NCM 119 COMMUNICATION TOOL

MIDTERM
PDF 1 S - Situation
B - Background
WHAT IS ORGANIZATIONAL COMMUNICATION? A - Assessment
R - Recommendation
ORGANIZATIONAL COMMUNICATION
• Communication aims to convey the same message across the 1. SITUATION ~
lack of monitoring
entire system. The flow of communication in an organization Dr. Jones, this is Deb McDonald RN, I am calling from ABC
is important especially to the individual employee because it Hospital about your patient Jane Smith.”
sets the organizational environment.
2. BACKGROUND
COMMUNICATION PROCESS “Here’s the situation: Mrs. Smith is having increasing dyspnea and is
complaining of chest pain.”

plans for
3. ASSESSMENT lack ~
of students who are not in RP

tre “The supporting background information is that she had a total knee
replacement two days ago. About two hours ago, she began
complaining of chest pain. Her pulse is 120 and her blood pressure is
128 over 54. She is restless and short of breath.”

PRINCIPLES OF COMMUNICATION 4. RECOMMENDATION warning and recommend to CI will

-

or
Cirating
• Clear lines of communication serve as the linking process by “My assessment of the situation is that she may be having a cardiac be deducted
which parts of the organization are unified towards goal event or a pulmonary embolism.” “I recommend that you see her
achievement. immediately and that we start her on O2 stat. Do you agree?”
• Simple, exact, and concise messages ensure understanding of
the message to be conveyed. Business writing is essentially used in a professional setting. It is a
• Feedback is essential to effective communication. purposeful piece of writing that conveys relevant information to the
• Communication thrives best in a supportive environment reader in a clear, concise, and effective manner.
which encourages positive values among personnel.
• A manager’s communication skill is vital to the attainment of TYPES OF BUSINESS WRITING CIIPT)
the goals of the organization. 1. Instructional
• Adequate and timely communication of work-related issues or – is directional and done for the purpose of completing a task. A user
change that may affect jobs enhance compliance. manual and memo fall under this type.
TYPES OF COMMUNICATION 2. Informational ↑

-refers to recording information or documents essential to the core

1. Verbal communication – involves spoken words. functions of an organization. For example, financial statements of a
2. Written communication – textual information usually in the company, minutes of a meeting and report writing.
form of memoranda, hospital orders, documentation, records and
3. Persuasive
reports, policies, procedures, and the like.
– it aims to impress the reader and influence their decision. It
3. Non-verbal communication – is the transmission of message
contains information about a product or service. This includes bulk
without the use of words. These are one’s facial expressions,
sales, emails and press releases.
gestures, touch, body language, or vocal tones.
4. Transactional
ORGANIZATIONAL COMMUNICATION LINES – is a day-to-day communication at the workplace. The bulk of
• DOWNWARD COMMUNICATION communication is sent by email, but also includes official letters,
• UPWARD COMMUNICATION forms, and invoices.
• LATERAL COMMUNICATION
PRINCIPLES OF GOOD BUSINESS WRITING
• DIAGONAL COMMUNICATION (Link will be given.)
1. Clarity of purpose
DOWNWARD COMMUNICATION 2. Clarity of thought
➢ This reflects the hierarchical nature of the organization. 3. Convey accurate and relevant information
Downward communication includes directives to 4. Avoid jargon
employees, expectations for employees, and performance 5. Read and revise
feedback according to Sullivan (2012) as cited by Murray 6. Practice is the key
(2017). 7. Be direct
8. Avoid verbosity
UPWARD COMMUNICATION 9. Correct grammar and sentence structure
➢ It is the sending of information up the hierarchal chain. The 10. Easy to scan
common instances of upward communication are requests
for resources, sharing ideas or suggestions for MEMO WRITING
improvement, and employee grievances. A memorandum or memo is a short message for internal
communication in an organization. It is written to communicate with
LATERAL COMMUNICATION a wide audience on something brief but important.
➢ It is the sharing of information among nurse leaders and Examples are procedural changes, price increases, policy additions,
managers or other staff at the same level. meeting schedules, reminders for teams, or summaries of agreement.
DIAGONAL COMMUNICATION • A memo has a header that includes:
➢ This occurs with others in the organization who are not on DATE, TO, FROM, and SUBJECT lines. Other lines such as CC or
the same level in the hierarchy is considered diagonal BCC, may be added.
communication. This occurs, for example, when a nurse • Most memos skip greetings and directly state the content. Besides
leader and manager communicates with the chief financial it does not include the “farewell part”.
officer or the medical director. • The text of memos typically uses block format, with single spaced
lines, an extra space between paragraphs, and no indentions for new
paragraphs.
DATE: July 20, 2021
TO: All Employees and Staff 2. TRANSFER REPORTS (TR)
FROM: Ms. Maria Consuelo, Store Manager • Is done when patients are transferred from one unit to
RE: Fire and Bomb Drill another to receive different levels of care and treatment.
Informing you of the schedule of Fire and Example: When a patient is transferred from a ward to the ICU.
Bomb Drill on August 23, 2021 at around 8:00 o’clock in the
morning. In this connection, you are expected to participate in the 3. INCIDENT REPORT (IR)
drill. Act naturally and do not panic. Your cooperation is • An incident is any event that is not consistent with the
highly appreciated. routine operation of an institution. IRs commonly occur
when the patient is under care and within the hospital
Minutes of the Meeting premises. This is major part of a unit’s quality improvement
·As cited by Rayos (2019), minutes of the meeting is considered an program
official Record of what transpired during a meeting. 4. TELEPHONE REPORTS (TER)
-It is a written record of what was discussed but also decisions made • The nurse informs attending physician or other health care
and the flow of discussions. team members regarding changes in the patient’s condition
-The documenter takes note of the concise way or matters that are during care
dealt with or decided upon in a meeting.
GUIDELINES IN MAKING A CSR
The basic purpose of the minutes is he basic purpose is to provide a
• Provide necessary patient’s data (e. g name, age, gender,
historical account of official business
medical diagnosis, and history).
conducted during a meeting and supporting a group as it carries out
• Describe objective measurements about patient condition.
its responsibilities.
• Evaluate results of nursing or medical care measures.
FORMAT OF MINUTES • Be clear on priorities to which incoming staff must attend.
➢ Minutes begin with the name of the institution, place, date, • Don’t review all routine care and procedure or tasks.
list of people present, absent and the time. All the agenda, • Don’t review all biographical data already available in
decisions, reports given and the persons involved and also written form.
votes tally are included. • Don’t use critical comments o patient behavior
➢ The recording in a meeting is done via video, audio or hand
recording. GUIDELINES IN MAKING TELEPHONE REPORTS
➢ Normally, a person is formally designated as secretary or a • Clear information about the patient/client
recorder to prepare the minutes. In some groups, a • Repeat the reports if communication error occurs.
secretary or clerk performs the task of taking the minutes. • Use clarification questions to avoid miscommunication.
TYPES OF MINUTES OF THE MEETING PREPARATION AND CONDUCT OF MEETINGS
• The conduct of a meeting is one of the manager’s role.
1.VERBATIM MINUTES
• It is held not as a ritual but to disseminate and discuss
• Usually taken by secretaries of a government legislature,
information; to solve a problem; to coordinate activities; to
council, or lawmaking body.
reach a consensus or decision; to build morale and to solve
• It is time consuming since everything that transpired during conflicts.
the meeting is documented.
• Keep in mind that meetings are very expensive activities so
• Annual meetings are transcribed in verbatim. take them very seriously.
• Every single word said at a meeting is transcribed • Have a clear purpose/s or outcome/s of your meeting and
• Will not always follow the agenda call the meeting only when you are ready with the agenda.
• These are often long and can be difficult. • The process used in a meeting depends on the kind of
2. SUMMARY MINUTES nurses usually use this ?
- meeting you plan to have, e.g., staff meeting, planning
• This provides a record of all information during a meeting but meeting, problem solving meeting, etc.
not necessarily word for word but a summary of the discussion BASIC GUIDE IN THE CONDUCT OF EFFECTIVE
and action on all agenda items MEETINGS:
• Meetings conducted at shorter intervals of time are
documented using this type. 1.SELECTING PARTICIPANTS
• Short and free from the complexities • Decide who should attend your meeting, call each person
• Most commonly used in the office and follow it up with a meeting notice.
• Normally written in full sentences rather than bullet points 2.DEVELOPING AGENDA
3. ACTION MINUTES • Design the agenda so that the participants get involved and
• Contains identifying information, brief summary of for them to be guided on the discussion
discussions made and key information presented 3.OPEN MEETINGS
• Emphasizes the transcription of decisions, tasks, and actions to • Always start on time; thank the attendees and welcome
be done related to the proceeding, thus making this minutes them; present the proposed topics; note that the recorder
quick and easily prepared. will be present; and clarify your roles in the meeting.
PRESENTATION OF REPORTS 4. ESTABLISHING GROUND RULES FOR MEETINGS
• A report is a formal document of a specific topic related to • Four basic ground rules are to participate; get focus,
once job which is addressed to a particular audience. Various maintain a momentum; and reach closure.
reports written at work includes sales reports, daily reports,
budget reports and business analysis reports. 5.TIME MANAGEMENT
• In nursing, reports are oral written exchange of information • This is one of the most difficult tasks..
shared between the health care team. Nurses communicate
6. EVALUATIONOF MEETING PROCESS
information about their clients in a report to the health team
• Get feedback during the meeting.
members to decide on client care.
TYPES OF REPORTS IN NURSING 7. EVALUATING THE OVERALL MEETING
1.CHANGE-OF-SHIFT REPORTS (CSR) • Leave at least 5-10 minutes at the end of the meeting to
evaluate the meeting; don't skip this portion of the meeting.
• The most common reports used which the nurse reports
information about their assigned clients to the nurses
8.CLOSING MEETINGS
working on the next shift. This report provides continuity of
client care. • Always end meetings on time and attempt to end on a
positive note.
 COSTUMER ENGAGEMENT MANAGEMENT

