, encourage keenness, use each person’s abilities, and reward each one’s merit w/o arousing jealousies and disturbing harmonious relations.

Theories of Management Frederick Taylor: Theory of Scientific

Management states that work should be studied scientifically to determine the method of task performance that would yield maximum work output with minimum work expenditure.

Henri Fayol: 14 Principles of Management Max Weber: Theory of Social and Economic

Organization advocated bureaucracy Mary Follett: emphasized training and suggested

that manager and employees should analyze the situation and take orders from the situation.

Elton Mayo & Fritz Roethlisberger: much more than the physical environment affects work productivity. Factors such as support from fellow workers, norms established by work group, opportunity to participate in decision making & recognition are important.

Kurt Lewin: Field Theory of Human Behavior describes the process of attitude and behavior change which are unfreezing, changing, and refreezing.

Douglas McGregor: Theory X and Theory Y. Theory X assumes that the average individual dislikes work & will avoid it, prefers to be directed, & more interested in financial than personal gains therefore they must be force & threatened. Theory Y assumes that work is as natural as play, workers have self control and self direction, and accepts responsibility.

Frederick Herzberg: Two-factor Theory identified two factors which motivate employees. Motivators or satisfiers include achievements, recognition, possibility for growth, and status. Hygiene or maintenance factors or dissatisfiers are salary, supervision, job security, working conditions, and interpersonal relations.

Chris Argyris: The rigid structure and stringent rules of bureaucracy block normal maturational changes and encourages passivity & dependency therefore diminishing job satisfaction.

Rensis Likert: System 4 Approach to Organizational Development – superiors and subordinates demonstrate trust in each other, information flows freely, group participation, decisions made at all levels

Herbert Simon: Two approaches to decision making – Optimizing approach used by the economic man where he seeks to achieve the greatest possible gain from each management decision. Satisficing approach used by the administrative man where one looks not at the best solution to a problem but one that is good enough.

Alvin Toffler: emphasized the increasing speed of change and the too rapid arrival of the future leading to “future shock”, a physical and psychological distress process. People must design personal and change regulators to decelerate change by modifying reactions.

Henry Mintzberg: identified the manager’s roles as interpersonal, informational, and decision roles.

William Ouchi: Theory Z involves lifetime employment, collective decision making, decision from within, non-specialized career paths.

Management ProcessPlanning: thinking ahead and making future projections to achieve desired results. It involves: 1. Forecasting 2. Setting objectives 3. Developing schedules and programs 4. Preparing budgets and allocating resources 5. Establishing policies and procedures

Management Process

Organizing: establishing formal authority. It involves: 1. Setting up the organizational structure 2. Determining the staff needed 3. Developing job descriptions

Directing or leading: actuating efforts to accomplish goals. It involves: 1. Decision making 2. Developing people 3. Communicating 4. Coordinating 5. Supervising 6. Utilizing, revising, & updating policies 7. Delegating 8. Conflict management

Controlling: assessing and regulating performances. It involves: 1. Specifying criteria and standards 2. Monitoring and evaluating. 3. Performance appraisal 4. Total quality management

PLANNINGMa. Irma C. Bustamante, RN, PhD

Planning is deciding in advance what to do; who is to do it; and how, when, and where it is to be done.

Planning Together

Kinds of planningStrategic planning or long range planning extends from 3 – 5 years.

Operational planning or short range planning extends from a few months to a year.Strategic planning

Purposes – It clarifies the following: 1. Beliefs and values 2. Strengths and weaknesses 3. Opportunities and threats 4. Direction of the organization EFFICIENCY

Strategic planning processSituational analysisDevelopment of: 1. Purpose or mission statement 2. Philosophy 3. Vision 4. Goals 5. Objectives

Organizations exist for a purpose. The mission is a brief statement identifying the reason why an organization exists and its future aim or function. This statement identifies the organization’s constituency and addresses its position regarding ethics, principles, and standards of practice.

The philosophy flows from the mission statement and delineates the set of values and beliefs that guide all actions of the organization. It is the basic foundation that directs all further planning towards the mission.

