nursing management in the local public health system

Nursing Management in the Local Public

Health SystemAligato – Bajarias - Banzon – Daaca – Hortezano – Odal -

Palmez - Parantar – Sajulga – Sinogaya – Villamero - Tinoy

MANAGEMENT (Rakich, Longest & Donovan) - It is a set of

interactive processes through which the utilization of resources results in the accomplishment of organization objectives

(Kast & Rosenzweig) - is the primary force within an organization that coordinates the activities of the subsystems and relates them to its environments

LEVELS OF MANAGEMENT Top managers: Responsible for overall

operations.

Middle managers: coordinate nursing activities of several units.

First line managers: (supervisors, or head nurses.) directly responsible for the actual production of nursing services.

MANAGEMENT FUNCTIONS

MANAGEMENT PROCESS : Planning Organizing Staffing Directing Controlling

PLANNING Includes defining goals and objectives; Developing policies and procedures; Determining resource allocation; Developing evaluation methods. Budgets are used in planning.

ORGANIZING The personnel can implement the plans with

efficiency and effectiveness; Includes identifying the management structure to

accomplish work; Determining communication processes; and coordinating people, time and work.

STAFFING Recruiting, selecting, orienting developing

personnel to accomplish the goals of the organization.

Determining assignment systems , case method, functional, team, primary nursing.

Schedules to meet the needs of the clients, personnel, and institution.

LEADING (or directing) (Direct personnel and activities to accomplish the

goals of the organization) Motivating and leading personnel . Knowledge of one’s leadership style . To get work done by others . Tasks require good communication skills and

assertive behavior

CONTROLLING Ensures progress toward objectives according to

plan and involves setting standards, measuring performance against those standards

• Analyzes results to evaluate a accomplishments and includes evaluating employee performance;

• Analyzing financial activities;• Monitoring quality of care.

SUPERVISORS POSSESS FOUR TYPES OF SKILLS

1. Technical skills: Involve methods, procedures, techniques & knowledge of work being performed.

2. Human relations skills: ability to motivate and lead others and to manage conflict.

3. Administrative skills: ability to perform the planning, organizing and controlling functions

4. Decision-making/problem solving skills: ability to critically analyze information and problems and make appropriate decisions.

RESPONSIBILITIES OF THE DIFFERENT LEVELS OF MANAGEMENT1. Setting objectives2. Planning strategy3. Setting goal-short-

term objective4. Developing company

philosophy5. Setting policies-the

plan6. Planning the

organization7. Providing personnel

8. Establishing procedures9. Providing facilities10.Providing capital 11.Setting performance

standards12.Initiating management

programs13.Developing management

informations systems14.Activating people

MANAGEMENT IN PUBLIC HEALTH

Public health in the Philippines setting- Is a unique undertaking given the different macro

and micro contexts of the local public health organization – • Government policies• Programs of the national government• National an local health budgets• Geography • Political dynamics• Local culture

THE LOCAL PUBLIC HEALTH ORGANIZATION

Health Department - serving as the governing agency, a department in the local government unit

LGU (Local Government units)and the local leaders – providing services to communities and individuals

RHU (Rural Health Units) – exist in every municipality to improve access to healthcare

PHN (Public Health Nurses) and Midwives – are assigned to the different health centers

STANDARD HEALTH SERVICES

HEALTH CENTERS PROVIDE:• Immunization• Prenatal and postnatal care• Consultations• Laboratory and diagnostic examinations• Emergency medical care• Treatment of common illnesses• Referral to hospitals

PHN AS A MANAGER AND SUPERVISOR PLANNING

Nurses participate in planning for the whole local health organization.

A component of the organization’s plan is a nursing unit plan.

PHNs are exposed to, and participate in different types of plans:

• Strategic plan• Operational plan• Program plan • Nursing care plan

PHN AS A MANAGER AND SUPERVISOR

STRATEGIC PLAN

Long-range plan which contains an organizational vision and mission, guiding principles, broad strategic objectives, and specific tactics projects or activities for achieving the broad objectives.

PHNs participate in reviewing the organization’s strengths, weakness, opportunities and threats (SWOT)

PHN AS A MANAGER AND SUPERVISOR

OPERATIONAL PLAN Short-range plan that generally deals with the routine activities of

the organization

Addresses the requirements for delivering health services on a daily basis

It may include training of health center staff, income generation, purchase of instruments and equipment, introduction of a new system in queuing of clients, how to improve intra-office intra-sectorial and intersectoral collaboration, participation in the training of affiliating nursing students

PHN AS A MANAGER AND SUPERVISOR

Plans should be realistic and should be acceptable to the decision-makers-the local council and the mayor

Preparing a budget for the health centers

Manual of personal policies, standards and procedures should contain all pertinent laws (such as: Magna Carta of Public Health Workers and Code of conduct and Ethical Standards)

PHN AS A MANAGER AND SUPERVISOR

ORGANIZING

Prior to RA 7160 (Local Government Code), the organizational structure of health departments or units was standard

In assessing an existing organizational structure, nurses should be familiar with some of the principles of organization

PRINCIPLES OF ORGANIZATIONDIVISION OF WORK: 1. Division of work or specialization alone can give

maximum productivity and efficiency. 2. Both technical and managerial activities can be

performed in the best manner only through division of labor and specialization.

