NURSING LEADERSHIP AND MANAGEMENT

Topic: Nursing Management Functions (Directing and Controlling)

1. forces exceed restraining forces ۩ Assess the capability of the individual if he needs
2. Refreezing – the last phase, the change agent assists in supervision
stabilizing the system change so that it becomes
integrated into the status quo CONTROLLING
Stages of Change and Responsibilities of the Change Agent Controlling
Stage 1 – 1. Gather data ۩ The fifth and final step in the management process
Unfreezing 2. Accurately diagnose the problem ۩ Because the management process, like the nursing process,
3. Decide if change is needed is cyclic, controlling is not an end in itself; it is
4. Make others aware of the need for implemented throughout all phases of management
change; often involves deliberate tactics ۩ Assessing and regulating performance
to raise the group’s discontent level; do ۩ Process of seeing that actual expenditures and activities
not proceed to stage 2 until the status conform to plan
quo has been disrupted and the need for ۩ Examples of management controlling functions:
change is perceived by others o The periodic evaluation of unit philosophy,
Stage 2 – 1. Develop a plan mission, goals, and objectives
Movement 2. Set goals and objectives o The measurement of individual and group
3. Identify areas of support and resistance performance against preestablished standards
4. Include everyone who will be affected by o Auditing of patient goals and outcomes
the change in its planning
5. Set target dates Continuous Quality Improvement
6. Develop appropriate strategies Total Quality Management (TQM) – aka CONTINUOUS QUALITY
7. Implement the change IMPROVEMENT (CQI), is a philosophy developed by Dr. W. Edward
8. Be available to support others and offer Deming. It assumes that production and service focus on the
encouragement through the change individual and that quality can always be better
9. Use strategies for overcoming resistance ۩ Identifying and doing the right things, the right way, the
to change first time, and problem prevention and reactive problem
10. Evaluate the change solving—lead to quality outcomes
11. Modify the change, if necessary
Stage 3 – Support others so that the change continues Quality Control – specific type of controlling, refers to activities that
Refreezing are used to evaluate, monitor, or regulate services rendered to
consumers
Time Management
۩ Techniques for allocating one’s time through the setting of Hallmarks of Effective Quality Control Programs
goals, assigning priorities, identifying and eliminating 1. Support from top-level administration
wasted time and using managerial techniques to reach 2. Commitment by the organization in terms of fiscal and
goals efficiently human resources
Steps in Time Management 3. Quality goals reflect search for excellence rather than
minimums
4. Process is ongoing or continuous

1. Allow time for planning and Quality Control Process

establish priorities. 1. The criterion or standard is determined
2. Information is collected to determine if the standard has
been met
3. Educational or corrective action is taken if the criterion has
2. Complete the highest priority task
not been met
whenever possible and finish one
task before beginning another.
Audit – a quality control tool, is a systematic and official
examination of a record, process, structure, environment, or
account to evaluate performance
3. Reprioritize based on the remaining ۩ In healthcare organizations, auditing provides managers
tasks and on new information that with a means of applying the control process to determine
may have been received the quality of services rendered

Audits most Frequently used in Quality Control

 Outcome Audits
Supervision o Reflect the end result of care or how the
۩ Guiding and directing the work to be done patient’s health status changed as a result of an
۩ Helping the individual do his work better intervention
 Process Audits
NURSING LEADERSHIP AND MANAGEMENT
Topic: Nursing Management Functions (Directing and Controlling)

