concept 1- leadership & management in nursing

Arellano UniversityCollege of NursingLegarda, Manila

Nursing Management and Leadership

I Introduction to Leadership

*WHY STUDY LEADERSHIP AND MANAGEMENT? Nurses have to keep up with the many changes in the health care system* From hospital care or institutional care, emphasis has shifted to community health delivery.* From emphasis on physical care, efforts are now directed towards holistic approach to the care of individual, families, and communities* From mere recipients of care, patients are now active participants in health care efforts

New developments in the health care system require that nurses continue updating their knowledge, skills and attitudes to competently and adequately meet those changing needs. Nurses have to learn and adjust to complex interrelationships between and among service units, departments, professional disciplines, community agencies, patients, families, significant others, employees groups, and the administration.WHY STUDY LEADERSHIP AND MANAGEMENT?

* Nurses have to know their place and their specific roles in the organizational hierarchy. Nurses have to find at varying levels that they have to manage people, their clients or patients, their resources and time.WHY STUDY LEADERSHIP AND MANAGEMENT?

How well do we know them ?

MAHATMAGANDHI

MOTHERTHERESA

MARTINLUTHERKING

MARGARET THATCHER

NELSONMANDELA

ALEXANDERthe GREAT

POPEJOHN PAUL II

TIGERWOODS

KobeBryant

OPRAHWINFREY

FLORENCENIGHTINGALE

WHAT MADE THEM GREAT and FAMOUS ?WHAT ARE THEIR TRAITS AS A GREAT LEADER ?

Historical traits attributed to leaders are the following: Intelligence Self-confidence Determination Integrity Sociability

Caring Respectability Trustworthiness Flexibility

What then is Leadership?process of influencing others toward goal achievement. (Yukl, 1998) Influence is an instrumental part of leadership and means that leaders affect others, often by inspiring, enlivening, and engaging others to participate.

Leadership can occur between the leader and another individual; between the leader and a group; or between a leader and organization, a community or society

Formal and informal leadership

1. Formal leadership is based on occupying a position in an organization, called assigned leadership.

2. Informal leadership occurs when an individual demonstrates leadership outside the scope of a formal leadership role or as a member of a group, rather than as the head or leader of the group. The informal leader can be considered to emerge as a leader when accepted by others and perceived to have influence.

* interpersonal process of influencing the activities of an individual or group toward goal attainment in a given situation. (Maloney)

* process of persuasion and example by which an individual (or leadership team) induces a group to take action that is in accord with the leaders purpose or the shared purposes of all. (Gardner)

* the process of directing and influencing task-related activities of group members. (Stoner)

* process of sustaining an initiated action; conception of a goal a method of achieving it; the mobilization of the means necessary for attainment; and the adjustment of values and environmental factors in the light of the desired level (Mitton)

*(Bennis and Nanus, 1985)* Leaders focus on a professional and purposeful vision that provides direction toward the preferred future.* Passion expressed by leaders involves the ability to inspire and align people toward the promises of life. *Leaders possess integrity based on knowledge of self, honesty, and maturity developed through experience and growth.

Intelligence Personality AbilitiesOther Leadership Characteristics

KnowledgeJudgmentDecisivenessOral fluency 1. IntelligenceOther Leadership Characteristics

PersonalityAdaptability CreativityCooperativenessAlertnessSelf-confidencePersonal integrityEmotional balance and controlNon-conformityIndependence Other Leadership Characteristics

Able to enlist cooperationInterpersonal skillsTact, diplomacyPrestigeSocial participationAbilitiesOther Leadership Characteristics

**** possesses a striking physical personality and is energetic*** possesses a sense of purpose and direction*** has the power of ready speech.*** is enthusiastic about the purpose of the group and is devoted to its cause.*** has keen sight into the human nature of people. He or she has faith and trust in the people he/she leads.

**** displays courage and persistence even in the face of the opposition.*** is decisive.*** is cheerful and even-tempered.*** shows technical mastery that inspires others to do above average performance in their jobs.*** is intelligent, versatile and has sense of humor.*** has moral vision, integrity and idealism.

Traits of a LeaderL -eads, love, learns E -nthusiastic, energeticA -ssertive, achieverD -edicated, desirousE -ffective, efficientR -espectful & responsible

Elements of Leadership1. Leader- one who motivates members of his group to achieve the goal2. Followers - are the constituents who are duty-bound to follow leaders orders & gives respect to the latter.3. Group includes both the leader and the group.4. Process is the means, style, formula, policies used by both the leader & his followers for the achievement of a common goal. 5. Goal - is the purpose; objective or reason of leadership

1. Trait TheoryFocused on what effective leader is not on howTraits common to all good leaders: honesty, trustworthiness, integrity, fairness, skilled communicator, goal- oriented, dedication, commitment, hard- workingPhysical traits: being young to middle age, energetic, tall handsomeSocial background traits: being educated at the right schools & being socially prominent

Social characteristics: charismatic, charming, tactful, popular, cooperative & diplomaticPersonality traits: self- confident, adaptable, assertive & emotionally stableTask- related characteristics: being driven to excel, accepting responsibility, having initiative & being results oriented

1. Trait Theory

a. Great Man TheoryAKA Genetic TheoryGreat leaders are born, not madeSome people are born to lead and others are born to be ledPortray great leaders as heroic, mythic, and destined to rise to leadership when needed. Great Man was used because, at the time, leadership was thought of primarily as a male quality, especially in terms of military leadership.

b. Charismatic TheoryLeader inspires others by obtaining emotional commitment from followers & by arousing strong feelings of loyalty & enthusiasmLeaders perceive themselves as having supernatural purpose or destinyFollowers trust the leaders beliefs, exhibit affection, obedience, and unquestioning acceptance of the leaderCharismatic an inspirational quality possessed by some people that makes others feel better in their presence.

Leaders likely to set an example by their behavior, communicate high expectations to followers and express confidence in them and arouse motives for groups mission and objectives. (House)

Leaders emerge during a crisis, accurately assess the situation, communicate self-confidence, use personal power, make self-sacrifices, and use unconventional strategies. (Conger and Kanungo)Charismatic Theory

Leaders perceive themselves as having supernatural purpose and destiny and that followers may idolize and worship them as spiritual figures or super-humans. (Bass)

Charismatic Theory

*Behavioral Leadership Employee-centered leadership Focus is on human needs of subordinates Job-centered leadership Focus is on costs and efficiency

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Leader Behavior

Initiating structure involves an emphasis on the work to be done, a focus on the task and production. Leaders who focus on initiating structure are concerned with how work is organized and on the achievement of goals.

Consideration involves activities that focus on the employee and emphasize relating and getting along with people. The leader is involved in creating a relationship that fosters communication and trust as a basis for respecting other people and their potential contribution.

3. Situational or Contingency TheoriesSituations will create different leadership style requirements for leaders.The solution to a managerial situation is contingent on the factors that impinge on the situation

a. Situational LeadershipHersey- BlanchardDetermining appropriate leadership style shall be based on:amount of direction (task behavior) amount of socio- emotional support (relationship behavior)

a. Situational Leadership Hersey- BlanchardTask behavior- one way communication, spelling out of duties & responsibilities to a group (what to do, how to do it, when to do it)

Relationship behavior- two- way communication by providing socio- emotional support

a. Situational Leadership Hersey- Blanchard4 leadership styles:Telling- high task/ low relationship behavior; provides clear instructions & specific directionSelling- high task/ high relationship behavior- leader encourages 2 way communication & builds confidence & motivation on the employeeParticipating- high relationship/ low task behavior- leader & followers share decision & no longer need or expect the relationship to be directiveDelegating- low relationship/ low task behavior- followers are ready to accomplish task & are motivated and competent to take full responsibility

b. Contingency ModelFred E Fiedler3 conditions that could define the situation:

Leader- member relation- how well do the manager and employees get along?

Task structure- is the job highly structured, fairly structured or somewhere in between?

Position power- how much authority does the manager possess?

b. Contingency Model Fred E FiedlerManagers are rated as to:Task- oriented leader- experiences pride and satisfaction in the task accomplishment for the organizationRelationship- oriented leader- seeks to build interpersonal relations & extend help for the team development of the organization

c. Path-Goal Model Robert HouseLeadership Styles:Directive leadership- specific advice is given to group & rules & structure are established; ground. Ex. Clarifying expectations

Supportive leadership- good relations are promoted with the group & sensitivity to subordinates needs is shown

Participative leadership- decision making is based on consultation with the group & information is shared with the group

Achievement-oriented style- provides high structure and direction as well as high support through consideration behavior.

c. Path-Goal ModelRobert House

Contemporary Leadership TheoriesThis addresses the leadership functions necessary to develop learning organizations and lead transforming change.

Contemporary Leadership Theories

There are two types of leaders:

1. Transactional leader traditional manager concerned with day-to-day operations

2. Transformational leader committed to a vision that empowers others; a leader who commits people to action, who converts followers into leaders and who converts leaders into agents of change.

