MANAGEMENT PROCESS

PLANNING

Planning is the first step in the management process. It is one of the fundamental elements of
administration. Planning is thinking ahead of time or well in advance with regards to what
needs to be done in an organised way to minimise the confusions in carrying out future
actions.

Meaning

 Planning is deciding in advance what to do, how to do it, when to do it and who to do
it.
 Planning is preparing a blue print
 Planning is the predetermined course of action

Definition

 Planning is defined as pre-determining a course of action in order to achieve a

designed result.
Venson
 Planning is a process of determining the objectives of administrative efforts and
devising the means calculated to achieve them.
Millet
 Planning means determination of what to be done, how and where it is be done, who
is to do it and how results are to be evaluated. Planning bridges the gap between
where we are where we want to go.
James Lundy
 Planning is a continuous process of making present entrepreneurial decisions
systematically and with the best possible knowledge of their futurity, organising
systematically the efforts needed to carry out these decisions and measuring the
results of these decisions against expectation through organised systematic feedback.
Peter Drucker

Nature of planning

i. Goal oriented: Planning must contribute to the achievement of pre-set goals. Well
defined goals are essential for efficient planning.
ii. Primary function: It is the basis or foundation of management process. All other
functions are designed to attain the goals set under planning.
iii. Pervasive: Planning is the function of each and every manger irrespective of the level
and area of his/her operation. Planning is essential at all levels from top to bottom.
But the nature may vary according to the level of management.
iv. Intellectual or rational process: Planning is a mental exercise involving imagination,
foresight and sound judgement. It is not guesswork or wishful thinking.
 v. Continuous process: It is an ongoing and dynamic exercise. As the assumptions and
events on which plans are based change, old plans have to be revised or new ones
have to be prepared.
vi. Forward looking: All planning is done with an eye on the future. Planning involves
anticipating the future course of events. Therefore forecasting is the essence of
planning. Forecasting involves assessing the uncertain future and making provisions
for it.
vii. Involves choices: Planning is essentially decision making or choosing among
alternative courses of action. A planning problem arises only when an alternative
course of action is discovered.
viii. Integrated process: Planning is a structured process and different plans constitute a
hierarchy. Different plans are interdependent and interrelated. Every lower level plan
serves as a means towards the end of higher plans.
ix. Directed towards efficiency: Planning has no relevance if it does not facilitate the
achievement of objectives economically and efficiently. It is a deliberate and
continuous process. The efficiency of plans is measured by how much they contribute
to the objectives economically and efficiently.

Principles of planning

1. Contribution to objectives: Every major and derivative plan should contribute

positively towards the accomplishment of enterprise objectives.
2. Efficiency of plans: The efficiency of plan is measured by the amount it contributes to
the objectives minus the costs and other undesirable consequences involved in the
formulation and operation of plans. This principle stress upon economical use of
individual effort to achieve group goals.
3. Primacy of planning: This principle emphasis that a manager can hardly perform other
managerial function without a road map of plans to guide him.
4. Planning premises: Perhaps the main deficiency of planning arises from poorly
structured plans. A coordinated structure of plans can be developed only when
managers throughout the organisation understand and agree to utilise a consistent
planning premises.
5. Policy framework: A consistent and effective framework of enterprise plans can be
developed if the basic policies that guide thinking in decisions are expressed clearly
and understood by managers who prepare the plans.
6. Timing: When the plans are structured to provide an appropriately limited,
intermeshed network of derivative and supporting programmes, the plan can
contribute effectively and efficiently toward attainment of enterprise objectives. Both
premises and policies are useless without proper timing.
7. Alternatives: In choosing from among alternatives the best alternative will be that
which contributes most efficiently to the accomplishment of a desired goal. This will
help in selecting the most favourable alternative.
8. Commitment: Logical planning should cover a time period necessary to forecast the
fulfilment of the commitment involved in a decision. This is necessary to make
reasonably sure that commitments are met.
9. Limiting factor: While choosing from among the alternatives, the planner should
focus on those factors which are critical to the attainment of the desired goal. This
will help in selecting the most favourable alternative.
 10. Flexibility: This principle deals with the ability to change what is built into the plans
and reduce the risk of loss due to unexpected events. However the cost of flexibility
should be weighed against the dangers of future commitments made.
11. Navigational change: The manager should periodically check on events and
expectations and redraw plans to maintain a course towards the desired goals. Unless
plans have inbuilt flexibility, navigational change is difficult or costly. But in built
flexibility should not be an excuse to refrain from periodic revision of plans, if
circumstances so warrant.
12. Competitive strategies: While formulating plans a manager should take into account
the plans of rivals or competitors. The plans should be chosen in the light of what a
competitor will do in the same situation.
Planning Process
Main steps in the planning process are as follows:
I. Identify goals: Objectives must be stated clearly and in measurable terms. Objectives
should laid down after an analysis of external and internal environment of the
organisation.
II. Developing planning premises: Planning is done for future which is uncertain.
Therefore certain assumptions are made about the future environment. These
assumptions are known as planning premises. In order to develop good planning
premises, it is necessary to collect data on the current status of the organisation and to
forecast future changes.
III. Determining alternative courses of action: Alternative courses of action should be
determined. This requires imaginations, foresight. In determining alternatives, the
critical or limiting factor must be kept in view.
IV. Evaluate the alternatives: Once alternative courses of action have been determined,
they must be evaluated. Alternative courses of action can be evaluated against the
costs, risks, benefits and organisational facilities. Strong and weak points of each
alternative should be analysed carefully.
V. Select a course of action: This is the point of decision where a plan is adopted for
accomplishing identified goals
VI. Formulate derivative plans: Final step in the planning process is to develop derivative
plans. Once a choice is made and the master plan is adopted functional and tactical
plans and action programmes are decided. The breakup of the master plan into
departmental and sectional plans provides a realistic picture of the actions to be taken
in future.

Identify goals

Developing planning premises

Determining alternative courses of action

Evaluate the alternatives

Select a course of action

Formulate derivative plans

Types of planning
Classified based on

1. Time : Long term and Short term

 Long term- involves more than one year period, usually three to five years.
 Short term (tactile planning)- usually covers one year. The short term planning is
made with reference to long term plans as short term plans contribute to long term
plans

2. Approach used: Proactive and Reactive planning

 Proactive planning- is planning in anticipation. The suitable course of action are
designed considering the changes expected in the relevant environment.
 Reactive planning- is the type of planning that is done after the environment
changes have taken place. This approach of planning is suitable in environment
which is fairly stable over a long period of time.
3. Degree of Formalisation: Formal and Informal Planning
 Formal planning- is based on systematic evaluation of environmental variables
and is in the form of well structured and systematic process where different
steps are taken for planning.
 Informal Planning- is usually based on managers own experiences or intuitions.

4. Managerial levels: Strategic plans, operational, directional and administrative plans

 Directional Planning: also called policy planning and is concerned with the broad
general direction of the program.
 Administrative Planning: concerned with the overall implementation of the
policies developed with mobilisation and coordination of the personnel and
material available in the administrative unit.
 Strategic versus operational plan
5. Coverage of activities: Management(corporate) and Functional Planning
 Management (corporate) planning- denotes planning activities at the top level
and it usually covers all the planning activities of the organisation. The basic
focus is to determine the long term objectives of the organisation as a whole
and then generate the plans.
 Functional Planning- is the segmental and it is taken for each major function of
the organisation, for example for personnel management, finance etc. It derives
from management planning and should contribute to it.

ORGANIZING

Organising is the basic function of management. It is a process of determining, grouping and

assigning activities of an organisation to achieve goals.

According to Fayol, to organise is to provide everything for the functioning- human resources,
materials and capital.

Meaning

Term organisation is derived from the word organism which means a structure of body divided
into parts that are held together by a fabric of relationship as one organic whole.

Organisation is the act of organising or the state of being organised.

The term organisation suggest a functional group working together for achieving a common
purpose/objectives.

Definitions

Organisation involves grouping of activities necessary to accomplish goals and plans, the
assignment of activities appropriate departments and the provision of authority delegation and
coordination.

-Koonts and O’Donnel

Organizing is the process of defining and grouping the activities of the enterprise and establishing
the authority relationships among them.

-Theo Haimann

Organizing may be defined as a group of individuals, large or small that is co-operating under the
direction of executive leadership in accomplishment of certain common object.

-Keith

A group of people who are cooperating under the direction of leadership for the accomplishment
of a common end.

-R C Davis
An identifiable group of people contributing their efforts towards the attainment of goal is called
an organisation.

-Mc Farland

It is the formal structure of authority through which work subdivisions are arranged, defined and
coordinated for the defined objectives.

-Luther Gullick

Principles of Organisation

Henri Fayol (1947) has defined the principles of organisation as follows:

1. Hierarchy or Scalar chain of command

2. Span of control
3. Delegation of Authority
4. Integration versus Disintegration
5. Centralisation versus Decentralisation
6. Unity of Command

1. Hierarchy (Scalar chain of command): This principle suggests that there should be a clear line
of authority from top to bottom linking all managers at all levels. It recognises the necessity
of formal authority in the organisation.
2. Span of control: Means the number of subordinates an officer can effectively supervise. It is
simply the number of subordinates or the units of work that an administrator can personally
direct.
3. Delegation of Authority: Means conferring of specified authority by a higher authority.
Delegation implies transfer of certain specified functions by the superior to the subordinate
authority. The subordinate authority acts as the agent of superior authority and the superior
always retain the right to issue directions to revise decisions.
4. Integration versus Disintegration: Integration means unification in administrative language,
integration means connecting one or more of independent organisation with the rest of the
organisational structure of the country by placing them under the executive directly or
through some department.
Disintegration means number of independent establishments and the line of authority from the
executive stops and it is broken
Integrated administration facilitates coordination and disintegrated administration creates
anarchy and conflict.
5. Centralisation versus Decentralisation: Centralisation stands for concentration of authority at
or near the top. An organisation is said to be centralised if most of the power of decision is
vested in the top level so that the lower ones have to refer most problem to the head of
organisation for decision.
Decentralisation means that the central authority gives certain power to the local authorities.
A decentralised organisation is one in which the lower levels are allowed the discretion to
decide most of the matters which come up, reserving comparatively a few bigger and more
important problems only for those higher up.
6. Unity of Command: Means that no individual employee should be subjected to the orders of
more than one immediate superior. That is, an employee should receive orders from one
superior only.
Organisation Structure

It includes arrangement of organisational activities and assignment of resources in those activities to

achieve goals of organization. It is the way in which the activities of each department in the
organisation are coordinated and integrated to achieve the organisational objectives. In a good
organisational structure each employee is assigned a responsibility and the activities of the employees
in each department are coordinated and integrated to achieve the organisational goals.

It refers to the formal configuration between an individual and the group with respect to the allocation
to tasks, responsibilities and authority within an organisation. The formal structure of an organisation
is two dimensional-horizontal and vertical. The horizontal dimension depicts differentiation of the
total organisational job into different departments. The vertical dimension refers to the hierarchy of
authority/relationship with a number of levels from top to bottom. Authority flows downward along
these levels.

Steps in Organisation Structuring

The organisation needs to be structured in such a manner that human and physical resources are
brought to action to achieve the goals and objectives. The following are some of the steps to build
organisational structure.

 Determination, identification and enumeration of activities: After setting vision, mission,

goals and objectives identify the activities required to achieve these objectives. These
activities are again divided in to sub activities so that each employee knows his role,
responsibilities and relationship with the others.
 Grouping and assigning of activities: All similar activities are grouped together and the
activities are further divided into sub activities as purchasing, budgeting etc. These group of
activities assigned to various divisions or departments. The departmental heads delegate and
distribute the job to their subordinates.
 Delegation of authority: The persons who are assigned the particular activity of job are
responsible for performing their work in an optimal manner. So they must be given
corresponding authority also.

Benefits of Good Organisational Structure

 Achievement of objectives: A good organisational structure facilitates achievement of

objectives.
 Minimum conflicts: Conflicts between employees are found to be less in good organisational
structure as each employee is assigned a particular job to perform.
 Reduction in duplication of work: Since a good organisational structure requires that the
duties be clearly defined and assigned, duplication of work is less.
 Interpersonal relations and communication: A good organisational structure facilitates
effective communication at all levels of organizational hierarchy and maintains good
interpersonal relations
 Effective planning: A well organised organisational structure provides a sound basis for
effective planning. Since the goals are clearly established and resources are clearly defined,
planning becomes more focussed and realistic.
 Increase in cooperation and proper coordination: A good organisational structure results in
increased cooperation and a sense of pride among members of the organisation.
Forms of organisational structure

I. Line organization: It is the simplest and oldest form of organizational structure. The line of
authority flows vertically from top most executive to the lowest subordinate throughout
the organization. The line of authority is vertical and workers at the same level perform the
same function. The direction flows from top, transmitted through the managers to the
supervisors and then to the workers and staff.

Advantages of line organization:

 Simple to establish and easily understood by employees

 There is a clear unity of command and all employees are directly involved in achieving the
objectives.
 Facilitates prompt decision making
 Economically effective
 Ensures better discipline and there is unified control
 Provides opportunity for the development of managers as every manager has to perform a
variety of functions.

Disadvantages of line organization:

 Cannot be used for large organisations

 It is rigid
 There is lack of expertise to give advice.
 All decisions come from top level.
 There is inadequate communication from bottom to top.
II. Line and Staff organization: Here there are staff specialists who give expert advice to line
managers to perform their duties. The staff specialists have the right to recommend but have
no authority. This type of organisational structure is most seen in large organisation. The
combination of line organization with expert staff constitute the lines and staff organization.

Advantages of lines and staff organizational structure

 There is possibility to receive specialised advice from experts.

 The work load is reduced and managers can utilise enough time for creative thinking.
 The line and staff organizational structure is highly flexible because new activities may be
introduced without disturbing line authority.
 There is chance for better decision making process.
 The principle of unity of command is followed in line and staff organizational structure.

Disadvantages

 There is possibility for conflicts between line managers and staff specialists.
 Line managers sometimes depend too much on staff experts.
 Staff specialists have no authority.
 There is chance of role confusion among staff and line officers.
III. Functional organization: Here the organisation is divided into a number of functional
areas.ie, organisation is grouped according to its purpose. The whole activities of the
organisation are divided into various functions and each functional area is put under the
charge of a functional manager.
Advantages

 High specialisation- Every functional head is an expert in his area and all employees get the
benefit of his expertise.
 Better control and coordination
 Duplication of work can be kept minimum and there is clarity in functioning
 Helps to improve efficiency of employees
 Facilitates adequate supervision

Disadvantages

 Complex relationship: Each employee is accountable to several superiors which results in

conflict between workers and specialists.
 As there are many cross relationships, an employee may receive conflicting orders.
 Slow decision making: As several specialists may involve in decision making process, there is
delay in decision making.
IV. Project organisation: Here each project is organised under a semi-autonomous project
division. A project team consists of specialists in different areas. The activities of the project
team members are coordinated by a project manager. Once a particular project is completed,
the project division undertakes a new project.

Advantages

 Facilitates more attention to completion of complex projects.

 Permits maximum use of knowledge, skill and experience of employees.
 Provides better coordination of organisation resources

Disadvantages

 Project manager has to deal with specialities from a number of diverse fields. The specialists
have different approaches and interests. It delays the decision making process.
 The job of project manager becomes difficult due to lack of clarity defined, responsibility and
lack of clear communication.
V. Matrix organization: is an organisational form in which there are multiple lines of authority
and is used in large multinational organisation. It is a combination of functional and project
organisation and it is otherwise called grid organisation. There are several departments under
matrix organisation. The available resources of the organisation can be used by each
department along with the coordination of other department in an organisation.
Under matrix organisational structure, the project teams are formed using personnel from
permanent functioning structure. Different project managers share resources and authority
with functional head. The employees are subjected to dual line of command from project
manager and functional head. When one project is over resources are diverted to new
projects.

Advantages

 Better utilisation of resources in the organisation.

 Offers operational freedom and flexibility
 Here employees learn new skills which help in their development.
 Helps to maintain professional identity
  Under matrix organisational structure, the motivation and morale of employees are lightened.

Disadvantages

 Double lines of commands: Here working relationships become complex and there is great
confusion among employees due to double line command.
 Problem of adjustment: After completion of one project, people are assigned to some new
project and employees may face problems of adjustment.
 Delayed decisions: There are chances of delay in taking decisions.

Factors influencing Organisational Structure

i. Size of the unit: Size indicates the scale of operation. Size is an important factor governing
cost, efficiency and profitability of an enterprise. Before any business or non-business
enterprise is started, the organisers will have to decide most profitable and viable size of the
unit.
ii. Job Design: The bricks that build up an organisation structure are jobs. The jobs to be done in
an organisation are decided by the top level. Job design is the first managerial decision of the
organisation structure.
iii. Grouping of activities: The designed job have to be formed into groups according to the
nature of activity. Grouping of activities are essential to achieve coordination. Each group is
termed as department.
iv. Span of Control: is the number of persons to be managed by each manager. Depending upon
the nature of the organisation some departments will be large in size and some will be small.
v. Delegation of authority: If the span is more there will be more authority levels and the top
management has to delegate authority to each level. In an organisation structure if the span
and levels of management are more, the delegation of authority will be more and there will
also be decentralisation of authority for the smooth functioning of tasks.