A value is a quality having intrinsic worth for a society or an individual.

Vision provides a picture of the future. It is an imagination or a dream.Healthy visions:

1. Stretch the possible 2. Are grounded in reality 3. Require courage 4. Are based on sound values and ethics

Goals and objectives are the ends toward which the organization is working. All philosophy must be translated into goals and objectives if they are to result into action. Thus, goals and objectives operationalize the philosophy.

A goal is the desired result toward which effort is directed.

Objectives motivate people to specific end and are explicit, measureable, observable,retrievable and attainable.

Example: BON MissionMISSION The BON shall unwaveringly pursue the advancement of nursing development in the country by:1. Providing leadership, information, options, scenarios and lobby efforts to targeted decision makers and stakeholders 2. Ensuring adherence to professional, ethical and legal standards as mandated by existing regulatory laws 3. Unifying the nursing sector through good governance 4. Fostering linkages with the domestic and international stakeholders Example: BON Core ValuesCORE VALUES

1. Love of God 2. Caring as the core of

nursing Compassion Competence Confidence Conscience Commitment

Example: BON Core ValuesCORE VALUES 3. Love of People Respect for the dignity of persons regardless of race, color, or creed 4. Love of Country Patriotism Civic duty, social responsibility and good governance Preservation and enrichment of our culture and environmentExample: BON VisionVISION The Board of Nursing under the guidance of the Almighty, with its unquestionable integrity and commitment, envisions itself to be the ultimate authority in regulating the nursing profession in the Philippines and to lead nursing development to its highest level of excellence.

ForecastingForecasting is estimating the future.It is setting the outline of work to be done.It is the primary process of selecting and relating facts, making use of assumptions regarding the future, and formulating activities necessary to achieve the desired results.

PoliciesPolicies are plans reduced to statements or instructions that direct organizations in their decision making.

They are derived from the organization’s philosophy, goals, and objectives.They direct individual behavior towards the organizational mission and define broad limits.It provides management with a means of internal control.

PoliciesImplied policies are neither written nor expressed verbally. They are developed over time and follow a precedent.

Expressed policies are delineated verbally or in writing. They promote consistency of actions.

ProceduresProcedures are plans that establish customary or acceptable ways of accomplishing a specific task and delineate a sequence of steps of required action.They identify the process needed to implement the policy.They are found in manuals of the organization.

ProgramsA program is a planned sequence and combination of activities designed to achieve specified goals.It normally involve: equipment, materials, money, personnel, and time.The term project is often used interchangeably with program in the academic circle.

BudgetA budget is an itemized summary of probable expenses and income for an organization over a period of time.The outcome of budgeting is maximal use of resources to meet organizational short and long term needs.

Types of budgetsPersonnel budget: expenditure used for the work force

Operating budget: reflects expenses that change in response to the volume of service. It includes daily expenses, cost of electricity, repairs, maintenance, and supplies.

Capital expenditure budget is composed of major actuations and short term budgeting components. Examples are purchase of buildings, major equipments that has long life (5 to 7 years).

Types of budget systemCentralized budgeting: budgets are derived and imposed by the comptroller and administration of the organization.

Decentralized budgeting: budgets are prepared by those who must implement them e.g. middle level managers.

Approaches to budget developmentOpen-ended budget: managers are given no explicit guidelines regarding budget amounts and are allowed to submit whatever amounts they consider necessary to run the department.

Fixed-ceiling budget: is constrained by the amount that is specifically stated for each department

Work measurement and unit costing: requires that a measuring criterion be established to determine the number of products or service units to be generated, based on this, the cost per unit can be determined and the budget projected.

Performance based budgeting (PBB): use statements of missions, goals and objectives to explain why the

money is being spent. It is a way to allocate resources to achieve specific objectives based on program goals and measured results. The elements are: 1. Result: the final outcome 2. Strategy: ways to achieve the final outcome 3. Activity/outputs: what is actually done to achieve the final outcome.

Zero based budgeting (ZBB): a method where all expenses must be justified for each new period. It starts from a "zero base" and every function within an organization is analyzed for its needs and costs. Budgets are then built around what is needed for the upcoming period, regardless of whether the budget is higher or lower than the previous one.

