Controlling and

Evaluation

Mechanism

Controlling and

Evaluation

Mechanism

Nelia B. Perez, RN, MSNPCU – MJCN

BSN 2012

Controlling• in the management cycle closely

related to planning.

• Controlling is a six-step process that involves several systematic approaches to ensure performance standards are met in the most efficient way possible.

Importance1. Establish performance standards. • Performance standards give

employees an idea of what is expected of them and tells them how you assess their performance.

• This is key to maintain management control.

2. Conduct a job analysis and create a job description for each position within the company.

• Give feedback regularly and give annual performance appraisals. This makes the employee aware of her individual strengths and weaknesses.

3. Monitor and measure performance.

• Draw up a new business plan and assess current performance against expectations. Refocus the efforts of managers, employees and stakeholders as needed.

4. Compare your measured performance against established standards.

• If anticipated performance is below average, take preventive corrective actions to ensure compliance to specified performance standards before a problem occurs.

5. Take corrective action. • This is often a difficult aspect of the

controlling function of management. When problems arise, handle the situations fast and efficiently. Ignoring a challenging situation only makes things worse.

6. Practice preventative methods like coaching in order to avoid corrective action.

• Coaching allows for consistent feedback from management. It also helps train employees on a daily basis and eliminates the need for severe corrective action except in extreme circumstances.

Why is there a need to conduct Evaluation?

• It ensures that the quality of care is provided

• To provide standards for establishing comparisons

• It promotes visibility for employees to monitor their own performance

• Provides feedback for improvement

Principles of Controlling

1. Critical Few

2. Point of Control

3. Self-control or discipline

Critical Few

• Also known as Pareto's Principle• vital few and trivial many• In Juran's initial work he identified 20

percent of the defects causing 80 percent of the problems.

• Project Managers know that 20 percent of the work (the first 10 percent and the last 10 percent) consume 80 percent of your time and resources. 

• The value of the Pareto Principle for a manager is that it reminds you to focus on the 20 percent that matters.

• Of the things you do during your day, only 20 percent really matter.

• Those 20 percent produce 80 percent of your results.

• Identify and focus on those things. 

Point of Control

• they are the points at which you are empowered to perform some action with a high degree of assurance of success.

Control of Resources

Discipline

• strong commitment to the vision, philosophy, goals and objectives of the institution.

• Laws that govern the practice of all professionsals and their respective Codes of Conduct.

Discipline (cont)

• Understanding the rules and regulations of the agency.

• An atmosphere of mutual trust and confidence.

• Pressure from peers and organization.

Disciplinary Approaches

Problem Solving

Disciplinary Action

Disciplinary Action (cont)

• Counseling and Oral Warning• Written Warning• Suspension• Dismissal

• The three respective types of control based on timing are feedforward, concurrent, and feedback.

Feedforward control

• focuses on the regulation of inputs (human, material, and financial resources that flow into the organization) to ensure that they meet the standards necessary for the transformation process.

• Feedforward controls are desirable because they allow management to prevent problems rather than having to cure them later. Unfortunately, these control require timely and accurate information that is often difficult to develop. Feedforward control also is sometimes called preliminary control,  precontrol,  preventive control, or steering control.

Concurrent Control

• Concurrent control takes place while an activity is in progress.

• t involves the regulation of ongoing activities that are part of transformation process to ensure that they conform to organizational standards.

• Concurrent control is designed to ensure that employee work activities produce the correct results.

• Since concurrent control involves regulating ongoing tasks, it requires a through understanding of the specific tasks involved and their relationship to the desired and product.

• Concurrent control sometimes is called screening or yes-no control, because it often involves checkpoints at which determinations are made about whether to continue progress, take corrective action, or stop work altogether on products or services.

Feedback Control

• This type of control focuses on the outputs of the organization after transformation is complete.

• Sometimes called postaction or output control, fulfils a number of important functions.

• For one thing, it often is used when feedforward and concurrent controls are not feasible or are to costly.

• Sometimes, feedback is the only viable type of control available.

• Moreover, feedback has two advantages over feedforward and concurrent control. 

• First, feedback provides managers with meaningful information on how effective its planning effort was. If feedback indicates little variance between standard and actual performance, this is evidence that planning was generally on target.

• If the deviation is great, a manager can use this information when formulating new plans to make them more effective. 

• Second, feedback control can enhance employees motivation.

• The major drawback of this type of control is that, the time the manager has the information and if there is significant problem the damage is already done.

Characteristics of Effective Control

• A focus on critical points. For example, controls are applied where failure cannot be tolerated or where costs cannot exceed a certain amount. The critical points include all the areas of an organization's operations that directly affect the success of its key operations.