Transactional LeadershipIdentifies needs of followers and provides rewards to meet those needs in exchange for expected performanceMotivate by means of exchange process

4 types of behavior:Contingent reward- to influence behavior, the leader clarifies the work needed to be accomplished; uses rewards or incentivesManagement by exception- leader uses correction or punishment as a response to unacceptable performanceActive management by exception- to influence behavior, the leader actively monitors the work performed & uses corrective methods to ensure the work is completed.Laissez- faire leadership- leader is indifferent and has a hands- off approach

1. Transactional Leadership

2. Transformational LeadershipHeinrich von PiererLeaders and followers raise one another to higher levels of motivation and morality (Burns)Leaders are charismatic and visionaryInstills feelings of confidence, admiration and commitment among followers; intellectually stimulates followers to develop new ways to think about problemsUses contingent rewards to positively reinforce performance consistent with the leaders wishes

In other words, transformational leadership isPromoting employee developmentAttending to needs and motives of followersInspiring through optimism, influencing changes in perceptionProviding intellectual stimulation & encouraging follower creativityUsing role modelingProviding sense of direction & encouraging self- management

c. Servant Leadership Robert GreenleafServant leader- steward of the resources such as human, financial & otherwise provided by the organization.

Encourages leaders to serve others while staying focused on achieving results in line with the organizations values & integrity

10 Characteristics of a Servant LeaderListeningEmpathyHealingAwarenessPersuasionConceptualizationForesightStewardshipCommitment to the growth of peopleBuilding community

If you as a leader is willing to help others rather than dominate them, you must be prepared to:Endure misunderstanding and suffering instead of seeking honor and gloryShow initiative when people are apatheticForge ahead so it will be easy to drift with the tide

Servant leadership in nursing is selfless commitment and devotion to duty. It recognizes the necessity of providing holistic care to the patient physically, and spiritually. Nurse leaders are duty-bound in the promotion of spiritual environment for their patients.

d. Quantum LeadershipChange dominates the climateContinual movement and change occur in reality and creativity and innovation are at the core of good work performance

Nurses as quantum leaders should:Offer creative & innovative solutionsSeek to discover educational opportunities instead of relying on past methodsProvide mentoring opportunities and expert preceptorshipQuantum Leadership

Motivation theoriesBelief that workers outputs are greater when they are treated humanistically.

Motivation Whatever influences our choices and creates directionProcess that occurs internally to influence and direct our behavior in order to satisfy needs

Maslows Hierarchy of NeedsAbraham Maslow

Motivation begins when a need is not met Ex. Thirst has to be satisfied first before a person is motivated to pursue higher needs

1. Maslows Hierarchy of Needs

1. Maslows Hierarchy of NeedsPhysiological needs- water, food, oxygen, elimination, rest, exercise, shelter & protection from elements (needs must be met repeatedly to remain fulfilled)Safety & security needs- safe working conditions, salary increases to meet inflation, job security, fringe benefits, pension, medical insuranceSocial/ belonging needs- acceptance by ones peers, recognition as an accepted member of a group, giving & receiving friendship, affectionate relations with others

Esteem needs- recognition, challenging tasks, participation in decision- making, chance for advancement, appreciation & respectSelf- actualization- achievement & promotions, development of employees skills

1. Maslows Hierarchy of Needs

2. Monistic TheoryFrederick TaylorMonistic methods- incentives (merit increases, bonus systems, profit sharing, savings sharing Pay would depend on productivity

3. ERG TheoryClayton AlderferExistence needs (physiological & safety needs)Relatedness needs (belongingness, social & love needs)Growth needs (self- esteem & self- actualization)

4. Theory X and Theory YDouglas McGregorConditions of Leadership:Security- fair pay and fringe benefits; leaders manner and attitudeKnowledge- company policy & philosophy; procedures, rules & regulations; job duties & responsibilitiesConsistent discipline- do jobs according to expectationsIndependence- actively involved in contributing ideas & suggestions concerning activities that affect them

Theory X & Theory Y

Theory XTheory YPeople dislike work.Work is naturalPeople must be directed to do workPeople will exercise self- controlPeople want to avoid responsibilityPeople enjoy responsibility

Theory X & Theory Y

Theory XTheory YPeople believe that achievement is irrelevantPeople value achievementPeople are dull & uncreativePeople have potential, imagination, creativityMoney is the reason for workingMoney is only one reason for workingPeople lack desire to improve qualityPeople want to improve quality

Herzberg: (Two-Factor Theory or Motivation-Hygiene Theory

Job dissatisfaction occurs when adequate salary, safe working conditions and relationships are not metMotivation occurs with meaningful work and advancement opportunities

Collaborative decision making Long-term employment Mentoring Holistic concernOuchi: (Theory Z)

Leadership stylesAutocratic/ authoritarianDemocraticLaissez-faireParticipative

Autocratic / authoritarian

Task oriented Facilitates rapid decision-making Effective in crisis Strong control is maintained over the work group Others are motivated with coercion Others are directed with commands Communication flows downward Decision making does not involve others Emphasis is on difference in status ( I and YOU ) Criticism is Punitive ( inflicting or aiming at punishmentAutocratic / authoritarian

Effective if:Employees are new and untrained Employees do not respond to any other leadership stylesThere is limited time in which to make a decisionA managers power is threatened by an employeeThe area is poorly managed

Employees become tense, fearful, resentfulEmployees expect to have their opinions heardEmployees become dependent on their leader on decision makingEmployees become hostileThere is low employee moraleShould not be used when:

Democratic

Values the individual characteristics and abilitiesLess control is maintainedEconomic and ego awards are used to motivateOthers are directed through suggestions and guidanceCommunication flows ups and down ( two way )Decision making involves othersEmphasis is on WE rather than I and YouCriticism is constructive. Democratic

Effective if:Leader wants to keep employees about matters that affect themLeader wants to provide opportunities for employees to develop a high sense of personal growth and job satisfactionThere is a complex problem that requires lots of input to solveLeader wants to encourage team building and participation

There is not enough time to get everyones inputThe business cant afford mistakesIts easier and more cost-effective for the manager to make the decisionThe manager feels threatened by this type of leadership Should not be used when:

Laissez-Faire

Is permissive, non- directive, passive and inactiveMotivates by support when requested by the group or individuals.Provides little or no directionUses upward and downward communication between members of the group.Dispenses decision making throughout the groupChaos is likely to develop Laissez-Faire

Effective if:Employees are highly skilled, experienced, and educatedEmployees have pride in their work and the drive to do it successfully on their ownOutside experts, such as staff specialists or consultants are being used

Should not be used when:It makes employees feel insecure at the unavailability of a leaderThe leader cannot provide regular feedback to let employees know how well they are doingLeader is unable to thank employees for their good workThe leader doesnt understand his or her responsibilities and is hoping the employees can cover for him or her

A compromise between authoritarian and democratic styles.Manager presents his analysis of problems and proposals for action to members, inviting their criticism and comments. The manager then makes final decision.Most positive effects on employees with high need for independence.Preferred when employee involvement in planning is needed to overcome resistance and increase motivation but employees are not sufficiently skilled in group dynamics to permit democratic style. Participative

Comparison

AutocraticDemocraticLaissez- faireStrong controlLess controlNo controlGives ordersOffers suggestionsNondirectiveDoes decision makingMakes suggestionsAbdicates decision makingLeader does planningGroup does planningNo planningDirectiveParticipativeUninvolvedFosters dependencyFosters independenceFosters chaos

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LEADERSHIP STYLES IN THE PHILIPPINE SETTING Autocratic Leadership- centralized decision making, with the leader making decisions and using power to command and control others.

Democratic Leadership- style is participatory, with authority delegated to others. To be influential, the democratic leader uses expert power and the power base afforded by having, close, personal relationships

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LEADERSHIP STYLES IN THE PHILIPPINE SETTING Laissez-Faire Leadership style is passive and permissive and the leader defers decision making.

Bureaucratic Leadership the bureaucrat (leader) acts as a representative of the power and prestige of the entire structure, irrespective of his position within the hierarchy

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IMPACT OF VALUES AND BEHAVIOR ON FILIPINO LEADERSHIP

Amor propio Also known as self-esteem but has a tendency to equate with self confidence, social insecurity, indolence or irritability. The core is the need of a Filipino to be treated as a person not as an object. It is an individual sense of dignityHiya A combination of feelings of inferiority, shyness or alienation. The threat of this experience is sometimes considered effective because it can be an approved behavior

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Utang na LoobA feeling developed when one has received a favor from another.This is a debt can not be repaid by money but at any rate, is expected to be paid in form decided by future circumstances.

PakikisamaA practice of respect which is the result of definition of rights and obligation in the structural positions of individuals in the filipino kinship.

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Lakad System (Kalakaran)practice of using go-betweens among filipino families especially in the government and private organizations.

