nov 2013 planning

8/10/2019 Nov 2013 Planning

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PLANNINGCECILLE O. MARTINEZ

RN,RM,MAN, EdD (c)


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PLANNING

Planning may be defined as a decidingin advance what to do; Who is to doit; and how; when, and where it is tobe done.

Therefore all planning involves achoice : a necessity to choose fromamong alternatives.

This definition implies that planningis proactive and deliberated process

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Planning Planning is concerned with the futureimpact of today's decisions. It is the fundamental function of

management from which the otherfour stem. The organizing, staffing, leading and

controlling functions stem from theplanning function


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PLANNING The manager is ready to organize and staff only

after goals and plans to reach the goals are inplace. Likewise, the leading function, influencing the

behavior of people in the organization, depends onthe goals to be achieved.

Finally, in the controlling function, thedetermination of whether or not goals are beingaccomplished and standards met is based on theplanning function.

The planning function provides the goals andstandards that drive the controlling function.


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Importance of PlanningPlanning leads to achievement ofgoals and objectivesPlanning gives meaning to work

Planning provides for effective useof available resources and facilities(best use of personnel and material

resources prevents wastage)Planning helps in coping with crisis

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Importance of Planning

Planning is cost effective costscan be controlled through planningfor efficient operation

Projecting the number of operations in a givenday, including daily dressings, helps indetermining accurately the needed weeklysupplies in the surgical units so as to preventundersupply, oversupply or pilferages (taken byother person)

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Importance of PlanningPlanning is based on the past and

future activities evaluation of programs,schedule and activities whether successful or notprevent and/or reduces the recurrence ofproblem and provides better ideas in modifying oravoiding them

Planning leads to the realization ofthe need for change establishment ofOPD rather than admission can greatly reduced

days in hospitalPlanning provides the basis forcontrol - basis for evaluating theaccomplishment of a program

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Importance of Planning

Planning is necessary for effectivecontrol nurse manager evaluate the

environment or setting in which they workor where the patients are confined andmake necessary recommendations to makehospital conditions more therapeutic not

only for the patients but for the workersas well.

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4 MAJOR ASPECTS

OF PLANNING1. PLANNING SHOULD CONTRIBUTETO OBJECTIVE

2. PLANNING PRECEDES ALL OTHERPROCESSES OF MANAGEMENT3. PLANNING PERVADES ALL

LEVELS4. PLANNING SHOULD BE

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Four Stages of Planning 1. Establish objectives (goals) 2. Evaluate the present situation and

predict future trends and events 3. Formulate a planning statement

(means)

4. Convert the plan into an actionstatement

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Planning Terminology Vision - Statement that outlines the

organizations future role andfunction Gives the agency something to strive for Nonspecific directional and motivational

guidance for the entire organization.

Top managers normally provide a vision for thebusiness. It is the most emotional of the four levels in

the hierarchy of purposes.


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Planning Terminology Mission statement that outlines

the agencys reason for existing(whether hospital or health care) It is concerned with scope of the business andwhat distinguishes this business from similar

businesses (includes: who the target clients are( the poor, the needy, middle and upper class);and what services will be provided (in-patient,out-patient, ER)

Mission reflects the culture and values of topmanagement.


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Planning Terminology

Philosophy describes the vision It is a statement of belief and values that direc

ones life or ones practice In an organization, it is the sense of purpose of

the organization and the reason behind itsstructure and goals

Its a written statement of philosophy thatexplains the belief that shape how the mission opurpose will be achieved

It gives direction towards the attainment of the13


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Planning Terminology Objectives Objectives refine the mission and address key

issues within the organization They are concrete and specific in nature

They are expected to be observable,challenging, and untimed.

They are stated in terms of results to beachieve and should focus on the production,

health care services to patients. They are action commitments through which

san organizations mission and purpose will beachieved and the philosophy or belief

sustained.


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Planning Terminology

Goals Goals are general statements of

anticipated results

They are expected to be SMART: S pecific, M easurable, A ttainable,R ewarding, and T imed.


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Planning Terminology Forecasting - helps manager look into the

future and decide in advance where the agencywould like to be and what is to be done in order toget there.

