controlling in nursing management

Group IV

Controling or evaluatiing is an on-going function of management which occurs during planning,organizing and directive activities.

Is the use of formal authority to assure achievement of goals and objectives

Action is taken to correct discrepancies between this standards and actual performance

1. Evaluation ensures that quality nursing care provided.

2. It allows for the setting of sensible objectives and with men

3. It provides standars for establishng comparisons.4. It promotes visbility and a means for the employes

to mnitor thier own perpormance.5. It highlight problems related to quality care and

determines the areas that require priority attention.

6. It provides an indicaion of the costs of poor quality.7. It justifies the use of resources.8. It provides feedback for improvement.

1. Must be based on the behavioral standars of performance which the position requires.

2. There should be enough time to observe employees behavior.

3. The employee should be given a copy of the job description, performance standars and evaluation.

4. The employees performance appraisal should include both satisfactory and unsatisfactory results with specific behavior instnces to exemplify there evaluative comment.

5. Areas needing improment must be prioritized to help the worker upgrade his/her performance.

6. Should be scheduled and conducted at a covineint time for the rater and the employee under evatustion in sush a way that it is perceiveding and with ample time for discussion.

7. Should be structured in sush a way that it is perceived and accepted positively as a mean of improving job performance.

Standards are desirable sets of condition and performance necessary to ensure the quality of nursing care services which are acceptable to those instrumental to or responsible for setting and maintaining them.

THREE TYPES OF PERFORMANCE STANDARDS:

A. STANDARDS ON STRUCTUREare those that focus on the structure or

management system used by the agency to deliver care.

B. PROCESS STANDARDSRefers to the decision and actions of the nurse

relative to the nursing process which are necessary to provide good nursing care.

C. OUTCOME STANDARDSare design to measure the results of care

provided in terms of changes of health status of clients served, changes in the level of their knowledge, skills and attitudes and satisfaction of those served including the members of the nursing and health team.

Measurable criteria or objectives specific to giving nursing care must be developed to evaluate process and outcome. The establishment of objectives provides clear direction and communication of expected levels of achievement. The greater the participation of the employee, the greater the motivation to achieve. Objectives should be challenging but attainable. The most commonly used methods for measuring nursing care are task analysis and quality control.

In task analysis task and procedures such are written guides, schedules, rules, records, budgets are expected.

Quality control refers to the activities and techniques employed to achieved and maintain the quality of a product, service or process, the level of nursing care provided and its effect to the client are assessed

A measurement of performance is an on-going, repetitive process with the actual frequency dependent on the type of activity being measured. For example, nursing care to patients is continuously monitored, whereas, a formal performance appraisal maybe done only twice a year.

Measurements maybe scheduled in advance, maybe done at periodic but unannounced intervals or may occur at random. The purpose of measurement should be clarified and the staff should be informed about the tasks and levels of care that need attention.

Positive feedback stimulates motivation, consistently high performance and growth of the employee. Corrective actions are applied to improve performance.

Comparing the results of performance with standards and objectives is one of the easiest steps in the control process. If performance matches standards and objectives, managers are assured that the needs of patients are met. However, if performance is contrary to standards and objectives set, then necessary action should be taken.

Being at the first level of supervision, the Head / Senior Nurses are in the best position to know whether their staff nurses perform satisfactorily at work. Their influence has an impact on promoting quality care to patients.

They have the responsibility to instruct subordinates regarding the appropriate methods and procedures in providing nursing care.

They should inform the staff of the likely causes of errors or defects and preventive measure necessary.

They should initiate and / or facilitate any steps necessary to improve methods, equipments, materials and conditions in the work area for which they are responsible.

The feeling of responsibility to render quality performance must be instilled in all employees for them to follow agreed upon written procedures and use materials and equipment correctly as instructed

-It is a control process in which a employee’s performance is evaluated against standards. It is the most valuable tool in controlling human resources and productivity.

Purpose of Performance Appraisal Determine salary standards and merit

increases. Select qualified individuals for promotion or

transfer. Identify unsatisfactory employees for

demotion or termination. Make inventories of talents within the

institution. Determine training and developmental

needs of employees. Improve the performance of work groups by

examining, improving, correcting interrelationships between members.

Improve communication between supervisors and employees and reach an understanding on the objectives of the job.

Establish standards of supervisory performance.

Discover the aspirations of the employees and reconcile these with the goals of the institution.

Provide “employee recognition” for accomplishments.

Inform employees “where they stand”.

Appraisal SystemCompatibility between the criteria for

individual evaluation and organization goals.

Direct application of rated performance to performance standards and objectives expected of the worker.

Development of behavioral expectations which have been mutually agreed upon by both the rater and the worker.

Understanding the process and effective utilization of procedure by the rater.

Rating of each individual by the immediate supervisor.

Concentration on the strengths and weaknesses to improve individual performance.

Encouragement of feedback from the rated employees about their performance needs and interests.

Provision for initiating preventive and corrective actions and making adjustments to improve performance.

Informalmay consist of incidental observation of

performance while the worker is engaged in performing nursing care or by responses made by worker during conferences

interaction of woker with clients, their families , visitors and co-workers should also be noted.

Formalis accomplished regularly and

methodically by colleing objective facts that can demostrate the difference between what is expected and what was done.

this mwthods include essay, checklist, ranking, rating scale, forced-choice comparison, and anecdotal records.