Bata SystemAn aspect of value system between a superior and a subordinate.This means a protg, favored individual, close friend or comrade to rely on in time of need.

Filipino styles of Management (Franco)Manager by kayod- hard work & dedication; introvert & formal; a serious worker who will not give in to bribing or anomalous dealManager by lusot- avoid much work; extrovert & informal; do shortcuts or unconventional or even illegal ways to attain objectivesManager by libro- by the books & established rules; systematic & analytical; has adequate formal training in management

Filipino styles of Management (Franco)Manager by oido- by ear; based on practical experience to compensate for his lack of formal management educationManager by ugnayan- avoid much work; extrovert & informal; do shortcuts or unconventional; hybrid of all types of manager; thoroughly situational, integrative, reconciler, participatory, highly adaptable & resilient

Leadership & Management RolesRoles of Managers:InterpersonalAs a symbol: duties include signing of papers/ documents required by the organizationAs a leader: hires, trains, encourages, fires, remunerates and judgesAs a liaison: coordinate with outside contacts (community, suppliers, organizations)

Roles of Managers:InformationalMonitors informationDisseminates information from both external and internal resourcesSpokesperson of the organizationDecisionaltrouble- shooterNegotiator- in cases of conflicts

Leadership & Management Roles

Management RolesOperational LevelFirst LineMiddleTop

Nurse Leader Manager RolesStaff NurseHN/ Senior NurseSupervisorAdministrator

Nurse Leader Manager RolesAdministrator- over- all planning Setting up of objectivesDeveloping & scheduling of programsBudget proposalsEstablishment of policiesSupervising Nurse- manage nursing care in 2 or more unitsHN/ Senior nurse-Management/ supervision of a particular unitOversee technical & interpersonal skills of her staffCoordinate services & activities ( daily rounds, reports, referrals, review of NCP

PowerAbility to efficiently and effectively exercise authority and control through personal, organizational & social strength

Sources of PowerLegitimate- bestowed upon a leader by a given positionEx. Wearing or displaying symbols of professional standing, including license and certification.

Reward- ability of manager to give rewards to her subordinates for compliance with orderEx. Using hospital award to alter another persons behavior.

Coercive- ability to punish subordinates for non- compliance with directivesEx. Using the hospital disciplinary evaluation to alter anothers behavior.

Expert- special abilities/ skills unique to a leaderInformation- well- informed and up- to- dateEx. Communicating information from current evidence-based journals and bringing expert knowledge to patient care.

Sources of Power

Referent- based on relationships or connections; networkingEx. Gaining power by affiliating with nurses and other who have power in the organization.

Connection- comes from personal and professional relationships that enhance ones resources and the capacity for learning and information sharing.Ex. Developing good working relationships and mentoring with your boss and other powerful people.Sources of Power

*A process of power sharing by involvement in the decision-making. (Kelly and Joel, 2005)A process of personal growth and development. (Kuokkanen, 2003)A form of capacity building, in which ones capacity to influence others is enhanced by an increase in any of the sources of power.

*PERSONAL POWER Find a mentor. Notice who holds power in your personal, professional and organizational life. Introduce yourselves to them. Find and maintain good sources of evidence-based information. Seek answers to questions. Make a plan to develop all sources of power. Evaluate the plan.

*PROFESSIONAL POWER Assess patients condition using relevant, objective measurements. Collaborate with administrators and other nursing and medical practitioners and health care workers involved in the care of your patients. Join your professional nursing organization. Consult with significant others, friends and members of the patients family. Monitor and improve patient care quality.

*ORGANIZATIONAL POWER Get involved beyond direct patient care. Volunteer for committee assignments that will challenge you to learn and experience more than what is expected of you. Understand committees you are involved with. Continually improve and add to your knowledge. Evaluate your plans. Readily share appropriate knowledge with others who will value and use it to good end.

*(RIGHTS)(RELATIONSHIPS)(RESULTS)(REPRODUCTION)(RESPECT)

*Position Level. People follow because they have to. (Rights)Permission Level. People follow because they want to. (Relationships)Production Level. People follow because of what you have. (Results)People Development Level. People follow because of what you have done for them. (Reproduction)Personhood Level. People follow because of who you are and what you represent. (Respect)

*Definition of ManagementA process of coordinating actions and allocating resources to achieve organizational goals

An art of accomplishing things through people

We can regard management as:

Taking place within a structured organizational setting and with prescribed roles;Directed towards the attainment of aims and objectives;Achieved through the efforts of other people; andUsing system and proceduresM A N A G E M E N T

*Managerial Roles Role includes behaviors, expectations, and recurrent activities within a pattern that is part of the organizations structure.Information-processing role: used to manage information people needInterpersonal role: figurehead, leader, liaisonDecision-making role: entrepreneur, disturbance handler, allocator of resources

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Management Functions (Yukl, 1998 and associates; Kim, 1995 and; Wall & Lepsinger, 1990) Managing the workManaging relationships

*Role Functions for Managing the WorkPlanningOrganizingProblem solvingClarifying roles and objectives

InformingMonitoringConsultingDelegating

*Role Functions for Managing RelationshipsNetworkingSupportingDeveloping and mentoringManaging conflict and team buildingMotivating and inspiringRecognizing and rewarding

constitutes the body of knowledge that describes how managers conduct activities to keep the organization operating in an effective manner.

Frederick Taylor Father of Scientific ManagementProductivity and goals are the area of focusOrganization viewed as machine to run efficiently to increase productionWorkers must have proper tools and equipmentTime and motion studies to time workers, analyze their movements and set work standards

1. Scientific Management A. Classical Approach

Frank & Lillian GilbrethPioneered time & motion studies- emphasized efficiency & culminated in one best way of carrying workRevolutionized surgical efficiency in OR shorter duration of operationreduced risk from surgery

A. Classical Approach

2. Bureaucratic TheoryMax Weber Bureaucratic organization- a hierarchy with clear superior- subordinate communications & relations; order from the top was transmitted down through the proper chain of command (top- down approach)Efficiency is achieved through impersonal relations within a formal structureCompetence should be the basis for hiring and promoting an employeeDecisions should be made in an orderly and rational way based on rules & regulations

Characteristics of the Organization

1. Tasks are specialized.2. People are appointed by merit or promotion because of their ability and not because of favoritism and whim.3. Career opportunities for the members are provided.4. Authority and responsibility are clearly specified.5. Activities are routine.6. A rational and impersonal climate exists.

3. Administrative PrinciplesHenri FayolPrinciples as unity of command & direction were identified & added to the management processUnity of command & direction- worker gets orders from only one supervisorChester BarnardNaturally forming social groups can become strong & powerful contributors to an organization (concept of informal organization)Acceptance theory of authority- people have free will & they choose to comply with orders they are given

B. Behavioral ApproachEspouse individual worker as source of control, motivation & productivity in organizations1930s- labor unions became instrumental in advocating for human needs of employees

Place: Chicago Hawthorne plant of Western Electric Increased lighting led to increased productivityIncreased productivity continued even if lights were dimmed

Hawthorne effect :Phenomena of being observed or studied results in changes in behaviorConclusion: Something else other than the light was motivating the workers2. The effect of being watched & receiving special attention could alter a persons behaviorHawthorne Studies- Elton Mayo

Useful because they help explain why people act the way they do & how a manager can relate to individuals as human beings & workersCritical part of leadership because we need to understand each other in order to be good leaders and good followersWhatever influences our choices and creates direction, provides intensity and persistence in our behavior (Hughes, Ginnett & Murphy, 1999)B. Behavioral Approach

AchievementRecognitionWorkResponsibilityAdvancementGrowthSupervisionCompany PolicyWorking conditionsInterpersonal RelationsStatusJob SecuritySalaryPerformanceOn the JobHygienic Factors(lower order needs)Job Context (cannotmotivate but can becomesource of dissatisfactionand low performanceMotivators(higher order needs)Job content (can raisePerformance)

Two Factor Theory (Motivation- Hygiene Theory)Frederick Herzberg

Two Factor Theory (Motivation- Hygiene Theory)Frederick HerzbergMotivation Factors (Intrinsic)AchievementRecognitionResponsibilityAdvancement & opportunity for development(Note: when present, people are very motivated and satisfied with their jobs; when absent people have a neutral attitude toward their organization)

1. Two Factor Theory (Motivation- Hygiene Theory)b. Hygiene factors (Extrinsic)SalaryJob securityWorking conditions, quality of supervisionRelationship with others(Note: when absent, people are dissatisfied; must be maintained to avoid job dissatisfaction)

2. Theory X and Theory YDouglas McGregorTheory XLeaders must direct and control Employees prefer security, direction, and minimal responsibility to get the job done

Theory YLeaders remove obstacles as workers have self-control and self-disciplineThe workers reward is their involvement in their work

William Ouchi (1981)Focuses on finding better ways to motivate people in order to increase worker satisfaction & productivityImportant elements:Collective decision makingLong term employmentSlower but more predictable promotionsIndirect supervisionHolistic concern for employees3. Theory Z

There is increased productivity in participation, interdependence & involvement of all members in an organization. Involves collective decision making, long-term employment, mentoring, holistic concern, and use of quality circles to manage service and quality Organization invests in its employees and addresses both home & workTo sum up Theory Z

The Managerial Grid Robert Blake & Jane Mouton

1:9 Country Club Management9:9 Real Team Management5:5 Middle of Road Management1:1 Impoverished Management 9:1 Autocratic Task Management

1:1 Impoverished Management Managers have very little concern with people and production.-Managers use this to avoid getting into trouble. The main concern for the manager is not to be held responsible for any mistakes, which results in less innovative decisions.