With estimates, provide the basis for planning Includes:

Environment in which the plan will beexecuted

Who the client is their customs, belief, language,dialect barriers. Public attitude and behavior, severityof` condition or illnesses, the kind of care they willreceive.

The number and kind of personnel required The necessary resources

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Planning Terminology Development of tactics is a fifth level of

planning. Tactics , the most specific and narrow

plans, describe who, what, when, where andhow activities will take place to accomplish

a goal.


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TYPE OF PLANNING Strategic Planning - refers to theprocess of continual assessment,

planning, and evaluation to guide thefuture. Its purpose is to create an image of

the desired future and design waysto make those plans a reality.

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Strategic Planning

In strategic planning, managementanalyzes inside and outside factors thatmay affect the company and so objectivesand goals.

Here they should have a study ofstrengths and weaknesses, opportunities

and threats. For management to do this efficiently, ithas to be very practical and ample.


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Tactical Planning Tactical planning deals primarily with

the implementation phase of theplanning process

Tactical planning turns strategy intoreality Tactical planning usually has a 1-2 year time horizon

Tactical planning is usually tightlyintegrated with the annual budgetprocess


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Elements of tactical

planning Project plans Project budgets

Project reviews Monthly reports Annual reports


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Operational Planning

Deals with the day-to-day and week-to-week work routine

Focus is on routine operational tasks and

long-term projects Primary goal is to communicate In many organizations, people are asked to

do both

Weekly meetings are often used tocoordinate efforts and review progress Weekly or monthly summaries are often

used to inform others


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StructureThe structure of operational planning is

closely related to organizational structure In a traditional hierarchical organization,

team leaders usually assemble with asenior manager on a regular basis to shareinformation

Additional periodic meetings are oftenrequired to coordinate efforts with otherunits

In a process-oriented organization, teamsare more ad-hoc in nature, so a mechanismmust be put in place to insurecommunication


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KINDS OF PLAN

1. MISSION OR PURPOSE identifiesthe basic function of theorganization

Defining specific task to be perform2. GOALS AND OBJECTIVES are theresults or achievements toward whicheffort is directed.

These two concepts represent not only the endpoint of the planning but also the end towardwhich organizing, staffing, leading andcontrolling are aimed.


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KINDS OF PLAN

Cont.Goals comprises mission and purpose

statements of the organization in awider perspective

Objectives are goals expressed inconcrete terms that are readilymeasurable.


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KINDS OF PLAN

3. Strategies - involves a plan or aseries of maneuvers for obtaining aspecific goal

-can be defined also as thedetermination of the basic long-termobjectives of an organization and theuse of course of action and allocation

of resources necessary to attainthese goals


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KINDS OF PLAN

4. Policies - basically general statements thatguide or channel the thinking of managers indecision-making

5. Procedures are plans spelled-out in adetailed manner in which certain activities mustbe accomplished

6. Rules are usually the simplest type whichspell out specific required action or non-action.

are regulations promulgated by the agencygoverning conduct observed by employees withoutspecifying a time sequence.


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KINDS OF PLAN7. Programs plans or schedules to be

followed comprised goals, policies,procedures, rules, tasks, assignment,

steps to be taken, resources to beused and other medium necessary tocarry out one as a given course of

action supported by budget8. Budget itemizes estimate ofexpected outcome and expenses


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Characteristics of a

Good Plan A well developed plan should:1. Be precise and clearly-worded

objectives, including desired resultsand methods for evaluation2. Be guided by policies and /or

procedures affecting the plannedaction


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Characteristics of a

Good Plan3. Indicate priorities4. Develop actions that are flexible and

realistic in terms of available personnel,equipment, facilities and time

5. Develop (actions that are flexible) alogical sequence of activities

6. include the most practical methods forachieving each objective, and

7. Perv ades the whole organization


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PRINCIPLES OF

PLANNING1. Planning is always based and focused onthe vision, mission, philosophy and clearlydefined objectives of the organization

2. Planning is a continuous process provision for proper analysis wouldindicate revision of flexibility to be done

to make it more effective


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PRINCIPLES OF

PLANNING3. Planning be pervasive within theentire organization covering the

various department, services andthe various levels of managementto provide maximal cooperationand harmony

4. Planning utilizes all availableresources


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PRINCIPLES OF PLANNING

5. Planning must be precise in its scopeand nature it should be realistic andfocused on its expected outcomes.

6. Planning should be time-bounded(e.g. with short and long range plans)7. Projected plans must be documented

for proper dissemination to allconcerned for implementation andevaluation as to the extent of itsachievement.