Allocation of resourcesAllocation of resources involves the minimal use of money, manpower, materials, machines, space and time (moment) to get the job done in a specified period.

Cost effectivenessCost effectiveness is the result of careful fiscal planning.It does not mean inexpensive.It means getting the most for your money or that the product is worth the price.A beautiful quoteEven the most rational approach is defenseless if there isn’t the will to do what is right.

Aleksandr Isayevich Solzhenitsyn Russian Novelist

Nobel Prize in Literature (1970)

OrganizingMa. Irma C. Bustamante, RN, PhD

Organizational structureAn organizational structure refers to the way a group is formed, its lines of communication, and its means for channeling authority, and making decisions.Each organization has a formal and an informal organizational structure.

The formal structure is generally highly planned and publicized.It provides a framework for defining managerial authority, responsibility, and accountability.Roles and functions are defined and systematically arranged, different people have different roles, rank and hierarchy are evident.

Informal structure is generally social in nature with blurred or shifting lines of authority and accountability.People need to be aware that informal authority and lines of communication exist in every group, even when they are never formally acknowledged.

Types of organizational structuresBureaucratic organizational designs are commonly called line structures or line organizations.Authority and responsibility are clearly defined which leads to efficiency and simplicity of relationships.Bureaucratic structure

Types of organizational structuresThe ad hoc design is a modification of the bureaucratic structure and is sometimes used on a temporary basis to facilitate completion of a project within a formal line organization.

It is a means of overcoming the inflexibility of line structure and serves as a way for professionals to handle the increasingly large amount of information.

A hierarchical organizational structure is a pyramid shaped systems that arranges the relations between the entities within an organization in a top-down way.Power, responsibility, and authority are concentrated at the top of the pyramid and decisions flow from the top downwards.

Hierarchical/Pyramidal

A matrix organization structure is designed to focus on both product and function.Function is described as all the tasks required to produce the product.The product is the end result of the function.Typical Matrix StructureMatrix Organization

Flat organizational designs are an effort to remove hierarchal layers by flattening the scalar chain and decentralizing the organization.More decision making and authority can occur where the work is being carried out. Flat Organizational Structure

Shared governance’s aim is the empowerment of people in the decision-making system.The organization’s governance is shared among board members, nurses, physicians, and managers.Participatory management is the foundation for shared governance.

StaffingStaffing is the process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patient’s demands.

Staffing involves the selection of personnel and assignment systems and the determination of staffing schedules.It involves recruitment, selection, orientation, personnel development, retention, and retirement. (in lay man’s terms it is from hiring to firing)

Recruitment is the process of actively seeking out or attracting applicants for existing positions.A leadership role in staffing includes identifying, recruiting, and hiring gifted people.

Selection is the process of choosing from among applicants the best qualified individual (s) for a particular job or position.This happens after the applications were completed and the interviews have been completed.

Introduction provides the employee with general information about the organization, whereas orientation activities are more specific for the position.The purpose of the orientation process is to make the employee a part of the team thereby increasing the probability of productivity and retention.

Staff development is the continuing liberal education of the whole person to develop her potential fully.It deals with the aesthetic senses as well as spiritual, technical and professional education.It includes in-service, courses, conferences, seminars, journal and book clubs, programmed learning, and independent studies.

In-service training is the education for employees to help them develop their skills in a specific discipline or occupation.Continuing education refers to the post college education that individuals engage in to enhance their professional growth.

StaffingSome turnover is normal and may be desirable because it infuses the organization with fresh ideas.Excessive and unnecessary turnover is expensive and may reduce the ability of the organization to achieve its goals.

Retention may be enhanced if there is a close fit between what the nurse is seeking in employment and what the organization can offer.

Nursing care deliveryCase method: each patient is assigned to a nurse for total patient care while that nurse is on duty.Functional nursing: involves regimentation of tasks or functions.Team nursing: utilizes the knowledge and skills of professional nurses to supervise auxiliary nursing staff at different levels.