1:9 Country Club Management Managers have little or no concern for production but are concerned with people- Managers pay much attention to the security and comfort of the employees in hopes that this would increase performance. The resulting atmosphere is usually friendly, but not necessarily that productive.

5:5 Middle of Road Management; The organization man-management

Managers have minimum concern for production and people.- Managers using this style try to balance between company goals and workers' needs.

9:1 Autocratic Task Management; The authority-obedience / produce or perish style

- Managers are concerned only with developing an efficient operation; little concern with people.- Managers using this style find employee needs unimportant; they provide their employees with money and expect performance back. Managers using this style also pressure their employees through rules and punishments to achieve the company goals. This is used in case of crisis management.

9:9 Real Team Management Displays highest possible dedication to both people and production.-Managers choosing to use this style encourage teamwork and commitment among employees. This method relies heavily on making employees feel as a constructive part of the company.

Organizational DesignRensis Likert4 types of Management Systems:

Exploitative- authoritativeBenevolent- authoritativeConsultativeParticipative

Exploitative- authoritativeManagement uses fear and threatsCommunication is top downRelationship between superiors and subordinates are distantBenevolent- authoritativeManagement uses rewardsInformation flow upward is restricted (only what management wants to hear)Some decisions may be delegated to lower levels

ConsultativeManagement offers rewards, occasional punishmentsBig decisions come from the topCommunication is downward ParticipativeGroup participation & involvement in setting high performance goals with some economic rewardsCommunication flows in all direction- is open & frankCloseness between superiors and subordinatesResult- high productivity

Based on the principle that the whole is the sum of its parts. Decisions are not made in isolation but concerned with the total organizationSystems Approach

PersonnelDataEquipmentSuppliesDataGatheringPlanning OrganizingStaffingLeadingControllingPatientCareStaffDevtResearchINPUTPROCESSOUTPUTSystems Approach

5. Total Quality Management (TQM)Centered on quality Based on the participation of all its members Aimed at long term success through customer satisfaction Benefits to all members of the organization & society.Aim: embedding awareness of quality in all organizational processes

3 basic principles:Focus on achieving customer satisfactionSeek continuous & long term improvement in all of the organization's processes & outputsTake steps to ensure full involvement of the entire work force in improving quality Total Quality Management (TQM)

6. Principles of Management Henry FayolSees management not as a personal talent but a skill. With scientific forecasting and proper methods of management, satisfactory results are inevitable.

Division of work work and tasks should be performed by people specialized in the work and similar tasks should be organized as a unit or department. Authority delegated persons ought to have the right to give orders and expect that they be followed. Discipline workers should be obedient and respectful of the organization

14 management principles- Henry Fayol

Unity of command employees should receive orders from only one person with authority Unity of direction the organization and employees are dedicated to one plan of action or set of objectives Subordination of individual interests to the general interest organizational conflict should be limited by the dominance of one objective. 14 management principles- Henry Fayol

Remuneration , the organization must recognize the economic value of employees and that their economic interests are important. Centralization whether an organization should be centralized or decentralized depends upon such factors as communications and the importance of who should make the decision. Scalar chain authority in an organization moves in a continuous chain of command from top to bottom. 14 management principles- Henry Fayol

Order people and resources have a place where they belong Equity fairness is important in management-employee relations Stability of tenure of personnel turnover is disruptive; shared experience is important Initiative Workers are exhorted to be productive and motivated. Esprit de corps there is a need for harmony and unity within the organization 14 management principles- Henry Fayol

3-FOLD CONCEPT ON THE SCOPE OF MANAGEMENT

Leadership is about creating a change.

Management is about controlling complexity in an effort to bring order and consistency.

Leadership involves establishing a direction, aligning people through empowerment, and motivating and inspiring them toward producing useful change and achieving the vision.

Management is planning, budgeting, organizing, staffing, problem-solving, and controlling complexity to produce predictability and order.

MANAGERS vs. LEADERS DO THINGS RIGHTARE INTERESTED IN EFFICIENCYADMINISTERDO RIGHT THINGSARE INTERESTED IN EFFECTIVENESSINNOVATEMAINTAINFOCUS ON SYSTEMS & STRUCTURERELY ON CONTROLDEVELOPFOCUS ON PEOPLERELY ON TRUST

ORGANIZE & STAFFEMPHASIZE TACTICS, STRUCTURES & SYSTEMSALIGN PEOPLE WITH A DIRECTIONEMPHASIZE PHILOSOPHY, CORE VALUES & SHARED GOALS HAVE A SHORT TERM VIEWHAVE A LONG TERM VIEWASK HOW AND WHENASK WHAT AND WHYACCEPT THE STATUS QUOCHALLENGE THE STATUS QUOMANAGERS vs. LEADERS

FOCUS ON THE PRESENTHAVE THEIR EYES ON THE BOTTOM LINEFOCUS ON THE FUTUREHAVE THEIR EYES ON THE HORIZON DEVELOP STEPS & TIME TABLES DEVELOPS VISIONS & STRATEGIESSEEK PREDICTABILITY & ORDERSEEK CHANGEMANAGERS vs. LEADERS

AVOID RISKSMOTIVATE PEOPLE TO COMPLY WITH STANDARDSTAKES RISKSINSPIRE PEOPLE TO CHANGEUSE POSITION-TO-POSITION INFLUENCEUSE PERSON-TO-PERSON INFLUENCEOPERATE WITHIN ORGANIZATIONAL RULES, REGULATIONS, POLICIES & PROCEDURESOPERATE OUTSIDE ORGANIZATIONAL RULES, REGULATIONS, POLICIES & PROCEDURESMANAGERS vs. LEADERS

Part II Nursing Management

DefinitionManagement:Process of coordinating actions and allocating resources to achieve organizational goals (Mintzberg, McCall, Hales)Process of getting things done through peopleNursing Management:Process of working through staff members to be able to provide comprehensive care to the patient. Includes planning, organizing, directing & controlling

Manager Roles of Nurses

*First-Level Manager Roles Nurse manager at the clinical bedsideManages patient care and supervision of others delivering carePlans for care

*Middle-Level Nurse ManagerUnit manager or directorSpends most time on coordinating and planning

*Executive-Level Manager Expanded role of planning and being generalistMay have title of Chief Nurse Executive or Vice President of Patient Care Services

1. Technical skills relate to the proficiency in performing an activity in the correct manner with the right technique2. Human relationship skills - pertain to dealing with people and how to get along with them.3. Conceptual skills deal with the ability to see individual matters as they relate to the total picture and to develop creative ways of identifying pertinent factors, responding to the big problems, and discarding irrelevant facts.Level of Skills in Management (Katz)

THE MANAGEMENT PROCESS* UNIVERSAL* PROCESS BY WHICH A COOPERATIVE GROUP DIRECT ACTIONS TOWARDS COMMON GOALS* USE OF MEANS TO ACCOMPLISH GIVEN ENDS, WITH CONSIDERATION TO MORAL AND ETHICAL STANDARDS

THE MANAGEMENT PROCESS

ASSESSINGPLANNINGIMPLEMENTINGEVALUATINGPLANNINGPLANNINGSTAFFINGORGANIZINGORGANIZINGDIRECTINGCONTROLLINGSIMPLIFIED NURSING PROCESSMANAGEMENT PROCESS FUNCTIONSIntegrating Nursing and Management Process

PLANNING:Definition: Predetermining a course of action in order to arrive at a desired resultContinuous process of assessing, establishing goals & objectives, implementing & evaluating them

Principles of PlanningBased & focused on vision, mission, philosophy, & objectives of organizationContinuous processPervasive within entire organizationUtilize all available resourcesPrecise in scope & natureTime- bound (short or long- range plans)Plans should be properly documented for proper dissemination to all concerned

PLANNING DIRECTS OUR THINKING TOWARDS WHAT ACTIVITY WE EXPECT TO DOWHY IT WILL BE DONEWHERE IT WILL BE DONEWHEN WE EXPECT TO DO ITHOW IT WILL BE DONEWHO IS GOING TO DO IT.