COSTUMER
• are persons or organizations that buys goods or services
from a store or business.
• They are end-users of good and services.
ENGAGEMENT
• it is the continuous development of an emotional
relationship
• In a business sense it's the emotional level the individual
has with their manager, team and organization.
What is customer or consumer engagement?
• It means that a client is connected to and engaged with the
products and services a company offers.
• This is the average amount of time customers spend on
your website.
• Social media interaction such as the numbers of likes and
shares you’re getting.
• The number of new customer referrals you’re receiving.
• It is how your audience warns up to you. And you need to
take baby steps to nurture the relationship.
• This refers to the start of a brand-new relationship. A long-
term investment.
BENEFITS OF COSTUMER ENGAGEMENT:
1. Better Customer Relationships
2. Improved Customer Relationship BLIBE
3. Improved Customer Retention
4. Better opportunities for cross-sell and upsell
5. Enhanced customer service

How to measure customer engagement?

• The average amount of time customers spends on your
website.
• Open and click-through rates for emails and push
notifications.
• Social media interaction such as the numbers of likes and
shares you’re getting.
• The number of new customer referrals you’re receiving
Elements of a successful customer engagement strategy
• Distinguishable from other Competitors
• Inspires Omnichannel conversations
• Gives customers an emotional connection to the brand
Customer Engagement Management
➢ provides ways to increase in customer value. To increase
and improve customer engagement product adoption and
customer retention. This in turn improves company's
reputation, their reference ability, revenue and capability to
drive referrals from customers (Gainsight, 2021).
Customer engagement managers
➢ play a vital role in the customer service process.
 ·

collection-gather same data

RECORD MANAGEMENT Section 19. General principles in collection, processing and from 1 participant to
PDF 2 retention. another

WHAT IS A RECORD? I. Collection must be for a declared, specified, and legitimate

- A record is any document created, received, and maintained that purpose.
documents the university’s activities, transactions, and functions in II. Consent is required prior to the collection and processing of ·
In CRMC strict sild,

personal data, subject to exemptions provided by the Act · Cannot retrieve records sa
the course of the its business or legal obligations, regardless of CRMC
format. and other applicable laws and regulations.
2. The data subject must be provided specific information regarding DP
WHAT IS A RECORD? the purpose and extent of processing, including, where applicable, ·
last part of coursepack
A record is any document (paper or electronic) created or received the automated processing of his or her personal data for profiling, or G

by offices or employees that allows them to conduct business. processing for direct marketing, and data sharing.

RECORD MANAGEMENT 3. Purpose should be determined and declared before, or as soon as

The systematic management of records ensures that information of reasonably practicable, after collection.
evidence is managed according to the legal frameworks put in place 4. Only personal data that is necessary and compatible with declared,
by the different countries and according to international standards.” specified, and legitimate purpose shall be collected.
(Svard, 2017). sentinel events
I Sentinel events
.

Any unanticipated patient’s safety event occurring in a health care

RECORDS MANAGEMENT PRINCIPLES setting resulting in death or serious injury to
1. Life-Cycle Model – resembles record to a living organism and patient/s not related to natural cause of the patient’s illness
presumes that they undergo 3 stages. This approach is applicable to
the paper-based environment. Sentinel events
-CanKeep record for yesa
a. Active Stage An unexpected incident, related to system process deficiencies ·
Ex : nahulog ang pt
b. Semi-active Stage which leads to death or major and enduring loss of function. wrong medication
c. Inactive Stage (event that causes death)
times TYPES OF SENTINEL EVENTS (SDPECC) 9%0 tapos administer
present
ex :
nag
• Active: Records that are required and referred to 1. Surgical events – an operation of a wrong body part; retained
furosemide

constantly for current use and need to be retained and instrument; death within the surgical procedure;
maintained in office space and equipment close to users. anesthesia related events ex : retained instrument
• Semi-Active: Records which are referred to operation of wrong body part
infrequently and not required for constant use. Semi- 2 Device or Product- events (contaminated drugs and device,
unintended use, breakdown or failure). infusion pump malfunction leads to incorrect dosage of med
-

active records still retain primary values but should be

-

removed from expensive office space to a low-cost off- 3. Patient protection events (infant discharge to wrong person, di nabigay na gamot
·

site storage facility because there is no immediate elopement, suicide, attempted suicide, self-harm, ·
harm
nangyari sapt
administrative or operational need for them. intentional injury, nosocomial infection, medical gas).
• Inactive Records: Records which have passed through
active and semi-active stages of their life cycle and are 4. Environmental events (burn, slip, trip, fall, electric shock, use of
scheduled for either destruction or permanent restrains and bed rails).
preservation at the archives. 5. Care management events (hemolytic reaction, maternal death,
Records
·

Digital 2. Records Continuum Model (RCM) – which deals with the

medication errors, delay in response).
-
pluralized
development of technology and the generation of digital records. It 6. Criminal events (impersonation, abduction, sexual assault, ·
ex : binaril (bawal sabihin ang room and
-