• Integration into established processes. Controls must function harmoniously within these processes and should not bottleneck operations.

• Acceptance by employees. Employee involvement in the design of controls can increase acceptance.

• Availability of information when needed. Deadlines, time needed to complete the project, costs associated with the project, and priority needs are apparent in these criteria. Costs are frequently attributed to time shortcomings or failures.

• Economic feasibility. Effective control systems answer questions such as, “How much does it cost?” “What will it save?” or “What are the returns on the investment?” In short, comparison of the costs to the benefits ensures that the benefits of controls outweigh the costs.

• Accuracy. Effective control systems provide factual information that's useful, reliable, valid, and consistent.

• Comprehensibility. Controls must be simple and easy to understand.

The Control Process1. .Establish and specify Criteria and

Performance

2. Monitor & Actual Performance of Nursing Care Services

3. Compare performance with standards, criteria to determine deviations

4. Enact Remedial measures or steps to correct deviations

1. Establish and specify Criteria and Performance

Standards -guidelines

Time -deadlines

Financial -budgeting

Operation

good services &quality, inventory

Statistical process control

if production operations have been performed accurately

2. Monitor & Actual Performance of Nursing Care Services

Nursing Rounds

Quality Assurance

Nursing Audit

• Quality Assurance• Is a process of evaluation that is applied to

the health care system and the provision of healthcare services by healthworkers

• TQM & CQI (continuous quality improvement)

• Customer satisfaction

• The primary purpose of QA programs in nursing is

• to measure and improve the quality of nursing delivery in the agency.

• The patient is the best and sometimes the only judge of the interpersonal aspects of care, like empathy, communication,  room & food services.

• Patient satisfaction is an essential goal of care.

• Patients attitude influence the degree of compliance to the medical regimen

• How to develop QA criteria?

Structure -----process------outcome

• Structure Approach – includes physical setting, instrumentalities and conditions through which nursing care is given such as the philosophy and objectives, the building, organizational structure, financial resources, and equipment.

• Process Approach –includes the steps in the nursing process in compliance with established standards of nursing practice.

• .

• Outcome Approach –identifies desirable changes in the patient’s health status such as modification of symptoms, signs, knowledge, attitudes, satisfaction, skill level, and compliance with the treatment regimen

4 main principles in CQI

1.Customer focus

2.Identification of key processes to improve quality

3.The use of quality tools and statistics

4.Involvement of all people in problem solving

Principles Underlying Quality Assurance Efforts

1.All health professionals should collaborate in the effort to measure and improve care.

2.Coordination is essential in planning a comprehensive quality assurance program

3.Resource expenditure for quality assurance activities is appropriate.

• 4.There should be focus on critical factors such as functions and activities that promise to yield the greatest health and financial benefit to reveal significant findings.

• 5. Quality patient care is accurately evaluated through adequate documentation.

• 6. The ability to achieve nursing objectives depends upon the optimal functioning of the entire nursing process and its effective monitoring.

7. Feedback to practitioners is essentials to improve practice. It perpetuates good performance and replaces unsatisfactory interventions with more effective methods.

8. Peer pressure provides the impetus to effect prescribed changes based on the results of assessments

9. Reorganizations in the formal organizational structure may be required if assessment reveal the need for a different pattern of healthcare.

10.Collection and analysis of data should be utilized to motivate remedial action.

Quality Assurance and Performance Evaluation

• Performance Evaluation• -focuses on the worker. It asks questions

about how well the worker satisfies the requirements of his or her job within the organization.

• Quality Assurance• -focuses on the care and service the

patient receives than on how well the professional performs the duties that the position requires.

Nursing AuditCommitee

• A nursing audit is composed of a representative from all levels of the nursing staff:

•  A member of the training staff •  Supervising Nurse•  Head/Senior Nurse• Staff Nurse• Patient Care Audits Patient care audits �

may be concurrent or retrospective.

Concurrent Audit• 1.Is one in which patient care is observed

and evaluated. It is given through:• 2.A review of the patient’s charts while the

patients are still confined in the hospital.• 3.Observation of the staff as patient care

is given.• 4.Inspection of patients and/or observation

of the affects of patient care where the focus is on the patient.

Retrospective Audit

• -Is one which patient care is evaluated through

• A review of discharged patient’s charts;• Questionnaires sent to or interviews

conducted on discharged patients.

Peer Review

-Patient care audits may be done by peers (employees of the sameprofession, rank, and setting) evaluating another’s job performance against accepted standards.

�

Quality Circles

-One of the most publicized approaches to quality control introduced by the Japanese.

-A group of workers doing similar work who meet regularly, voluntarily, on normal working time, under the leadership of their supervisor, to identify, analyze and solve work related problems and to recommend solutions to management.