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FORECASTING OR ESTIMATING THE


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FORECASTING OR ESTIMATING THEFUTURE

Forecasting - helps manager look into thefuture and decide in advance where the agencywould like to be and what is to be done in order toget there.

With estimates, provide the basis for planning

Includes: Environment in which the plan will be

executed Who the client is their customs, belief, language,

dialect barriers. Public attitude and behavior, severityof` condition or illnesses, the kind of care they willreceive.

The number and kind of personnel required The necessary resources

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DEFINING THE PHILOSOPHY ANDOBJECTIVES

The philosophy flows from the purpose or missionstatement and delineates the set of values andbelief that guide all actions of the organization.It is the basic foundation that directs furtherplanning toward a mission.Societies and organizations have philosophies orsets of beliefs that guide their behavior whichcalled VALUES.Values quality having intrinsic worth for asociety or an individual and identifiesindividualism, the pursuit of self-interests, and

competition.

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DEFINING THE PHILOSOPHY AND OBJECTIVES


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4 CHARACTERISTICS THATDETERMINE A TRUE VALUE :

1. It must be freely chosen from among thealternatives only after due reflection

2. It must be prized and cherished3. It is consciously and consistently repeated

(part of a pattern)4. It is positively affirmed and enacted

IF A VALUE DOES NOT MEET ALL 4CRITERIA, IT IS A VALUE INDICATOR.

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Individual values should not conflictwith the organization.

Manager should have a value systemconsistent with the organization

All philosophies must be translatedinto specific goals and objectives ifthey are to result in action.

Thus, goals and objectivesoperationalize the philosophy.

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A goal may be defined as the desired result

toward which effort is directed. it is the aim of philosophy. Goals, much like philosophies and values, change

with time and require periodic reevaluation and

prioritization. Objectives are similar to goals in that theymotivate people to a specific end and are explicit,measurable, observable or retrievable andobtainable.

Objectives however are more specific andmeasurable than goals because they identify how And when the goal is accomplished.

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Objectives can focus either on thedesired process or the desired result.

Processed objectives are written in termsof the method to be used, whereas result-focused objectives specify the desired

outcome Objectives should have a specific time

frame, be behaviorally stated, beobjectively evaluated, and identify positiverather than negative outcomes.

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FORSETTING THE TIME FRAME

TIME MANAGEMENT is a techniquefor allocating ones time through thesetting of goals, assigning priorities,identifying and eliminating wasted time,

and using managerial techniques to reachgoals efficiently. Nurse-leaders who learn to manage time

effectively will be more productive, inboth their professional and their personallives.

Taking time to plan time saves time.

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TIME MANAGEMENT In some ways, time management is amisnomer: what is managed is how time is

used. In todays downsized health care

organization, the pressure to do more inless time has increased.

Job enlargement occurs when a flatter

organizational structure causes positionsto be combined and results in mangershaving more employees to supervise.

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Time Management In a horizontal organizational structure fewformal channels for communication exist so thetime needed to communicate with staff increases.

Time can be used proactively and reactively Proactive approach when energy is focus on

people and events over which the manager havedirect or indirect control

Reactive approach if majority of the managerstime is spent on what concerns him most aboutother people and events that troubles him whichmakes his efforts less effective.

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TIME WASTER It is something that prevents a personfrom accomplishing the job or achieving

the goal. Common Time waster:

Interruptions such as telephone calls and drop-in visitors

Meetings both scheduled and unscheduled Lack of clear-cut goals, objectives, and

priorities Lack of daily/weekly plans Lack of personal organization and self

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Cont. Lack of knowledge about how one spends

ones time Failure to delegate, working on routine

tasks

Ineffective communication Waiting for others, not using transition

time effectively

Inability to say no

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TIME ANALYSIS The 1st step is to analyze how time is being used. The 2 nd is to determine whether time use is

appropriate to your role

( some time may be used in doing things that seem tobe busywork rather than activities thatcontribute to a particular outcome)

Job redesign- places emphasis on ensuring that

time is spent wisely and that the right individualis correctly assigned the responsibility for tasks.Time Logs- useful in analyzing the

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HOW TO MANAGE THE

MANAGERS TIME 1. Setting Goals it is establishingones own goals and time frames Nurses are accustomed to setting both long andshort- range goals, although typically such goalsare stated in terms of what patients willaccomplish rather than what the nurse willachieve.Defining goals and time frames helps reducestress by preventing the panic people often feelwhen confronted with multiple demands.