EssayThe appraiser writes a paragraph or

more about the worker’s strengths, weakness and potentials. In most situations, particularly in managerial positions, essays appraisals carry significant weight on the presumption that an honest statement from someone who knows the person well is valid.

ChecklistsA checklist is a compilation of all nursing

performances expected of a worker. The appraiser’s task is to mark the appropriate column whether the worker does or does not show the desired behavior.

RankingIn simple ranking, the evaluator ranks

the employees according to how he or she fared with co-worker with respect to certain aspects of performance or qualifications.

Rating ScalesA rating scale includes a series of item

representing the different task or activities in the nurse’s job description or the absence or presence of desired behaviors and the extent to which these are possessed.

Forced-choice ComparisonIn this method, the evaluator is asked to choose the statement that best describes the nurse being evaluated. The items are so grouped that evaluator is force to choose from favorable as well as unfavorable statements and to counter the tendency towards leniency by some evaluator.

Anecdotal RecordingIt describes the nurse’s experience with a group or a person, or in validating technical skill and interpersonal relationship.The anecdotal records should include1. A description of the particular occasion2. A delineation of the behavior noted including

answers to the question who, what, when, and how3. The evaluator’s opinion or assessment of the

incident or behavior

Assurance-means achieving a sense of

accomplishment and implies a guarantee of excellence.

Quality -is the degree of excellence-common language for improvement-enables different people to

communicate with each other in pursuit of common goal.

Quality of Care-degree to which health services for

individuals and population increase the likelihood of desired health outcomes and are consistent with the current professional knowledge.

-exist to the degree that service is efficient, well-executed, effective and appropriate.*Workers must accept the responsibility that they have to do the right thing/job the first time and every time.

Quality Assurance-is a process of evaluation that is applied

to the health care system and the provision of health care services by health workers.

Quality Improvement Program-is the umbrella program that extends

the many areas for the purpose of accountability to the consumer and payor.

- continuous, on-going measurement and evaluation process that includes structure, process, and outcome.

Sentinel event indicators-Measures a low volume but serious

undesirable and often avoidable process or outcome such as falls and medication errors.

Benchmarking-is a tool to assists in quality of care

decision making.-It is a continuous process of measuring

what exists against the best in search for industry best practices.

Best Practice-is a service, function or process that has

been fine tuned, improved and implemented to produce superior outcomes.

-lead in establishing benchmarks

Total Quality Management-Is way to ensure customer satisfaction by

involving all employees in the improvement of the quality of every product or service.

- all systems are evaluated and improved.-It aims to reduce waste and cost of poor

quality-It is a structured system for involving an

entire organization in a continuous quality improvement process targeted to meet and exceed customer expectations.

Continuous Quality Improvement-is a process of continuously improving a

system by gathering data or performance and using multi-disciplinary tem to analyze the system, collect measurements , and propose changes.

FOUR MAIN PRINCIPLESCustomer focusIdentification of key processes to improve

quality The use of quality tools and statisticsInvolvement of all people in problem solving

PRINCIPLES UNDERLYING QUALITY ASSURANCE EFFORTS1.All health professionals should collaborate in

the effort to measure and improve care.2.Coordination is essential in planning a

comprehensive quality assurance program3.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 and needed improvements on the quality of care

9. Reorganizations in the formal organizational structure may be required if assessment reveal the need for a different patternof health care.

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 the duties that the position requires.

Quality Assurance Methods-purpose is to measure and improve the

quality of nursing delivered in the agency.Several methods:

Concurrent and retrospective patient care audits

Patient care profile analysisPeer reviewQuality circles

Developing Quality Assurance CriteriaStructure, process and outcome or any

combination of these, are common approaches to evaluation.

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.

A nursing audit is composed of a representative from all levels of the nursing staff:A member of the training staffSupervising NurseHead/Senior NurseStaff Nurse

Patient Care AuditsPatient care audits may be

concurrent or retrospective.

Concurrent Audit1. 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 sane profession, 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.

Discipline meant rigid obedience to rules and regulations, the violation of which resulted in punitive actions in the past. Today, discipline is regarded as constructive and effective means employees take personal responsibility for their own performance and behavior.

Factors that influence self discipline

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

2.Laws that govern the practice of all professionals and their respective codes of conduct.

3.Understanding the rules and regulation of the agency.

4.An atmosphere of mutual trust and confidence

5.Pressure from peers and organization.

Disciplinary Approaches This should include a set of disciplinary

policies and procedures, a uniform application of discipline rules, a disciplinary committee, and an orientation program for all new employees were expectations of appropriate performance and behavior are emphasized. There must be continuous communication to all employees regarding changes in personnel and discipline policies.

Problem SolvingAn effective supervision aids supervisor is

analyzing the work problems of their subordinates.

Disciplinary ActionAny employee charged for breach of the

rules and regulations, policies, norms of conduct shall be given due process.Counseling and Oral warning

-The employee is given a fair chance to air his/her side

Suspension-Suspension over minor violation is

given after an evidence of oral and written warnings. Suspension is applied when management feels that the employee can still be rehabilitated.

Dismissal-Dismissal is invoked only when all

the other disciplinary efforts have failed.

Written warning -The employee must be told after the

interview that he will be given a written warning this include the statement of the problem, identification of the rule which was violated, consequences of continued deviant behavior, the employee’s commitment to take correction action, and any follow-up action to be taken.