3. A group or team of service providers (physician, nurse, midwife and others) are assigned to a specific program, service or unit.

4. In small health centers, division of work is based on position(profession)

PRINCIPLES OF ORGANIZATIONCOORDINATION:

Conscious activity of assembling and synchronizing differentiated work efforts so that they function harmoniously in the attainment of organization objectives.

Many nurses are designated as coordinators of health programs like:• EPI• NATIONAL TB PROGRM• HEALTHY LIFESTYLE • LEPROSY CONTROL PROGRAM • REPRODUCDTIVE HEALTH AND FAMILY PLANNING PORGRAM • IMCI

PRINCIPLES OF ORGANIZATION

UNITY OF COMMAND: In order to avoid any possible confusion and

conflict, each member of an organization must receive orders and instructions only from one superior (boss).

PRINCIPLES OF ORGANIZATION

AUTHORITY AND RESPONSIBILITY: Authority means a superior’s right to command and exact

obedience from his/her subordinates. If a PHN is given responsibility as an EPI coordinator she

should also be granted corresponding authority

PRINCIPLES OF ORGANIZATION

SPAN OF CONTROL: The number of subordinates reporting directly to a

superior. If a PHN is given responsibility as an EPI coordinator she

should also be granted corresponding authority PHN is the direct supervisor of midwives, determined by:

• Level of training or competence of subordinates•Degree of geographical dispersion • Level of difficulty or complexity of the supervisees’ work

NURSING IN THE ORGANIZATIONAL STRUCTURE

STAFFING

• The concern in staffing is to have an adequate number of nurses, midwives and barangay health workers for the total

• population• There should be a contingency plan in times of greater

need such as disasters• Major problem of LGUs is inadequacy of health personnel

which is mostly due to inadequate health budget• Nurses should properly and adequately document their

activities so that their proposal for increased staffing will be considered seriously

NURSING IN THE ORGANIZATIONAL STRUCTURE

LEADERSHIP

• PHN leads the midwives so that they could deliver health services and meet the targets for their respective barangays

• The challenge for PHNs is how to influence their subordinates to pursue the goals of the organization, specifically for them to:

1. Behave respectfully towards their clients2. Provide quality service3. Meet program an/or service targets4. Observe cost containment measures5. Observe organizational values such as honesty,

cooperation, and punctuality

NURSING IN THE ORGANIZATIONAL STRUCTURE

COMMUNICATION

Nurse managers communicate to their subordinates about a number of things: policies, standards, procedures and the work that need to be done

Nurses also communicate upwards-to inform, give feedback and to influence

Nurse managers also communicate with their peers from other offices

NURSING IN THE ORGANIZATIONAL STRUCTURE

DELEGATION

PHNs should delegate to save time, develop others for their future roles and responsibilities

If a midwife can do a task very well, then the nurse should delegate

NURSING IN THE ORGANIZATIONAL STRUCTURE

CONTROLLING : Important in improving service delivery because they

serve as reminders if there are deviations from targets and standards

4 Components of the control process:1. Plan, instructions, principles and standards2. Observation, measurement and comparing “what is”

with “what should be”3. Identification of weaknesses, problems, or errors4. Correcting rectifying or doing something about them

NURSING IN THE ORGANIZATIONAL STRUCTURE

CONTROLLING:Controls that could be introduced into the public

health unit, some of which are:1. Statistical reports, records eg inventory of

medicines, FP Supplies), audit, Gantt-chart or schedule activities, client feedback

Evaluation of personnel:The evaluation of the performance of government employee is mandatoryThe performance appraisal of PHNs should focus on their duties and responsibilities

NURSING IN THE ORGANIZATIONAL STRUCTURE

QUALITY ASSURANCE (QA)An important management activity to honor the health

facility’s commitment to provide quality care to its clients

1. Structure Standards – define the rules under which service must be delivered

2. Process Standards– define how the rules under which service must be delivered. These cover thee health care facility

3. Process Standards – define n the other hand, define how nursing care is provided

4. Outcome standards - define both the desired results to be achieved and the undesirable results to be avoided

NURSING IN THE ORGANIZATIONAL STRUCTURE

SENTRONG SIGLA MOVEMENT

Certification recognition program which develops and promotes standards for health facilities Joint effort bet.:

DOH – provides technical and financial assistance packages for health care

LGUs – direct implementers of health programs & prime developers of health centers and hospitals making services accessible to every Filipino

NURSING IN THE ORGANIZATIONAL STRUCTURE

NURSING AUDIT It is a method of evaluating the quality of care given

to client through the systematic review of client records

It is a process, not an outcome evaluation If the process of delivering care/service is in

accordance with established standards, then there must be quality(outcome)