Bago publish manage saang hospital)

has four dimensions which are: create, capture, manage and
,

muna
physical assault on the grounds of healthcare facility)
pluralize. The pluralizing dimension which promotes the reuse of
information in different stakeholders. WHY DO SENTINEL EVENTS OCCUR?
• Inadequate communication among health care providers.
DATA PRIVACY PROTOCOLS • Incorrect assessment of patient’s condition.
Implementing Rules and Regulations of the Data Privacy Act of • Inadequate leadership, orientation, or training.
2012
• This act also is known as the Republic Act No. 10173 How to handle sentinel events?
• Secure the situation
RULE IV. DATA PRIVACY PRINCIPLES • Preserve anything for investigation. Provide support for
patients, family members, and staff. ·
IR-harm done to the
Section 17. General Data Privacy Principles. The processing of • Follow the Joint Commission’s reporting and root-case patient
personal data shall be allowed, subject to compliance with the analysis requirements as stated in the organization’s manual.
ex : medication error

requirements of the Act and other laws allowing disclosure of

information to the public, and adherence to the principles of ROOT CAUSE ANALYSIS & ACTION PLAN
transparency, legitimate purpose, and proportionality. • This analysis focuses on systems and
• processes, not individual performance.
Section 18. Principles of Transparency, Legitimate Purpose and • All persons involved with the event in any way should
Proportionality. The processing of personal data shall be allowed participate in the analysis, as each may have important
subject to adherence to the principles of transparency, legitimate insights and observations.
purpose, and proportionality.
• The sooner root-cause analysis takes place, the better—while
TRANSPARENCY the circumstances are fresh in participants’ minds.
• The data subject must be aware of the nature, purpose, and • The action plan should describe the organization’s risk- Leadership style
· -

author
-

extent of the processing of his or her personal data. reduction approach, set a definitive timeline, assign itarian

responsibility for implementation and oversight, specify pilot

LEGITIMATE PURPOSE testing as appropriate, and delineate strategies for measuring
It should be valid
the plan’s effectiveness
·

• The processing of information shall be compatible with a

declared and specified purpose which must not be contrary to • In addition to addressing the innermost concentric circle of the
law, morals, or public policy. sentinel event, the plan should spiral out to the larger circles
enclosing the entire organization—even, in some cases, to
PROPORTIONALITY other healthcare systems.
it should be • The processing of information shall be adequate, relevant, Growth Mindset
·

enough
and appropriate suitable, necessary, and not excessive in relation to a declared A growth mindset is the belief that one's abilities can change and
and specified purpose only if the purpose of the processing improve over time.
could not reasonably be fulfilled by other means.
· "I will improve overtime"
Hi French french
French fries
 2. Anecdotal Reports Disadvantages of Anecdotal Records
PDF 3 • If carelessly recorded, the purpose will not be fulfilled.
(Anecdotal) • Only records events of interest to the person doing the
• based on or consisting of reports or observations of usually observing.
unscientific observers (Webster, 2021). • Quality of the record depends on the memory of the person
• An anecdotal record is a detailed narrative record done after a doing the observing.
specific behavior or interaction happens. Incidents can be taken out of context.
• Anecdotal records inform teachers as they plan learning • Subjectivity.
experiences, provide information to families, and give insights • Lack of standardization.
into identifying possible developmental delays. • Difficulty in scoring.
• This is a record of a written observation transcribed like a • Time consuming
short story. • May miss out on recording specific types of behavior.
• Limited application.
Characteristics of Anecdotal Records
• They should contain a factual description of what USES of Anecdotal Records
happened, when it happened, and under what circumstances • Record unusual events, such as accidents.
the behavior occurred. • Record children's behavior, skills and interests for planning
• The interpretations and recommended action should be purposes.
noted separately from the description. • Record how an individual is progressing in a specific area of
• Each anecdotal record should contain a record of a single development.
incident. • It provides a means of communication between the members
of the health care team and facilitates coordinated planning
Purposes of anecdotal records: and continuity of care. It acts as a medium for data exchange
1. To furnish the multiplicity of evidence needed for good between the health care team.
cumulative record. (not at all times negative, in teachers • Clear, complete, accurate and factual documentation provides
positive) a reliable, permanent record of patient care.
2. To substitute for vague generalizations about student’s
specific exact description of behavior. 3) Incident Report
3. To stimulate teachers to look for information i.e pertinent in PDF 4
helping each student realize good self- adjustment. • Incident is an unplanned event that causes, or has the potential
4. To understand individual’s basic personality pattern and his to cause, an injury or illness and damage to equipment,
reactions in different situations. buildings, plant or the natural environment.
5. They should contain a factual description of what
-

• The purpose of the incident report is to document the exact

happened, when it happened, and under what circumstances
I
details of the occurrence while they are fresh in the minds of
the behavior occurred.
those who witnessed the event. This information may be
6. The interpretations and recommended action should be
useful in the future when dealing with liability issues
noted separately from the description.
stemming from the incident.
7. Each anecdotal record should contain a record of a single
• The nurse who witnessed the incident or who found the client
incident. &
at the time of incident should file the report.
Guidelines in making anecdotal record:
PRINCIPLES IN MAKING AN INCIDENT REPORT:
1. Keep a notebook handy to make brief notes to remind you
of incidents you wish to include in the record. Also include • The nurse describes in concise what happened specifically
the name, time and setting in your notes. objective terms, etc.
2. Write the record as soon as possible after the event. The • The nurse does not interpret or attempt to explain the cause of
longer you leave it to write your anecdotal record, the more the incident.
subjective, and vague the observation will become. • The nurse describes objectively the clients, conditions when
3. In your anecdotal record identify the time, child, date and the incident was discovered.
setting
• Any measures taken by the nurse, other nurses, or doctors at
4. Describe the actions and what was said.
the time of the incident are reported.
5. Include the responses of other people if they relate to the
• No nurse is blamed in an incident report
action.
6. Describe the event in the sequence that it occurred. • The report is submitted as soon as possible.
7. Record should be complete. • The nurse should never make photocopy of the incident report
8. They should be compiled and filed. TYPES OF INCIDENT
9. They should be emphasized as an educational resource.
10. The teacher should have practice and training in making • Near Miss - is an incident did not result in harm, loss or
observations and writing records. damage. Reporting is done to highlight the weaknesses in
systems, policies/procedures and practices. It is reported
within 24 hours.
PARTS of ANECDOTAL RECORDS • Adverse Events - is an adverse incident in the clinical area
that could led or did lead to unintended or unexpected harm.
• The first part of an anecdotal record should be factual, This should be reported within 2 hours.
simple and clear. • Name of the students • Unit/ ward/ • Sentinel Events - which is reported immediately.
department • Date and time • Brief report of what HOW TO REPORT AN INCIDENT
happened.
• The second part of an anecdotal record may include • Obtain proper forms from your institution.
additional comments, analysis and conclusions based on • Start the report as soon as possible.
interpretations and judgments. • Write it the same day as the incident, if possible.
• Provide the basic facts.
Advantages of Anecdotal Records • Write a fist person narrative telling what happened, when you
• Supplements and validates of other structured instruments. report to the scene.
• Provision of insight into total behavioral incidents. • Use full names of each person who is included in the report,
• Needs no special training. and start a new paragraph to described each person's actions.
• Use of formative feedback. Use a new paragraph to describe each person's actions
separately.
 4. KARDEX 201 File consist this list:

• A Kardex or a patient care summary - is a tool that is by ✓ Birth certificate

and for nurses. Nurses should have a sense of ownership of ✓ Marriage contract
the nursing Kardex since it has been serving the needs of
✓ SSS Registrations/E1 Form
countless nurses for decades.
• A Kardex is "a desktop file system that gives a brief ✓ SSS Loan Voucher
overview of each patient and is updated every shift. It is ✓ HDMF Registrations/Online
like having a cheat sheet for nurses to reference that is ✓ HDMF Loan Voucher
separate from the patient chart. It is usually kept in a central ✓PHIC Registrations/PMRF
location, such as the nursing station, for quick access." ✓ BIR Registration form (Those without TIN /BIR form 1902
(Lieberman, 2019). ✓ BIR update of taxpayer's information (Those with previous
• A Kardex is used in nursing as a quick reference guide to employer)/ BIR form 2305
the particular need of individual patients. It is updated and
✓Birth certificates of qualified dependents
kept as a reference when receiving reports from outgoing
nurse. This will assist the nurse in remembering important ✓Other credentials (ATM Payroll Accounts, acknowledgements)
information, procedures and management in relation to ✓Employee attendance sheet attached by DTRs
patient care. ✓Ledger of leave credits (Vacation and Sick Leaves)
• The purpose of a nursing Kardex is to serve as a record of ✓Change of departments
medical and nursing orders currently in effect for each ✓Employment evaluations
patient in the ward cared by nurses. An institution may ✓Written reprimands/Incident reports
adapt to a Kardex form that will best suit the needs of their
✓Notice of promotion/Increase in salary rates
nursing service.
• Nurses used the nursing Kardex to streamline the workflow ✓Withholding tax certificates (BIR Form 2316)
of caring for patients ✓Resignation letter/Termination letter
• In nursing Kardex, nurses would be able to browse through ✓Clearance form
patient information, such as name and demographics, ✓Acknowledgement of receipt of quitclaim, withholding tax
allergies, chief complaints or reason for admission, certificates, etc)
resuscitation code, list of medications, and plan of care. ✓Other related documents
This can be thought of as a cheat sheet when skimming
through information of different patients. Roles of Nurses in Records Management