Primary nursing: features a nurse who gives total patient care to 4 – 6 patients while she is on duty and remains responsible for the care of those patients 24/7 throughout the patient’s hospitalization.Private duty nursing: nurses provide total patient care while on duty to patients who directly pay them for professional services.

Nurse case manager: works to ensure that quality health care is being delivered in an efficient, cost-effective manner to individual patients as they move from setting to setting within the health care system. A Nurse Case Manager usually specializes in the delivery of care to a specific population, such as adults, families, children, the elderly, AIDS patients, patients with cardiovascular disease, etc.

The primary role of a case manager is to coordinate the continuity of care and to ensure that patients get the proper treatment at the proper time to maximize health and minimize hospitalization.

Clinical pathways delineate a predetermined written plan of care for a particular health problem. They specify desired outcomes and transdisciplinary intervention.Patient classification system

Category I – Self care: requires 1 – 2 hours of nursing care/dayCategory II – Minimal care: requires 3 – 4 hours of nursing care/dayCategory III – Intermediate care: requires 5 – 6 hours of nursing care/dayCategory IV – Modified intensive care: requires 7 – 8 hours of nursing care/dayCategory V – Intensive care: requires 10 – 14 hours of nursing care/day

Job descriptionJob descriptions are derived from job analysis and are affected by job evaluation and design.They contain specifications that are the requirements for the job, major duties and responsibilities, and the organizational relationships of the given position.The title of the job indicates the major responsibilities and sets that job apart from others.Making patient assignments

Assignments are based on: 1. Patient needs 2. Available staff 3. Job descriptions 4. Scope of practice for licensed nurses 5. Scope of functions

National League for NursesFormula for StaffingABO X NCH = Total # of Nursing # of working hrs Service Personnel for 24 hoursWhere: ABO = Average Bed Occupancy NCH = Nursing Care Hours # of working hours = 8 Based on RA 5901 The 40 Working Hours per Week Law

Formula for StaffingStandard values for NCH Medical = 3.4 OB = 3.0 Surgical = 3.4 Pedia = 4.6 Mixed MS = 3.5 Nursery = 2.8

Formula for Staffing% of Professionals to Non-professionals Formula for Staffing% Distribution per Shift Morning = 45% Afternoon = 37% Night = 18%

Staffing for an OB Ward: 30 Beds 30 X 3.0 = 11 nursing personnel 8 for 24 hours% of Professionals to Non-professionals Professionals: 11 X 0.6 = 7 Non-professionals: 11 X 0.4 = 4 Staffing for an OB Ward: 30 BedsDistribution per Shift Professionals Non-professionalsAM: 7 X 0.45 = 3 4 X 0.45 = 2PM: 7 X 0.37 = 3 4 X 0.37 = 1Night: 7 X 0.18 = 1 4 X 0.18 = 1 Staffing for an OB Ward: 30 BedsSummary of Staffing: OB Ward 30 Beds Types of SchedulingCentralized: one person, usually the DON or a designate assigns personnel scheduleDecentralized: the supervisor or head nurse do the schedulingCyclical schedule: a cycle of shift is repeated e. g. Afternoon to Morning to Night to RelieverRemember People who have given up are ruled by their darkest mistakes, worst failures, and deepest regrets. If you want to be successful, then be governed by your finest thoughts, your highest enthusiasm, your greatest optimism, and your most triumphant experiences. John C. Maxwell

DirectingMa. Irma C. Bustamante, RN, PhDLeadership qualities for directing• Ability to lead• Ability to guide• Ability to show the way

Types of Leaders• Formal leader is a member of organization who has

given authority by virtue of his position to influence other members of organization to achieve organizational goals.

• An informal leader has no formal organizational authority to influence others but possesses special skills and talent to influence and lead other members of organization.

Continuum of Leadership BehaviorLeadership theories• Great man theory: its premise is leaders are born

and not made• Charismatic theory: a person may be a leader

because of charisma, an inspirational quality• Trait theory: traits are inherited but may be

improved by learning and experience. Traits are: energy, drive, enthusiasm, ambition, decisiveness, self-assurance, self-confidence, friendliness, honesty, dependability, & mastery.