ORGANIZATION CHART

Organizational chart and manuals are prepared for the purpose of describing the organisation
structure. They give full information on a particular organisation. An executive finds out his exact
place in the organisation structure from the charts and manuals. It shows the responsibility and
authority of an executive. He knows his superior for whom he is responsible and his subordinates
whom he has to supervise.

Definition

An organizational chart is a diagrammatic representation of framework or structure of an

organization.

- J Batty.

An organization chart is a diagrammatical form which shows the important aspects of an organization
including the major functions and their respective relationship, the channels of supervision and the
relative authority of each employee who is in charge of respective function.

-Terry

Contents of organizational chart

  Basic organisational structure and flow of authority
 Authority and responsibility of various executives
 Relationship between the line and staff officers
 Names of components of organization
 Position of various office personnel
 Number of persons working in the organization
 Present and proposed organisation structure
 Ways of promotion
 Requirements of management development
 Salary particulars

Principles of organisation chart

 Observation of lines of authority by top executives: The executives should never bypass the
lines of authority. The executives should give orders or obtain information by following the
lines of authority.
 Observation of lines of authority: by subordinates
 Defining lines of position: The position of each individual in an organisation should be
clearly stated. The staff should be assured that there would not be overlapping and two
persons would not be appointed for the same position when their authorities and
responsibilities are different.
 Non assignment of same duty twice: An individual should not be compelled to work under
two masters for same work performance.
 Avoid unique concentration of duty: The work should not be concentrated in a single point.
Instead it should be divided according to the duties and responsibilities of each worker and
the administrative relationship with others
 Organisational charts should be above personalities: Prime importance should be given to an
organisation than to an individual.
 Simple and flexible: understandable. Size and nature of the organisation may be changed in
course of time. Need may arise for periodical modification in the organisation chart. Then the
existing organisation chart should permit these modifications.

Types of organizational chart

1. Hierarchial organizational chart: it indicate the formal structure of an organisation. The

number of boxes vertically represents the number of ranks and depicts the power status, while
the horizontal level of boxes represents the number of departments or people in a particular
level. A top level administrator is represented at the top rectangular box. The level underneath
contains high managers of executives and each succeeding level includes the subordinates of
the line above. An executive position may have a larger rectangle than a subordinate position.
The same level generally have boxes of similar size on an organisation chart.
2. Matrix organisational chart: Here the organisation is divided in such a pattern that the same
skilled employees are pooled together in a group reporting to the respective managers of their
group. The matrix structure has two axes, representing two chains of command. One chain of
command that runs vertically is functional or divisional in nature, while the chain that runs
horizontally represents the group of people from the various functional departments.

3. Flat or horizontal organizational chart: There are few or no horizontal layers. It may consist of
only managers and the operation level employees and this type of organisation charts are
possible only in small or individual unit organisation. Due to few layers, communication
between levels is simple and more effective.

Other types

a. Basic (Vertical): The basic relationship is that between superior and subordinate and
this is shown vertically. The lines of command flows from top to bottom in vertical
lines. The vertical chart is in the form of a graph. This type is followed in companies.
 b. Horizontal Chart: The line of command flows horizontally and has ales defined chain
of command. Employees across lines have similar input into how the organisation is
run. Employees may perform many different functions and may report to several
supervisors, rather than a single boss.
c. Circular Charts: Top management is shown at the centre of the circle and other
management levels are shown in concentric circles.

d. Departmental chart: This chart is devoted exclusively to particular department and

give details of relationships, authority, responsibility etc. within the department.

Advantages of organizational charts

 Give a clear picture of the organization

 Shows the levels of authority and relationship prevailing among employees.
 Instructing work is simplified.
 Newly hired personnel can understand their role in the organization and behave accordingly.
 Strengths and weaknesses of an organization are evaluated.
 Acts as an authoritative source of information.
 Lines of authority shown are definite and formal.
 Lines of promotion can be understood.
 Helps in planning and improving communication both inward and outward.
 Degree of contribution to organisation and achievements can be identified.
 Obstacles to the efficient functioning of the management can be found while drawing the
organisation chart.
 Outsiders can have a quick understanding of each department in the organisation.

Limitations

 Create more rigidity of relationship prevailing among the employees of the organisation.
 Difficult to maintain and ensure that the organization charts up to date
 Don’t show informal relationship existing among the organization’s staff members.
 If the charts are not correctly prepared, they will lead to misleading inference.
 Organizational charts produce a psychological complex such as superiors, inferiors etc.
 Relationship shown in an organizational chart does not actually prevail in the organizations.
 The words and the lines used in an organisational chart give different meanings to different
people.
DELEGATION

Means conferring authority from one person to another to accomplish a work or activity.

It is assignment of authority and responsibility to another person to carry out specific activities. The
person who delegated the work remains accountable for the outcome of delegated work.

Definition:

Delegation is defined as the transfer of responsibility for the performance of a task from one person to
another.

“ The act of empowering to act for another”

Delegation refers to a manager’s ability to share his burden with others. It consists in granting
authority or right to decision making in certain defined areas and charging subordinates with
responsibility of carrying through an assigned task.

Purposes

 Assigning routine task.

 Problem solving
 Capability building.
 Assigning task for which manager does not have time.

Principles

i. Select right person to whom job is to be delegated.

ii. Delegate both interesting and uninteresting task
iii. Provide subordinates with enough time to learn
iv. Delegate gradually
v. Delegate in advance
vi. Consult before delegating
vii. Avoids gaps and overlaps.

Types of delegation

a. Formal delegation: This is found in the exercise of authority defined by a

organisations role.
b. Fimak delegation: This is downward delegation. It is effective to the extent of
acceptance and responsibility for formal authority.
c. Informal delegation: It occurs because people want to do something apart from
what they are told to do. It is something that is formally required to be done.

Rights to delegation

 Right task
 Right circumstance
 Right person
 Right direction/communication
 Right supervision/evaluation
Elements of delegation

1. Assignment of work or duties

2. Grant of authority
3. Creation of accountability

Delegation process

define the
feedback
task

monitor
decide
progress

determination
of task

Strategies for effective delegating

 Plan head
 Identify necessary skills and levels
 Select most capable person
 Communicate goal clearly
 Empower the delegate
 Set deadlines and monitor progress
 Model the role; provide guidance
 Evaluate performance
 Reward accomplishment

Common delegation errors

 Under delegating
 Over delegating
 Improperly delegating

Barriers of effective delegation

 The belief that ‘that I can do it better myself”

 Lack of confidence and trust in workers
 Low self confidence, in security
 Vague job description
 Inadequate training
 Lack of adequate recruitment and selection
  Time involved in explaining the task
 Reluctance to take the risks involved in depending on others.
 Fear of loss of power
 Subordinate resistance to delegation
 Failure to the delegator to see the subordinates perspectives
 Workload assigned are highly challenging both physically and mentally
 Belief of employees that they are incapable of completing the delegated task
 Inherent resistance to authority
 Due to over delegation

PARTICIPATORY MANAGEMENT

Definition

Participatory management is the practice of empowering employees to participate in organizational

decision making.

Characteristics of participatory management

a) Trust
b) Commitments
c) Goals and objectives
d) Autonomy: State of being independent of having responsibility, authority and accountability
for one’s work and personal time.

Process of Participatory management.

1. Training
2. Changing roles of supervisors-decentralised decision making
3. Communication

Advantages

 High trust and mutual support

 Increase accountability of managers and employees
 Reduced ambiguity in work requirements
 Enhanced role for clinical nurses
 Increased dependence of the nursing division
 Legal clarity
 Teamwork
 Improved organisation communication
 Decreased absenteeism
 Increased effectiveness and productivity
 Uplifting morale and motivation
 Increased job satisfaction
 Recognition of contributions of the members of organisation
 Less overtime and lower cost
Disadvantages

 Occasional failures will cover

 Initiation of programs takes time and money
 Policies and procedures must be changed
 Difficult to determine which responsibility are whose
 Lack of knowledge of the process of individual

Activities involved in participatory management.

i. Job enrichment: Creates job with greater responsibility and more flexibility and promote
personal development.
ii. Personalisation: Strategy that focuses on people and knowledge.
iii. Primary nursing
iv. Shared governance: Allocation of control, power or authority among mutually interested
parties.
v. Entrepreneurship : Forming small companies with the support of government agencies
vi. Gain sharing
vii. Pay equity: Extrinsic rewards from financial business, stock options and profit sharing.

HUMAN RESOURCE MANAGEMENT (HRM)

STAFFING

The most distinct and important component of any health organisation is the staff, neither its physical
facilities, building, equipment nor is the sophistication of computer services, high tech machines or
streamlined procedures. If the right kind of employees is not employed, there will be wastage of
equipment, time, effort and energy, even the software is flawed. The services provided would be of
low quality and organisation goals would have not been achieved. This can be only be prevented by
efficient and effective system of staffing.

Meaning

It is the process that ensures that an organisation has qualified staff available at various levels of
management to meet the short term and long term requirements.

Definition

Staffing is the function by which managers build an organisation through recruitment, selection and
development of individuals as capable employees.

-Mc Farland

The managerial function of staffing is defined as filling positions in the organisational structure
through identifying workforce, requirements, inventorying the people available, recruitment,
selection, placement, promotion, appraisal, compensation and training of needed people.

-Koontz et.al

Staffing pertains to recruitment, selection. development and compensation of subordinates.

 -Theo Haimann

Staffing is the whole personnel function of bringing in and training the staff and maintaining
favourable conditions of work.

-Luther Gullick

Mission:

 To ensure maximum utilisation of human resources.

 To discover and obtain competent personnel for various job
 To ensure the continuity and growth of the enterprise through adequate staffing.
 To improve job satisfaction and morale of the employees through objective assessment
 To be able to meet crisis/emergency situations.
 To deliver good quality of care and attain job satisfaction and patient satisfaction

Steps of Staffing Process

1. Man power planning: concerned with determining number and type of personnel required for
different type of organisations.
2. Job analysis: finalising the job specification and job description; thereby help in developing
recruiting policies.
3. Recruitment: identification of sources of manpower availability and making efforts to attract
applicants for various job positions.
4. Selection: process of choosing and appointing right candidate for the job. It includes receiving
and screening of applications, tests, interview and medical exam of candidate.
5. Placement: ensures the right staff is placed or assigned.
6. Induction and orientation: orienting a new employee to organisation and job
7. Training and development: various methods of training can be used. On the job and off the
job methods are employed.
8. Remuneration: kind of compensation provided monetarily to the employees for their work
performance.
9. Performance Appraisal
10. Promotion and Transfer: Promotion is said to be an non monetary incentive in which worker
is shifted from a higher job demanding bigger responsibility as well as shifting and
transferring workers to different units.

HUMAN RESOURCE MANAGEMENT (HRM)

HRM is a subsystem of the total management, primarily concerned with the management of people,
individual or group of workers as also their relationship.

HRM is a function within which an organisation that focus on recruitment of, management of and
providing direction for the people who work in organisation.

HRM is a process of bringing people and organisation together so that the goals of each are met.

HRM is planning, organising, directing and controlling of the procurement, development,

compensation, integration, maintenance and separation of human resources to the end that individual
organizational and social objectives are accomplished. -Edwin B Flippo
Features of HRM

 It is pervasive in nature as present in all organization.

 The focus is on results rather than on rules.
 Its motive is to help employees develop their potential fully.
 It encourages employees to utilise their potentials to give their best to organisation.
 It is all about people at work both as individuals and groups
 It tries to put people on assigned jobs in order to produce good results.
 It helps an organisation to meet its goals in the future by providing for competent and well-
motivated employees.
 It tries to build and maintain cordial relations between people working at various levels in the
organisation.

Objectives of HRM

 To develop teamwork among the workers and on organisation culture that helps the
organisation grow and make individuals workers dynamic.
 To make the personnel acquire power to perform the different types of work that come in
there at present or in near future.
 To develop hidden talent of individual workers that may be used for the development of
organisation
 To provide an opportunity for employees to grow and strengthen the management and
professional team in all the areas of the organisation.
 To develop employee capabilities according the needs and areas of the organisation
 To train new employees to the level required by the organisation to perform their tasks
effectively.
 To train employee to take up more responsibilities.
 To adopt problem solving techniques for the problem related to disciplinary cases and
grievance.
 To increase cooperation and trust and involve employees actively in the company affairs.
 To make the organisation dynamic and vibrant, so that it will adjust to competitive and fast
changing environment.

Functions of HRM

 Human resources or man power planning

 Recruitment
 Promotion
 Career planning
 Job and salary administration
 Training counselling, performance feedback etc.

MAN POWER PLANNING

It is the process of developing and determining objectives, policies and programmes that will develop,
utilise and distribute manpower so as to achieve the goals of the organisation.

WHO Chronicle States:- "Manpower Planning is concerned with organizing, in systematic fashion,
the goals, objectives, priorities and activities of manpower development in order to ensure that the
right number of staff with the appropriate skills are provided at the right time to meet the requirements
of the work to be done".

Need for man power planning

 To fulfil the need of organisation to accomplished its goals

 To replace the employees who retire, have physical and mental ailments etc.
 To combat turnover that is unavoidable
 To meet the needs of changing and expanding demands
 To meet the challenge arises due to socio-economical, political and of a new and changing
technology
 To identify the areas of surplus personnel or areas in which there is shortage of staff

Objectives of man power planning

 Ensure optimum use of HR

 Keeping the organisation work force to cope with the technological development and
modernisation.
 Ensure high labour productivity.
 Fulfilling future needs for managerial and technical skills.
 Directing future recruitments just to suite the appropriate needs of the organisation
 Ensuring career planning of every employee of the organisation and making succession
programme
 Streamlining uninterrupted supply of work force to the functional needs of work from time to
time.

STAFFING PROCESS

 Recruitment
 Selection
 Placement
 Training
 Development
 Appraisal and remuneration

RECRUITMENT

It is the first step in the process of filling a vacancy. Recruitment is a process of searching for
prospective employee.

MEANING

Recruitment in simple term means as the process of searching for and obtaining applicants for job
from among whom the right person can be selected.

DEFINITION

Recruitment is defined as the process of searching for prospective employee and stimulating them to
apply for job in the organisation. –B Flippo
Recruitment is the process of locating, identifying an attractive capable applicant.

-Bergman and Tylor

Recruitment involves seeking and attracting a pool of people from which qualified candidates for job
vacancies can be chosen

-Byars and Rue

PURPOSES AND IMPORTANCE:

 Determine the present and future requirements of the organization in conjunction with the
personnel planning and job analysis activities
 Increase the pool of job candidates with minimum cost.
 Help increase the success rate of the selection process reducing the number of obviously
under qualified or over qualified job applicants.
 Help reduce the probability that the job applicants, once recruited and selected will leave the
organization only after short period of time.
 Meet the organization‘s legal and social obligations regarding the composition of its work
force
 Start identifying and preparing potential job applicants who will be appropriate candidates
 Increase organizational and individual effectiveness in the short and long term.
 Evaluate the effectiveness of various recruiting techniques and sources for all types of job
applicants.

OBJECTIVES

 To attract people with multidimensional skills and experiences that suit the present and future
organisational goals.
 To induct outsiders with new perspectives to lead the company.
 To infuse fresh blood at all levels of organisation.
 To develop an organisational culture that attracts competent people to the company.
 To search or hunt people whose skills fit the company values.
 To devise methodologies for assessing psychological traits.
 To search for talent globally and not just within the company.

PRINCIPLES

i. Recruitment should be done from a central place Eg: Administrative officer/Nursing Service
Administration.
ii. Termination and creation of any post should be done by responsible officers, eg: regarding
nursing staff the Nursing superintendent along with her officers has to take the decision and
not the medical Superintendent.
iii. Only the vacant positions should be filled and neither less nor more should be employed.
iv. Job description should be made before recruitment.
v. Procedure for recruitment should be developed by an experienced person
vi. Recruitment of workers should be done from internal and external sources
vii. Recruitment should be done on the basis of definite qualifications and set standards.
viii. A recruitment policy should be followed
ix. Chances of promotion should be clearly stated
 x. Policy should be clear and changeable according to the need.

FACTORS EFFCTING RECRUITMENT

All organization, whether large or small, do engage in recruiting activity, though not to the same
extent. This differs with:

 The size of the organization

 The employment conditions in the community where the organization is located
 The effects of past recruiting efforts which show the organization‘s ability to locate and keep
good performing people
 Working conditions an salary and benefit packages offered by the organization- which may
influence turnover and necessitate future recruiting
 The rate of growth of organization
 The level of seasonality of operations and future expansion and production programs.
 Culture, economical and legal factors etc.

RECRUITMENT PROCESS

It involves a systematic procedure from sourcing the candidate to arranging and conducting the
interviews and requires many resources and time. A general recruitment process is as follows:

i. Identify vacancy or job requirement

The recruitment process begins with the HRD receiving requisitions for recruitment from any
department of the company. These contain –posts to be filled, number of persons, duties to be
performed, qualification required etc.
ii. Prepare job description and person specification
iii. Deciding the source of recruitment and selection methods
iv. Advertising the vacancy
v. Managing the response
vi. Short listing of the candidates
vii. Conducting interview and select and appoint successful candidates.

The recruitment process is immediately followed by the selection process ie, the final interviews
and the decision making, conveying the decision and the appointment follows.

TYPES OF RECRUITMENT

 Planned: arise from changes in the organisation decisions and retirement

policy.
 Anticipated: arises due to change in the environment. Organisation can
predict by studying trends in internal and external organisation.
 Unexpected: arises due to accidents, transfers, death, illness, retirement etc.