Utilization of Results

-The Nursing Staff in the unit is given a feedback on the results of the quality assurance study.-Positive Feedback reinforces desirable performance. Consistent positive findings deserve a commendation from the nursing service.

-Negative Feedbacks should tactfully be conveyed in a face-to-face situation so that assessment results may easily be clarified.

Control of Resources

Part of the control process is the periodic review of the utilization of materials and supplies in the various nursing units.

-Requisitions of and/or stocking a large number of supplies and materials should be avoided to prevent pilferage, misuse, or spoilage.

• 3. Compare performance withstandards, criteria to determinedeviations

• PERT• BENCHMARKING

• 4. Enact Remedial measures or steps to correct deviations

• Maybe done by changing the number of personnel, training subordinates, minimizing resources or increasing quality care.

PERFORMANCE APPRAISAL

• A control process in which an employee’s performance is evaluated against standards.

• It Is the most valuable tool in controlling human resources and productivity.

PURPOSE

• COMPENSATION• CAREER PLANNING• FEEDBACK• TRAINING• HUMAN RESOURCE PLANNING• EXIT• RESEARCH

MOTIVATION IS THE OVERALL PURPOSE

WHAT IS APPRAISED?

• INDIVIDUAL TASK OUTCOMES• BEHAVIOUR• TRAITS• COLLECTIVE OUTCOMES• COLLECTIVE PROCESSES

WHAT IS EXPECTED OF THE PERSON?

WHO APPRAISES?

• IMMEDIATE SUPERIOR• HIGHER LEVELS• PEERS• SELF• IMMEDIATE SUBORDINATES• COMMITTEE

Different tools in measuring performance

• Essay - strength & weaknesses• Checklist - compilation of all nursing

performances• Ranking - educational level, clinical

efficiency, ska• Anecdotal Recording• Rating scale - 1 - 5

• Trait scale - job description, personal trait• Peer review• Self appraisal• BARS/BES = Behaviorally Anchored;

desired behaviors to improve performance

BARS focuses on behaviors that are determined to be important for completing a job task or doing the job properly, rather than looking at more general employee characteristics (e.g. personalitY)•  Answers phone promptly and courteously, • , a BARS approach may break down

that task into behaviors: For example:• Answers phone within five rings.• Greets caller with “Hello, This is the

Dinkle Company, how may I help you?

Forced Choice Comparison

Ex. Select the statement that best describes the nurse being evaluated and the statement that least describes him/her.

• 1 -respects ideas for other• 2 -limited communication ability• 3 - even tempered• 4 - capable of enduring long hours• 5 - tends to be a loner

APPRAISAL BY OBJECTIVES

• Set the organization’s goals• Set the departmental goals• Discuss developmental goals• Define expected results• Performance reviews• Provide feedback

Common errors in appraisal• halo effect or Logical error – impressions• Central tendency error - used when

feedback tools are inadequate, staff is rated average

• Leniency error - overlooking the weaknesses of the subordinate

• Hawthorne effect – subjects improve or modify an aspect of their behavior being experimentally measured simply in response to the fact that they are being studied,[not in response to any particular experimental manipulation.

• Horn’s effect - low rating because of an error committed

OVERCOMING PROBLEMS

• USE MULTIPLE CRITERIA• DE-EMPHASISE TRAITS• USE MULTIPLE EVALUATORS• EVALUATE SELECTIVELY• FOCUS ON TRAINING NOT REWARDS

OVERCOMING PROBLEMS (Contd.)

• FROM FITTING IN A JOB TO CONTINUOUS LEARNING

• TRAIN APPRAISER• DIARY KEEPING

– Keep a diary of critical incidents• GRIEVANCE HANDLING SYSTEM• CAREFUL RECORD KEEPING

OVERCOMING PROBLEMS (Contd.)

• INVOLVE USERS IN DESIGNING THE SYSTEM

• REWARD FOR PERFORMANCE APPRAISAL

• PERFORMANCE INTERVIEW– Handle Sensitively– Open/ direct/ objective

An Activity in Performance Appraisal

ADDRESSING SALLY’S ERRORS IN JUDGEMENT

You are a senior student nurse and this is your sixth week of MS + Leadership Clinical Focus. Your CI assigns two students to work together in caring got gour to six patients. The students alternate fulfilling leader and follower roles and providing total patient care. This is the second full day that you have worked as a team with Sally Kayumanggi.

Last week, when you were assigned with Sally, she was the leader and made numerous errors in judgment. She got a patient up who was on strict bed rest. She made an IV Medication error giving a medication to the wrong patient. She gave Nubain too soon because she forgot to record the time in the therapeutic sheet and she frequently did not seem to know what was wrong with her patients.