• Leadership theories• Later research on trait theory found other traits:

intelligence, initiative, creativity, emotional maturity, communication skills, persuasion, perceptive, & sociable

• Situational theories: traits required of a leader differ according to varying situations.

• Leadership theories• Contingency theory: Fred Fiedler identified 3

aspects of a situation that structure the leader’s role. They are:

1. Leader-member relations 2. Task structure 3. Position power

• Leadership theories• Path-goal theory: (Robert House) the leader

facilitates task accomplishment by minimizing obstruction to the goals and by rewarding followers for completing their tasks.

• Life-cycle theory: predicts the most appropriate leadership style from the level of maturity of the followers

• Integrative leadership model: leadership behavior needs to be adaptive.

•• Transformational leadership: is a leadership

style where one or more persons engage with others in such a way that leaders and followers raise one another to higher levels of motivation and morality. It was described by James MacGregor Burns in 1978.

• “Selling style”

• Transactional leader: works through creating clear structures whereby it is clear what is required of their subordinates, and the rewards that they get for following orders.

• Allocates work to a subordinate, they are considered to be fully responsible for it, whether or not they have the resources or capability to carry it out. When things go wrong, then the subordinate is considered to be personally at fault, and is punished for their failure (just as they are rewarded for succeeding). “Telling style”

• Servant leadership: Greenleaf (1977) says that true leadership "emerges from those whose primary motivation is a deep desire to help others." Servant leadership is a very moral position, putting the well-being of the followers before other goals.

•

• Principles of servant leadership defined by the Alliance for Servant Leadership are:

• Transformation as a vehicle for personal and institutional growth.

• Personal growth as a route to better serve others.

• Enabling environments that empower and encourage service.

• Service as a fundamental goals. • Trusting relationships as a basic platform for

collaboration and service. • Creating commitment as a way to collaborative

activity. • Community building as a way to create

environments in which people can trust each other and work together.

• Nurturing the spirit as a way to provide joy and fulfillment in meaningful work.

•• Autocratic: leader has total control• Democratic: leader shares power with the

people• Bureaucratic: leader bases leadership on

implementing rules• Laissez faire: leader is permissive• Multicratic: leader uses different styles and is

situation based• Guess the leadership style• Guess the leadership style• Guess the leadership style• Levels of Leadership:

Dr. John C. Maxwell• Power• Power• Power is the ability to impose the will.• The different forms of power are (French and

Raven, 1959) 1. Legitimate power: given by virtue of position. Authority is the legitimate right to give commands. 2. Reward power: based on the ability to give rewards 3. Coercive power: based on the ability to give punishment

• Power• Forms of power…cont

4. Expert power: based on a special ability, knowledge, or skill demonstrated by an individual. Ex. “Knowledge is power.” 5. Referent power: based on the attractiveness or appeal of one person to another or based on a persons connections or relationship with another powerful individual

• Is this true?• Decision making• Decision making is the process of selecting

one course of action from alternatives.• Decision making process• Identify the problem• Explore alternatives• Choose the most desirable alternative• Implement decision• Evaluate results• Decision tree• A decision tree is a graphic method that can

help visualize the alternatives available, outcomes, risks, and information needs for a specific problem.

Nothing is more difficult, and therefore more precious,than to be able to decide. - Napoleon

Communication• All management process involve

communication.• Forms: verbal and non-verbal• Process: Sender Message

Receiver

• Downward communication: traditional line of communication from the superior to the subordinate. It helps coordinate activities at different levels.

• Upward communication: provides a means of motivating and satisfying personnel by allowing employee input.

• Lateral communication or horizontal communication is between personnel of the same level.

• Diagonal communication occurs between individuals or departments that are not of the same level.

• The grapevine: informal methods of communication co-existing with formal channels. It moves fast and is often distorted, fragmentary, and incomplete.