Importance of PlanningLeads to achievement of goals & objectives.Gives meaning to workProvides for effective use of available resources & facilitiesHelps in coping with crisesCost effectiveBased on past & future activitiesLeads to the realization of the need for changeProvides basis for effective control

Characteristics of a Good PlanPrecise with clearly worded objectives to include desired results and methods of evaluationGuided by policies and proceduresIndicate prioritiesActions are flexible & realistic (personnel, equipment, facilities, time)Activities are logically sequencedInclude practical methods to achieve objectivesPervade whole organization

* Delivery dates are not met.* Machines are idle.* Materials are wasted.* Some nurses are overworked, others are underworked.* Skilled nurses doing unskilled work.* Nurses are fumbling on jobs for which they have not been trained.* There is quarreling, bickering, buck-passing, and confusion

* Lack of knowledge of the philosophy, goals and objectives of the agency or lack of understanding of the significance of the planning process* They may not know how to manage their time to devote for planning.* They lack confidence in formulating plans or may fear that planning may bring unwanted changes that they are unwilling to undertake or unable to cope with.

Strategic OperationalUnitLevels of Planning

1. Strategic PlanningRefers to determining the long term objectives of the institution and the policies that will be used to achieve these objectives.Usually done at the executive level of management. it is future-oriented.Long range (3-5 years)

STRATEGIC PLANNINGPurposes:1. Clarifies beliefs and valuesOrganization's strengths and weaknessesPotential opportunities and threatsWhere is the organization going?How is it going to get there?

STRATEGIC PLANNINGPurposes:

Gives directionImproves efficiencyWeeds out poor or underused programsEliminates duplication of effortsConcentrates resources on important servicesImproves communication and coordination of activitiesAllows adaptation to the changing environmentSets realistic & attainable yet challenging goalsHelps ensure goal achievement

STRATEGIC PLANNING PROCESS1. Do a situation audit.2. Review philosophy. 3. Identify vision and values.4. Write a purpose or mission statement.5. Identify organizational goals and objectives.6. Identify required resources7. Determine priorities.8. Set a time frame.9. Determine accountability.

Strategic Planning FrameworkAssessment of ExternalEnvironmentOPPORTUNITIES/THREATSAssessment of Internal EnvironmentSTRENGTHS/WEAKNESSESOBJECTIVESSTRATEGIC INTENTSPLANS

Steps in Strategic Planning Process:

Environmental Analysis

Requires a broad view of the organizations current environment

Need for both internal and external environmental appraisal

External environmental assessment: broad-based; attempts to view trends and future issues and needs that could impact the organization Internal assessment: seeks to inventory the organizations assets and liabilities

EnvironmentThreats and Opportunities(External Analysis)Strategic PlanningOrganizationWeaknesses and Strengths(Internal Analysis)

B. SWOT ANALYSIS

STRENGTHSWEAKNESSESOPPORTUNITIESTHREATS

StrengthsINTERNAL FACTORS THAT ARE FAVORABLE WHICH HIGHLIGHTS THE DISTINCTIVE COMPETENCIES OR ADEQUACY OF RESOURCES THAT CAN BE USED TO THE OPTIMUM ADVANTAGE.WeaknessesINTERNAL FACTORS THAT ARE UNFAVORABLE WHICH PRESENTS INADEQUACIES OF RESOURCES, SKILLS OR STRUCTURES THAT HAVE TO BE ATTENDED TO BY THE ORGANIZATION

OpportunitiesEXTERNAL FACTORS THAT ARE FAVORABLE IN THE BUSINESS ENVIRONMENT OR ORGANIZATION WHICH CAN BE IMPLEMENTED OR TAKEN ADVANTAGED OF TO COUNTERACT THE THREATSThreatsEXTERNAL FACTORS THAT ARE UNFAVORABLE AND WHICH MUST BE COUNTERACTED FOR REASONS THAT THEY ENDANGER THE SURVIVAL OF THE ORGANIZATION

THE INTERNAL WEAKNESSES OR STRENGTHS OF A HEALTH CARE ORGANIZATION MAY INCLUDE THE FOLLOWING:EXPERTISE OF NURSING AND MEDICAL PERSONNEL STAFFABUNDANCE OR SCARCITY OF MEDICAL EQUIPMENT AND SUPPLIES, ETC.QUALIFICATIONSOVER- OR UNDERSTAFFEDFINANCIAL STATUSQUALITY OF PATIENT CARE

THREATS MAY BE:COMPETITIONDECREASE IN PATIENT LOADSHORTAGES OF NURSES & OTHER PERSONNELLOW PATIENT SATISFACTIONINCREASE OF CHARGESLEGAL THREATSOPPORTUNITIES WOULD INCLUDE:IMPROVED OR NEW FACILITIESREFERRALSRECRUITMENT OF MEDICAL OR NURSING PERSONNELNEW HEALTH CARE PROGRAMS

C. Community and Stakeholder Assessment

A stakeholder is any person, group, or organization that has a vested interest in the program or project under review.

Stakeholder assessment is a systematic consideration of all potential stakeholders to ensure that the needs of each of these stakeholders are incorporated in the planning phase.

D. Other Methods of Assessment

Surveys/questionnaires> Used when large numbers of stakeholders and general idea of the options are available

Focus group interviews: small groups of individuals with a common characteristic who meet in a group and respond to questions about a topic> Time-consuming and expensive to conduct> Works best when the topic is broad and the options are not as clear

Advisory board

Benefits large projects Board members come from various constituencies affected by project Has no formal authority, but reviews plan and makes recommendations

Identifying best practices or evidence-base innovations

Review of literature related to identified programs

Allows project team to identify similar programs, their structures and organization, potential problems and pitfalls, and successes

Ongoing process; programs tentatively identified, literature searched for successes and issues, program ideas then refined

Summary of Steps in Strategic Planning

Perform an environmental assessment Conduct stakeholder analysis Review literature for evidence and best practices Determine congruence with organizational mission

Identify planning goals and objectives Estimate resources required for the plan Prioritize according to available resources Identify time lines and responsibilities

Develop a marketing plan Write and communicate the business or strategic paln Evaluate

ORGANIZATIONVISIONMISSIONGOALSORGANIZATIONAL CULTURE & STRUCTUREROLE DESCRIPTIONSQUALITY MEASURESINDIVIDUAL AND ORGANIZATIONAL OUTCOMESEXTERNAL FORCESSWOT/ Environmental Scanning

Strategic Goals

Strategic Plan Relationship of strategic planning to organizing care.

REDGREENBLUEYELLOWPINK

ORANGEBLUEGREENBLUEWHITEGREENYELLOWORANGEWHITEBLUEVIOLETREDPINKYELLOWGREEN

PINKYELLOWGREENBLUERED

HOW MANY TRIANGLES CAN YOU SEE?

2. Operational PlanningDeals with the day-to-day maintenance of activities. It is done in conjunction with the preparation of the budget.

Done a few months before the new fiscal year

Develops improvement and maintenance goals for the coming year.

Nurse managers are most likely to be involved in this type of planning.

3. Unit PlanningMay be done on a daily, weekly or long-range basis. Related to client care taking of the health history assessing health status formulating nursing diagnosisimplementing care plan

CRITICAL THINKING

Thinking about your thinking while youre thinking in order to make your thinking better (Paul 1992)

Critical thinking is analyzing the way one thinks. It should be incorporated into all steps of problem solving and decision-making.

A good critical thinker is able to examine decisions from all sides and take into account varying points of view.

Four (4) basic skills are necessary for the development of critical thinking skills: critical reading, critical listening, critical writing and critical speaking. These skills are part of the process of developing and using thinking for decision-making.

Problem-solving

is an active process that starts with a problem and ends with a solution; it consists of identifying the problem, gathering and analyzing data, generating alternatives and selecting an action, implementing selected action and evaluating the action.

EVALUATINGTHE PLANDEVELOPING THEPLAN OF ACTIONCOLLECTINGDATAPHASES OF PLANNINGDETERMININGOBJECTIVES

Elements of Planning: Forecasting Setting of Vision, Mission, Philosophy, Goals & Objectives Developing and Scheduling Program Preparing the Budget Establishing Nursing Standards, Policies & Procedures

Forecasting:- look into the future & decide in advance where the agency would like to be & what is to be done in order to get there. In Nursing:Clients: Customs & beliefs Language / dialect barriers Public attitude & behavior Severity of their condition Kind of care they will receive Number & kind of personnel required The necessary resources needed

Questions to Ask when Forecasting:If this is happening now, what are the possible consequences? For this to come about, what needs to happen when? For this to come about in 2 or 3 years what should be happening today and where should I look for these trends?

2.Setting of Vision, Mission, Philosophy, Goals & Objectives

a. VISION A power of imagination to see something that is not visibleA preferred future stateVague enough to encourage initiative 2.Setting of Vision, Mission, Philosophy, Goals & Objectives

DEVELOPING A VISIONSpecific Questions to Ask:1. What business are we in now?2. What business do we want to be in?3. What do our stakeholders expect?4. What will our customers want in the future?5. What environmental scenarios are possible?