5. Patient Health Record/Chart • Increased task automation and use of artificial Intelligence.
• Extra focus on high-value tasks. Nurses have a duty to
• A complete record of a patient's clinical data and medical maintain confidentiality of information revealed to them by
history, such as demographics, vital signs, diagnoses, their patients
medications, treatment plans, progress notes, problems, • Continuous investment in cybersecurity and security
laboratory and test results (Practice fusion, 2021). technology.
• It consists of medical notes transcribed by the physician, • A better conscious focus on mental health.
nurse, and other members of the health team. • Greater geographic distribution and representation of the
workforce.
Who has access to medical chart?

Only the patient and the health care providers who are directly
involved in care can view a medical chart. The medical chart
belongs to the patient, and she or he has the right to make sure the
charts are accurate or grant another party access to them.

• Reduce the incidence of medical error by improving the

accuracy and clarity of medical records and coordination of
diagnosis and treatment among health providers
• Make the health information instantly accessible, reducing
duplication of tests, reducing delays in treatment, and
patients well informed to take better decisions.
• Allow patients to log on to her own record and see
lifetime health trends to be better informed about their
health.

6. 201 File

An employee's 201 file is a record pertaining to the employee's

personal information, employment contract, duties, salary,
performance and employment history, among others.

Main Categories of employment life cycle

(1) the hiring process

(2) the employment period
(3) the separation process.
 INTRA-DISCIPLINARY AND MULTI – DISCIPLINARY
TEAMWORK AND COLLABORATION STAGES OF TEAM DEVELOPMENT

A TEAM IS A SMALL NUMBER OF PEOPLE WITH STAGE 1: FORMING:

COMPLEMENTARY SKILLS WHO ARE COMMITTED TO A Leader encourages equitable participation, begin focus on project.
COMMON PURPOSE, PERFORMANCE GOALS, AND The goal is to create a safe environment and find common interests
APPROACH FOR WHICH THEY ARE MUTUALLY and areas of acceptance.
ACCOUNTABLE • Characteristics of this stage: impatience, confusion about
group purpose, anxiety, silence, awkwardness, off-topic
TEAMS ARE REAL GROUPS IN WHICH INDIVIDUALS MUST chatter.
WORK COOPERATIVELY WITH EACH OTHER IN ORDER TO • Members are aware of the similarities and differences
ACHIEVE SOME OVERARCHING GOAL. • Discussion will be on the scope of the task and how to
approach it.
Teams have command or line authority to perform tasks, and
membership is based on the specific skills required to accomplish STAGE 2: STORMING:
the tasks. Leader helps team to focus on strengths, not weaknesses, in working
toward the task at hand. As work begins the group tries to get
Teamwork refers to the efforts within one team to produce the organized, competition and conflict develop among personal
highest quality and most efficient results. It is the ability to relations.
communicate and cooperate effectively to achieve common goal. • Conflict occurs because many individuals attempt to
contribute, blend, and mold their ideas, feelings, attitudes
Collaboration refers to the joint efforts between various and beliefs.
independent teams or groups.
Stage 3: Norming:
The word collaboration is derived from the Latin word ‘co’ and Collective decision to behave professionally, and agree to norms
‘laborare’ which mean “work together.” • The group becomes cohesive and tolerant of the differences
This means an interaction among two or more individuals • With good leadership, roles and responsibilities become
It is an important component of team process. It requires clearer, and members fells less tension
competence, confidence, and commitment on the part of all parties.
• The group engages in problems solving, sharing ideas,
.
doing research and produce facts.
FACTORS to a Successful Collaboration
• The groups shows high creativity.
• joint venture,
• cooperative endeavor, STAGE 4: Performing
• willing participation, The teamwork and cooperation, members individually committed,
• shared planning and decision-making, multiple leaders.
• team approach, contribution of expertise, • Not all groups reach the performing stage. If they do the
• shared responsibility, group members have deep relationship among each others
• non-hierarchical relationships and shared power based on and it has established in a high functioning capacity.
knowledge and expertise • Members feels secure, and the need for group approval is
no longer an issue and become productive.
Collaborative care as partnership relationship between doctors and
nurses and other health care providers with patients and their Stage 5: Adjourning:
families. (Virginia Henderson) Termination and consolidation occur in this stage.
• It is when evaluation is done and identification of strengths
Objectives of Collaboration: and weaknesses of the team.
• Provide client-directed and client-centered care using a
multidisciplinary, integrated, participative framework.
• Enhance continuity across continuum of care. Team Strategies and Tools to Enhance
• Improve client and family satisfaction with care. Performance and Patient Safety
• Provide quality, cost effective, research-based care. (TeamSTEPPS)
• Promote mutual respect, communication. - is a program developed by the Department of Defense and
• Develop interdependent. the Agency for Healthcare Research and Quality (AHRQ)
to integrate teamwork into practice (Henriksen et al., 2008;
advantages of teamwork King et al., 2008).