• Barriers to communication: 1. Personal/emotional 2. Physical/environmental 3. Semantic

• Improving communication 1. Ideas should be clarified 2. Consider the setting 3. Be organized 4. Actions speak louder than words 5. Listen

• Conflict• A conflict is present when an inner or an outer

struggle occurs regarding ideas, feelings or actions.

• Conflict• Kinds of conflict:

1. Intrapersonal – conflict within the individual 2. Interpersonal – between individuals 3. Interdepartmental – between departments 4. Intradepartmental – within departments 5. Extrainstitutional – between organizations Conflict resolution

• Competition/Power: there is an all out effort to win regardless of the cost. It reflects a strong stance to defend important principles or protect vulnerable parties.

• Smoothing: diplomatic way – relationships are important

• Avoidance: not taking a position regarding the conflict

• Compromise: each side makes a concession. It is used when time pressures require quick solution or when each party is firmly committed to different views.

• Collaborative problem solving: a constructive process in which the parties involved recognize that conflicts exist, confronts the issue, and openly try to solve the problem that has arisen between them. It builds understanding

• Accommodation: is used when the other person really does have a better idea. Agreement is reached.

• Controlling• Ma. Irma C. Bustamante, RN, PhD• Quality control• Quality control is a specific type of controlling

that include activities that evaluate, monitor or regulate services rendered to consumers

• Quality control• Effective quality control entails:• 1. Program needs to be supported by top level

administrators.

• 2. Sincere commitment by the institution as evidenced by fiscal and human resource support.

• 3. Presence of a developed quality control criteria

• Quality control process• Determine criterion or standard• Collect information if the standard has been met.• Educational or corrective action is taken if the

standard has not been met.• Standard• A standard is a predetermined level of

excellence that serves as a guide for practice.• Characteristics:• 1. Predetermined• 2. Established by authority• 3. Communicated to and accepted by people

affected by the standard.• Standards • Standards of Nursing Practice: Code• PNA of• Standards of Safe Nursing Practice: Ethics• ANSAP • CMO # 5 s. 2008: CHED – TCNE PNA• RA 9173: Nursing Law ICN• Audits• While standards provide the yardstick for

measuring quality, audits are measurement tools.

• An audit is a systematic and official examination of record, process, structure, environment, or account to evaluate performance.

• Audits• Retrospective audits are performed after the

client receive the service.• Concurrent audits are performed while the

client is receiving the service.• Prospective audits attempt to identify how

future performance will be affected by current interventions

• Audits• Outcome audits determine what results

occurred as a result of specific nursing interventions to clients.

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

• Structure audit monitors the structure or setting in which patient care occurs.

• Accreditation• Accreditation is the voluntary process of being

certified as meeting the minimum requirements as designated by an accrediting agency.

• It engages the organization in meeting high quality standards, implementing a continuous improvement process, and engaging in quality assurance through internal and external review.

• Accreditation• Joint Commission International, or JCI, is one

of the groups providing international healthcare accreditation services to hospitals around the world and brings income into the US-based parent organisation. This not-for-profit private company currently accredits hospitals in Asia, Europe, the Middle East and South America, and is seeking to expand its business further.

• Accreditation• ISO (International Organization for

Standardization) is the world's largest developer and publisher of International Standards.

• ISO is a network of the national standards institutes of 157 countries, one member per

country, with a Central Secretariat in Geneva, Switzerland, that coordinates the system.

• Accreditation• PACUCOA – Philippine Association of Colleges

and Universities Commission on Accreditation• PAASCU – Philippine Accrediting Association of

Schools, Colleges, and Universities.• Performance Appraisal• Performance appraisal is an assessment of

how well employees perform the duties of their job as delineated by the job description.

• If done fairly, it increases the employees motivation because it identifies areas where one can improve.

• Methods• Anecdotal notes are objective descriptions of

behaviors recorded on paper.• Rating scales locates behavior at a point on a

continuum.• Ranking forces the appraiser to rank staff in

descending order from highest to lowest even if she does not feel there is a difference.