Purposes of VisionProvides a larger purpose, meaning and contextProvides focusInspires and excites peopleCreates alignmentClarifies style and manner of doing things

Characteristics of A VisionResults from creative thinkingDoes not consider present realitiesAlways written in the present tenseDescribes WHO, WHERE, WHAT and HOW we do itSeemingly impossible to achieve but drives motivation

Elements of A VisionSimpleEngages the heart and spiritAssertion of what we are and what we want to createA living document that can be modifiedA starting place for increasing levels of specificityBased on two deep human needs: Quality and Dedication

Formulating A Vision Statement1. Identify WHO we ARE?

Describe the type of people that constitutes the groupDescribe the knowledge and skills they possess Describe how these are seen by others

2. Identify WHERE WE ARE?

Describe the business arenaDescribe the position of the group in relation to other groupDescribe the geographic location

3. Identify WHAT WE DO?Describe the core responsibilities, services or activities

4. Identify HOW WE DO IT?Describe the technology to be usedDescribe the norms of behavior to be followed

X General Hospital Vision StatementX General Hospital is to be the preeminent health care provider in the region by:Being the premier full service, integrated health care delivery network that provides a continuum of health servicesCreating an environment that exceeds the expectations of our customersDeveloping a creative solutions to the challenges facing usProviding an economically, viable, cost effective services to customers and Working in partnership with other leading health care organizations

b. MISSIONAlso known as PURPOSE for EXISTENCEIt contributes to the achievement of the organizational visionIt is a statement that reflects the purpose and direction of the organizationMaking the vision more tangible

Characteristics of A MissionIt captures an organizations unique and enduring reason for beingIt energizes stakeholders to pursue common goalsIt enables a focused allocation of organizational resourcesIt identifies what is unique about the character of the organization (Dess, 1993)

It attempts to answer the following questions:What is our reason for being?What is unique about our organization?What is likely to be different about our business 3 to 5 years in the future?Who are or should be our principal customers, clients or key market segments?What are our principal products and services, present and future?What are our principal economic concernsWhat are the basic beliefs, values, aspirations and philosophical priorities? ( Drucker, 1989)

Examples of Mission StatementsKodak: To be the best in chemicals and electronic imagingMc Donalds:To offer fast food customers food prepared in the same high quality manner worldwide, tasty and reasonably priced, delivered in a consistent, low key dcor and friendly atmosphere

The mission of X General Hospital is to deliver comprehensive health care services to promote physical and mental health; to prevent disease, injury and disability; and to promote healing of the body, mind and spirit. Related instruction, public service programs, research will facilitate high quality health care

c. PHILOSOPHYArticulates the vision and provides a statement of beliefs and values that directs practiceExplains the beliefs that determine how the mission or purpose is achievedValue statement of the principles and beliefs that directs the organizations behavior

Example of PhilosophyX General Hospital is committed to assessing and meeting the physical, emotional, spiritual, environmental, social, and rehabilitative health needs of the citizen of the region. The worth, dignity and autonomy of individuals are recognized, as each individuals right to self-direction and responsibility for ones own life. Individual uniqueness will be considered when assessing needs delivering quality of care. Educational pursuits, research, and public service programs will be used toward innovations and improvement of health care in the region. X General Hospital personnel will work in collaboration with customers and in partnership with other organizations to provide cost effective services.

d. GOALS and OBJECTIVESUltimate aim of an action or series of actionsA long range specified state of accomplishment toward which programs are directedUsed interchangeably to connote EXPECTED RESULTS

Describes an effort to reach somethingState actions for achieving the mission and philosophyIt addresses services rendered, economics, innovations and social responsibilities

Difference of GOAL and OBJECTIVEGoals are broad statements of end results while Objectives are specific statements of end result

Goal and Objectives of Staff Development Department

Goal: Develop and implement staff development programs to meet the need for increased knowledgeObjectives:1. To develop and implement 12 staff development programs by the end of 20042. To devise a monitoring mechanism for tracking down continuing education activities of the staff

Mission Nursing Service, Manila Naval Hospital To provide comprehensive and quality nursing care to preserve the manpower strength of the Philippine Navy.

VISIONA more productive, value- driven and dynamic Nursing Service committed to ensure quality of life of every man and woman of the Philippine Navy in the 21st century.

PHILOSOPHYThe MNH Nursing Service believes that a soldier who is assured of adequate health services at all times to include his dependents, is ready to serve and give his best for his country and people.

GOALA healthy Philippine Navy capable of protecting the maritime interests of the Filipino in the 21st century.

TO ENHANCE THE DELIVERY OF NURSING CARE TO MILITARY & CIVILIAN PERSONNEL, THEIR DEPENDENTS & AUTHORIZED CIVILIANS.TO MAXIMIZE THE EFFECTIVE UTILIZATION OF NURSING SERVICE PERSONNEL.

3.Developing & Scheduling ProgramsPlanning formula (Kron)WHATWhat has been done?What should be done?What equipment / supplies needed?WHENWhen should the job be done?When it could be done?WHEREWhere is the job to be done?Where could supplies be stored / cleansed?

HOWHow will the job be done?How will the time & energy of staff be used?How much will it cost / much time will it require?WHOWho has been doing the job?Who else could do it?WHYWhy is Job / procedure necessary?Why is job done this way / in this place / at this time / bythis person?Planning formula (Kron)

CANCan some steps or equipment be eliminated?Can this actively be efficiently combined with other operations?Can somebody do it better?Can we get enough budget?

Planning formula (Kron)

Time ManagementDefinition: A set of related common- sense skills that makes a person use his time in the most effective and productive way possible.4 Generations of Time Management (Covey): 1st generation- notes and checklists2nd generation- calendars & appointment books3rd generation- 1st & 2nd generations + prioritization of activities, clarifying values, setting goals (long, intermediate, short term), daily plan4th generation- challenge is not to manage time but to manage ourselves; instead of focusing on things and time, focus on preserving & enhancing relationships

Time Management MatrixImportantNot Important

UrgentNot UrgentI Activities:Crises, pressing problems, deadline driven projectsII Activities:PC balance, relationship building, recognizing new opportunities, planning, recreationIII Activities:Interruptions, some calls, some mails, some reports, some meetings, pressing matters, popular activitiesIV Activities:Trivia, busy work, time wasters, pleasant activities

Time Management Matrix

Urgent- immediate attentionNot UrgentI Results:Stress, burnout, crisis managementII Results:Vision, perspective, balance, disciplined, control, few crisesIII Results:Short term focus, crisis management, seed goals, plans as useless, feel victimized & out of control, shallow or broken relationshipsIV Results:Total irresponsibility, fired from jobs, dependent on others or institution for basics

Principles ( for planning time effectively)Anticipate problems be proactive rather than reactiveSequencing of tasks / priority settingSet and keep deadlines.Decide on how time will be spent.Understand & prevent procrastination (Maana Habit)Delegate responsibility devote time to more sensitive job.

Time-saving techniques, Devices, and Methods to better use of time:Conduct an inventory of activities.Set goals & objectives and write them down.With the use of calendars, executive planners, logs or journals, write what you expect to accomplish yearly.Breakdown large projects into smaller parts.Devote few minutes at the beginning of each day for planning.Organize work space so it is functional. sort paper works by priority

7. Close door when you need to concentrate.8. Learn to delegate- develops subordinates initiative, skills, and confidence.In a meeting, define clearly the purpose clearly before starting - (conduct the meeting according to time schedule).Take or return phone calls during specified time.Develop effective decision-making skills. (Do not be afraid to say NO).Take rest breaks and make good use of your spare time. (reward yourself periodically).

MULTITASKINGNet effect of multi-tasking is that when several tasks are done at-once, some or all of them end up being performed in a haphazard manner. This can have disastrous consequences.Nurses, doctors, parents, and even students are trying to get more things done in less time.

Anyone who wants to get more work done should be mindful. Anyone who wants to have more time should be more mindful. Mindful means one thing at a time. It is how the brain works, no matter how people try to convince themselves otherwise.Nurses, therefore must learn to prioritize the tasks at hand even if they have to do them one after the other, as this remains the best way to make sure that they get done.

* How hard was it to keep the chart?* Were you surprised by what you learned? How?* Are there places you tend to waste time?* How much time did you spend on relaxation or fun?* Are you happy with the way your time is spent? Why or why not?* What items are you spending much on?What are you doing that does not need to be done at all?* What are you spending a little time on?* What are you doing that could be done better (more economically, more effectively) by others?* How can you avoid overusing the time of others?

SituationSharon has just completed her Medical- Surgical orientation as a new graduate registered nurse. This evening is her first solo shift. But she is not ready alone. Sharon and Carole, another RN and one qualified nursing attendant are responsible for 12 possible patients in this section of the unit. Currently, there are 10 patients in this section, but a new admission is on the way, another patient is returning from surgery, the dinner trays are arriving, and Sharon has medications to administer. Just as the dinner trays arrive, a family member runs out to Sharon & states hat her mother is confused and incontinent & has pulled out her IV.How would you react if you were Sharon?What would you do first?