• Teamwork promotes safe and efficient patient care TeamSTEPPS involves three phases:
delivery.
• Collaboration among health team optimizes safe patient 1.Assessing the need
care outcomes. 2.Training onsite
• Teamwork equalizes power through shared governance. 3.Implementing and sustaining training
• Teamwork improves interpersonal relationships and job
satisfaction. Anatomy of a Winning Team
The elements and skills you need for a successful team
• It can decrease employee turnover.
1)A conducive environment for teamwork to flourish.
DISADVANTAGE OF TEAMWORRK
2)A collection of effective team members.
3)An effective team leader.
1. Team members may take longer to achieve a goal than
individual.
2. The team members may have disagreements on best course
of action to take for a specific task.
3. Team process take times, effort and resources,
4. Some team members may lack interest, motivation, ability
or skill to participate in the team process.
5. Factors like personal differences, personal work ethics, and
varied perceptions of tea, goals may impede effective team
collaboration.
 Different Types of Teams Found in Health Care: Communication Tools
❖ SBAR
1.Core teams – these are the team leaders and members who are ❖ Call-out
directly involved in caring for the patient. A tactic used to communicate important or critical information. It
2.Coordinating teams – a group responsible for day-to-day informs all team members simultaneously during emergent situations
operational management, coordination functions and resource and helps team members anticipate next steps.
management for core teams. ❖ Check-back
3.Contingency teams – is created for emergent or specific teams. A strategy for closed-loop communication to ensure that information
4.Ancillary services – consists of individuals such as cleaners. conveyed by the sender is understood by the receiver as intended.
5.Support services and administration – consist of individuals who ❖ HANDOFF
provide indirect task in a health care organization. The transfer of information during transitions in care across the
continuum. It provides an opportunity to ask questions, clarify and
Importance of Teamwork confirm. A specific tool for this is “I PASS THE BATON” which is
1)Clinical care is becoming more complex and specialized, forcing designed to enhance the information exchange.
medical staffs to attempt complicated health services and quickly ❖ STEP (Situation Monitoring)
learn new methods. A tool for monitoring situations in the delivery of health care and
2)Working together reduces the number of medical errors and useful in situation monitoring of the patient. STEP stands for Status
increases patient safe. of the patient, Team members, Environment, Progress towards a
3)Because teamwork is centered on solid goal.
communication, patients and their families sometimes feel more at ❖ Cross Monitoring
ease and report they accept treatments and feel more satisfied with A harm error reduction strategy that involves: monitoring the actions
their health care. of other team members, providing a safety net within the team,
ensuring that the mistakes or oversights are caught quickly and
2.Teamwork and Collaboration in the Community Setting easily. “Watching each other’s back”
Community Health Workers (CHWs) served as a link, liaison or
intermediary with the health care services. I’M SAFE checklist
The CHWs helps the community by increasing health knowledge A checklist used during situation monitoring by each team member
and self-sufficiency through a range of activities like: to assess his or her own safety status. I’M SAFE stands
- Outreach for Illness, Medication, Stress, Alcohol and Drugs, Fatigue, Eating
- Community education and Elimination.
- Informal counseling
- Social support BARRIERS TO INTERPROFESSIONAL COLLABORATION
- Advocacy ❖ Differences in professional values
❖ Power struggles
Six key areas of CHW activities: ❖ Lack of respect
1.Creating linkages between communities and the healthcare system ❖ Lack of a sense of how to work together
2.Providing health education and information, ❖ Not always possible to organize meetings where everyone
3.Assisting and advocating for underserved to receive appropriate is present
services ❖ Stereotypical views of professions
4.Providing informal counseling
5.Directly addressing basic needs How to overcome interprofessional collaboration barriers?
6.Building community capacity in addressing health issues. 1.Educate all professions on other professions
2.All disciplines must be aware of their practice affects each other
Assumptions of Effective Interpersonal Teamwork between 3.Be aware of the responsibilities of each team member
CHW and Health Care Teams: 4.Need to set shared goals
1.shared understanding of roles, norms, values, and goals of the team 5.Universal Documentation (Vyt,2008)
2.egalitarianism
3.cooperation Nurses Role in Establishing
4.interdependence Collaborative Relationship in the Delivery of Health Care Programs
5.synergy and Services
1.To provide patient-centered care.
GOOD TEAMWORK REQUIRES THE FOLLOWING: 2.Collaborate to achieve a common goal
1.Communication - Teams that work well together and communicate 3.Assess a patient's clinical, emotional, and social needs
effectively perform better and provide safer care.
2.Leadership - A team leader can create a positive culture by telling
your team to raise any concerns and ask any questions if they may
have.
3.Situational awareness is defined as an “accurate awareness or
understanding of the situation in which the team is functioning”
(Alonso and Dunleavy, 2013). In simple terms, it is knowing what is
going on around us.
4.Mutual support - Mutual support is a key in effective teams.
People in a team support each other. Everyone look after each other
and watch out for signs of stress and overload.

How to apply teamwork?

1. Always introduce yourself to the team.
2. State the obvious to avoid assumptions
3. Ask questions, check and clarify.
4. Clarify your role.
5. Use objective not subjective language.
 The Nurse Manager in the Health Facility Managerial ROLES

Nurse Managers Mintzberg’s Behavioral Description

(Sullivan and Decker, 1988)
o Interpersonal Roles
Perform these roles simultaneously: o Informational Roles
• Subordinates o Decisional Roles
• Superiors
• Customer service representatives -The figurehead role -Performance of ceremonial
duties
Key leadership position directly related to the delivery of nursing
care. -The leader role -Direct involvement to
approve decisions and
Job Description - Nurse Manager (Sullivan and Decker, 1988; choose a managerial team
Marquis and Huston, 2006)
-The liaison role -Dealing with outside people
Position Purpose
Serves as the official supervisor of an assigned division and -The monitor role -Receipt & sending of info for
functions to: plan, direct, coordinate, implement, control, evaluate control purposes
and improve the quality of patient care delivered.
-The dissemination role -Sharing of info, collected as
Specific Responsibilities monitor, with subordinate