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How to Manage Time

Determine priorities Take into consideration both long-term andshort term goals as well as the importance andurgency of each activity

Daily planning and scheduling Prepare a to-do list (planned for workday or

workweek) Flexibility must be a major consideration to

allow to deal with emergency and crises Focus is not on the activities or events but

on the outcomes that can be achieved in thetime available.

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cont. Daily planning and scheduling It is necessary to have a system to keep track

of regular schedules (should be used whenestablishing the to-do list)

It should include calendar and files (Calendar includes information on the

purpose, who will attend, time and place) (Files are maintained by date so that they are

readily retrievable when needed)

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Cont. Grouping activities and minimizing routine work

Work items that are similar in nature andrequire similar environmental surroundings andresources should be grouped within divisions ofthe work shift.

Group routine tasks, esp those that are notimportant or urgent, during the leastproductive time

Pick a task that can be successfully completedand save it for the end of the day. can reducea sense of overload and stress

Implementing the daily plan and daily follow-upis essential in managing time

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Cont. Personal organization and self-discipline

Managers must have clearly defined prioritiesbased on a well-defined, measurable, andachievable objectives.

These objectives are often related to those of

many professionals, as well as to objectives ofpatients and their families. Managers must have the ability to say NO Taking on too much work can lead to overload

and stress Being realistic about the amount of work towhich the manager commit is an indication ofeffective time management.

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Cont. Personal organization and self-discipline

Be assertive in communicating own needs toothers

A cluttered desk, working on too many tasks atone time, and failing to set aside blocks ofuninterrupted time to do important tasks alsoindicate a lack of personal discipline.

Managers should clean their desk, get out thematerials needed to complete the most highest

priority and start working on it immediately FOCUS on one task at a time, making sure to

Start with a high-priority task.

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Time-saving techniques

Devote a few minutes at the beginning of eachday for planning

Organize the work space so it is functional

Close the door when there is a need toconcentrate Learn organization /manager can delegate Develop effective decision making skills in the

agency Make good use of the spare time

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Controlling Interruptions Keep an interruption log on an occasional basis this should show who interrupted, nature ofinterruption, when it occurred, how long it lasted,

what topics were discussed, the importance ofthe topics, and time-saving actions taken. Analysis of these data may identify patterns that

can be use to plan ways to educe the frequencyand duration of interruptions

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Controlling Interruptions E-mail

E-mail can enhance time managementor it can be a time waster

Checking email too often can wastetime

Set specific times of the day tocheck e-mail

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Controlling Interruptions Paperwork Plan and schedule paperwork

Sort paperwork for effective processing Send every communication electronically unless a

paper memo, report, or letter is required. Analyze paperwork frequently review filing

policies and rules regularly, and purge files atleast once each year. Do not be afraid torecommend changes, when possible, formats canbe revised if needed to.

Do not be a paper shuffler handle a piece ofpaper only once, means each time a paper ishandled, an action should be taken to furtherprocess it.

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Respecting TIME The key to using time management techniques isto respect ones own time as well as that ofothers

People who respect their time are likely to findothers respecting it also Reciprocate by respecting the time needs of

others

The effort to manage time is by: Determiningpriorities, organizing the workday and minimizinginterruptions.

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BUDGETING


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BUDGETING Budgeting is the process of planning and

controlling future operations by comparing actualresults with planned expectations A BUDGET is a detailed plan that communicates

these expectations and serves as the basis for

comparing them to actual results The budget show how resources will be acquiredand used over some specific time interval;

Its purpose is to allow management to project

activities into the future so that the objectivesof the organization are coordinated and met. It helps ensure that resources necessary to

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BUDGETING Managing a budget is a process of planning for a

specified time in the future, usually one year,monitoring how well the plan is working during thebudget time period, and adjusting the budgetaccordingly for the next budget cycle.