4. Preparing The BudgetBudgeting definition:Allocation of scarce resources on the basis of forecasted needs for proposed activities over a specified period of time.Budget definition:A plan that uses numerical data to predict the activities of an organization over a period of time and it provides a mechanism for planning and control, as well as promoting each units needs and contributions.

* ENSURE THE MOST EFFECTIVE USE OF SCARCE FINANCIAL AND NON-FINANCIAL RESOURCES* COORDINATE EFFORTS AMONG ORGANIZATIONAL DEPARTMENTS * ESTABLISH A FRAME OF REFERENCE FOR MANAGERIAL DECISIONS * PROVIDE A CRITERION FOR EVALUATING MANAGERIAL PERFORMANCE

* manpower budget * capital expenditure budget * operating budget- includes wages, salaries, and compensation paid to permanent employees; it may also include fees paid to temporary or casual workers.requires long-range planning; it includes purchases of land, equipment, buildings or expansion of existing building or plant.includes physical changes such as replacement or expansion of a unit, major equipment and inventories

- includes purchase of minor equipments, repairs, supplies or overhead expensesTypes of Budget

OPEN-ENDED BUDGET. Characterized by a single cost estimate for each program in the proposed unit.FIXED-CEILING BUDGET. One in which the uppermost spending limit is set by the top executive who then asks managers to develop budget proposals for individual units.FLEXIBLE BUDGET. Contains several financial plans for each level of activity or for different operating conditions. Top management can select the budget or shift the spending level upwards or downwards, whichever is best for optimum productivity.

PERFORMANCE BUDGET. Based in the functions involved in the operation budgeted.PROGRAM BUDGET. Costs are computed for a program as a whole or the entire program itself, rather than for individual activities or functions.ZERO-BASED BUDGET. Justifies in detail the cost of all programs, both old and new, in every annual budget preparation.SUNSET BUDGET. Designed to self-destruct within a prescribed period to ensure cessation of the funded program at a pre-determined date.

ASSETS financial resources that a healthcare organization receives, such as accounts receivablesBASELINE DATA historical information on money spent, acuity level, patient census, resources needed, hours of care and so forthACUITY INDEX weighted measurement that refers to severity of illness of patients for a given time. BREAK-EVEN POINT point at which revenue covers cost

CASE MIX type of patients served by an institution.CASH FLOW rate at which money is received and dispersedCAPITATION a prospective payment system that pays health plans or providers a fixed amount per enrollee per month for a defines set of health services.CONTROLLABLE COSTS costs that can be controlled or that vary. COST-BENEFIT RATIO numerical relationship between the value of an activity or procedure in terms of benefits and the value of the activitys or procedures cost.

DIRECT COSTS cost that be attributed to a specific source such as medications and treatment. Costs that are identifiable with goods and services.FIXED BUDGET style of budgeting that is based on a fixed, annual level of volume, such as number of patient-days or tests performed, to arrive at an annual budget total.COST CENTER smallest functional unit for which cost control and accountability can be assigned.FIXED COSTS costs that do not vary according to volume. Examples are mortgage or loan payments.

HEALTH MAINTENANCE ORGANIZATIONS (HMOs) originally, a prepaid organization that provided health care to voluntarily enrolled members in return for a preset amount amount of money on a per-person, per-month basis. (presently, Managed Care Organization or MCO)FULL COSTS total of all direct and indirect costsINDIRECT COSTS costs that cannot be directly attributed to a specific area. These are hidden costs and are usually spread among different departments. Housekeeping services are considered indirect costs.

NONCONTROLLABLE COSTS indirect expenses that you cannot usually control or vary. Examples might be rent, lighting and depreciation of equipment.OPERATING EXPENSES daily costs required to maintain a hospital or health care institutionPATIENT CLASSIFICATION SYSTEM method of classifying patients. Different criteria are used for different systems. In nursing, patients are usually classified according to severity of illness.REVENUE source of income or reward for providing service to a patient.

STAFFING DISTRIBUTION determination of number of personnel allocated per shift; hospitals vary on how staff are distributed.STAFFING MIX ratio of RNs to other personnel; hospitals also vary on their staffing mix policies TURNOVER RATIO rate at which employees leave their jobs for reasons other than death or retirement; the rate is calculated by dividing the number of employees leaving by the number of workers employed in the unit during the year and multiplying by 100.

VARIABLE COSTS costs that vary with the volume. Payroll costs are variable costs.WORKLOAD UNITS in nursing, workloads are usually the same as patient-days. For some areas, workload units might refer to the number of procedures, tests, patient visits, injections, and so forth.ZERO-BASED BUDGETING type of budgeting that begins at zero each year. That means every peso or dollar spent needs to be justified; it ensures that activities arent continued simply because they were carried out in the past.

Zero- based BudgetingNo program is taken for grantedEach program must be justified each time funds are requestedManagers decide what will be done, what will not be done, and how much of an activity will be implementedMajor advantage: forces managers to set priorities and justify resources

Budgetary Process:STEPS:Assess What needs to be covered in the budget

Nursing Service personnel:Number of staff vs average number of patientsNursing care hours Vacation, sick or other leavesContinuing educ, conventions, etcStaff development programs

Supplies: Ex. Face towels, thermometers, pajamas, linens, etc

Plan may be developed in many ways. Ex., 12 months = called the Fiscal Year Budget.

Implement ongoing monitoring and analysis occur to avoid inadequate or excess funds at the end of the year.

Evaluate budget is reviewed periodically and modified as needed.

Nursing Standards: Standards to measure performance (Venzon):Structure- Organizational chartCriterion- Philosophy & goals provides direction towards development of programs to improve delivery of carePrimary goal- provision of prescribed quality & quantity of nursing careStandards- objectives shall reflect philosophyPolicies Nursing procedures specific directions for implementing written policies; consider the safety of the patient, comfort while undergoing the procedures; use of supplies and equipment.Establishing Nursing Standards, Policies & Procedures:

Nursing Service PoliciesPolicy:Definition: broad guidelines for the managerial decisions; govern actions of workers and supervisors at all levels; basis for future actions and decisions

Characteristics of Good Policies:Written and understandable and known by those who will be affected by them.Comprehensive in scope, stable, flexible.Consistent to prevent uncertainty, feelings of bias, preferential treatment and unfairness.Realistic and should prescribe limits.Allow for discretion and interpretation by those responsible for it.

Nursing Service Policies:AccidentsAdmissionsAutopsyBreakageBulleting boardCommitteesComplaintsConsentDeathDischarge of patientsDoctors ordersEquipment & suppliesFire regulations

Nursing carePreparation & administration of medications, IV infusion, blood transfusionChartingDaily assignmentsEmergency drug supplyKardexMedicationsReferralsSafety devices

3 general areas in nursing that requires policy formulation:

Responsibility (Ex. Job description) Patients and family rights (ex. Right to privacy)Personnel management & welfare (absences, decorum, etc)

Nursing Procedures (Venzon):Procedure- specific directions for implementing written policiesExamples:Admission of patientsAM careBathing of patientsBed makingInsertion of catheterCatheterizationdischarge of patientO2 administration

* ANALYZE EACH MOTION OR STEP FOR EFFICIENCY, SAFETY AND COMFORT OF AND THERAPEUTIC EFFECTIVENESS FOR THE PATIENT* LIST EACH ACTION IN THE ORDER OF PERFORMANCE* WORD DIRECTIONS CLEARLY AND CONCISELY, MAKING THEM EASY TO UNDERSTAND* INCLUDE COMPLETE DIRECTIONS FOR THE PREPARATION OF THE PATIENT AND EQUIPMENT AND FOR THE NECESSARY CARE AND FOLLOW UP OF THE PATIENT AFTER A PROCEDURE IS COMPLETED

Decision-makingDefinition of terms:

Decision a resolution of alternative choices; choosing among options. Decision-making process of identifying & choosing a particular course of action from among several possible choice (influenced by values and preferences of the decision- maker)

Process in Decision- making:

Identify the problem and analyze the situation (What is wrong?; Where is improvement needed?) Explore the alternatives (check if situation is covered by policy; if there is none, draw on education or experience) Choose the most desirable alternatives (Will this decision accomplish the stated objectives?; Will it maximize effectiveness and efficiency?) Implement the decision (put into action) Evaluate the results (audit, checklists, ratings, rankings)

Managerial decision-making process:

Set objectives Search for alternatives Evaluate alternatives Choose alternatives Implement Follow-up & control

Types of decisionsCONSIDERED DECISIONSOPERATIONAL DECISIONSare usually of great magnitude, that is they tend to be complicated and call for considerable reflection; requires time.are those we make practically everyday; some may be made at approximately the same time each day, and they may prevent problems as well as solve them.