RECRUITMENT SOURCES

Internal sources

Internal sources include present employees, employee referrals, former employee and former
applicants.
  Present employees: promotion and transfers from among the present employees can be good
source of recruitment. Promotions to higher positions have several advantages. They are:
 It is good public relations
 It builds morale
 It encourages competent individuals who are ambitious
 It improves the probability of a good selection, since information of the candidate is readily
available
 It is less costly
 Those chosen internally are familiar with the organization.

However promotions can be dysfunctional to the organization as the advantage of hiring outsiders
who may be better qualified and skill is denied. Promotions also results in breeding which is not good
for the organization.

Another way to recruit from among present employees is the transfer without promotion. Transfers
are often important in providing employees with a broad based view of the organization, necessary for
the future.

 Employee referrals: this is the good source of internal recruitment. Employees can develop
good prospects for their families and friends by acquainting with the advantages of a job with
the company, furnishing cards introduction and even encouraging them to apply. This is very
effective because many qualified are reached at very low cost.
 Former employees: some retired employees may be willing to come back to work on a part
time basis or may recommend someone who would be interested in working for the
company. An advantage with these sources is that the performance of these people is already
known.
 Previous applicants: although not truly an internal source, those who have previously
applied for jobs can be contacted by mail, a quick and inexpensive way to fill an unexpected
opening.

External sources

Sources external to an organization are professional or trade associations, advertisements,

employment exchanges, college/university/institute placement services, walk-ins and writer-ins,
consultants, contractors.

 Professional or trade associations: many associations provide placement services for their
members. These services may consist of compiling seekers‘ lists and providing access to
members during regional or national conventions.
 Advertisements: these constitute a popular method of seeking recruits as many recruiters;
prefer advertisements because of their wide reach. For highly specialized recruits,
advertisements may be placed in professional/ business journals. Newspaper is the most
common medium.
 Employment exchange: Employment exchanges have been set up all over the country in
deference to the provisions of the Employment exchanges (Compulsory Notification of
Vaccination) Act, 1959. The Act applies to all industrial establishments having 25 workers or
more. The Act requires all the industrial establishments to notify the vacancies before they are
filled. The major functions of the exchanges are to increase the pool of possible applicants
 and to do preliminary screening. Thus, employment exchanges act as a link between the
employers and the prospective employees.
 Campus recruitment: colleges, universities and institutes are fertile ground for recruitment,
particularly the institutes.
 Walk-ins, write-ins and Talk-ins: write-ins those who send written enquire. These job-
seekers are asked to complete applications forms for further processing. Talk-in is becoming
popular now-in days. Job aspirants are required to meet the recruiter (on an appropriated date)
for detailed talks. No applications are required to be submitted to the recruiter.
 Consultants: ABC consultants, Ferguson Association, Human Resources Consultants Head
Hunters, Bathiboi and Co, Consultancy Bureau, Aims Management Consultants and The
Search House are some among the numerous recruiting agents.
 Contractors: Contractors are used to recruit casual workers. The names of the workers are
not entered in the company records and to this extent, difficulties experienced in maintaining
permanent workers are avoided.
 Radio Television:
 International Recruiting: Recruitment in foreign countries presents unique challenges
recruiters. In advanced industrial nations more or less similar channels of recruitment are
available for recruiters.

Advantages
Internal recruitment
Disadvantages
 Cheaper and quicker
 People already familiar
with the business
 Provides opportunities
for promotion within the
business- can be
motivating.
 Business already knows
the strengths and
weaknesses of
candidates.
 Limits the number of
potential applicants
 No new ideas can be
introduced from outside
the business.
 May cause resentment
among the candidates
not appointed.
 Creates another vacancy
which needs to be filled.

External recruitment  Outside people bring in  Longer process

new ideas.
 Larger pool of workers
from which to find the
best candidate.
 People have wider range
of experiences.
 More expensive due to
advertisements and
interviews required
 Selection process may
not be effective enough
to reveal the best
candidate.

RECENT TRENDS IN RECRUITMENT

1. Outsourcing: The outsourcing firms help the organisation by the initial screening of the
candidates according to the needs of the organisation and creating a suitable pool of talent for
the final selection by the organisation. Outsourcing firms develop their HR pool by
employing people for them and make available personnel to various companies as per their
needs. In turn the outsourcing firms charge the organisation for their service.
 2. Poaching/Raiding: ‘Buying talent’ is the latest mantra being followed by the organisation
today. Poaching means employing a competent and experienced person already working with
another reputed company in the same or different industry. A company can attract talent from
another firm by offering attractive pay packages and other terms and conditions better than
the current employer of the candidate. But it is seen as an unethical practice and not openly
talking about it.
3. E-Recruitment: It is the use of technology to assist the recruitment process. They advertise job
vacancies through World Wide Web. The job seekers send their applications or CV through e-
mail using the internet. Alternatively job seekers place their CV in World Wide Web which
can be drawn by prospective employees depending upon their requirements.

Selection

Selection is an integral part of staffing, where in one person is chosen in preference to other for the
announced job position. It leads to employment of personnel. It involves a series of steps by which
candidates are screened for choosing the most suitable person for vacant post in the organisation.

Definition:

Selection is a process of differentiating between applicants in order to identify those with a

greater likelihood of success in the job.
It is a process of choosing the fit candidates or rejecting the unfit candidates or combination
of both.
-Thomas S Stone.
It refers to negative process of eliminating of all those who appear uncompromising from all
candidates considered for possible employment.
-Yodar

Selection process:

There is no standard process that can be followed by all institutions in all area. Institutions may follow
different selection techniques or methods depending upon the size of the organisation, nature of the
duty, kind and number of person to be employed, government regulations to be followed etc.

Steps of selection procedures

i. Receipt of Application: Everyone who applies for job is an enterprise may not be qualified
for the job. Those who do not possess adequate experience and qualifications should not be
included in the list of candidates to be called for a preliminary interview. A proper scrutiny
of applications is made to select the candidate to be called for a preliminary interview.
ii. Preliminary interview: Here the employers try to find out whether the candidate is physically
and mentally fit for the job. In general candidates are asked about the qualifications,
experiences, interests, residence etc. Employers should not take much time for conducting
preliminary interview.
iii. Selection test: Those candidates who have passed preliminary interview will be asked to
appear for the selection tests. Tests serve as an important device in the process of selection.
Tests aims at discovering and measuring selected qualities, abilities and skills of candidate
in terms of job specification.
 iv. Employment interview: Interview is a face to face observational and personal appraisal
method to evaluate a candidate fitness for the job. Every person who is selected by a
company for interview is interviewed by one or more persons.
v. Medical examination: It reveals whether or not a candidate possesses the required stamina,
strength and tolerance of hard working conditions.
vi. Reference checks: Reference are sought after selection is finalised. These may be either in a
written form or checked over the telephone.
vii. Employment: After the final decision, the institution has to intimate this decision to the
successful as well as unsuccessful candidates. The organisation sends the appointment orders
to the successful candidates either immediately or after some time, depending upon the
schedule.
viii. Appointment: the selected candidate is given an appointment letter with all the details such
as terms and condition of the appointment and the period of probation, job description, salary
scale, hospital policy etc. The candidate should inform the management about the job
acceptance and the date of joining.
ix. Placement: A proper placement of the worker reduces employee turn over, absenteeism and
improve morale. After selection, the employee is generally from one or two years and after
this employment may be regularised provided that during this period, his work has been
found to be satisfactory.
x. Induction: Final step in the selection process is the induction of new employees into the
setting of his/her work. The main objective of induction is familiarising the new employee
with the new surroundings and company rules and regulations. And also integrating the
personal goals with the organisational goals.

Placement

It is defined as the appointment of right employees at the right place that arouse the will to work in the
mind of the operators.

Effective placement can be made in the following ways:

 Job rotation
 Teamwork
 Training and development
 Job enrichment
  Empowerment

Orientation of New Staff

Components of orientation programme

 Aims and principles

 Organizational policies
 Clinical policies
 Administrative policies
 Relationship between various departments and personnel
 Standards of nursing practice
 Physical facilities
 Records
 Educational opportunities
 Legal and ethical responsibilities
 Infection control practices
 Emergency response procedures
 Evaluation procedures

Training

It is the act of increasing the knowledge and skills of an employee for doing a particular job.

It is an activity which involves the development of hidden talent of an individual and using it for the
benefit of the organisation. It is directed towards maintaining and improving current job and
developing skills in employees for future job. After the candidates are selected for various jobs, there
is a need for management to provide for their training and development which is essential for the
efficiency of an organisation.

Reasons for training

 Increased use of technology in production

 To minimise labour turnover arising from normal separation
 To increase the productivity of employees
 To enable employees to keep abreast of the changing methods, techniques and use of
sophisticated tools and equipment.
 To manage time effectively
 To raise the morale of employees

Objectives

 To provide basic knowledge and skill to new employees to perform the tasks designed by the
organisation
 To develop the capabilities of existing employees by exposing them to latest concepts,
information techniques and thereby strengthen their skills.
 To develop 2nd and 3rd line executives to strengthen the working links and levels so that they
can occupy higher positions.
 To improve the outlook of senior managers and other policy makers enabling them to look to
future prospects for the organisation.
  To make employees more effective and productive thereby increasing their earning power and
ensuring job security.
 To mould employee attitude with the purpose of achieving their better cooperation with the
company and develop loyalty to the organisation

Characteristics

i. Allowance for individual difference: There are difference in ability, learning capacity and
interest of trainees and the management should consider this factor while designing
programmes.
ii. Relevance of job requirements: Training programmes must relate to the requirements of the
job for which they are intended.
iii. Determination of training needs: Management should determine the training needs of the
employees and should select a method of training that is most effective.
iv. Training programme should be result oriented: Management should avoid training for the
sake of training and show greater interest in the benefits of the training programme

Steps of training

 Identifying training needs

 Getting ready for the job
 Preparation of the learner
 Presentation of operations and knowledge
 Performance tryout
 Follow-up

Advantages of training

 Reduces wastage and spoilage.

 Improves efficiency and brings confidence in employees.
 Improves quality of work
 Helps the employee to discharge their social obligation along with departmental duties.
 Training enables the employees to adjust according to changed situations.
 Reduces the supervisory burden

Staff deployment

Meaning

“The use of some thing or someone in an effective way”. Deployment means arrange manage or give
positions to their employees.

It is a systematic and organised way of introducing the staff members into an activity process or into a
particular working area in an organisation.

Advantages of Staff deployment

 Area of deployment should be selected based on the competency of the staff.

 No duplication of work is possible
 There will be no interruption in work mode by the staff in any case.
 Staff has a sense of belongingness and a right mind to work with team spirit.
  Unnecessary expenditure is avoided.

Retaining staff

Employee retention involves measures to encourage employees to remain in the organisation for the
maximum period of time. Organisations are facing a lot of problems in retaining employees these
days. They may leave for personal and professional reasons. Organisation are becoming aware of
these concerns and adopting many strategies for employee retention. The various strategies include:

 Salary increment
 Appreciation for their outstanding work
 Contests and incentives
 Motivating conversation and good communication
 Promoting from within
 Fostering employee and management relationship
 Participative leadership
 Employee ownership
 Compelling corporate purposes and mission statement

Advantages

 Saves man, money, material and time.

 Save the advertisement, recruitment, orientation and training expenses.
 Increase productivity of an organisation
 Motivates the staff to work efficiently in the organisation.
 Maintains smooth functioning in the working environment.

Staff Promotion

Promotion is the upward movement of the employee in the hierarchy level of the organization,
associated with higher accountabilities, status and pay.

Definition

 Promotion is the advancement of an employee to a better job , better in terms of greater

responsibility more prestige or status, greater skill and especially increased rate of pay and
salary.
 According to Scott & Clothier, A promotion is the transfer of an employee to a job that pays
more money or one that carries some preferred status.

Purposes

i. Improve the workers and the institutions efficiency and effectiveness

ii. Builds morale and belongingness on the part of the employee
iii. Promotes job satisfaction on the part of the employee
iv. Increases interest in training and self-development as a necessary preparation for promotion.

Types of promotion

 Horizontal promotion: In this case position of the employee and pay may be increased but
there is no change in the nature of jobs.
  Vertical promotion: In this case there is a change in the status, responsibilities, job
classification and pay.
 Dry promotion: In this case responsibilities and status group increase but not financial
benefits.

Basis of Promotion

 Seniority
 Merit
 Seniority cum merit system

Seniority as the basis of promotion

Provides an objective criterion

Prevents arbitrary selection or favouritism
Develop a sense of loyalty to the organisation
Reduce employee turnover and minimise dispute on promotion
It tends to demoralise competent persons and leads to higher turnover and mobility
Organisation may not be able to attract capable and talented personnel
Strongest argument against such a policy is that experience which goes with longer service
does not make anyone more competent.

Merit as the basis of promotion

Provides due incentives to employees for continuous improvement in work performance

Adds positively to overall organisation effectiveness and success.
Limitation is that it is difficult to assess merit objectively and leaves a wide scope for
arbitrariness and favouritism.

Seniority cum merit system

Most widely used basis for promotion combines both seniority and merit which provides for
ability or merit being the deciding factor in promotional selection, when two employees are of
equal seniority.
Similarly when two employees who are almost equally competent, one who is senior in
service should be preferred for promotion.

Demotion

Demotion is the shift to a position in which responsibilities are decreased. It is the lowering of rank,
reduction in salary, reducing of status and responsibilities. It may be defined as “the assignment of an
individual to job of lower rank and pay usually involving lower level of responsibility”.

Causes

 Inadequacy on the part of the employees.

 Organisational staff reductions
 Disciplinary tool to regulate and control the staff behaviour.
 Employee is unable to adjust to the new technology, employee encounters ill health or for
some personal reasons an employee cannot do his job.
Superannuation

It is a retirement fund or pension given to the employees at the time of retirement. It is also a basic
right of the employees to be paid for by the employer for their sincere hard work or service rendered
to the institution.

Benefits

 Helps the employee to plan for their future life.

 Motivates the current working employees to work efficiently.
 It reflects the institutional or organisational image
 It helps to increase the productivity and quality directly and indirectly.

Separation

It occurs when an employee leaves the organisation

Types

 Voluntary-Quits, resignation
 Involuntary- Discharge,resignation

JOB ANALYSIS

It is a process to identify and determine in detail the particular job duties and requirements and the
relative importance of these duties for a given job. It is a formal and detailed examination of job. It is
a process where judgements are made about data collected on a job.

Purposes

 Manpower planning
 Recruitment
 Selection
 Placement and induction
 Determining training needs
 Compensation
 Counselling
 Employee safety
 Performance review
 Job evaluation
 Job design and redesign

JOB DESCRIPTION

A job description is a clear, concisely and clearly communicating written statement of duties and
responsibilities and organisational relationships that constitute a given job or position.

JOB SPECIFICATION

It is a written statement of qualifications, traits, physical and mental characteristics that an individual
must possess as a minimum requirements to perform the job duties and discharge responsibilities
effectively and satisfactorily.
DIRECTING

Direction represents one of the essential function of management because it deals with human
relations. Direction is the managerial function of guiding, motivating, leading, supervising the
subordinates to accomplish the desires objectives. In order to maintain healthy working environment
proper direction plays an important role.

Definition

Direction consists of the process and techniques utilised in issuing instructions and making
certain that operations are carried out as originally planned. It is the process around which all
performance revolves. It is the essence of operations and coordination is necessary by product
of good managerial direction

Theo Haimann

Directing is a complex function that include all those activities which are designed to
encourage subordinates to work effectively and efficiently in both the short and long run.

Koontz and O’Donnel.

Directing is what has to be done and in what manner through dictating the procedures and
policies for accomplishing performance standards.
Earnest Dale

Importance of direction

 Direction initiates action

 Direction integrates employee effort
 Direction attempts to get maximum out of the individual.
 Direction facilitates change in the organization
 Direction provides stability and balance in the organisation.
Principles of Direction

i. Harmony of objectives: means the employee should go side by side with the organisational
goals. There should be harmony between these goals, their objectives, then only the
organisation will progress.
ii. Unity of command: Employee should receive orders and instructions only from one superior.
iii. Appropriate technique: Use of correct techniques to ensure efficiency of direction. These
techniques used should be suitable to the superior, the subordinate and the situation.
iv. Direct supervision: Effective supervisor makes direct personal contact with her subordinates
for giving any direction. Such direct contact improves morale and commitment of the
employees. Therefore wherever possible direct supervision should be used.
v. Effective leadership: Supervisors should be effective leaders instead of doing the same things
as subordinates are doing to secure maximum output from them.
vi. Understanding and Comprehension: Direction conveyed by the supervisor should be clear and
comprehensive for the subordinates to understand.
vii. Effective communication: Success of the direction depends on the effective communication
between the superior and subordinates.
viii. Use of informal communication: Organisation should have informal groups because the
information passes very quickly and management can take appropriate steps in time.
ix. Utilisation of maximum individual efforts: Supervisors should use the effective directional
techniques to maximise the individual efforts to accomplish organisational goals.
x. Clear orders: The instructions or the orders given by the superiors should be very clear,
logical, concise and acceptable by the subordinates.
xi. Follow up: Directing is a continuous process. It should have the means of evaluating the
performance of employee and provide the feedback to them. After providing the directions,
subordinates should follow them.