• Plans and executes administrative programs -The spokesman role -Speaks for his department
• Selects, evaluates and terminates nurses in the unit. The entrepreneurial role -involvement with constant
• Establishes standards, goals, objectives, priorities and addition or deletion of new
facilities projects
• change based on the needs of patients and their families,
and significant -The disturbance handler role -Attention to problems arising
• Holds regularly meetings, out of strikes, bankruptcies,
• Creates a work climate that encourages positive staff and interference
morale, motivation and commitment. -The resource allocator -Allocation of budgets, time
• Supervises the allocation of division resources role and information
• Controls work time schedules for entire staff
• Delegates patient care/division -The negotiator role -Ranges from negotiation of an
• Advocates for both patient and staff argument to negotiation of a
• Evaluates the quality of care provided alongside the labor contract
standards and policies
Management Process
MANAGERIAL LEVELS o PLANNING
o ORGANIZING
Levels o DIRECTING
o CONTROLLING
TOP MANAGERS
o Looks at organization in broader context, coordinates Planning
internal and external influences ■ Forecast estimate future
o Determines philosophy of organization ■ Set objectives, determine results desired
o Sets policies ■ Develop and schedule programs, define activities needed and set
o Creates goals and policies for resource allocation time frame
o Less involved in day to day operations ■ Prepare budget, allocate resources
■ Establish policies, procedures, definite course of action and
MIDDLE MANAGERS methods.
o Coordinates with actions of lower hierarchal employees
o Serves as channel between lower and top-level managers Organizing
o Carries out day to day operations but still involved in some ■ Set up organizational structure, identify groupings, roles,
long-term planning and establishing unit policies relationships
■ Determine staff needed, develop and maintain patterNs, distribute
FIRST-LINE manager in areas as needed
o Oversees employees ■ Develop job descriptions, define qualifications and functions of
o Deals with immediate problems in daily operations, Personnel
organizational needs and employee’s personal needs
o Motivates staff to achieve goals of organization Directing
o Represents staff to upper administration ■ delegate nursing care assignments
■ Utilize/revise/update policies and procedures
Charge Nurse ■ Supervise, harmonize goals through guidance
o Liaison to the nurse manager, assisting in shift by shift ■ Coordinate, unite personnel and services
coordination and promotion of quality patient care as well ■ Communicate, ensure common understanding via various routes
as efficient use of resources. ■ Develop people, provide staff development programs
o Often troubleshoots problems, assists in decision making ■ Decide/make judgement
o Role model, mentor, educator
o May have more informal power than manager Controlling
■ Specify criteria and standards, utilize performance standards
Staff Nurse ■ Monitor and evaluate nursing care/services, utilize various
o Not formally a manager methods
o Supervises others to ensure safe, quality patient care ■ Performance appraisal, assess, interpret, correct, apply discipline.
 Management Functions SCOPE OF PLANNING
PART 1 - PLANNING 1. Top Management – get the overall goals, and policies of
PART 2 - ORGANIZING an organization.
PART 3 - DIRECTING 2. Middle Management – directs the activities to actually
PART 4 - CONTROLLING implement the broad policies of an organization.
A. PLANNING 3. First Level Management – deals with the daily and
● Is defined as pre-determining a course of action in order to weekly plans for administration in directing patient care in
arrive at a desired result. A continuously process of assessing, their units.
establishing goals and objectives, implementing and
evaluating them. MAJOR ASPECTS OF PLANNING
● is a process that entails formulation of steps to be undertaken 1. Planning should contribute to the objectives.
in the future in order to achieve a desired end. 2. Planning precedes all other process of management.
● takes place in order to efficiently allocate available resources 3. Planning pervades all levels.
(Maglaya, 2000). 4. Planning should be efficient.
● This is the first phase of management process; a proactive &
deliberate process that requires deciding in advance what to TYPES OF PLANNING
do, who is to do it, & how, when, & where it is to be done; A. Strategic Planning (Long- Ranged) - determines where an
involves choice (Marquis & Huston, 2017). organization is going over the next year or more, how it is going
● the managers spend scarce material and human resources to get there and how it will know if it got there or not.
wisely, so carefully to avoid waste, confusion and error. •The focus here is usually on the entire organization.
Principles of Planning
B. Operational Planning (Short Term/ Ranged)
1. Planning is always based and focused on the vision, mission,
- Usually pertain to activities in specific departments of an
philosophy, and clearly defined objectives of the organization.
organization. The plan’s main question is “how does one do things
2. Planning is a continuous process.
right?”
3. Planning should be pervasive within the entire organization
- Deals with tactics or techniques for accomplishing these
covering the various departments, services, and the various
things. They are generally shorter in time frame (e.g. one year), and
levels of management to provide maximal cooperation and
usually involve the middle and lower level managers.
harmony.
- This type of planning is observed in connection with budget
4. Planning utilizes all available resources.
preparation as it deals with day to day maintenance activities in the
5. Planning must be precise in its scope and nature.
organization.
6. Planning should be time-bound.
- Done in connection with improvement and maintenance of
7. Projected plans must be documented for proper dissemination
facilities.
to all concerned for implementation and evaluation.
Importance of Planning Phases of Strategic Planning
1. Planning leads to the achievement of goals and objectives. 1. Strategic Analysis- activities includes the conduct of some sort
2. Planning gives meaning to work. of scan, or review of the organization’s environment, ex.
3. Planning provides for effective use of available resources and Political, social, economic, & technical environment.
facilities. ● Planners consider here the various Strengths, Weaknesses,
4. Planning helps cope with crises. Opportunities and Threats regarding the organization.
5. Planning is cost effective. SWOT is the acronym for this activity. This is also known
6. Planning is based on past and future activities. as the Situational Analysis.
7. Planning leads to the realization of the need for change. ▪ Strengths: internal resources and capabilities that can be
8. Planning provides the basis for control. used as a basis for developing a competitive advantage.
9. Planning is necessary for effective control. ▪ Weaknesses: internal weaknesses (attributes on your firm)
Characteristics of a good plan: ▪ Opportunities: external opportunities for profit and growth.
A well-developed plan should: ▪ Threats: external changes in the environment
1. Be precise with clearly-worded objectives, including desired
results and methods for evaluation. 2. Setting Strategic Direction- includes what the overall
2. Be guided by policies and/ or procedures affecting the planned accomplishments or strategic goals the organization should
action. achieve.
3. Indicate priorities.
4. Develop actions that are flexible and realistic in terms of ● Planners carefully come to conclusions about the
available personnel. equipment, facilities and time. organization must do as a result of the major issues &
5. Develop a logical sequence of activities. opportunities facing the organization. Goals are designed
6. Include the most practical methods for achieving each and worded as Specific, Measurable, Attainable, Realistic,
objective Timely, Extending the capabilities of those working
7. Pervade the whole organization. towards the goals & Rewarding. SMARTER is the
PLANNING PROCESS acronym of these criteria.
1. Determine your strategic position.
● This stage knowing where to go and determining how to get In the activity of setting the strategic direction planners
there is essential in planning. identify & update the b strategic philosophy, mission/vision and
values statements of the organization.
● In the conduct of initial analysis SWOT framework is
commonly used. These are identifying the strengths, Action Planning includes specifying responsibilities and timelines
weaknesses of an organization and looking into the with each objective, or who needs to do what and by when. It should
opportunities and threats outside. include methods to monitor and evaluate the plan, which includes
knowing how the organization will know who has done what & by
2. Prioritize your objectives. when.
● Once you have identified your current position in the market,
it is time to determine objectives that will help you achieve
your goals. Your objectives should be in line with your
company mission and vision.
3. Develop a strategic plan.
4. Execute and manage your plan.
5. Review and revise the plan.
 Strategic Planning Benefits Goals and Objectives
>Goals are more general statement of results.
1. Clearly defines the purpose of the organization & establishes >Objectives are stated in terms of results to be achieved and should
realistic goals & objectives focus on the production of services to the patients.
2. Communicate those goals & objectives to the organization’s
constituents. Example:
3. Develop a sense of ownership of the plan. Goal / General Objective:
4. Ensures the most effective use is made of the organization’s “To provide the best possible healthcare services to its clients in a
resources by focusing the resources on key priorities. high quality setting conducive to attaining its vision as a center of
5. Provides a base from which progress can be measured & wellness and a standard medical center.”
establishes a mechanism for informed change when needed. Specific Objective:
6. Brings together of everyone’s best and most reasoned efforts “To establish an organized governing body so functioning that has
which has an important value in building consensus about where an overall responsibility for the conduct of the hospital in a manner
organization is going. consonant with its philosophy, mission, and objectives.”
7. Provides clearer focus of the organization, producing more
efficiency & effectiveness. C. Developing and Scheduling Programs
8. Bridges staff & board of directors Programs are determined, developed and targeted within a time
9. Builds strong teams in the board and the staff frame to reach the set goals and objectives.
10. Provides the glue that keeps the board together
11. Produces great satisfaction among the planners around a Planning Formula:
common vision. What – when planning ask, “What should be done? What are
12. Increases productivity from increased efficiency & effectiveness. needed? What has been done? What are the necessary steps? What
13. Solves major problems. method to use?”
When – during planning one should ask, “When could it be done?”
Guidelines for Strategic Planning Where – asks, “Where is the area/place the work be done? Where
the supplies be stored?”
1. It should be done when an organization is just getting started. Who – determine the responsible person to do the work and who can
2. It should also be done in preparation for a new major venture. help facilitate them.
3. It should be conducted at least once a year in order to be ready for Why – This is determining the purpose of doing assigned task or
the coming fiscal year. It should be conducted in time to identify the work.
organizational goals to be achieved at least over the coming fiscal How - This is determining how the task be accomplished.
year, resources needed to achieve those goals, and funded needed to Can – asks, “Can some steps or materials be eliminated?”
obtain the resources.
4. Each year, action plans should be updated. GANTT CHART
5. During the implementation of the plan, the progress of the This is commonly used in management and one of the most
implementation should be reviewed at least on a quarterly basis by popular ways of showing activities (tasks or events). On the left of
the board. the chart is a list of the activities and along the top is a suitable time
scale. Each activity is represented by a bar; the position and length
ELEMENTS OF PLANNING of the bar reflects the start date, duration and end date of the activity.
A. Forecasting – helps the manager look into the future and decide This allows you to see at a glance.
in advance where the agency would like to be and what is to be
D. BUDGETING
done in order to get there. The following are considered when
forecasting: ⮚ Defined as allocating of scarce resources based on forecasted
needs for a proposed activity over a specified period.
● Environment
⮚ A financial “roadmap” and plan that serves as an estimate of
● The clients future costs in the operating budget of an organization.
● Number and kind of personnel required ⮚ Budgeting is the process of planning and controlling future
● Necessary resources operations of a specific period usually a year.
⮚ . monetary terms
B. Setting the Vision, Mission, Philosophy, Goals and ⮚ These are usually included in the strategic and annual plan,
Objectives and with work plans.
Vision – a statement that outlines the organizational future role and
⮚ It specifies money needed for the resources that are necessary
function (Venzon, 2003). This is something to strive for.
to implement the annual plan.
Mission – communicates in broad terms the organizational reason
for existence, the geographical area, the organization it serves, ⮚ Budgets also indicate how the money will be spent. e.g for the
attitudes, and beliefs within the organization functions. This outlines human resources, equipment, materials, etc.
the agency’s reason for existing, who the target clients are, and what PURPOSES OF BUDGETING
services will be provided. 1. Mechanism for translating fiscal objectives into projected monthly
spending pattern.
Philosophy – the study of principles underlying conduct, though and 2. Enhances fiscal planning and decision making.
the nature of the universe; general principles of the field of 3. Clearly recognizes controllable and uncontrollable cost areas.
knowledge (Thesaurus). 4. Offers a useful format for communicating fiscal objectives.
>a value statement of the principles & beliefs that direct the 5. Allows feedback of utilization of budget.
organization’s behavior. 6. Helps to identify problem areas and facilitates effective solution.
● describes the vision. 7. Provides means for measuring and recording financial success
● A statement of beliefs and values that directs one’s life or with objectives of organization.
one’s practice.
CHARACTERISTICS OF BUDGETING:
● The sense of purpose. ✔ Should be flexible.
● It gives direction toward the achievement of the ✔ Should be synthesis of past, present and future.
organizational goals and objectives
✔ Should be product of joint venture and cooperation of
Values are the fundamental principles that people believe in and
executive/department head at different level of
that govern their behavior.
management.
>Core values provide the basis to move forward with the
development of a strategic plan. ✔ Should be in the form of statistical standard laid down in
> Values drives future decisions and actions in an organization. the specific numerical terms.
✔ Should have support of top management throughout the
period of its planning and implementation.
 TYPES OF BUDGETS: The methods for costing out nursing services:
1. Operating/ recurrent budget (Revenues and Expenses): Per diem or cost per day: It used for both rate setting and
Provides an overview of agency function by projecting the reimbursement is calculated by dividing the total nursing care cost
planned operation for upcoming year. Deals with salaries, by the number of patient days for a specific period.
medical-surgical supplies, office supplies, laundry services,
books periodicals, recreation and contractual services. Cost per diagnosis:(diagnostic related group) It used to reduce
reimbursement costs for patient payment, categories patients based
2. Plant/ Capital expenditure budget: Related to long range on diagnosis and number of days of hospitalization by using four
planning. Includes physical changes (replacement and methods which are reduce the prices paid for resources, reduce the
expansion of plant, major equipment and inventories). They length of stay, reduce the intensity of services provided and finally
are major investment and reduce flexibility in budgeting. improve efficiency.