The budgetary process allows the manager tovisibly identify resource problems early and toadjust them to changing situations. Well-managed budget uses the organizations

resources to best provide quality patient care.

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The Budgeting Process Budget is a quantitative statement, usually in

monetary term, of the plans and expectations of adefined area over a specified period of time.

Budget- provide a foundation for managing andevaluating financial performance

Budget detail how resources (money, time,people) will be acquired and used to supportplanned services within the defined period oftime.

Budget purpose - allow management to projectaction plans and their economic impact on thefuture so that objectives of the organizations arecoordinated and met.

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B d ti P


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Budgeting Process Increases the awareness of costs and also helps

employees understand the relationships amonggoals, expenses, and revenues.

Budgets also help management control theresources expended through an organizationalawareness of costs.

Budget performance provides management withfeedback about resources management and theimpact on the budget

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Approaches to Budgeting Cost Centers managers are responsible for

predicting, documenting, and managing the costs(staffing, supplies)

Revenue Centers managers are responsible forgenerating revenues (patient volumes)

Profit Centers managers are responsible forgenerating revenues and managing costs so thatthe department shows a profit (revenue exceedcosts)

Investment Centers managers are responsiblefor generating revenues and managing costs andcapital equipment (assess)

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Incremental Budget Incremental or line-by-line budget

each expense item or category is distributed ina budget worksheet

Finance department distributes a budgetworksheet listing each expense item or categoryon a separate expense line

Expense line divided into salary and nonsalaryitems

Advantage simplicity of preparation Disadvantage discourages cost efficiency

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Fixed or Variable Budgets

Fixed budgets - amounts are setwithout regard to changes that mayoccur during the year, such aspatient volume or program activities

Variable budgets - adjusted based onchanges in revenues, patient census,

utilization of supplies, and otherexpenses

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Fixed or Variable Budgets Budget that are categorized as fixed if the

budget amount are set without regard to changesthat may occur during the year, such as patientvolume or program activities, that have an impactof the cost assumptions originally used for the

coming year Variable budgets- developed with the

understanding that adjustments to the budgetmay be made during the year based on changes in

revenues, patient census, utilization, and otherexpenses.

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Preparing the Budget


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Preparing the Budget A budget is an annual operating plan, a

financial road map and plan which serves a anestimate of future costs and a plan forutilization of manpower, material and otherresources to cover capital projects in theoperating programs.

A budget is a plan for future activitiesexpressed in operational as well as financial ormonetary terms. In a health care institution, this consists of 4

components: 1. revenue budget, an expense budget, a cash budget

and a capital budget

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BUDGET


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REVENUE BUDGET SUMMARIZES INCOMEWHICH MANAGEMENT EXPECTS TO GENERATEDURING THE PLANNING PERIOD

EXPENSE BUDGET DESCRIBES THE EXPECTEDACTIVITY IN OPERATIONAL AND FINANCIALTERMS FOR A GIVEN PERIOD OF TIME.

CAPITAL BUDGET OUTLINES THE PROGRAMMEDACQUISITIONS, DISPOSALS ANDIMPROVEMENTS IN AN INSTITUTIONSPHYSICAL CAPACITY

CASH BUDGET REPRESENTS THE PLANNED CASHRECEIPTS AND DISBURSEMENTS AS WELL AS THECASH BALANCES EXPECTED DURING THEPLANNING PERIOD.

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Revenue Budget Represents the patient care income expected for

the budget period. Revenue projections for the next year are based

on the volume and mix of patients, rates, anddiscounts that will prevail during the budgetperiod.

Projections are developed from historical volumedata, impact of new and modified clinicalprograms, shifts from inpatient to outpatient

procedures, and other influences. Also taken into consideration are projected revenuesderived from Medicare, Medicaid, commercial insurancecompanies, HMOs, and other 3 rd party payers.

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Cont. Medicare payments for inpatient services

are made as a predetermined specific ratefor each Medicare recipient based on thepatients diagnosis

Care is classified into diagnosis-relatedgroups (DRGs). Payments are made based on the assumption

that patients with the same DRG use similarresources.