Elements of directing

There are five elements of effective directing- Supervision, Leadership, Communication,

Motivation and Order giving.

LEADERSHIP

Leadership is the process of influencing the thoughts and actions of other people to attain the desired
objectives. The leaders job is to get work done by other people and make people willingly want to
accomplish something.

DEFINITIONS

 Leadership is the ability to influence other people.

- Landsdale
 Leadership is the ability of a manager to induce subordinate to work with zeal confidence.
-Koontz &O’Donnel
 Leadership is the art of motivating a group of people to act towards achieving a common goal.
 Leadership is shifting of own vision to higher sights, raising of man’s performance to higher
standards, building of man’s personality beyond its normal limitations
- Peter Drucker
 Leadership is interpersonal influence exercise in a situation and directed through common
process, towards the attainment of a specific goal or goals.
CHARACTERISTICS OF LEADERSHIP

 Leadership is a continuous process of behaviour and it is not oneshot activity

 Leader tries to influence the behaviour of individuals around him/her to achieve common
goals.
 Leadership gives an experience to help to followers to attain common goals.
 Leadership is exercised in a particular situation at a given point of time and under a specific
set of circumstances.
 Leadership may be seen in terms of relationship between a leader and his followers, which
arises out of their working for common goals.

IMPORTANCE OF LEADERSHIP

 Motivating employees: a good leader motivates the employees for high performance by
exercising his leadership.
 Creating confidence: a good leader creates confidence among his followers by directing them,
giving suggestions and getting good results.
 Building morale: high morale leads to high productivity and organisational stability.

QUALITIES OF GOOD LEADER

Managerial abilities

 Plans organises makes decisions effectively, encourages cooperation and participation.

 Assists the subordinates in solving the problems and provides constant feedback.
 Guide subordinates to develop new skills
 Provides the subordinates with adequate facilities

Interpersonal skills

 Supportive and caring behaviour towards subordinates.

 Good listener and sensitive to others needs
 Guides and motivates workers.
 Establish harmonious relationship

Temperament(nature of person)

 Reliable, open, honest and sincere

 Sense of humour, tactful, friendly and loyal
 Positive, energetic, hardworker, happy and enthusiastic

Credibility and forward thinking

 Acts as a role model and influence others

 Acts as an activist
 Challenger and creative thinker
 Change and agent innovator
 Risk taker and courageous
 Acts as a facilitator and solution seeker
Professionalism

 Committed to the profession

 Maintains confidentiality
 Instils hope and pride in the profession
 Stands for rights while considering others rights.

Advocacy

 Acts as an advocate for the rights and standards of workers.

TYPES OF LEADERSHIP/STYLES OF LEADERSHIP

1. Autocratic/authoritarian leadership
2. Democratic/participative leadership
3. Laissez Faire /free rein/delegative leadership

Autocratic/authoritarian leadership:

 Here leader alone establishes policies and makes plans.

 Leader assumes complete control over the decisions and activities of the group

Characteristics

 Firm personality, insistent, self-assured, highly directive, dominating.

 Has high concern for the work than for the people who performs task
 Shows no regards to the interests of the employees
 Set rigid standards and method of performance and expects the sudordinates to obey the rules
and follow the same
 Makes all decision by himself or herself
 Minimal group participation or none from the workers

Merits and Demerits

Merits
Efficient in time of crisis, easy to make decision
by one group and less time consuming
It is useful when there is only leader who is
experienced having new and essential
information, while subordinates are in
experienced and new
It is useful when the workers are unsure of taking
decision and expect the leader to tell what to do
Demerits
Does not encourage the individuals growth and
does not recognize the potentials, imitativeness
and creates less cooperation among members
Leader lacks supportive power that results in
decision made with consultation although he may
be correct
Less job satisfaction leads to less commitment to
goals of the organization

Democratic/Participative leadership:

Here the whole team is involved and accepts responsibility for achieving the desired goal.
Subordinates have considerable freedom of action.
Characteristics

 Sense of equality among leader and followers

 Open system of communication prevails
 Interaction between the leader and group is friendly and trusting
 Leader works through people not by domination but by suggestions and persuasions

Merits and Demerits

Merits
Encourages all employee in decision making
Promotes personnel involvement, greater
commitment to work and enhance job satisfaction
Increase the employee productivity
Reduces the number of greivances of people
Demerits
It takes more time for taking decision by the
group than the leader alone
This style can be used as a way of avoiding
responsibility

Laissez Fairre/Free rein/Delegative leadership:

Here leader has absolutely no control. He only gives information, materials and facilities to his/her
employees to enable them to accomplish desired goals.

Features

 Group members are free to set their own goals and determine their own activities.
 This style is effective in highly motivated professional groups.
 Not useful in a highly structured organisation
 When there is no appointed leader, the group collectively assumes leadership.

Merits and Demerits

Merits
In limited situations creativity
encouraged for specific purposes
To try new method of action
Demerits
may be May lead to instability, disorganization,
inefficiency, no unity of action
Lack of feeling responsible to solve the problem
that may arise. Individual will lose interest,
initiative and desire for achievement

FUNCTIONS OF A LEADER

14 functions performed by leaders in general. By Krech and Crutchfield

 Executive: Leader is responsible for seeing that the appropriate activities of the organisation
are carried out.
 Goal setter: A leader either establishes organisational goals and objectives himself or he may
participate with his superiors or subordinates in establishing them.
 Planner: Leader makes decision concerning the ways and means with which the organising
goals can be achieved.
 Mediator or Arbitrator: The leader tries to maintain harmony among the members of the
organisation.
  Expert: The technical information and skills the supervisor possess are useful in aiding and
instructing their subordinates in an effective work procedure.
 Symbol of group: Leader provides a kind of continuity and stability to the group standing for
it despite changes in circumstances and membership.
 Exemplar: A leader serves as an exemplar, a model for others to emulate.
 Controller of internal relationship in the organization
 External group representative: Leader acts as a representative of an organisation to deal with
outside and groups.
 Surrogate for individual responsibility: Leader relieves other members of the group of certain
responsibilities and they in turn place their trust in his decisions.
 Ideologist: By presenting his ideas concerning the group, he is a source of moral strength to
them.
 Father figure: Fulfils an emotional role for the members of the group. By identifying
themselves with their leaders, the members of a group drew strength and a feeling of security.
 Scapegoat: Leader provides a ready target for the dissatisfaction of the group. Failure can be
attributed to him.
 Administrator of rewards and punishment: Encourages upgrade and promote workers who
deserve and remove, transfer or dismiss workers who violate rules or regulations of the
organisation.

THEORIES OF LEADERSHIP

1. Trait theory/Great man Theory

This theory suggests that leaders have some inborn traits. They have certain set of
characteristics that are crucial for inspiring others towards a common goal. A successful
leader is supposed to have the following traits- good personality, tirelessness, capacity to read
other‘s mind, ability to make quick decision, courage, persuasion, intelligence, reliability,
imagination
2. Behaviour theory
Behavioural theories of leadership are based upon the belief that great leaders are made, not
born .This leadership theory focuses on the actions of leaders not on mental qualities or
internal states. According to this theory, people can learn to become leaders through teaching
and observation.
Assumptions of Behavioural Theories
 Leaders can be made, rather than born.
 Successful leadership is based in definable, learnable behaviour.
3. Situational theory
This theory believes that leadership effectiveness depended on the relationship among the
leaders task at hand, their interpersonal skills and the favorableness the work situation. This
theory considers the challenge of situation and encourages an adaptive leadership style to
complement the issue being faced.
4. Contingency Theories
According to contingency theory, leader’s success depends upon a number of variables,
including the leadership style, qualities of the followers and aspects of the situation. Different
styles of leadership may be more appropriate for certain types of decision-making. For
example, an authoritarian style might be most appropriate in a situation where the leader is
the most knowledgeable and experienced member of a group. In other instances where group
members are skilled experts, a democratic style would be more effective.
APPLICATION OF LEADERSHIP IN NURSING
1. Patient care coordination : Even new graduate nurses have leadership responsibilities
when they begin in nursing. Nursing leadership begins with nursing care of the individual
patient. The students are guide to organize nursing care.
o Establish good and priorities for each day.
o Establish time
o Establish success and failure
2. Employee responsibilities : Nurses have specific tasks or duties to perform. These tasks
are determined by the plan and objective of the health care agency. It is important to read
your job description carefully and to continue to evaluate how institutional factor s
influences your own practice of nursing. Factors that compromise quality care should be
noted and addressed in construction with experience nurses.
3. Guidelines for delegating nursing care : New graduate nurses use leadership techniques
when they direct the work of nonprofessional staff and volunteers and consider
delegating tasks to nonprofessional staff.
4. Mentorship: It is a relationship in which an experienced individual advise and assist a
less experienced individual. This is an effective way of easing a new nurse into leadership
responsibilities
5. Preceptor ship: An alternative model is preceptor ship. The preceptor is selected to
introduce an employee to new responsibilities through teaching and guidance. The
relationship is limited by the new employee s needs.
6. Continuing education : leadership , managerial and administrative skills are needed

Difference between management and leadership

 Assertiveness

Assertiveness means being firm to stand up for your own rights and that of others in a calm, direct and
positive way without being overly aggressive.

Benefits of Assertiveness

 Increased self-confidence

 Stress reduction

 Prevents or reduces strife

MOTIVATION

 Derived from a Latin word ‘movere’ which means to move or to energize or to activate.
 Motivation is the core of management
 Success of any organisation depends on the ability of managers to provide a motivating
environment for its employees.
Definitions

 Motivation is the process of stimulating people to action to accomplish desired goals. It

refers to the way which urges, drives, desires, aspires, stirs or needs direct control or
explain the behaviour of human beings. W.G Scott.
 Motivation refers to the way in which urges, drives, desires, aspirations, striving or needs
direct, control or explain the behavior of human beings. -Dalton E. McFurland,
 Motivation is the act of stimulating someone or oneself to get a desired course of action to
push the right button to get a desired action. Michael. J.Jucious.
 Motivation is an inspirational process that impels the members of a team to pull their
weight effectively to give their loyalty to the group, to carry out properly the tasks that
they have accepted and generally to play an effective part in the job, that the group has
undertaken. E.F.L Brech

Concept of Motivation

 Psychological concept: as it is concerned with the intrinsic forces operating within a

person that forces him/her to act or not to act in a specificway.
 Dynamic and continuous process: as it deals with human beings, an everchanging entity
modifying itself every moment.
 Complex and difficult function: People adopt different approaches to satisfy their needs
and one specific need may cause different behavioural response on the part of different
people.
 Circular process: An unsatisfied need causes tension in people and they take action to
overcome this tension
  Stimulating individual: It is the process of encouraging an individual or a group of people
to take desired action.
 Product of anticipated value: It is the product of anticipated value from given course of
action and the perceived probability that the action will lead to these values.

Types of Motivation

i. Extrinsic motivation: motivation that is received from external environment. Comes from
outside of the performer.
ii. Intrinsic motivation: Actual self motivation. Originates from within the heart of the person.
It is the inner gratification and feeling of fulfilment rather than just achieving a goal.
iii. Achievement motivation: It is the drive to pursue and attain goals. An individual with
achievement motivation wishes to achieve objectives and advance up the ladder of success.
iv. Affiliation motivation It is a drive to relate to people on a social basis. Individuals with
affiliation motivation perform work better when they are complimented for their favourable
attitude and co-operation.
v. Competence motivation: It is the drive to be good at something, allowing the individual to
perform high quality work. Competence/skill motivated individuals seek job mastery, take
pride in developing and in using their problem solving skills and strive to be creative when
confronted with obstacles. They learn from their experiences.
vi. Power motivation: It is the drive to influence people and change situations. Power motivated
people wish to create an impact on their organisation and are willing to take risks.
vii. Attitude motivation: Attitude motivation is how people think and feel. It is their self-
confidence, their belief in themselves and their attitude to life. It is how they feel about the
future and how they react to the past.
viii. Fear motivation: Motivation by known or unknown fear and act contrary to her original
tension.
ix. Incentive motivation: Motivation that arises due to incentives, rewards to do the particular
work.

Theories of Motivation

1. Abraham Maslow’s Need Heirarchy theory: Maslow‘s theory included 5 basic needs in his
theory, namely the- The physiological needs, Safety and security needs, Love needs, self-
esteem needs and self-actualization needs. Maslow suggested that human needs are ordered in
a hierarchy from simplex to complex. Higher level needs do not emerge as motivators until
lower needs are satisfied and a satisfied need no longer motivates behaviour.
2. Fredrick Herzberg Two Factor theory: Herzberg felt that job satisfaction and
dissatisfaction exists on dual scales. Workers are motivated by two types of needs/factors-
 Needs relating to the work itself called intrinsic/motivation factors (satisfiers):
challenging aspects of the work, achievement, added responsibility, opportunities for
growth and opportunities for advancement
 Needs relating to working conditions called extrinsic/hygiene factors (dissatisfiers):
salary, status, working conditions, quality of supervision, job security and agency
policies.
According to Herzberg, the hygiene factors must be maintained in quantity and
quality to prevent dissatisfaction. They become dissatisfiers when not equitably
administered, causing low performance and negative attitudes.
 3. Clayton Alderfer’s ERG Theory: ERG theory is similar to Maslow‘s hierarchy of needs.
The existence (E) needs are equivalent to physiological and safety needs; relatedness (R)
needs to belongingness, social and love needs. The growth (G) needs to self-esteem and self
actualization- personal achievement and self-actualization.
4. McClelland’s Theory of needs: David McClelland has developed a theory on three types of
motivating needs:
 Need for Power
 Need for Affiliation
 Need for Achievement
McClelland observed that with the advancement in hierarchy the need for power and
achievement increased rather than Affiliation. He also observed that people who were at the
top, later ceased to be motivated by this drives.
5. ‘Theory X and Theory Y’ of Douglas McGregor: Douglas McGregor proposed two
different motivational theories- theory X and theory Y. He states that people inside the
organization can be managed in two ways. The first is basically negative, which falls under
the category X and the other is positive, which falls under the category Y.

Assumptions of theory X:

 Employees inherently do not like work and whenever possible, will attempt to avoid
it.
 Because employees dislike work, they have to be forced, coerced or threatened with
punishment to achieve goals.
 Employees avoid responsibilities and do not work until formal directions are issued.
 Most workers place a greater importance on security over all other factors and display
little ambition.

Assumptions of theory Y:

 Physical and mental effort at work is as natural as rest or play.

 People do exercise self-control and self-direction and if they are committed to those goals.
 Average human beings are willing to take responsibility and exercise imagination, ingenuity
and creativity in solving the problems of the organization.
 That the way the things are organized, the average human beings brainpower is only partly
used.

Role of Manager

 Should understand the dynamics of employee motivation theories.

 Consider employees as individuals and be available for them
 Initiate communication and be a good listener.
 Involve them and set challenging but realistic goals for the welfare of employees
 Create clear work objectives for workers
 Include all workers in planning process
 Initiate team work and cooperation
 Be fair and consistent
 Provide opportunities for professional development.
 Provide workers with resources, freedom and authority to meet expectations.
  Provide opportunities for social interaction with employees
 Give workers lots of feedback about the way they are performing.

MORALE

Morale is a way of describing how people feel about their jobs, employers and companies, and those
feelings are tied to the behaviours and attitudes that employees exhibit in the workplace. When
employees have good morale, they feel committed to their employers, loyal to their jobs and
motivated to be productive.

Importance of morale

 Better productivity
 More focused on customers or outcomes
 Less employee turnover
 Increased communication between co-workers and management
 Better work attendance and timeliness
 Enhanced care about work product
 Fewer workplace-related injuries or accidents
 Increased attention to detail

COMMUNICATION

Meaning of Communication:

Communication is a process of change. In order to achieve the desired result, the

communication necessarily is effective and purposive.

Definition of Communication:

Communication is a process in which a message is transferred from one person to other

person through a suitable media and the intended message is received and understood by the receiver.

It is defined as an exchange ideas, facts, feelings, opinions or emotions between two or more persons.

Newman and Summer

Importance of Communication:

Promotes motivation:

Communication promotes motivation by informing and clarifying the employees about the task
to be done, the manner they are performing the task, and how to improve their performance if it is not
up to the mark.

Source of information:

Communication is a source of information to the organizational members for decision making

process as it helps identifying and assessing alternative course of actions.

Altering individual‟s attitudes:

 Communication also plays a crucial role in altering individual‘s attitudes, i.e., a well informed
individual will have better attitude than a less-informed individual. Organizational magazines,
journals, meetings and various other forms of oral and written communication help in moulding
employee‘s attitudes.

Helps in socializing:

Communication also helps in socializing. In today‘s life the only presence of another individual
fosters communication. It is also said that one cannot survive without communication.

Controlling process:

Communication also assists in controlling process. It helps controlling organizational member‘s

behavior in various ways. There are various levels of hierarchy and certain principles and guidelines
that employees must follow in an organization

Techniques To Improve The Communication:

 Listening
 Broad openings
 Restating
 Clarification
 Reflection
 Focusing
 Sharing perceptions
 Silence
 Humor
 Informing
 Suggesting

Listening:
An active process of receiving information. The complete attention of the nurse is required and
there should be no preoccupation with oneself. Listening is a sign of respect for the person who is
talking and a powerful reinforce of relationships. It allows the patients to talk more, without which the
relationship cannot progress.