• Methods• Management by Objectives (MBO) is a tool for

effective planning and appraisal. It emphasizes the achievement of objectives instead of personality characteristics. It focuses attention on individual achievement, motivates individuals to accomplish and measures performance in terms of results. Main

• proponent: Peter• Drucker• Pitfalls to avoid in appraisal• Halo effect occurs when the appraiser lets one

or two positive aspects of the assessment or behavior of the employee unduly influence all other aspects of the employee’s performance.

• Pitfalls to avoid in appraisal• Horn effect occurs when the appraiser allows

negative aspects of the employee’s performance to influence the assessment to such an extent that other levels of job performance are not accurately recorded.

• Pitfalls to avoid in appraisal• Central tendency is hesitancy on the part of the

appraiser to risk true assessment and therefore rate all employees as average.

• Pitfalls to avoid in appraisal• First impression error is making initial positive

or negative judgment and allow that first impression to color or distort one’s evaluation.

• Pitfalls to avoid in appraisal• Stereotyping error is the tendency to

generalize across groups and ignore individual differences.

Delegation• Delegation is the process of assigning work

from one organizational level to another or from superior to subordinate.

• It is transferring the responsibility of performing a nursing activity to another person while retaining accountability for the outcome.

• DelegationPurposes

• It is a tool that may be used by the registered professional nurse to allow unlicensed assistive personnel (UAP) to provide standardized routine health services under the supervision of the nurse when permitted by the Nurse Practice Act and supported by the nurse’s clinical judgment to be appropriate.

• DelegationPurposes

• It maximizes the utilization of every health care worker and ensure proper delegation of responsibilities and tasks

• It uses latent abilities of personnel that contribute to their growth and development.

• Delegation: Definitions• Accountability: Being responsible and

answerable for actions and inactions of self or others in the context of delegation.

• Delegator: The person making the delegation.• Delegatee: The person receiving the delegation. • Delegation: Definitions• Supervision: The provision of guidance or

direction, evaluation and follow-up by the licensed nurse for accomplishment of a nursing task delegated to unlicensed assistive personnel.

• Unlicensed Assistive Personnel (UAP): Any unlicensed personnel, regardless of title, to whom nursing tasks are delegated

• 5 Rights of Delegation1. Right TaskOne that is delegable for a specific patient. 2. Right CircumstancesAppropriate patient setting, available resources, and other relevant factors considered.

• 5 Rights of Delegation 3. Right Person

Right person is delegating the right task to the right person to be performed on the right person.

4. Right Direction/CommunicationClear, concise description of the task, including its objective, limits and expectations.

• 5 Rights of Delegation 5. Right Supervision

Appropriate monitoring, evaluation, intervention, as needed, and feedback.

ControllingMa. Irma C. Bustamante, RN, PhDQuality controlQuality control is a specific type of controlling that include activities that evaluate, monitor or regulate services rendered to consumers

Quality controlEffective quality control entails: 1. Program needs to be supported by top level administrators. 2. Sincere commitment by the institution as evidenced by fiscal and human resource support. 3. Presence of a developed quality control criteria

Quality control processDetermine criterion or standardCollect information if the standard has been met.Educational or corrective action is taken if the standard has not been met.

StandardA standard is a predetermined level of excellence that serves as a guide for practice.Characteristics: 1. Predetermined 2. Established by authority 3. Communicated to and accepted by people affected by the standard.Standards Standards of Nursing Practice: Code PNA ofStandards of Safe Nursing Practice: Ethics ANSAP CMO # 5 s. 2008: CHED – TCNE PNA

RA 9173: Nursing Law ICNAuditsWhile standards provide the yardstick for measuring quality, audits are measurement tools.An audit is a systematic and official examination of record, process, structure, environment, or account to evaluate performance.Audits

Retrospective audits are performed after the client receive the service.

Concurrent audits are performed while the client is receiving the service.

Prospective audits attempt to identify how future performance will be affected by current interventionsAudits

Outcome audits determine what results occurred as a result of specific nursing interventions to clients.

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

Structure audit monitors the structure or setting in which patient care occurs.