SWALLOW-HARD DECISIONSTEN-SECOND DECISIONSare those that are personally uncomfortable to make because they may result in discomfort or uneasiness for subordinates or others.the overriding factor in this type of decision is the pressure to make it quickly; they are the ones we make daily, the decisions that bring the operation together, keep it ready and alive, and running well.

decision-making process1. ANALYZE & IDENTIFY THE SITUATION2. DEVELOP ALTERNATIVES3. COMPARE ALTERNATIVES4. RATE THE RISK5. SELECT THE BEST ALTERNATIVE6. GET INTO THE GEAR

Quantitative Decision-Making Tools*

Decision Grid

allows one to visually examine the alternatives and compare each against the same criteria. Although any criteria may be selected, the same criteria are used to analyze each alternative. A number value may be assigned to each criterion.

ALTERNATIVEFINANCIALEFFECTPOLITICALEFFECTDEPARTMENTALEFFECTTIMEDECISION#1#2#3#4

2. PERT (Program Evaluation and Review Technique)

is a popular tool to determine the timing of decisions

PERT is essentially a flowchart that predicts when events and activities must take place if a final event is to occur.

provides a visual picture depicting the sequence of tasks that must take place to complete a project

StaffedrecruitedStaffhiredStafftrainedPlanningcompleteRoomguttedRenovationcompleteEquipment orderedEquipmentreceivedEquipment & staff readyEquipmentinstalledDecision to developa staffedoutpatienttreatmentroom2-3-42-3-42-3-42-3-44-5-65-7-91-2-310-12-143-4-5Critical pathNumber of weeks to complete task ranked from most optimistic, to most likely, to most pessimistic times

3. Decision Tree

are useful in making the alternatives visible.

these are developed by management analysts because decisions are often tied to the outcome of other events. Used to plot a decision over time, decision trees allow visualization of various outcomes.

POSSIBLE EVENTSALTERNATIVE ACTIONSIncreased demandfor proceduresDecreased demandfor proceduresIncreased demandfor staffDecreased demandfor staffHire regular staffPay overtime and on-call wagesDecision point(Last event to occur)

4. Gantt Chart

useful to illustrate a project from beginning to end.

Decision- making ModelsRational model- based on the premise of common goals, technical competence & sequential process to achieve goalsPolitical model- based on the premise of win- win situation; majority makes the decision; changes are based on negotiationsCollegial model- involves full participation of peers for decision making; group consensus, mutual respect, adequate time; tend to support general welfare

Bureaucratic model- based on premise of historical norms & operating routines; implementation of change is through use of routines as determined by policies and procedures that lead to predictable outcomesGarbage can model- based on the premise of pure accident; decisions are unplanned and coincidental; no goals or criteria for evaluating outcomesDecision- making Models

Cybernetic modelNeeds assessment- determine desired outputs for the program, nature of problem, level of goal accomplishmentProgram implementation- determine that program is ion place & progressing according to time planResults assessment- determine if program outcomes were met & that program outputs justified the costs

Decision- making Models

Group Decision Making

Group decision making may be necessary in some situations.

People affected by a decision often will be involved in the decision.

People with information or resources that contribute to the decision may be involved.

Advantages:

A group can generate more ideas, thus allowing for more choices and an increased chance of higher quality outcomes.

When members participate in the decision-making process, the decision is more likely to be accepted.

Groups may be used as a medium for communication.

Disadvantages:

Time-consuming

Can be wasteful and unproductive if not managed effectively

Can be costly

Can generate conflict

Techniques of Group Decision MakingBrainstorming: creating a free flowing of ideas without fear of criticism and then thinking about the good in the wild ideas generatedDelphi TechniqueThere is no face-to-face meeting. Questionnaires are distributed to groups. Responses are summarized & disseminated to group members. The process is repeated until the group reaches consensus. It can involve a large number of participants and thus a greater number of ideas.

Consensus

an opinion or position reached by a group as a whole; general agreement or accord. means that all group members can live and fully support the decision regardless of whether they totally agree.

Groupthink

the goal for everyone is to be in100 % agreement; discourages questioning and divergent thinking

increases cohesiveness of the group

Benchmarking: process of identifying best practices and comparing it with the agencys practices to improve performance; learning and borrowing from othersFish bone Diagram: used to identify root causes of a problem

Fish Bone DiagramEffectFALLSMaterialNo Risk Assessment FormFloppy SlippersFacilitiesPoor LightingClutterUnfamiliar EnvironmentMethodsLow StaffingRisk Assessment not done No Fall PreventionPeopleConfusionLack of KnowledgePatient AcuityFirst LevelCauseSecond Level CauseThird Level Cause

DOS AND DONTS OF DECISION MAKING

DO

Make only those decisions that are yours to make.

Write notes and keep ideas visible about decisions to utilize all relevant information.

Write down pros and cons of an issue to help clarify your thinking.DONT

Make snap decisions.

Waste your time making decisions that do not have to be made.

Consider decisions a choice between right & wrong but a choice among alternatives.

DOS AND DONTS OF DECISION MAKING

DO

Make decisions as you go along rather than letting them accumulate.

Consider those affected by your decision.

Trust yourself.DONT

Prolong deliberation

Regret a decision; it was the right thing to do at the time.

Always base decisions on the way things have always been done.

Nurse as Patient Advocate Advocacy is representing the patient to others in the health care organization.

Originally, nurses act as an intermediary and pleader for the patient. Now, they act to insure that the patients rights to self-determination and free choice are not violated (Rudolph, 2005)

Nurse as Patient Advocate Advocacy can enable people to make more responsibility and control for the decisions which affect their lives.

Advocacy represents the strategies devised, action taken and solutions proposed to influence decision-making at the local/national level to create positive change for people and their environment.

Helping Consumers Make Better Health Care Choices Nurses have a professional responsibility to help consumers make better health care choices and not fall victim to misleading information, quick cures, or dangerous practices.

Beyond advocacy for an individual patient, or a patient group, nurses can work to create a more supportive health care environment that encourages input and feedback among the various stakeholders or constituencies.

ADVOCACY WORK AND PNAPNA has a clear mandate to take action towards changing of public policies, programs and resource allocation especially on the issues and concerns directly affecting the nurses, clients and the nursing profession.

ADVOCACY WORK AND PNAAs an advocate , the PNA acts on behalf of the nurses of the country, with the conscious effort to empower not only the nurses but the target audience through consciousness-raising in the process of generating the broadest support possible in upholding the associations interest.

Nurse as Political Activist Nurses who are politically active have a definitive voice in their work environments for patient welfare, as well as for themselves.As nurses develop politically, they come to understand the need for political strategy.

It is critical that nurses listen to other policy perspectives and understand as many facets of the issue as possible when making health policy proposals.

Nurse as Political Activist To be most politically effective, nurses must be able to clearly articulate at least four dimensions of nursing to any audience or stakeholder:What nursing isWhat distinctive services nurses provide to consumersHow nursing benefits consumersWhat nursing services cost in relation to other health care services

Politics and AdvocacyThe nursing profession has embraced patient advocacy for several decades.

Some concern has been voiced that the restructuring of health care is eroding the advocacy role of nurses.

Interestingly, some patients have begun advocating for nurses.

Advocacy and Consumer Partnerships Consumers expect the best people to be health care providers, but are confused about what the roles and responsibilities of professional nurses entail.

Nurses are responsible for ensuring that consumers understand the critical role nurses play as consumer advocates and political activists in health care politics, as well as what nurses do as direct care providers.

Making Health Care More Service-orientedAs recipients of health care are required to pay a larger portion of the cost for health care services, consumers are demanding to be treated as something more than passive recipients of health care.

Nurses, working through professional organizations, have been strong, early supporters for patient rights, regardless of the patients ability to pay.

Any political vision to make health care more consumer-friendly and service-oriented must address cost, access, choice, and quality.

Organizing Having qualified people and the right materials, information, and equipment needed to deal with contingenciesConsists of the structure and process which allow the agency to enact its conceptual framework to achieve its goals. Refers to a body of persons, methods, policies and procedures arranged in a systematic process through the delegation of functions and responsibilities for the accomplishment of the purpose.

One way in which nursing management coordinates the various activities of a department or a unit so that the staff can get its work done in an orderly fashion.Organizing

FORMAL ORGANIZATIONA system of well-defined jobs, each with measure of authority and responsibility and accountability. It is well-defined, bounded by delegation and relatively stable.

INFORMAL ORGANIZATIONRefers largely to what people do because they are human personalities, and to their actions in terms of needs, emotions, and attitudes and not in terms of procedures and regulations.

Principles in OrganizingChain of Command: a formal line of authority and communication; refers to top to down flow of communications and authority

In newer structures, chain of command is flatter and communications flow in all directions, authority and responsibilities are delegated to lower level positions

2. Centrality: indicates the location of a position in organization where frequent communication occurs; determined by the organizational distance of employees to where communication comes from

3. Unity of Command: represente

concept 1- leadership & management in nursing

Documents

study leadership

leadership team

assigned leadership

care of individual

formal leadership role

health care system

hospital care

institutional care