Broad openings:

These encourage the patient to select topics for discussion, and indicate that nurse is there,
listening to him and following him. For e.g. questions such as what shall we discuss today? ―can you
tell me more about that‖? ―And then what happened?‖ from the part of the nurse encourages the
patient to talk.

Restating:

The nurse repeats to the patient the main thought he has expressed. it indicates that the nurses is
listening. It also brings attention to something important.

Clarification:
 The person‘s verbalization, especially when he is disturbed or feeling deeply, is not always
clear. The patients remarks may be confused, incomplete or disordered due to their illness. So, the
nurses need to clarify the feelings and ideas expressed by the patients.

Reflection:

This means directing back to the patient his ideas, feeling questions and content. Reflection of
content is also called validation. Reflection of feeling consists of responses to the patient‘s feeling
about the content.

Focusing:

It means expanding the discussion on a topic of importance. It helps the patient to become
more specific, move from vagueness to clarity and focus on reality.

Sharing perceptions:

These are the techniques of asking the patient to verify the nurse understands of what he is
thinking or feeling. For e.g. the nurse could ask the patient, as ―you are smiling, but I sense that you
are really very angry with me‖.

Theme identification:

This involves identifying the underlying issues or problem experienced by the patient that
emerges repeatedly during the course of the nurse-patient interaction. Once we identify the basis
themes, it becomes easy to decide which of the patient‘s feeling and thoughts to respond to and
pursue.

Silence:

This is lack of verbal communication for a therapeutic reason. Then the nurse‘s silence
prompts patient to talk. For e.g. just sitting with a patient without talking, non verbally communicates
our interest in the patient better.

Humor:

This is the discharge of energy through the comic enjoyment of the imperfect. It is a socially
acceptable form of sublimation. It is a part of nurse client relationship. It is constructive coping
behavior, and by learning to express humor, a patient learns to express how others feel.

Informing:

This is the skill of giving information. The nurse shares simple facts with the patient.

Suggesting:

This is the presentation of alternative ideas related to problem solving. It is the most useful
communication technique when the patient has analyzed his problem area, and is ready to explore
alternative coping mechanisms. At that time suggesting technique increase the patient‘s choices.

Types of Communication:
One-way v/s two way communication:

One-way communication:

The flow of communication is one way from the communicator to the audience. Example receive
method.

Drawbacks are:

 Knowledge is imposed.
 Learning is authoritative.
 Little audience participation.
 No feedback.
 Does not influence human behavior.

Two way communication:

In this both the communicators and the audience take place. The process of communication is
active and democratic. It is more likely to influence behavior than one way communication.

Formal v/s informal communication:

Communication has been classified into formal (follows lines of authority) and informal (group
line) communication.

Formal communication:

It is officially organized channels of communication and it is delayed communication. It is

generally used for all practices purposes. This authoritative, specific, accurate and reaches everybody.
The medium of formal communication may be department meeting, conferences, telephone calls,
interviews, circular etc.

Informal network:

Gossip circles such as friends internet group, like minded people and casual groups.
Communication is very faster here. The informal channels may be more active. It follows grapewine
route. It may be a fact but more in native of rumor. It does not reach every one informal
communications are quite fast and spontaneous.

Verbal v/s nonverbal communication:

 The traditional way of communication has been by word of mouth language is the chief
vehicle of communication. Through it, one can interact with other can be passes through. Direct
verbal communication by word of mouth may be loaded with hidden meanings. The important aspects
if verbal communications are as follows.

Vocabulary:

Communication is unsuccessful if senders and receivers cannot translate each others word and
phrases when a nurses cases for a client who speaks another language an interpret may be necessary.

Denotative and connotative meaning:

A single word has several meaning. Individuals who use a common language share the
denotative meaning, baseball has the same meaning for everyone who speaks English, but code
denotes cardiac arrest primarily to health care providers.

The connotative meaning is the shade or interpretation of a word‘s meaning influences by the
thoughts, feelings or ideas people have about the word.

Pacing:

Conversation is more successful at an appropriate speed or pace nurse should speak slowly
enough to enunciate clearly. Pacing is improved by thinking before.

Adoptability:

Spoken messages need to be altered a according with behavioural due from the receiver.

Intonation:

Tone of voice dramatically affects a meaning. The nurse must be aware of voice line to avoid
sending unintended messages.

Clarity and brevity:

Effective communication is simple, brief and direct. Clarity is achieved by speaking slowly,
enunciating clearly and using, repeating important parts of a message also clarifies communication.

Brevity is achieved by using short sentences and words that expresses an idea simply and
directly.

Credibility:

Credibility means worthiness of belief, trustworthiness and reliability.

Time and relevance:

Timing is critical in communication. Even though message is clear, poor timing can prevent
it from being effective. Often the best time for interaction is when a client express an interest in
communication. If message are relevant of important to the situation at hand, they are more effective.

Oral communication:
 Oral communication is a transmitting message orally either by meeting the person through
artificial media of communication such as telephone and intercom systems.

Written communication:

It is transmitting message in writing. Written communication can be followed when a record of

communication is necessary.

Non verbal communication:

Communication can occur even without word. Non-verbal communication is message

transmission through body language without using words. It includes bodily movements, positive,
facial expression. Silence is non verbal communication. It can speak louder than words.

Personal appearance:

Nurse learn to develop a general impression of clients health and emotion status through
appearance and clients develop a general expression of the nurse‘s professionalism and caring in the
same way personal appearance includes physical characteristics, facial expression, manner of dress
and grooming first impressions are largely based on appearance.

Poster and gait:

Poster and gait are forms of self expressions. The way people sit, stand and more reflect
attitudes, emotion and self concept and health status.

Facial expression:

The face is the most expressive part of the body. Facial expression convey emotion such as
surprise, fear, anger, happiness and sadness. People can be unaware of the messages their expression
convey doing procedure and the client may interpret. This is anger or disapproval.

Eye contact:

Maintaining eye contact during conversation shows respect and willingness to listen, lack of
eye contact may indicate anxiety, discomfort or lack of confidence in communicating.

Hand movements and gestures:

Hands also communicate by touch, slapping or caring another‘s head communicates obvious
feelings.

Channels of communication

i. Based on the number of people to which the message has to be conveyed

 Intrapersonal communication: Person communicates himself.
 Interpersonal communication: Interaction between 2 or more persons. It involves
listening, speaking, watching, observing and responding between 2 people.
 Group communication: Message is conveyed to a large number of people called
audience. Group can be small or large.
 Mass communication: Kind of communication delivered with the help of mass media.
ii. Based on the medium used to transmit the message
  Verbal communication
 Non -verbal communication
iii. Based on the flow of communication
 One- way communication
 Two-way/cyclic/socratic communication
 Vertical/formal communication
 Horizontal/informal communication

ADVANTAGES OF COMMUNICATION:

Oral communication:

 It is face to face system and hence can be clarified.

 There is an opportunity to ask questions, exchange ideas and clarify meaning.
 It can develop a friendly and co-operative spirit.
 It is easy and quick.
 It is flexible and hence effective.

Written communication:

 It has permanent record for future reference.

 It is less likely to be misunderstood.
 It will have adequate coverage and accuracy.
 Suitable for communicating lengthy messages.
 It is an authoritative communication.

DISADVANTAGES OF COMMUNICATION:

Oral communication:

 The spoken words may be misunderstood.

 The facial expression and tone of voice of the communicator may misled the receiver.
 Not suitable for lengthy communication.
 It requires the art of effective specificity
 It has no record for future reference.

Written communication:

 It requires skill and education for understanding.

 It is also one way communication and hence may not be effective.
 There is no opportunity for the subordinates to ask questions and exchange ideas.
 It may not communicate all aspects.

INTERPERSONAL RELATIONSHIP (IPR)

Means interaction or relations between two or more individuals.

Purposes:

IPR for an individual

  Personal growth and development
 Sense of security
 Interpersonal needs

IPR for Nurses

 Improved decision making

 Improved problem solving
 Building mutual understanding and cooperation

IPR for Patients

 Developing a sense of security and comfort

 Facilitating communication
 Improve socialisation

Phases

1. Orientation phase- problem defining phase

 Initial encounter between nurse and a patient having problems.
 Nurse clarifies his/her responsibilities.
 Identify the patient problems, define the problems and settles on type of
service needed.
2. Identification phase:
 Nurse approaches the patient with empathetic understanding to understand
accurately the problem.
 Nurse helps the patient to identify his problems in their own context and uses
the available resources to solve them.
3. Exploitation phase:
 Patient understands his problems and explores all possible alternative solution
to his problems.
 Nurse helps the patient to learn how to explore and use the available resources
to solve the problem.
4. Resolution phase:
 Termination of professional relationship that begins with the convalescence
and rehabilitation stage of the hospitalisation and ends with discharge of
patient.

Barriers of IPR

 Personal barriers-gender, lack of honesty, trust, fear of rejection

 Situational barriers.
 Sociocultural barriers-cultural diversity, ethnic diversity, social diversity and language
diversity.
SUPERVISION

 Very important element and essential component of staffing.

 Involves the management, planning and leadership of employees.
 Operates in all functions of administration

Meaning:

 Derived from two Latin words- ‘Super’ means above and ‘video’ means see
 Means overseeing or superintending the work of others.

Definition

 Supervision is an act of a superior person to see the work of the personnel working
under him or her.
 Supervision is observing the subordinates at work to ensure that they are working
according to places and policies of the organisation and to help them in solving the
problems.
-Terry
 Supervision can be defined as a process by which the subordinates are guided
according to their needs by the immediate superiors so that they can make the best use
of their knowledge and skill and improve their so as to do their job efficiently and
effectively to fulfil the objectives of the organisation.
-Williamson

Objectives of supervision:

 Meeting predetermining work objectives.

 Promotion of motivation and morale
 Bridging the gap between the workers personal goals and the organisational goals
 Ensuring that the subordinate staff or supervisor does what she is supposed to do.
 Promotion of team work
 To assist and to help in the development of the staff of their highest potential
 To interpret policies, objectives, need of the organisation.
 To develop coordination and to avoid overlapping
 To develop standards of service.
 To plan the services cooperatively.
 To develop the method of evaluation
 To assist in problem solving of the matters concerning personnel
 To evaluate the service given in wards and in community setting

Principles of supervision

 Good supervision do not overburden a staff

  Good supervision do not exert undue pressure
 Coordinates and unifies efforts of staff
 It is based on the needs of the individuals
 Give autonomy to staff depending upon personalities, expertise, capabilities,
knowledge, competence, experience and characteristics.
 Provide necessary counselling, guidance and training to staff.
 Encourage staff in decision making
 It is well planned.
 Good supervision generates and guarantees quality of nursing care.
 Good supervision foster the ability of each staff member to think and act for
himself/herself.
 Communicate with workers freely.
 Encourage innovation allowing free flowing of ideas, share positive experiences
specially.
 Adopt and positive attitude rather than an attitude for inspection.
 Focus on continued and sustained staff growth.
 Ensure good planning, organising and coordination
 Provide good leadership
 Create suitable climate for productive work
 Good supervision helps the individual nurses set up objectives which are for her
dynamic, reasonable and worthwhile and helps her to attain her objectives.
 Good supervision strives to make the ward a good learning situation.

Tips for effective supervision

 Don’t overburden a staff.

 Don’t exert undue pressure
 Give autonomy to staff.
 Be professional and technically competent.
 Encourage staff in decision making
 Provide good leadership.
 Ensure good planning, organising and coordination
 Create suitable climate for productive work.
 Be flexible.
 Communicate
 Motivate
 Be fair
 Decide on facts
 Be acceptable

Methods of supervision

 Direct method- direct supervision on staff. This is done at the time of performing the
activities by the staff to assess their skills and expertise
  Indirect method- through records and reports. Retrospectively observed to compare
work performance against performance indicators.(work diary, performance report,
copies of monthly report, other reports)
 Other methods- staff meetings, individual and group conferences

Tools of supervision:

i. Observational checklist- it comprises of a list of skills and knowledge, attitude and

other variables to be assessed and a space to put tick mark whether or not that
particular behaviour has occurred.
ii. Rating scale- is a device for obtaining judgement of degree to which a particular
characteristic or attitude is expressed or performed which is readily detectable simple
observation. It consists of a straight line to represent a range of behaviour provided
with units on scale or divisions.
iii. Nursing rounds
iv. Observation
v. Written policies, printed materials
vi. Reports
vii. Staff meeting
viii. Inservice education
ix. Follow up visits and evaluation

Techniques of Supervision

 Group conference
 Individual conference
 Anecdotal records
 Incidental teaching

Methods of supervision

1. Technical versus creative supervision

2. Cooperative versus authoritarian supervision
3. Scientific versus intuitive supervision
4. Task oriented versus employee oriented supervision

Technical versus creative supervision

 Technical – These are basic supervisory skills and which need to be trained – group
discussion and conference
 Creative – provides maximum adaptation to the situ

Cooperative versus authoritarian supervision

 Cooperative – full participation of each member of the group in planning, action and
decision.
  Authoritarian: supervision responsibility centers entirely on the supervisor, with the
staff following his / her orders.

Scientific versus intuitive supervision

 Scientific supervision – Relies on objective study and measurement than personal

judgment / opinion.
 Intitutive supervision: It needs to maintain IPR

Task oriented versus employee oriented supervision

 Task oriented supervision emphasize the task more than performer.

 Employee oriented: Supervisors are more concerned about worker staff their needs
and welfare than assigned tasks

Steps in Supervision:

When supervision is needed the superior has to make plan for supervision by using certain
steps to follow.

1. Defining of the job to be done

2. Selection and organization of supervisor activities based on available resources.
3. Anticipation of difficulties
4. Establishment of criterion for evaluation determining what extent the programme has
met problem / objectives according to plan.

Functions of Supervision

Administrative:

 Assignment of the work loads of individual and groups according to the level of
physical and mental competence (or) preparing the duty roaster.
 Identify the needs for supplies and equipment and providing materials and supplies to
facilitate the staff performance.
 Identify the problem and helps to solve.

Educative:

 Orientation
 Teaching subordinates
 Plan and conduct in service education program
 Ensuring staff developments

Communicative

 The supervision act as a communicator between the staff and authorities and other
health team members.
 She facilitates communication
  She should encourage free communication among persons between worker and
community representatives and members of health team.

Evaluative:

 Supervisor is supposed to carryout performance appraisal of all the staff this include
identify the cause of difficulty.
 Providing Continuing Education and guidance.

Functions of Supervisor

Administrative- Assigning duties, preparing duty roster, providing material.

Teaching- providing technical guidance
Helping-help by solving problems
Linking- acts as a communicator between superior and subordinates
Evaluation- carrying out performance appraisal

Qualities of a Supervisor:

 IPR and Professional Skills

 Professional and technical knowledge
 Thoroughness
 Fairness
 Initiative
 Tactful
 Enthusiastic
 Emotionally mature
 Teaching abilities
 Positive attitude

ORGANISATIONAL BEHAVIOR AND HUMAN RELATIONS-CONCEPT, PRINCIPLES

AND THEORIES

Organizational behaviour

It refers to the behaviour of individuals and groups within organisation and the interaction between its
members and their external environment.

Definition

 Organizational behaviour is the study and application of knowledge of how people act or
behave within an organisation.
– Keith Davis and John Newstorm
 Organizational behaviour is a field of study that investigates the impact that individuals,
groups and structure have on behaviour within organisation for the purpose of applying such
knowledge towards improving an organizations effectiveness.
 – Stephen P Robins

Concepts of organisational behaviour

 Individual difference- Each person is different in several ways. Whether

intelligence,physique, personality and any other trait. Individual difference means that
management can cause the greatest motivation among employees by treating them differently.
 A whole person- When an individual is appointed her skill alone is not hired,his or her social
background,likes and dislikes,pride and prejudices are also hired. A persons family life
cannot be separated from his or her work life. So managers should endeavour to make work
place a home away from home. Management not only strive to develop a better employee not
of a worker but a better person in terms of growth and fulfilment.
 Caused behaviour- The behaviour of the employee is caused and not random behaviour. It is
directed towards someone that the employee believes, right or wrong in his or her interest.
 Human dignity- It recognizes that people want to be treated with dignity and respect and
should be so treated.
 Organisation as a social system- Organisation is a social system, the actions there in are
governed by social as well as psychological laws. Just as people have psychological needs
they also have social roles and status. Their behaviour is influenced by their group as well as
their individual drives.
 Mutuality of interest-Organistion need people and people also need organisation.
Organisation have a human purpose. They are formed and mentioned on the basis of some
mutuality of interest among their participants.
 Holistic concepts- this concepts interprets people and organisation relationship in terms of
whole person, whole group, whole organisation as a whole social system.

Elements of organisational behaviour

a. People- In an organisation people exist both as individual and in group. As individual

differences exist with respect to perception, personality, motivation and individual
learning etc.It is necessary to understand the individual traits and characteristics. This
helps each individual understand another’s behaviour.
b. Structure- Organisation is a social system. It has its own structure and that could be
either formal or informal. Company is a formal organisation. Informal organization
are formed by individuals. As the saying goes men may come and go but company
goes on forever. The organisation structure may change due to technology and
environment.
c. Environment- Two types of environment in which organisation operate: internal and
external. Internal environment include: for instance, the working environment,
 individual attitude etc. External environment –Govt. rules, procedures, customers of
company etc. Both internal and external environment affects the organisation.
d. Technology- This means the materials, equipment, machines and systems with which
the individual works. The company purchases technological tools for purpose of
production and service.