o Used to measure the process of care or how the o ISO certified hospitals tend to have lower costs
care was carried out and assume that a due to their streamlined processes and improved
relationship exists between the process used by efficiency
the nurse and the quality of care provided ISO Certified Hospital in the Philippines
 Manila Doctors Hospital
 Makati Medical Center
 Structure Audits  St. Luke’s Medical Center-Global City
o Assume that a relationship exists between  Asian Hospital and Medical Center
quality care and appropriate structures  The Medical City
o Are often set by licensing and accrediting bodies Nursing Audit – method for assuring documentation of quality of
to ensure a safe and effective environment nursing care in keeping with established standards
o Includes resource inputs such as the
environment in which healthcare is delivered Types of Nursing Audit
o Includes elements that exists prior from the  Retrospective Audits
interaction between the patient and the o Performed after the patient receives the service
healthcare worker such as staffing ratios, staffing  Concurrent Audits or Open Chart Review
mix, emergency department wait times, and the o Are performed while the patient is receiving the
availability of fire extinguishers in patient care service, check charting, observation of patient
areas
o Ex: call lights, breast feeding rooms Auditing Quality Control Steps
Establish control criteria
Joint Commission
۩ An independent, not-for-profit organization that accredits Identify the information relevant to the criteria
healthcare organization and programs has historically had
a tremendous impact on planning for quality control in Determine ways to collect the information
acute-care hospitals
۩ JC was first to mandate that all hospitals have a QA Collect and analyze the information
program in place by 1981. These QA programs were to
include: Compare collected information with the established criteria
o Review of the care provided by all clinical
departments, disciplines, and practitioners Make a judgement about quality
o Coordination and integration of the findings or
quality control activities Provide information and, if necessary, take corrective action
o Development of specific plans for known or regarding findings
suspected patient problems
Reevaluation
ISO Certification
۩ ISO – International Organization for Standardization Performance Appraisal
۩ In the Philippines, ISO Certification is becoming ۩ Evaluated by supervisors
increasingly common for hospitals ۩ Method of evaluating accomplishments to help employees
۩ Many hospitals are now looking to achieve ISO improve his work methods
certification in order to improve their quality management ۩ When done correctly, it is one of the greatest tools an
system organization has to develop and motivate staff
۩ This can help to improve the quality of care and increase ۩ When done poorly, it has the potential to discourage and
patient satisfaction demotivate
۩ ISO certification can also help to reduce costs and improve
efficiency Evaluation
۩ Plays an important role in quality and productivity
Benefits of having ISO Certification improvement for several reasons:
 Improved quality of care o Ensures quality nursing care is provided
o ISO certified hospitals must meet strict quality o Allows for setting of sensible objectives and
standards, which leads to improved patient care ensures compliance
 Increased patient satisfaction o Provides standards for establishing comparisons
o Patients are more likely to be satisfied with the o Promotes visibility and means for employees to
care they receive at an ISO certified hospital monitor their own performance
 Greater staff satisfaction o Highlights problems related to quality care and
o Employees of ISO certified hospitals report determines the areas that require priority
higher job satisfaction rates attention
 Lower costs o Provides an indication of the costs of poor
quality
NURSING LEADERSHIP AND MANAGEMENT
Topic: Nursing Management Functions (Directing and Controlling)

o Justifies the use of resources  Halo Error – based on the good traits one sees in person,
o Provides feedback for improvement good things done overshadow errors
 Horn’s Effect – poor performance overshadowed good
Types of Evaluation Responses performance
Checklists  Logical Error – first impression, first encounter may
۩ Is a compilation of all nursing performances expected of a provide the rater the qualities or specific traits which
worker serves as bars to the quality of performance of the ratee
۩ Appraiser’s task is to mark the appropriate column  Central Tendency Error – all treated as average, used by
whether the worker does or does not show the desired the rater when feedback tools are adequate and when
behavior there’s insufficient time for the rater to observe the ratee
 Leniency Error – given mercy rating
Benchmarking – a technique whereby an organization seeks out the
best practice in its industry to improve its performance

Discipline – part of the controlling process in management

۩ Regarded as a constructive and effective means of by
which employees take personal responsibility for their own
performance and behavior

Principles of Disciplinary Actions

1. Have a positive attitude
2. If they are treated as suspects, they are more likely to
provide the trouble that the manager anticipates
3. Investigate carefully
4. Be prompt
5. Protect privacy
6. Focus on the act
7. Enforce rules carefully. Use extreme caution in instituting
Ranking disciplinary measures
۩ The evaluator ranks the employees according to how he 8. Be flexible
fared with co-workers with respect to certain aspects of 9. Take corrective, constructive actions
performance 10. Should be progressive in nature preceded with counselling
۩ Ex: educational requirements, clinical proficiency
Disciplinary Actions
Rating Scale 1. Counseling and Oral Warning
۩ Includes series of items representing the different tasks or o Best given in private and in an informal
activities in the nurse’s job description atmosphere
o Employee is given a fair chance to air his side
o The relevant facts are analyzed and evaluated
against his performance
o Employee is then counseled regarding
expectation of improved behavior/performance,
ways of correcting problem and a warning that a
repetition of the same offense may warrant
further disciplinary action
2. Written Warning
o Second step in the disciplinary action
o The employee must be told after the interview
that he will be given a written warning
o This includes the statement of the problem,
Free Response Report identification of the rule which was violated,
۩ Comment in writing on the quality of the nurse’s consequences of continued behavior,
performance employees’ commitment to take corrective
action, and any follow up action to be taken
Forced-choice Comparison 3. Suspension
۩ The evaluator is asked to choose the statement that best o Given after an evidence or oral and written
describes the nurse being evaluated warnings
o Suspension, rather than dismissal is applied
Common Errors of Evaluation when management feels that the employee can
still be rehabilitated
NURSING LEADERSHIP AND MANAGEMENT
Topic: Nursing Management Functions (Directing and Controlling)

4. Dismissal
o Invoked only when all other disciplinary efforts
have failed
o The disciplinary committee should be very sure
that the cause for dismissal conforms with the
criteria of a major discipline violation as
contained in the policy manual