DRGs are based on primary and secondarydiagnoses, age and treatment received.

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Expense Budget Consist of salary and nonsalary items Expenses should reflect patient care

objectives and activity parametersestablished for the nursing unit It is comprehensive and thorough;

taking into consideration all availableinformation regarding the next yearsexpectations.

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Cost Centers Nursing units bare typically considered cost

centers A cost center is described as the smallest area

of activity within an organization for which costsare accumulated. Nursing managers are commonly given the

responsibility for costs incurred by theirdepartment, but they have no revenueresponsibilities.

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Profit Center If manager is responsible for

controlling both costs and revenuesand if their financial performance ismeasured in terms of profit (thedifference between revenues andexpenses) then the manager isresponsible for a profit center

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Classification of Costs Direct Costs are expenses that directly

affect patient care. Example salaries for nursing personnel

who provide hand-on patient care areconsidered direct costs.

Indirect Costs are expenditures that a

are necessary but dont affect patientcare directly. Example - Salaries for security or

maintenance personnel79

BENEFITS DERIVED FROM


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BENEFITS DERIVED FROMBUDGETARY PROCESS

Budgeting stimulates thinking inadvance. It anticipates futureopportunities or problems and

prepares for them. It leads to specific planning Budget preparation stimulates action

and intercation

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Factors in Budget Planning (in


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nursing)

1. Type of patient2. Size of hospital and its bed capacity3. Physical layout of the hospital, the size

and plan of wards or units, the Nursesstation, treatment rooms, etc

4. Personnel policies5. Grouping of patients

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nursing)

6. Standards in nursing care7. The method of performing nursing carewhether simple or complex

8. The method of documentation9. Proportion of nursing care provided by

professional nurse and those given by non-professionals

10. The amount and quality of supervisionavailable and provided

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Factors in Budget Planning (innursing)

11. Efficiency of job description and jobclassification

12. Method of patient assignment13. The amount and kind of labor-saving devices and

equipment; intercommunication systems14. The amount of centralized service provided;

sterile supply central oxygen service; linen supply15. The nursing service requirements of the ancillary

dept.: clinics. Admitting office, ER16. Reports required by administration whether

s simple or complex17. Affiliation of nursing students

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Determining the Salary(personnel) Budget

Salary Budget - also known as Personnelbudget projects the salary costs thatwill be paid and charged to the cost centerin the budget period.

Managing the salary budget is directlyrelated to the managers ability tosupervise and lead the staff.

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Benefits FTEs or full-time equivalents are necessary to

replace personnel for benefit time (vacations,holidays, personal days, and so on).

This factor can be calculated by determining theaverage number of vacation days, paid holidays,personal days, bereavement days, or other daysoff with pay that the organization provides andthe average number of sick days per employee asexperienced by the cost center

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Determining FTEs


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Determining FTEsrequired for replacement Determine hours of replacement time per

individual Then determine FTE requirement

Benefit Time Hours/Shift Replacement Hrs15 vacation days x 8 hours =1208 holidays x 8 hours = 644 personal days x 8 hours = 325 sick days x 8 hours = 40

total = 256

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Cont. Divide replacement time by annual FTE

base 256 / 2,080 = 0.12 From the FTE calculations an FTE budget is

calculated This budget provides the base for the salary

budget However the shift differentials, overtime, and

bonuses or premium also may affect budgetperformance and need to be considered

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Capital Budget This budget identifies physical renovations, new

construction, and new or replacement equipmentplanned within a specified time period.

Limited to a specified amount and decisions needto be made how best to allocate available funds The nurse manager is responsible for assisting in

selecting and determining the amount ofequipment needed.

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Future Trends


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Future Trends A major trend in financial management of health

care organizations is the shift from a revenue-based to a cost-based accounting system. With the shift to managed care, the focus is

decreasing the cost to maintain adequate profit

margins in an era of diminishing compensation. This trend has serious implications to nursing Nursing has always been considered a cost, not a

source of revenue. It is a challenge to be

consistently cost conscious and to measure,manage and document nursing cost-effectivenessin this financial environment.

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nov 2013 planning

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