Theories

 Classical doctrine theory

 Oldest theory in the study of organisation. It emphasises rigid, centralised control of
workers to promote high production.
 Fredrick Taylor- Father of Classical theory & the Father of Scientific Management
High production was his primary concern in developing this theory. He believed that high
production could be achieved by paying high wages. Taylor’s scientific management
approach involves timing various work activities with a stop watch. The purpose is to
determine the exact time in which a worker should be able to accomplish task.
Further, in the classical approach, strict obedience to authority is expected. Workers must do
the handwork exactly as told by their superiors. Only top level managers may do brain work
and workers job is to keep production going.
 Henry Fayol theory of management: Fayol identified 14 principles of management. His
principles made it clear that production, efficiency and profit were of prime importance, while
individuals/workers were of comparatively less importance.
 Humanistic School (Behavioural or Neoclassical theory):It was demonstrated lack of concern
for workers that led to the formation of a new theory of organisation in 1930. It identifies two
major functions of organization: one maintaining the external balance, that is the economics
and other maintaining the internal balance, that is the social organisation of the workers
through which they satisfy their own desires and needs. Together these functions have equal
importance in the humanistic theory.
The theory also recognises that an individual goal may differ from organisational goals.an
institution organised according to humanistic theory therefore allows and encourages
participation of workers in planning and decision making. The institution tries to promote
general job satisfaction for workers because according to this theory concern for workers
needs as well as for profit and production will lead to improved production and economic cost
effectiveness.
 Modern organisation theory:
Began in the late 1950s, as researchers recognised that in the humanistic as well as in the
classical approach something is missing. The modern organization theory consists of two
approaches: system and contingency. The theory comes from the field of sociology,
economics, mathematics, engineering and administration, but its unifying strand is human
systems in their totality. However the modern organization theory is still evolving. Its basic
assumption lies in a system framework- that the organisation is an open system- consisting of
input, throughput, output and feedback.

GROUP DYNAMICS:

 It is a social process by which people interact in a group environment. The influence of

personality and power of behaviour on the group process can influence the dynamics of
any group.
 A branch of social psychology which studies problems involving the structure of a group.
  The interactions that influence the attitudes and behaviour of people when they are
grouped with others through either choice or accidental circumstances.
 A field of social psychology concerned with the nature of human groups, their
development, and their interactions with individuals, other groups, and larger
organizations.

OBJECTIVES OF GROUP DYNAMICS

 To identify and analyze the social processes that impact on group development and
performance.
 To acquire the skills necessary to intervene and improve individual and group performance
in an organizational context.
 To build more successful organizations by applying techniques that provide positive impact
on goal achievement.

PRINCIPLES OF GROUP DYNAMICS

 The members of the group must have a strong sense of belonging to the group.
 Changes in one part of the group may produce stress in other person, which can be reduced
only by eliminating or allowing the change by bringing about readjustment in the related parts
 The group arises and functions owing to common motives.
 Groups survive by placing the members into functional hierarchy and facilitating the action
towards the goals
 The intergroup relations, group organization and member participation is essential for
effectiveness of a group.
 Information relating to needs for change, plans for change and consequences of changes must
be shared by members of a group.

ELEMENTS OF GROUP DYNAMICS

1. Communication- One of the easiest aspects of group process to observe is the pattern of
communication. The kind of observation we make give us clues to other important things
which may be going on in the group such as who leads whom or who influences whom.
2. Content versus process- Content of group discussion often tells us what process issues may be
on people’s mind. Process really means to focus on what is going on in the group and trying
to understand it in the terms of other things that have gone on in the group.
3. Decision- Many kind of decisions are made in groups without considering the effects of these
decision have on other members.
4. Influence- Some people may speak very little, yet they may capture the attention of the whole
group. Other may talk a lot, but other members may pay little attention to them.
5. Task versus relationship- The group task is the job to be done. People who are concerned with
the task tend to make suggestions as to the best way to proceed or deal with a problem.
Relationships means how well people in the group work together.
6. Roles- 3 types:
 Task roles: (which helps the group accomplish its task)
Initiator: proposing tasks or goals; defining a group problem; suggesting
ways to solve a problem.
Information/opinion seeker: requesting facts; asking for expressions of
feeling; requesting a statement; seeking suggestions and ideas.
 Information or opinion giver: offering facts; providing relevant information;
stating an opinion; giving suggestions and ideas.
Clarifier and elaborator: interpreting ideas or suggestions; clearing up
confusion; defining terms; indicating alternatives and issues before the group.
Summarizer: pulling together related ideas; restating suggestions after the
group has discussed them; offering a decision or conclusion for the group to
accept or reject.
Energizer; who stimulates and prods the group to act and raise the level of
their actions.
Coordinator: who clarifies and coordinates ideas, suggestions and activities
of the group members.
 Relationship roles (which helps group members get along better)
Harmonizer: who mediates, harmonizes and resolve conflicts.
Gate keeper: helping to keep communication channels open; facilitating the
participation of others; suggesting procedures that permit sharing remarks.
Encourager; being friendly, warm, and responsive to others; indicating by
facial expression or remarks the acceptance of others' contributions.
Compromiser: when one's own idea or status is involved in a conflict,
offering a compromise which yields status; admitting error.
Follower: who accepts the group‘s ideas and listens to their discussion and
decisions.
 Self oriented roles(which contributes to neither group task nor group relationship)
Dominator: interrupts others; launches on long monologues; is over-positive;
tries to lead group and assert authority; is generally autocratic.
Negativist: rejects ideas suggested by others; takes a negative attitude on
issues; argues frequently and unnecessarily; is pessimistic, refuses to
cooperate.
Aggressor: tries to achieve importance in group; boasts; criticizes or blames
others; tries to get attention; shows anger or irritation against group or
individuals; deflates importance or position of others in group.
Playboy: is not interested in the group except as it can help him or her to
have a good time.
Storyteller: likes to tell long "fishing stories" which are not relevant to the
group; gets off on long tangents.
Interrupter: talks over others; engages in side conversations; whispers to
neighbour

STAGES OF GROUP DEVELOPMENT

Dr. Bruce Tuckman published his Forming, Storming, Norming, Performance model in 1965.He then
added a fifth stage Adjourning in1970.

Stage 1: Forming: It is the initial stage marked by uncertainty and confusion. The structure of the
group is uncertain and unpredictable. Leadership cannot be implemented effectively.

Stage 2: Storming: There is a huge rift created because of various disparities and disagreements
between members.
Stage 3: Norming: Situation of chaos is finally settled. The groups are finally realised and ‘I’ is
replaced by ‘We’.

Stage 4: Performing: Team work forms the very essence of the group. The assigned task is completed
with devotion and perseverance.

Stage 5: Adjourning: This represents the end of the group. In this case the mission is accomplished
and its time to disband the group or have a new composition. All the stages starts over again.

GROUP DYNAMICS PROCESS

A. Group formation
A group is able to share experiences, to provide feedback, to pool ideas, to generate insights,
and provide an arena for analysis of experiences. The group provides a measure of support
and reassurance.
 Participation- Participation is a fundamental process within a group, because many of
the other processes depend upon participation of the various members. Levels and
degrees of participation vary. Some members are active participants while others are
more withdrawn and passive. In essence, participation means involvement, concern
for the task, and direct or indirect contribution to the group goal. If members do not
participate, the group ceases to exist.
 Communication- Communication within a group deals with the spoken and the
unspoken, the verbal and the non-verbal, the explicit and the implied messages that
are conveyed and exchanged relating to information and ideas, and feelings. Two-
way communication implies a situation where not only the two parties talk to each
other, but that they are listening to each other as well. It helps in clarification of
doubts, confusions and misconceptions, both parties understanding each other,
receiving and giving of feedback.
 Problem solving - Most groups find themselves unable to solve problems because
they address the problem at a superficial level. After that they find themselves
blocked because they cannot figure out why the problem occurred and how they can
tackle it.
 Leadership- Leadership involves focusing the efforts of the people towards a common
goal and to enable them to work together as one. In general we designate one
individual as a leader. This individual may be chosen from within or appointed from
outside.
B. Development of groups
Viewing the group as a whole we observe definite patterns of behavior occurring within a
group. These can be grouped into stages.
Stages include:
 The initial stage in the life of a group is concerned with forming a group.
 The second stage in this group is marked by the formation of dyads and triads
 The third developmental stage is marked by a more serious concern about task
performance.
 This is a stage of a fully functional group where members see themselves as a group
and get involved in the task.
C. Facilitating a group
A group cannot automatically function effectively, it needs to be facilitated. Facilitation can
be described as a conscious process of assisting a group to successfully achieve its task while
 functioning as a group. Facilitation can be performed by members themselves, or with the
help of an outsider.

HUMAN RELATIONS

 It is a skill or ability to work effectively through and with other people.

 Human Relation is defined as a phenomenon of organised human activity directed towards the
promotion of cooperative and happy work relationship. It is getting the work done by people
with their heart in the job.
 HR can be defined as the way in which people work with one another in a cordial manner
recognizing other needs, views, values and temperament.
 HR is a process of effective motivation of an individual in a given situation in order to
achieve balance of objectives that will yield greater human satisfaction and help accomplish
company goals

Objectives

 Practice of good HR
 Helps establish a cordial relationship between the management and the employees
 Enable the manager to have an integrated approach to situations.
 Establishes a mutual regard and recognition vertically and laterally.
 Facilitates employee involvement in the affairs of organisation leading to better
productivity
 To facilitate effective organisational communication.
 To achieve cooperation between various individuals particularly between the boss and the
subordinates
 Will improve team work and team spirit.
 To improve organisational behaviour.
 To improve employee morale and job satisfaction.
 Facilitate close coordination in the environment.

Goals

To gain better understanding of oneself.

To develop respect for others.
To broaden and sharpen sensitivity to the feeling of others.

Elements of Human relations

Five major elements of HR

1. Human needs satisfaction: According to Maslow theory, there are hierarchy of needs,
physiological safety, esteem and self- actualization needs.
2. Motivation: Act of stimulating an individual or oneself to contribute utmost to achieve desired
objectives.
3. Distribution of status and roles: Employees should be inspire and encourage updating
knowledge and for staff and professional development.
4. Informal social groups: Important to have social gatherings to exchange the views and to
share the feelings.
 5. Spontaneity of group formation: These are a form of associations through which they can
work together and can take decisions for the betterment of staff.

Principles of Human relations

 Respect for human dignity of employees

 Encourage for the personality development
 Have provisions for good incentives for good accomplishments
 Be fair and honest
 Be cooperative
 Be punctual and observe punctuality.

Basic Principles of Human Relations Approach:

 Recognition and appreciation.

 Fair treatment
 Informal relations.
 Job security and job satisfactions.
 Effective communication
 Decentralisation: Individual staff and functional areas should be given greater autonomy and
decision making power.
 Participatory decision making
 Concern for developing self -motivated nurses: Employees should be self motivated who can
set their own task related goals and monitor their own performance in achieving them.

Advantages of good Human relations

 Great impact on efficiency, productivity and profitability of organisation.

 Reduces the incidence of absenteeism, strikes acts of indiscipline.
 More preventive in nature than curative.

Prerequisites for good human relations

 Providing individual recognition to each staff.

 Understanding the personality of individual staff.
 Avoid arguments.
 Deal with fair mind and facts
 Keep an open mind.
 Act on what is right and who is right

Role of Nurse Manager to develop Human Relations

 Recognise the importance of the individual and deal with human relations.
 Must be mutual understanding of their position.
 Nurse employees and administrators should have common interest.
 Mutual discussion, exchange of views and good communication should be inculcated.
 Set a good example for your employees.
 Try to understand nurse employees.
  Be fair and impartial
 Plan work carefully and keep the perspectives.
 Give clear, concise and complete instructions.
 Get result, develop safe, efficient and competent nurses.
 Know your duties, responsibilities and authorities and of your subordinates

PUBLIC RELATIONS IN CONTEXT OF NURSING

 Public relations are the skilled communication of ideas to the various public with objective of
producing a desired result.
 Public relations is finding out what people like about you and doing more of it: finding out
what they don’t like about you and doing less of it.
- Bernays
 Public relation is defined as a planned effort to establish and improve the degree of mutual
understanding between an organisation and the public with the primary objective of acquiring
a good reputation.
 Public relations is government is the composite to all the primary and secondary contacts
between the borealis and the citizen and all the interaction of influences and attitudes
established in these contacts.

Goals of Public Relations:

 To form, maintain and the organisation reputation, enhance its status and present a favourable
image.
 To create or develop goodwill for the organisation.

Elements of public relations

 Human relations- Getting along with people. One should be aware of other person and
interested in his/her progress.
 Empathy: feeling with others.
 Persuasion: Causing somebody to do something by reasoning with him; compelling is against
the principles of social contact.
 Dialogue: Conversation with a purpose.

Functions of public relation:

 Anticipating, analysing and interpreting public opinion, attitudes and issues that might impact
for good or ill.
 Counselling management at all levels in the organisation with regard to policy decision,
courses of action and communication.
 Researching, conducting and evaluating on a continuing basis, programs of action.
 Planning and implementing the organisation efforts to influence or change public policy

FORMS OF PUBLIC RELATION:

 Employee relations: It is a function of public relations that includes responding to employee

concerns and informing and motivating staff.
 Community relations: It is the function of actively planning and participating with and within
a community for the benefit of the community and the hospital.
  Government relations: It is a function of relating to government officials and agencies about
issues that impact the hospital and its audiences.
 Media relations: It is often considered synonymous with public relations, is the function of
working with the media to communicate news.

METHOD OF IMPROVING PUBLIC RELATION IN HOSPITAL

 General: High quality patient care by the hospital is the theme of any public relation
programme.
 Physical facilities: Well planned hospital with sufficient waiting area for the patient and its
relation in the hospital, optimum floor space for each department of t e hospital, logical layout
of the department and work areas, provision of adequate facilities like toilets, public utility
services like canteen, drinking water facility and so on go a long way in improving the image
of the hospital.
 Staff: In a hospital the staff consists of variety individuals drawn from different status of the
society with different levels of education and background .
 Name Labels and Uniform: All functionaries should wear uniforms and name labels. This
creates initial good impression on patients and reflects good administration.
 Importance of Color: Color affects many of our moods and emotions. Proper choice of color
can transform depressing and monotonous atmosphere into pleasing and exciting one.
 Operating facility: The operating efficiency in an organization like, hospital is the outcome
of its soundness of objectives, policies, procedures, programmes and standing orders.
 The speciality clinics: The speciality clinics if located proximally are one of the
concentrated areas of the OPD services.
 Waiting time: The waiting time in the OPD is invariably the sore point of public grievances.
 Delay in Admission: Anxiety and distress is the result of delays in admission due to long
waiting list.
 Ward Reception: Patients are generally vulnerable to anxiety and fear on arrival in the ward.
The reception they get tends to leave a deep impression
 Privacy: It is normally observed that majority of the patients are dissatisfied with the type of
privacy provided in the ward.
 Food: Good food, well prepared and attractively served to patients, makes a very favorable
impression.
 Cleanliness: Cleanliness is much a desired thing in a hospital.
 Information about Illness: The most important thing to a patient is to know as to what is
wrong with him and how long will it take to recover.
 Visitors: Relatives and friends come rushing to the hospital the moment they learn about the
illness of their near and dear one.
 Complaints and Suggestions: The best way to deal with complaints is to do everything
possible to avoid getting them by anticipating the problems
 Mortuary and Chaplain Facility: The disposal of the dead is influenced by religion, social and
cultural beliefs and practices. It is necessary to provide within the hospital or its premises a
place to which a dead body can be moved quietly so that other patients do not get upset.

PUBLIC RELATION OPERATES IN TWO AREAS

Within an organization:
1. The first area within an organization is between leadership and the people

2. Second to area is between different professional and specialists. Every organization is subject to
professional jealousies. Conflicts or interest and personalities

3. A third area is between different departments. There is frequently competition for funds, honours,
and fever with an organization

4. Public relations also operates between individual on all levels of authority and responsibility

Between an organization and in environment

 Between an organization and its competitions and other unrelated agencies

 This may be between the organization and the community
 It also inter groups or organization and regulates with other similar organizations .

Public Relation Tools

1. Advertising- drawing attention by big public announcement to a commodity or service with
the goal of selling it.
2. Publicity- The technique of telling the story of any organisation. It includes all the techniques
employed to get a story across to the public. It includes advertising.
3. Propaganda- The political application of publicity and advertising on a large scale for selling
an idea or candidate or both.
4. Diplomacy-The management of international relations by negotiations. Diplomacy is the
application of intelligence and actions to conduct and maintain official relations
5. Promotions- Commercialisation of publicity usually on a grand and coordinated scale aimed
at selling a product.
6. Campaigns- Concerted single purpose publicity programmes usually on a large or small scale
using coordinated publicity through a variety of media aimed at a number of targets, but
focussed on specific goals.
7. Lobbying- Campaigning for legislative action. It is an informal way of pulling strings .
lobbying entails the exercising influence and pressure.
8. Public affairs- A substantial and significant participation by individuals, private institutions,
foundations and Government in economic, social and political areas that singly or through
interaction shapes the environment in which the free enterprise exists.
9. PR Counselling- A PR personnel first determines the character of the company, its existing
status or image. He then suggests what should be done to improve the company’s image.
10. PR Budgetting- A person or establishment desiring to run a PR campaign should have a
budget that will depend upon the need of the individual or establishment.