Today you have been the leader and have observed her contaminate a dressing and forget to observe the 5 basic rights twice when she was giving medications. When

you asked her about checking placement of the NGT, she did not know how to perform this skill. You have heard some of the other

students complain about Sally.

What is your obligation to your patients, your fellow students, the Clinical Agency (Hospital) and your instructor? Outline what you would do. Give rationale for your decisions.

DEVELOPMENT OF STANDARDS

•Types of Standards–Structure standards–Process Standards–Outcome Standards

Structure standards

• The Structure Standards are the policies necessary to run the department of nursing. No longer just word of mouth, they are written for all to see and easily found on the hospital Intranet.

• The Structure Standards are written at the department level as well as the nursing unit level. The Structure Standards include medication and safety policies, descriptions of the standards program and quality improvement activities, and unit admission criteria.

• The Structure Standards are reviewed and revised annually by the Standards Committee and nursing leadership.

• This annual review assures that the Structure Standards represent a real and accurate reflection of the function of the department and patient care units.

Process Standards• The Process Standards define the "action

and behaviors of nurses giving care and what constitutes that care" (Marker, 1988b, p. 5).

• The Process Standards include job descriptions, the job performance evaluation tool, procedures, and protocols. Central to the standards program are the protocols, which guide the majority of nursing actions and are a key component of the patients' plan of care.

• The protocols truly provide what the staff nurse needs. The protocols set the standard for care, provide a wonderful reference and teaching tool for the nurse, and serve as the nursing orders to define the plan of care for the patient.

Outcome Standards• Outcome Standards "define the end

results of care" (Marker, 1988b, p. 6) in the form of goals for desired patient outcome. Approximately 50 preprinted Plans of Care (based on medical diagnosis) were developed to serve as a single-page standard of care for the patient.

• The Plans of Care include expected outcomes for the patient and a list of all protocols and problems likely to be used when caring for the patient.

Protocols

• Protocols are the foundation for nursing actions. They define in "specific terms the management for broad categories of patient care problems" (Marker, 1998a, p. 26). NWHMC uses three categories of general and unit-specific protocols: interdependent protocols, independent protocols, and teaching protocols. The Standards Committee writes and approves all protocols.

• Independent protocols describe the management of patient problems through independent nursing functions that can be carried out autonomously.

• Interdependent protocols are approved through physician committees and contain dependent functions (noted by asterisk) as well as independent functions.

SETTING STANDARDS

Setting Standards

• Everyone doing a job should know what

he/she is expected to do.• Standards must be attainable.• There must be a point against

whichperformance can be measured.

Setting Standards

• Involve your staff in setting standards.• Self-evaluation will then become automatic.• Corrective action can be taken immediately.• You provide the encouragement to stay ontarget.

ACTION STEPS

Action Steps

Working with Human Resources:• Review your department’s job descriptions.• If needed, add a list of standards to be met.• Design an evaluation system – how will youmeasure performance?

There’s More!Part 2: Structuring the

performance review• Review and preparation

• Putting the employee (and you!) at ease

• Giving feedback

There’s More!Part 3: Giving negative feedback &

setting goals• Structure for giving negative feedback

• Reviewing last year’s goals/setting new goals

• Career development plans• What NOT to do

• Ending on a positive note

Dysfunctional Consequences of Control

– Game Playng– Resisting Control– Providing Inaccurate Information– Following Rules to the Letter– Sabotaging– Playing One Manager Off Against Another– Implications to Patient Care

Dysfunctional Consequences of Control

• Managers expect people in an organization to change their behavior in response to control. However, employee resistance can easily make control efforts dysfunctional. The following behaviors demonstrate means by which the manager’s control efforts can be frustrated:

• 1. Game playing–> control is something to be beaten, a game between the “boss and me and I want to win.”

• 2. Resisting control–> a “blue flu” reaction to too much control

CONT

• 3. Providing inaccurate information –> a lack of understanding of why the information is needed and important leading to “you want numbers, we will give you numbers.”

• 4. Following rules to the letter–> people following dumb and unprofitable rules in reaction to “do as I say.”

CONT..

• 5. Sabotaging –> stealing, discrediting other workers, chasing customers away, gossiping about the firm to people in the community

• 6. Playing one manager off against another –> exploiting lack of communication among managers, asking a second manager if don’t like the answer from the first manager.

IMPLICATION TO PATIENT CARE

• The role of the nurse in the delivery of quality health care is vital for patient recovery.

“Do the thing you fear to do and keep on doing it... that is the quickest and surest way ever yet discovered to conquer fear.

”