TYPES OF BUDGETING: Cost per Relative Intensity Measures: (RIM) It is calculated by

1. Cash budget: Planned to make adequate funds available and dividing the total nursing costs for hospital by the total minutes of
to use extra funds profitably. Should not have too much cash care estimated or nursing resource used to provide care to all patients
on hand during budgetary period. then by dividing the number of minutes used by the total hospital
2. Labor or personnel budget: Estimate cost of direct labor population including adjustments for downtime, such a sick leave
necessary to meet agency objectives. Determine the and vacation time, is calculated and finally the cost of care for each
recruitment, hiring, assignment, layoff, discharge of patient is determined by multiplying the RIM by the minute of care
personnel. Nurse Manager has to decide number of aids, required by the patient as estimated by an equation.
orderlies required during a shift months and areas. Patient classification system: It is the method that grouping patients
3. Flexible budget: Some costs are fixed, others changes with according to some observable or interfered characteristics. It focuses
volume of business. Some expenses are unpredictable and can on a mean to categorize patients according to assessments of their
be determined only after change has begun. Periodic reviews nursing needs that can be quantified to determine a measure of
required to compensate for changes. nursing effort interfaced with nursing care system.
4. Strategic planning budget: Long range budget for long range
planning. Projected for 3-5 years. Programme budget is a part Work-sampling technique: It is an industrial engineering technique
of this budget. in which data an individual from outside the primary work group
5. Standard Cost- may be developed to predict what labor and observes the activities of a selected sample of employees on regular
supplies should cost. Multiplying the standard cost by the intervals, records their activities and generalize from the observed
volume predicts the variable cost. sample to estimate the percentage of the employer total time that
6. Zero-based Budgeting - Many budgeting procedures allocate workers spend in each task.
funds based on their previous year’s expenditures. This
procedure usually allows for enrichment and enlargement of Time and motion studies: all nursing procedures are timed and
programs but seldom for decreases or deletion of programs. norms established for each task. The average level of the worker
Obsolescence is seldom examined, and this leads to increased doing the task also determined. when the average time of each of
costs. A major advantage to zero-based budgeting is that it them known direct costs of labor are determined and added to cost
forces managers to set priorities and justify resources. materials. Calculation by knowing the specific tasks performed on a
7. Supplementary Budgets - some budgetary flexibility may be unit on a given day.
obtained through a supplemental monthly budget. A basic or
minimal budget is planned, usually for a year’s time, to outline BARRIERS IN PLANNING
the framework for the agency’s plans, establish department
objectives, and coordinate departments. 1. No clear purpose. Without a clear understanding of our desired
8. Moving Budgets - The projections progress a month at a time outcomes for strategic planning, there is no focus.
but always for a fixed period such as one year. It is an annual 2. Not Linked to vision & goals. It doesn’t matter how brilliant
budget revised monthly. your strategic plan is if it doesn’t align with the vision, goals
and values of your organization.
NURSING BUDGET – a plan for allocation of resources based on 3. Lack of Research. The process, and ultimately the strategic
preconceived needs for proposed series of programs to deliver plan, ends up being based on opinions rather than real and
patient care. objective information.
4. Lack of Structure. Without some up front planning and a
HOSPITAL BUDGET - financial plan to meet future service systematic approach for developing your strategy, things can
expectations. quickly get off track.
COSTING OF NURSING CARE SERVICES 5. No linkage to Implementation. Who is going to do what? If we
Costing nursing service is the process of estimating the monetary don’t know, it’s likely that the strategic plan will sit on the shelf.
(fiscal or financial) value of providing nursing care to patients. It is 6. Not Aligned with Reality. Once again, it doesn’t matter how
thus of major importance that nursing acquires a cost allocation brilliant your strategy is if you lack the resources, knowledge
system that can define and measure the consumed time of providing and skills to implement.
nursing care by different personal categories per patient and its cost. 7. No Measures or Evaluation. How will you stay on track? How
It can be estimated per hour, per patient, or per day. will you know if you are successful? Chances are, if you don’t
review regularly, you won’t achieve results.
The benefits of costing out nursing services:
1. Charging out nursing services makes it possible for the C. ORGANIZING
customer to pay for the care. ● Consists of structure and process which allows the agency
2. Customers start to realize that direct care has a price value. to enact its philosophy and utilize its conceptual framework
3. Hospitals can receive compensation for what they provide, to achieve its goals (Venzon, 2003).
maximizing profits. ● An organization includes people working together for a
4. Nursing can be viewed as a revenue-generating center rather common purpose while working in different areas.
than cost. Relationships are emphasized in an organization.
5. Charging a fee for services helps enhance the professionalism
of nursing through the traditional pattern of reimbursement for
services.
6. Costing out nursing services to enhance the use of human
resources, contains costs and mention quality.
7. Using a cost accounting system to assess and change the
nursing department helps establish a reputation for innovation
and leadership.
 ORGANIZATIONAL THEORIES: 6. Decentralization or Proper Delegation of Authority – the
1. Classical Theory process of conferring specified decision making to the lower
● This is an approach to organizations focuses on the levels of the organization.
efficiency achieved through a design. And people are place
there according to plan. ELEMENTS of ORGANIZING:
● It is built around four elements: division and specialization - Organizational Structure
of labor, organizational structure, chain of command, and - Staffing
span of control. - Schedule
- Job Description
2. Humanistic Theory
● Due to criticism of classical theory the humanistic theory Organizational Structure
was developed. ⮚ The organizational structure provides the framework in
● It is an approach identified A major assumption of this which management process is carried out in an
theory with the human relations movement of the 1930s. organization.
● It assumes that people desire social relationships, respond to ⮚ It is designed to show clear lines of authority, flow of
group pressures, and search for personal fulfillment. communication, and relationships among the various
departments, and to pinpoint person/s responsible and
● One important assertion of this school of thought was that accountable.
individuals cannot be coerced or bribed to do things they
⮚ The optimal organizational structure integrates
consider unreasonable; formal authority does not work
organizational goals, size, technology, and environment.
without willing participants.
Various organizational structures have been utilized over
time.
3. Systems Theory
● This theory provides a framework by which the interrelated Purposes:
parts of the system and their functions can be studied. ▪ It informs the members of the organization of their
● Resources, or input, such as employees, patients, materials, responsibilities.
money, and equipment, are imported from the environment. ▪ It allows the workers and managers to concentrate on their
specific role.
● Within the organization, energy and resources are utilized
▪ Duplication of effort or conflict is minimal and avoided.
and transformed; work, a process called throughput, is
▪ Doubt and confusion is reduced.
performed to produce a product. The product, or output, is
then exported to the environment. Characteristics of Organizational Structure:
1. Informal Structure – consists of personal and social
4. Contingency Theory relationships among the members of the organization.
● Matching an organization’s structure to its environment. - It is not reflected in the organizational chart. It is through the
● Health care organizations are unique with respect to the informal structure that people with little or no formal status or
kinds of products and services they offer. position may gain recognition.
● The organization’s structure depends on the environment - This unofficial personal relationship among workers may
necessary for patient care. influence their working effectiveness.
- Has its own channel of communication called the grapevine,
● Thus, the optimal form of the organization is contingent on where information is disseminated faster than in the formal
the circumstances faced by that organization. system of communication.
- Information transmitted through the grapevine may or may not
5. Chaos Theory be accurate.
● Organizations are living, self-organizing systems that are - Is unplanned and covert
complex and self-adaptive.
● The life cycle of an organization is fully dependent on its 2. Formal Structure – describes the positions, the
adaptability and response to changes in its environment. responsibilities of those occupying the positions and the
working relationships among the various units or
● This theory requires us to abandon our attachment to any
departments.
particular model of design and to reflect instead on creative
- is planned and made public.
and flexible formats that can be quickly adjusted and
changed as the organization’s realities shift. Basic Forms of Formal Organizational Structure:
1. Tall/Centralized
6. Complexity Theory The chart of relationship appears tall and narrow.
● Complexity theory originated in the computational sciences Most decision making authority and power is held by a few persons
when scientists noted that random events interfered with in central positions that typically found at the top of the chart or
expectations. structure.
● The theory is useful in health care because the environment
is rife with randomness and complex tasks. 2. Flat/Decentralized
The chart of relationship shows a few levels and broad span of
ORGANIZING PRINCIPLES: decision- making is commonly spread out among many people and
In designing the organizational structure, the following those that closest to the situation are given wide latitude in
organizational principles are observed: determining appropriate actions.
1. Unity of Command – employees are responsible to one
superior in the discharge of their duties. 3. Matrix
2. Scalar principle or hierarchy – also called as chain of A structure that either tall ot flat. It is thought as the functional
command. Authority and responsibility should flow in clear structure.
unbroken lines from the highest in rank to the lowest.
3. Homogenous Assignment/ Departmentation – workers are 4. Adhoracy structure
group together with similar assignments for a common Uses teams of specialist who organized to complete a particular task
purpose. or project. (explains the basis of ad hoc).
4. Span of control - this refers to the number of workers that a
supervisor could handle and supervise. Also refers to as the 5. Shared Governance
managerial responsibility. Represents a professional practice model in which the nursing staff
5. Exception Principle – day to day problems are handled in a and nursing management are both involved in decision making
routine manner by the supervisor. decisions as opposed to having the decision made only by the
administrative level.
 Accountability – taking full Power – the ability to ● It represents a conceptual, rather than a functional, view of the
responsibility for the quality of influence another to organization.
work and behavior while engaged behave in accordance
in the practice of the profession. with one’s wishes. • Head Nurse
• Staff Nurse
Authority – the right to act or Responsibility – is the • Staff Nurse
make decisions without approval obligation to perform • Staff Nurse
of higher administrators the assigned tasks.
Figure 4. Organizational Chart