AccreditationAccreditation is the voluntary process of being certified as meeting the minimum requirements as designated by an accrediting agency.It engages the organization in meeting high quality standards, implementing a continuous improvement process, and engaging in quality assurance through internal and external review.Accreditation

Joint Commission International, or JCI, is one of the groups providing international healthcare accreditation services to hospitals around the world and brings income into the US-based parent organisation. This not-for-profit private company currently accredits hospitals in Asia, Europe, the Middle East and South America, and is seeking to expand its business further.

AccreditationISO (International Organization for Standardization) is the world's largest developer and publisher of International Standards.ISO is a network of the national standards institutes of 157 countries, one member per country, with a Central Secretariat in Geneva, Switzerland, that coordinates the system.

PACUCOA – Philippine Association of Colleges and Universities Commission on Accreditation

PAASCU – Philippine Accrediting Association of Schools, Colleges, and Universities.

Performance AppraisalPerformance appraisal is an assessment of how well employees perform the duties of their job as delineated by the job description.If done fairly, it increases the employees motivation because it identifies areas where one can improve.

MethodsAnecdotal notes are objective descriptions of behaviors recorded on paper.Rating scales locates behavior at a point on a continuum.

Ranking forces the appraiser to rank staff in descending order from highest to lowest even if she does not feel there is a difference.Management by Objectives (MBO) is a tool for effective planning and appraisal. It emphasizes the achievement of objectives instead of personality characteristics. It focuses attention on individual achievement, motivates individuals to accomplish and measures performance in terms of results. Main proponent: Peter DruckerPitfalls to avoid in appraisal

Halo effect occurs when the appraiser lets one or two positive aspects of the assessment or behavior of the employee unduly influence all other aspects of the employee’s performance.Pitfalls to avoid in appraisalHorn effect occurs when the appraiser allows negative aspects of the employee’s performance to influence the assessment to such an extent that other levels of job performance are not accurately recorded.Pitfalls to avoid in appraisalCentral tendency is hesitancy on the part of the appraiser to risk true assessment and therefore rate all employees as average.Pitfalls to avoid in appraisalFirst impression error is making initial positive or negative judgment and allow that first impression to color or distort one’s evaluation.Pitfalls to avoid in appraisalStereotyping error is the tendency to generalize across groups and ignore individual differences.

Quick ChecksLeadership and Management Ma. Irma C. Bustamante, RN, PhDMrs. Agusto has just been appointed as Chief Nurse of a 150 bed hospital because she is the only one from among the nursing service personnel with an MAN. As such, she is a: A. Leader B. Manager C. Both D. NeitherAfter 6 months of service, with good performance, Miss Rosario has been classified as permanent employee. This is in line with which management principle? A. Scalar chain B. Remuneration C. Equity D. Stability of tenureThe process of attitude and behavior change described as unfreezing, change, and refreezing was developed by: A. Kurt Lewin B. Frederick Taylor C. Douglas McGregor D. Alvin TofflerWhen Mrs. Agusto engages in setting objectives and preparing the budget for the nursing service department, she is doing: A. Planning B. Organizing C. Directing D. ControllingMrs. Agusto called for a meeting with the supervisors to discuss understaffing and the need to hire new nurses. They are engaging in: A. Planning B. Organizing C. Directing D. ControllingTo be able to provide a temporary remedy to understaffing, Mrs. Agusto delegated her supervisors to

have the nurses on the floors divide the tasks to finish the work. What nursing care delivery has been utilized? A. Case method B. Functional method C. team Nursing D. Primary nursingWhat style of leadership is being utilized by Mrs. Agusto? A. Autocratic B. Bureaucratic C. Democratic D. Laissez faireMiss Manuel, one of the supervisors, decided to hold a journal club in her units once a week. Which aspect of directing is involved? A. Coordinating B. Developing people C. Communicating D. SupervisingHow can Miss Manuel identify the weaknesses and strengths of the nurses under her supervision? A. Through performance appraisal B. Through interviews with doctors C. Through interviews with patients D. Through a course auditMrs Agusto has been hearing unfavorable stories about one of her head nurses. These came from the staff and some nursing aids. This communication is: A. Downward communication B. Lateral communication C. Diagonal Communication D. Grapevine