SKILLS REGARDED FOR EFFECTIVE PUBLIC RELATIONS:

1. One should have a thorough knowledge of the organization

2. One requires the ability to co-ordinate skill as co-ordain of meeting, interview.
3. One requires skill in communications
4. He should be able to communicate the manage be it written, spoken, printed and
photographed
5. One also requires the ability to understand people
6. A good public relations person must understand human nature and behaviours as well as
human needs and aspirations
7. Skill of diplomacy or feet fullness
8. Public relations have to deal with many different people. Causal diplomacy enables on to
fell through the attitudes and prejudices and reach common ground
 9. One should pass integrity so that one is trussed inside and outside the organization and
especially by the media.
10. One must have the skill to guide others to reasonable thought and orderly considerations
and understanding
11. One should be alert to public moods and trends

ADVANTAGES OF PR

 Ability to reach specific groups

 Image building
 Lead generation
 Cost
 Credibility

DISADVANTAGES OF PR

 Lack of communication
 Lack of coordination with the marketing department.

ROLE OF NURSE IN MAINTAINING PR

 Care provider
 Communicator
 An administrator
 Educator and counsillor
 Liason officer

RELATION WITH PROFESSIONAL ASSOCIATION AND EMPLOYEE UNION:

COLLECTIVE BARGAINING, WORK CULTURE

COLLECTIVE BARGAINING

 Phrase coined by Sydney Webb & Beatrice Webb, who believed that collective bargaining
was the collective equivalence of individual being whose primary aim was achieving
economic advantage.
 The term collective bargaining consists of 2 words-collective which implies group action
through its representative and bargaining which suggests negotiating. The phrase therefore
implies collective negotiations of a contract between management representative on one side
and those workers on other.

Definition

“Collective bargaining is an agreement between a single employer or an association of employers

on the one hand and a labour union on the other, which regulates the terms and conditions of
employment.

(Tudwig Teller)

The continuous relationship between an employer and a designated labour organisation

representing a specific unit of employees for the purpose of negotiating written terms of
employment.
 (Carrel & Heavrin)

Collective bargaining is a process of discussion and negotiation between two parties, one or both
of whom is a group of persons acting in concert…. More specifically it is the procedure by which
an employer or employers and a group of employees agree upon the conditions of work

Objectives of Collective Bargaining

 To provide an opportunity to the workers, to voice their problems on issues related to

employment.
 To facilitate reaching a solution that is acceptable to all the parties involves.
 To resolve all conflicts and disputes in a mutually agreeable manner.
 To prevent any conflict/disputes in the future through mutually signed contracts.
 To develop a conducive atmosphere to foster good organizations relations.
 To provide stable and peaceful organization (hospital) relations.
 To enhance the productivity of the organization by preventing strikes lock – out etc.

Important Functions of Collective Bargaining

 It is a rule making or legislative process- It formulates terms and conditions under which the
labour and management will cooperate and work together over a certain stated period.
 It is also a judicial process- In every collective bargaining there is a provision or clause
regarding the interpretation of the agreement and how any difference of opinion about the
intention or scope of a particular clause is to be resolved. Such interpretation can be left to a
joint committee of workers and management representative or the top level management or to
a third party jointly selected by the union and the management.
 It is an executive process- For both the management and the trade unions undertake to
implement the agreement signed, each accepting a series of obligations under the agreement.

Characteristics of Collective Bargaining

I. It is a group process
II. Negotiations form an important aspect of the process of collective bargaining
III. Collective bargaining is a formalized process by which employers and independent
trade unions negotiate terms and conditions of employment and the ways in which
certain employment-related issues are to be regulated at national, organizational and
workplace levels.
IV. Collective bargaining is a process in the sense that it consists of a number of steps. It
begins with the presentation of the charter of demands and ends with reaching an
agreement, which would serve as the basic law governing labour management
relations over a period of time in an enterprise. Moreover, it is flexible process and
not fixed or static.
V. It a bipartite process. This means there are always two parties involved in the process
of collective bargaining.
VI. Collective bargaining is a complementary process.
VII. Collective bargaining tends to improve the relations between workers and the union
on the one hand and the employer on the other.
VIII. Collective Bargaining is continuous process.
IX. Collective bargaining takes into account day to day changes, policies, potentialities,
capacities and interests.
Legal framework for Collective Bargaining

Employees have the right to

 Form, to join or to assist a labour organisation of their choice.

 Bargain collectively through that labour organisation.
 Protect employees by defining and prohibiting unfair labour practices such as:
-interfering with employees in the exercises of their right.
-interfering with the formation or administration of a labour organisation.
-Discriminating against employees for engaging in or refraining from union activities.

Principles to be followed by the management in Collective Bargaining

i. The management must form and follow a realistic labour policy which should be accepted
and carried out by its representatives.
ii. The management should deal only with one association or trade unions in the organisation.
iii. The management must agree to reform the trade unions or associations without any
reservation and take it as a beneficial step in the organisation.
iv. The management should treat the trade union fairly in order to make it a responsible part of
the organisation.
v. The management should regularly check the rules and regulations to determine the attitude
and degree of comfort of its employees and in turn gain their goodwill and cooperation.
vi. The management should place greater importance on social considerations while weighing the
economic consequences of collective bargaining.
vii. The management should not wait for the trade union to bring employee problems to its notice
but should rather form the condition in which employees can directly approach the
management without taking the help of trade unions or associations.

Collective Bargaining Process

I. Prepare: This phase involves composition of a negotiation team. The negotiation

team should consist of representatives of both the parties with adequate
knowledge and skills for negotiation. In this phase both the employer‘s
representatives and the union examine their own situation in order to develop the
issues that they believe will be most important.
II. Discuss: Here, the parties decide the ground rules that will guide the negotiations.
A process well begun is half done and this is no less true in case of collective
bargaining. An environment of mutual trust and understanding is also created so
that the collective bargaining agreement would be reached.
III. Propose: This phase involves the initial opening statements and the possible
options that exist to resolve them. In a word, this phase could be described as
‗brainstorming‘. The exchange of messages takes place and opinion of both the
parties is sought.
IV. Bargain: negotiations are easy if a problem solving attitude is adopted. This
stage comprises the time when ‗what ifs‘ and ‗supposals‘ are set forth and the
drafting of agreements take place.
V. Settlement: Once the parties are through with the bargaining process, a
consensual agreement is reached upon wherein both the parties agree to a
 common decision regarding the problem or the issue. This stage is described as
consisting of effective joint implementation of the agreement through shared
visions, strategic planning and negotiated change.

Steps

 Selection of a bargaining agent.

 Certification to contract.
 Contract administration.
 Decertification.

The nurse manager‟s role:

The nurse manager in a health care organization where nurses are organized into a collective
bargaining unit participates in resolving grievances, using the agreed upon grievance procedure.

Advantages and Disadvantages of Collective Bargaining:

Advantages:

 Equalization of power
 Viable grievance procedure
 Equitable distribution of work
 Professionalism promoted
 Nurses control practice

Disadvantages:

 Adversary relationship
 Strikes may not be prevented
 Leadership may be difficult to obtain
 Unprofessional behaviour
 Interference with management

Relation with Professional Associations and Employee Unions

Professional Associations

 Is a group of professionals who are responsible for maintaining and enhance the status of their
members
 They are self regulating and independent from government.
 Professions tend to regulated by senior, highly qualified members of the profession.
 Professional bodies have important role in maintaining standards of professional education.
 "A group of people in a learned occupation who are entrusted with maintaining control or
oversight of the legitimate practice of the occupation;" also a body acting "to safeguard the
public interest;" organizations which "represent the interest of the professional practitioners,"
and so "act to maintain their own privileged and powerful position as a controlling body."

Objectives:
  To understand the role of professional organisations in empowering nurses in their emerging
professionalism.
 To discuss the functions of each professional organisations.
 To discuss importance of self-assertiveness in safeguarding our profession.
 To study the vast scope of collective bargaining in nursing profession

TRAINED NURSES ASSOCIATION OF INDIA (TNAI)

The Trained nurses association of India is a national professional association of Nurses. The present
name and organization were established in 1922.
Objectives
 Improve living and working condition for nurses.
 Uphold the dignity and honour of nursing profession.
 Promote a sense of spirit among all nurses.
 To advance professional education and general welfare of nurses.
Activities
 Establish standards and qualifications for nursing profession.
 Establish standards of nursing education
 Establish code of professional conduct
 Provide professional counselling.
 Promote and protect economic welfare of nurses
 TNAI may support strikes if all other means of negotiating have failed to being about
satisfactory working conditions.
 TNAI gives scholarships for nurses who wish to go on for advanced study either here or
abroad.
 It helped to remove discrimination against male nurses.
Membership
 Obtained by application and submission of a copy of your state registration certificate. It is
possible to apply for a life membership. The official organ of the TNAI is The Nursing
Journal of India which is published monthly. The cost of this is included in the annual
subscription for membership in the association.
INTERNATIONAL COUNCIL FOR NURSES (ICN)
It was formed in 1899. It’s an international association for all nurses in the world. Great emphasis has
been on non-discrimination.
Objectives
 Promote the development of strong national nurses associations.
 Assist national nurses association to improve the standards of nursing and the competence of
nurses.
Activities
 Makes policy statements on health and social issues.
 Offers a great variety of seminars
 Maintaining and improving the status of Nursing around the world
Membership
 All nurses can become members of the ICN but not as individuals. The individual nurse
becomes a member if his/her national nurses association is a member of ICN. Nurses in India
become members of ICN when they become members of the TNAI.
THE COMMONWEALTH NURSES FEDERATION
The Commonwealth Nurses Federation was formally organized in 1973 and operates in Six regions of
the world which are East, Africa, Atlantic, Australia, Pacific, South Asia and Europe. The TNAI is
also affiliated with the Commonwealth Nurses Federation .It is made up of nurses associations from
commonwealth countries.
Aims
 Promote sharing, better communications and closer relationships between its member
associations.
  Provides expert professional advice.
 Scholarships for advanced study.
 Financial assistance for professional meetings and seminars.
THE INDIAN NURSING COUNCIL (INC)
The Indian Nursing Council, which was authorized by the Indian Nursing Council Act of 1947, was
established in 1949.
Purpose
Providing uniform standards in Nursing education and reciprocity in Nursing Registration throughout
the country.
Responsibilities
 Prescribes curricula for nursing education in all the states.
 Refuses or Recognizes Programmes of Nursing Education according to standards required.
 Support high standards in Nursing.
 Providing registration for foreign nurses.
 Maintenance of the Indian Nurses Register. This register contains the names of all nurses,
midwives, auxiliary nurse midwives who are enrolled on all state registers.

RED CROSS SOCIETY

 It follows the directions of the Geneva conventions in an effort to protect victims of
armed conflict. Its headquarters is in Geneva, Switzerland.
 They delegate visit and inspect prisoner of war camps. They arrange for delivery of
mail and food packages to the prisoners. They also offer emergency relief by
providing food and medical supplies.
THE WORLD HEALTH ORGANISATION
 The world health organisation, commonly called the WHO is also a specialized agency of the
United Nations. It was organized in 1948 for the purpose of helping to achieve the highest
possible level of health for all people
 The WHO has been active in nursing education and practice in a number of ways in India.

THE STUDENT NURSES ASSOCIATION (SNA)

The Student Nurses Association organized in 1920, is associated with and under jurisdiction of the
TNAI. In addition to providing a means of personal and professional development for the nursing
student. The assistant secretary of the TNAI serves as advisor for the SNA.
Purposes and functions
 Help student Nurses learn how the professional organisation serves to uphold the dignity and
ideals of the nursing profession.
 Promote a close rapport with other student Nurses.
 Furnish student Nurses advice in their courses of study leading up to professional
qualifications.
Activities
 Fund raising for the TNAI.
 Fund raising done for fine arts and sports competitions and conferences.
 Special prizes given for outstanding achievement in specific areas of nursing education.
Membership
Fees are minimal and easily met by the nursing student. Nursing students who participate in the
Student nurses association have a valuable opportunity to begin to develop leadership skills,
competitive skills and an interest for the profession as a whole.
THE NURSES LEAGUE OF THE CLINICAL MEDICAL ASSOCIATION
The Nurses league of the clinical medical association of India was founded in 1930. It became
affiliated to the TNAI in 1936 and promotes membership in this organisation.
Objectives
 Promote cooperation and encouragement among Christian Nurses.
  Promote efficiency in nursing education and service.
Activities
 Activities include national and area conferences and retreats for its members. Development
of leadership abilities is encouraged by participation in these meetings.
 Each meeting also allows for sharing of problems common to the Christian nurse.
Membership
Membership fees are required and a life membership is available. Nursing students may become
associate members of the league. Membership in the Nurses league may be a requirement for certain
nursing positions under control of Christian employing authorities.
THE CHRISTIAN MEDICAL ASSOCIATION OF INDIA
The CMAI began in 1905 as a fellowship of Christian missionary doctors to provide spiritual sharing
and support. It gradually developed into a larger organisation which included other Christian health
professionals and health institutions.
Functions
 To provide professional training through formal and informal education, publication of
textbooks and other materials and scholarships.
 To encourage community health work through training, advisory services and technical
support.
Membership
Membership is open to doctors, registered nurses and ANM/Health workers, all health professionals.
Students in health professional courses may also become members

UNIONS
Meaning
A union or labor organization is any organization in which employees participate for the purpose of
dealing with their employer about grievances, labour disagreements, wages, hours of work, and
conditions of employment.
Objectives of unions
 Wages- Employees and their union can be expected to ask for wages which are comparable to
those in similar jobs in the local market.
 Promotions- Unions will insist the length of services a factor in promotion.
 Grievances procedures- The union will insist that grievances procedure be established where
by management decisions will be reviewable by representatives of management and union.
 Fringe benefits- Pensions, vacations, holidays and general welfare programs will be the part
of negotiation.

Unions in India
At present three unions of nurses are working at the central level.
1. All India Government Nurses Federation (AIGNF)
2. Trained Nurses’ Union (TNU) and
3. Trained Nurses Association of India (TNAI)
Besides, there are two state level unions, namely,
 Orissa Nursing Employee’s Association (ONEA)
 Trained Nurses Association of India, Orissa branch.
 United nurse association (UNA)

CONTROLLING
It is an important element of the management process. It is the process of verification and comparison
that ascertains anticipated performance.
Definition:
  Controlling can be defined as the regulation of activities in accordance with the requirements
of plans.
 Controlling is determining what is being accomplished, that is, evaluating the performance
and if necessary, applying correctives so that performance takes place according to plans.
-George R Terry

Steps of control:
The control function, whether it is applied to cash, medical care, employee morale or anything else,
involves four steps.
1. Establishments of standards.
2. Measuring performance
3. Comparing the actual results with the standards.
4. Correcting deviations from standards
Importance of controlling
i. Facilitates decision making
ii. Facilitates decentralisation
iii. Stimulates action
iv. Enhances employee morale
v. Promotes efficiency of operation
vi. Promote coordination
vii. Psychological pressure

COORDINATION
Is the essence of nursing management. It is the life line for the management. It is the process in which
different people or things work together to attain specific goals or aims.
Definition
 Coordination is the achievement of orderly group efforts and unity of action in the pursuit of
common goals.
-Mooney and Railey
 Coordination is the integration of several parts into an orderly whole to achieve the purpose
of understanding.
-Charles Worth
Features of coordination
 Group effort
 Essence of management- it is inherent in all managerial function.
 Conscious activity- Various skills are required to have the coordination within the
department.
 Responsibility of management
 Continuous and dynamic process
 Unity of actions
 Unity of purpose
 Integration of activities
 Pervasive function- It is required at every level and by every manager.
 Common purpose
Principles of coordination
i. Direct personal- Coordination is best achieved through direct personal contact with the people
concerned. Direct face to face communication is most effective way to convey ideas and
information and remove misunderstanding.
ii. Early beginning- Coordination can be achieved more easily in early stages of planning and
policy making.
iii. Reciprocity- Means that all factors in a given situation are interdependent and interrelated.
Coordination becomes easier when people appreciate the reciprocity of relations.
 iv. Continuity- Coordination is an on-going or never ending process rather than a once for all
activity
Types of Coordination
On the basis of scope
 Internal- Coordination between the different units of an organisation within and is achieved
by integrating the goals and activities of different departments of the organisation.
 External-between an organisation and its external environment comprising Govt.community,
customers etc.
On the basis of hierarchy
 Vertical-When coordination is between different levels of the organisation and has to ensure
that all the levels in the organisation act in harmony and in accordance with the goals and
policies of the organisation.
 Horizontal or lateral- It refers to coordination between different departments and other units at
the same level of the management hierarchy.
Barriers of Effective Coordination
 Loss of Adhoc communication- lack of informal communication can lead to ineffective
coordination.
 Lack of contact among employees
 Time to initiate contact or communication
 Common difference or preferences
 Lack of trust
 Personal work style differences
 Different background of members
 Not realising there is a need to communicate.

QUALITY MANAGEMENT
The process by which people are mobilised to achieve quality goals. Quality management is becoming
integral to health care.