ORGANIZATIONAL STRUCTURE / CHART STAFFING

o An organizational chart is a drawing that shows how the ● The process of determining, providing the acceptable
parts of an organization are linked. number and mix of nursing personnel to produce a desired
o It depicts the formal organizational relationships, areas of level of care to meet the patients demand.
responsibility, persons to whom one is accountable, and
channels of communication.
● The purpose is to provide each nursing unit with
appropriate and acceptable number of workers in each
o An organizational chart is a graphic representation of the
category to perform the nursing tasks required.
chain of authority from chief executive to each member of
the organization. (Murray and DiCroce,1992)
Factors Affecting Staffing:
o The organizational chart depicts the chain of command,
1. Type, philosophy and objectives
division of work, levels of management, and functional
2. Population served
communication pattern.
3. Number of patients and severity of illness
Uses: 4. Availability and characteristic of nursing staff
1. It outlines administrative control. 5. Administrative policies
2. It is used for policy making and planning. 6. Standard of nursing care
3. It is used to evaluate strengths and weaknesses of the present 7. Availability of resources
structure. 8. Budget
4. It shows the relationship with other departments and agencies. 9. Professional activities and involvement in formal
5. It is used to orient new personnel to the organization. organization
10. Teaching program, staff involvement
Characteristics of an Organizational Structure/Chart
11. Expected hours of work per year
a. Division of work – boxes that represent individual/sub unit
12. Patterns of works schedule
responsible for a given work.
b. Chain of Command – indicate who reports to WHOM and by
SCHEDULING:
WHAT authority.
●Refers to a timetable showing planned work days and shifts for
c. Type of work to be performed – consists of labels or
nursing personnel.
descriptions
Objective: To assign working days and off-days to the nursing
d. Grouping of work groups – clusters of group working together.
personnel so that adequate patient care is assured.
e. Levels of management – refer to the entire management
hierarchy and individual worker.
Factors/variables to be considered in making schedule:
*Organizational Charts may be VERTICAL, HORIZONTAL, OR 1.Adequate coverage for 24 hours, 7 days a week; length of
CONCENTRIC OR CIRCULAR. scheduling period whether 2 or 4 weeks.
1. Vertical Chart or Tall Structure 2.Staggered vacations and holidays – can’t enjoy the holiday, off on
● Depicts the chief executive at the top with lines of authority exactly the same day that they occur.
flowing down the hierarchy. 3.Weekends – lower (lesser medical rounds, fewer medical orders &
● This structure is most effective when managers desire better lower pt. Census)
coordination and effective communication. 4.Long stretches of working days are to be avoided
● This structure clearly defines the relationships between and 5.Evening shifts and night shifts and floating/ shift rotation – lower
among the different levels in the organization. 6.Different levels of nursing staff should be observed - so that they
● More attention is given to messages which come from only assume duties that are legally responsible for.
managers than those from the lower echelons. 7.Job descriptions
● Members are given more opportunities to participate in 8.Scheduled events in the hospital training programs, meetings, etc.
decision-making activities because of limited or small span 9.Continuing Professional Education (CPE) programs.
of control.
Type of Scheduling:
2. Horizontal Chart or Flat Chart Centralized Schedule
● Depicts the manager at the top with a wide span of control. ●one person assigns the personnel to various unit.
● The levels of management are not shown in a flat chart. ●a staffing coordinator in the central nursing office is responsible for
● Employees in this structure report to one manager. They scheduling both the staff nurses who are permanently assigned to
have more freedom. each nursing unit & those who are rotated among units to ensure
● Head nurses or frontline managers are given more adequate staffing during periods of increased patient census or
authority. excessive absenteeism.
● Communication in this structure is direct, simple, and fast
with minimal distortions of messages since the distance Decentralized Schedule
between the top and lower levels is shorter. ●shifts and off duties are arranged by the head nurse of the particular
3. Circular or Concentric Chart unit.
● Depicts top management in the center represented by the ●Department manager decides or is given the responsibility &
Board of Trustees or Directors, Chief of Hospital or Hospital authority for staffing.
administrator and the Chief Nurse. ●The head nurse of each unit or the supervisor of each section
● Those in the middle and lower levels of management such as develops time schedules for her subordinates that are independent of
the nurse supervisor, charge nurse and staff nurse are in personnel schedule prepared by other head nurses or supervisors.
concentric circles.
● This chart shows the outward flow of formal authority which Sample Schedule:
is from the center moving outward. - Cyclical Schedule
● This type of structure minimizes or reduces the implications of - Self- schedule
status or positions.