QUALITY ASSURANCE
QA provides the mechanisms to effectively monitor patient care provided by health care professionals
using cost effective resources. QA originated in manufacturing industry. The idea was to ensure that
product consistently achieved customer satisfaction
Definition
 Quality assurance is a judgment concerning the process of care based on the extent to which
that care contributes to valued outcomes.
Donabedian 1982
 Quality assurance is the measurement of provision against expectations with declared
intention and ability to correct any demonstrated weakness.
–Shaw
 QA is an ongoing systematic, comprehensive evaluation of health care services and impart of
those services on health care services.
-Kozier.

Objectives and goals:

1. To establish technical assistance and frame effective planning strategies to implement and
monitor quality care by checking and correcting errors in health care services.
2. To upgrade the existing system of nursing care and improve the care to obtain maximum
quality care by conducting evidence based research activities.
3. To create awareness and popularise the work of nurses in the public thus improving the image
of nurses by providing quality nursing care.
4. To frame the evaluation process methodically which help to attain and improve quality patient
care.
5. To demonstrate the efforts of health care provider to deliver quality care.
 6. To successfully achieve sustained improvement in health care, as clinics need to design
processes to meet the needs of the patient.
7. To design processes well and systematically in order to monitor, analyse and improve patient
outcomes.
8. To ensure that a designed system includes standardised, predictable processes based on best
practices.
9. To set incremental goals as needed.

Purposes/ Need
 Rising expectations of consumer of services.
 Increasing pressure from national, international, government and other professional bodies to
demonstrate that the allocation of funds produces satisfactory results in terms of patient care.
 The increasing complexity of health care organizations.
 Improvement of job satisfaction.
 Highly informed consumer
 To prevent rising medical errors
 Rise in health insurance industry
 Accreditation bodies
 Reducing global boundaries.

Components of QA
1. Structure evaluation- focus on the setting in which care is provided to the patient.
2. Process evaluation-focus on how the care was provided
3. Outcome evaluation- focus on visible changes in the patient’s health status as result of
nursing care provided.

Approaches
 General approach
 Specific approach
General approach: - It involves large governing or official bodies evaluating a person or agencies‘
ability to meet established criteria or standard during a given time.
a) Credentialing- It is the formal recognition of professional or technical competence and
attainment of minimum standards by a person and agency. Credentialing process has 4
functional components
o To produce a quality product
o To confirm a unique identity
o To protect the provider and public
o To control the profession
b) Licensure- It is a contract between the profession and the state in which the profession is
granted control over entry into an exit from the profession and over quality of professional
practice.
c) Accreditation- It is a process in which certification of competency, authority, or credibility is
presented to an organization with necessary standards.
d) Certification –Certification is usually a voluntary process with in the profession. A person’s
educational achievements, experience and performance on examination are used to determine
the persons qualifications for functioning in an identified speciality area
e) Charter- It is a mechanism by which a state government agency under state law grants
corporate state to institutions with or without right to award degrees.
f) Recognition- It is defined as a process whereby one agency accepts the credentialing states
of and the credential confined by another.
g) Academic degree

Specific approach: - These are methods used to evaluate identified instances of provider and client
interactions.
 a. Audit- It is an independent review conducted to compare some aspect of quality
performance, with a standard for that performance.
b. Direct observation- Structured or unstructured based on presence of set criteria.
c. Appropriateness evaluation- The extent to which the managed care organization provides
timely, necessary care at right levels of service.
d. Peer review- Comparison of individual provider‘s practice either with practice by the
provider‘s peer or with an acceptable standard of care.
e. Bench marking- A process used in performance improvement to compare oneself with best
practice.
f. Supervisory evaluation
g. Self-evaluation

Quality assurance cycle:

In practice, QA is a cyclical, iterative process that must be applied flexibly to meet the needs of a
specific program. The process may begin with a comprehensive effort to define standards and norms

I. Planning for Quality Assurance -This first step prepares an organization to carry out QA
activities. Planning begins with a review of the organizations scope of care to determine
which services should be addressed.
II. Setting Standards and Specifications
To provide consistently high-quality services, an organization must translate its programmatic
goals and objectives into operational procedures. In its widest sense, a standard is a statement
of the quality that is expected.
III. Communicating Guidelines and Standards
Once practice guidelines, standard operating procedures, and performance standards have
been defined, it is essential that staff members communicate and promote their use. This will
ensure that each health worker, supervisor, manager, and support person understands what is
expected of him or her.
IV. Monitoring Quality
Monitoring is the routine collection and review of data that helps to assess whether program
norms are being followed or whether outcomes are improved. By monitoring key indicators,
managers and supervisors can determine whether the services delivered follow the prescribed
practices and achieve the desired results.
V. Identifying Problems and Selecting Opportunities for Improvement
Program managers can identify quality improvement opportunities by monitoring and
evaluating activities. Other means include soliciting suggestions from health workers,
performing system process analyses, reviewing patient feedback or complaints, and
generating ideas through brainstorming or other group techniques. Once a health facility team
has identified several problems, it should set quality improvement priorities by choosing one
or two problem areas on which to focus. Selection criteria will vary from program to program.
VI. Defining the Problem
Having selected a problem, the team must define it operationally-as a gap between actual
performance and performance as prescribed by guidelines and standards. The problem
statement should identify the problem and how it manifests itself. It should clearly state where
the problem begins and ends, and how to recognize when the problem is solved.
VII. Choosing a Team-
Once a health facility staff has employed a participatory approach to selecting and defining a
problem, it should assign a small team to address the specific problem. The team will analyze
the problem, develop a quality improvement plan, and implement and evaluate the quality
improvement effort. The team should comprise those who are involved with, contribute inputs
or resources to, and/or benefit from the activity or activities in which the problem occurs.
VIII. Analyzing and Studying the Problem to Identify the Root Cause
Achieving a meaningful and sustainable quality improvement effort depends on
understanding the problem and its root causes. Given the complexity of health service
delivery, clearly identifying root causes requires systematic, in-depth analysis.
IX. Developing Solutions and Actions for Quality Improvement
The problem-solving team should now be ready to develop and evaluate potential solutions.
Unless the procedure in question is the sole responsibility of an individual, developing
solutions should be a team effort. It may be necessary to involve personnel responsible for
processes related to the root cause.
X. Implementing and Evaluating Quality Improvement Efforts
The team must determine the necessary resources and time frame and decide who will be
responsible for implementation. It must also decide whether implementation should begin
with a pilot test in a limited area or should be launched on a larger scale. The team should
select indicators to evaluate whether the solution was implemented correctly and whether it
resolved the problem it was designed to address.
QA Methods
o Nursing audit
o Peer review
o Patient care profile analysis
o Quality circles- is a small group of 5-15 employees who perform similar work and
meet for an hour each week to solve problems related their work.
o Patient satisfaction

Factors affecting QA in nursing

1. Lack of resources.
2. Personnel problems
3. Improper maintenance
4. Unreasonable patients and attendants
5. Absence of well -informed population
6. Absence of accreditation laws
7. Lack of good hospital information system
8. Absence of patient satisfaction surveys
9. Lack of nursing care records
TOTAL QUALITY MANAGEMENT(TQM)
 Introduced by Edward Deming
 Is a management approach in an organisation centered on quality based participation of all its
members and aiming at long term success through customer satisfaction
 TQM is a systematic approach to the practice of management requiring changes in an
organisational process, strategic priorities, individual beliefs, individual attitude and
individual behaviour.
 TQM is a management approach in an organisation centered on quality, based on
participation of all workers.
 TQM means that the organization culture is defined by and supports the constant attainment
of customer i.e., the patient satisfaction through an integrated system of tools, techniques and
training.
 It involves the continuous improvement of organization processes, resulting in high quality
products and services.
 Hence, TQM is “a continuous, customer- centered, employee driven improvement.”
Elements

Customer focused which will bring satisfaction to clients.

Adopts the philosophy of continuous improvement and should start from top management.
Commitment and attitude of work force
Encourage active participation of employees
Develop leadership at top level management.
Education and training at the work force.
Good communication networking
Mutual respect and team work.
Principles of TQM by Deming
 Create a constancy of purpose for improvement of service.
 Adopt a philosophy of continual improvement
 Focus in improvement process
 End the practice of awarding service on price alone
 Constantly improve every process of quality management
 Institute job training and retraining
 Develop leadership in the organisation
 Encourage employees to participate actively in the process
 Foster interdepartmental cooperation
 Eliminate target on work force
 Focus on quality and not quantity
 Promote team work
 Educate and train employees to maximise personal development.
 Charge all employees for carrying out the TQM package.
Benefits of TQM
 Satisfaction of patient and relatives
 Improved job
 Less staff conflicts
 Continuous improvement of organisation
 Increased organisation outcome and image
 Improvement in employee morale
 Good team work and work culture
 Motivated employees
 Good communication among employees and good relationship between patient and relatives.
Barriers of TQM
 Lack of policy and administrative manuals
 Lack of motivation among employees
 Lack of proper leadership
 Deficient work culture dynamism
  Lack of adequate resources
 Poor evaluation system
 Lack of good hospital management system
 Lack of incident review procedures
Role of nurse manager in TQM
 Encourage all staff to involve actively in quality control process
 Communicate goals and outcome to all staff
 Act as a role model for subordinates
 Actively involve in research activities related to quality assurance
 Organising continuing education program
 Create a work culture. Support and actively participate in activities of QA process.
 Develops a system for continuous monitoring of nursing service
 Develops QA tool and criteria for evaluation, teaching and training the nurses to use tool
 Observe nursing care services and review nurses documentation
 Participate in team activities
 Continuous evaluation of program is essential for periodic and continuous appraisal of
nursing care.
 Actively participate in implementation of program.
 Regularly evaluate quality management system being implemented. Identify defects and its
cause.

PROGRAM EVALUATION AND REVIEW TECHNIQUE (PERT)

Meaning

The program evaluation & review technique (PERT) was developed by the Special Projects Office of
the U.S. Navy and applied to the planning &control of the Polaris Weapon system in 1958. It worked
then, it still works; and it has been widely applied as a controlling process in business & industry.

PERT uses a network of activities. Each activity is represented as a step on chart. It is an important
tool in the timing of decisions. In simplest form of PERT, a project is viewed as a total system and
consisting of setting up of a schedule of dates for various stages and exercise of management control,
mainly through project status reports on this progress.

Program (Project) Evaluation and Review Technique (PERT) is a project management tool used to
schedule, organize, and coordinate tasks within a project  It is basically a method to analyze the tasks
involved in completing a given project, especially the time needed to complete each task, and to
identify the minimum time needed to complete the total project.
Objective 
The main objective of PERT is to facilitate decision making and to reduce both the time and cost
required to complete a project.

Prerequisites
 Personnel should already have a good understanding of formal project management
terminology, tools, and techniques
 PERT form template of equivalent tool (e.g. software)
 Create of project plan
 Choose the most appropriate scheduling method
 Select and organize a team to perform project tasks.
Program Evaluation & Review Technique includes:
1. The finished product or service desired
2. The total time & budget needed to complete the project or program.
3. The starting date & completion date.
4. The sequence of steps or activities that will be required to accomplish the project or program.
5. The estimated time & cost of each step or activity.

Steps for accomplishing the project are:

a. The optimistic time: This occasionally happens when everything goes right.
b. The most likely time : It represents the most accurate forecast based on normal developments.
c. The pessimistic time: This is estimated on maximum potential difficulties.
Calculation of the ―critical path, the sequence of the events that would take the greatest amount of
time to complete the project or program by the planned completion date. The reason this is the critical
path because it will leave the least slack time.
Steps

Uses

1. It forces planning and shows how pieces fit together.

2. It does this for all nursing line managers involved.

3. It establishes a system for periodic evaluation & control at critical points in the program.

4. It reveals problems & is forward- looking.

5. PERT is generally used for complicated & extensive projects or programs.

6. Many records are used to control expenses and otherwise conserve the budget.

Advantages of PERT:

 It encourages logical discipline in planning, scheduling and control of project.

 It encourages more long range & detailed project planning
 It provides a standard method of documenting and communicating project plans, schedules,
and time and cost- performance.
  It identifies the most critical elements in the plan, thus focusing management attention .i.e.
most constraining on the schedule.
 It illustrates the effects technical procedural changes on overall schedules

Limitations of PERT

 Expert guidance is always needed for the proper judgement of time.

 It will be difficult to categorise the activities if there are more than hundreds or thousands of
them
 Mere guess or approximation of time estimate can lead to errors in the evaluation of time
during work.
 PERT chart is usually very large and requires several pages for printing. It also needs a
special signed paper.
 Before planning a PERT chart one needs to do proper planning to estimate the time frames for
each activity.

GANTT CHARTS

Early in this century Henry L. Gantt developed the Gantt Chart as a means of controlling
production. It depicted a series of events essential to the completion of a project or program. It is
usually used for production activities.

Definition

Gantt chart is a type of bar chart that illustrates a project schedule.  This chart lists the tasks to be
performed on the vertical axis, and time intervals on the horizontal axis.  The width of the horizontal
bars in the graph shows the duration of each activity.  Gantt charts illustrate the start and finish dates
of the terminal elements and summary elements of a project
Elements of Gantt chart
 Task list: Runs vertically down the left of the Gantt chart to describe project work and may be
organized into groups and subgroups
 Timeline: Runs horizontally across the top of the Gantt chart and shows months, weeks,
days, and years
 Dateline: A vertical line that highlights the current date on the Gantt chart
 Bars: Horizontal markers on the right side of the Gantt chart that represent tasks and show
progress, duration, and start and end dates
 Milestones: The diamonds that call out major events, dates, decisions, and deliverables 
 Dependencies: The lines that connect tasks that need to happen in a certain order
 Progress: Shows how far along work is and may be indicated by % Complete and/or bar
shading 
 Resource assigned: Indicates the person or team responsible for completing a task
Uses of Gantt chart
 To show the current schedule status
 To measure task duration in the project
 To represent cost, time and scope of the project
 A useful tool for planning and scheduling projects
 To plan how long a project should take
 Lays out the order in which the tasks need to be carried out
 Modern Gantt chart software provides dependencies between tasks
 To monitor a project’s progress
 To visualize immediately what should have been achieved at any point in time
 To assist in taking remedial action to bring the project back on course , if required
 Advantages of Gantt chart
 It helps in planning and monitoring the work of project
 Time is explicitly expressed in the chart
 All tasks are visible at a glance in relation to other
 Deadlines are depicted in the chart
 It organizes your thoughts.
 It demonstrates that you know what you’re doing.
 It (should) help you to set realistic time frames.
Disadvantages of Gantt chart
 They can become extraordinarily complex.
 The size of the bar does not indicate the amount of work
 They need to be constantly updated.
 Difficult to see on one sheet of paper.
BENCHMARKING

Definition

 Benchmarking is a process of finding what best practices are and then proposing what
performance should be in the future.
 It is a practice of identifying, understanding and adapting successful practice and processes
used by other companies, which help to improve chances of success in one’s own company.
The three principles of benchmarking are maintaining quality, customer satisfaction and continuous
improvement
Purposes
To improve the competitive position of a company.
To gain a better understanding of efficiency, effectiveness of business process.
To recognise the strength and weakness of company business.
To create a positive driving force in the company there by promoting more profits.
To learn from those who are excelling in performance.
To incorporate the best practices made possible through benchmarking.
The Bench marking Process
i. Planning-Benchmarking involves deciding what is to be benchmarked, who are the members
and partners and what data collection methods are going to be employed. Through this one
will come to know how to understand the business strategy in a better way.
ii. Analysis of Benchmarking- It involves analysing the performance of the partners and
comparing their work to figure out how and why they are better.
iii. Integration of Benchmarking- It involves developing the goals and combining them to
perform standard benchmarking to improve the performance. Main focus is on whether the
management agrees on the findings, whether there is any need to modify goals based on the
findings, and whether all goals are clearly explained to all the partners involved or not.
iv. Action in Benchmarking- This phase involves creation of action phase based on modified
goals. There is recalibration of benchmark in this phase. It involves new plans to achieve the
goals, plans to evaluate the progress and work schedule for recalibration of the benchmarks.
Stages of Benchmarking
i. Identify the subject or problem area- Identify the point where it needs improvement in terms of
quality control, satisfaction of consumers or profit increase.
ii. Defining the process- Be clear what should be benchmarked.
iii. Identify the potential barrier- Identify as to whom comparisons are made, their strengths and
weakness.
iv. Identify the data sources- Identify from where the information is obtained.
v. Collecting the data and selecting the partners-Analyse the information whether it is true or not.
Select the partners after detailed analysis.
vi. Determining the gap- Find out what is the correction to be made from the beginning
vii. Establishing difference in benchmarking process.
viii. Targeting future performance.
ix. Communicating efficiently
x. Modifying the goals framed
xi. Implement the newly framed goals of benchmarking
xii. Reviewing and recalibrating
Types
 The benchmarking literature can be mainly separated into two parts: internal and external
bench marking.
 Competitive, functional and generic benchmarking are classified under external
benchmarking .The process is essentially the same for each category. The main differences
are what is to be benchmarked and with whom it will be benchmarked.
Internal benchmarking
 Internal benchmarking covers two way communication and sharing opinions between
departments within the same organisation or between organisations operating as part of a
chain in different countries Advantages of internal benchmarking
 Ability to deal with partners who share a common language, culture and systems.
 Easy access to data, and giving a baseline for future comparisons.
 The outcomes of an internal benchmarking can be presented quickly.
 External benchmarking-External benchmarking requires a comparison of work with external
organisations in order to discover new ideas, methods, products and services
 Competitive benchmarking - Comparison with direct competitors only.
 Generic benchmarking -Refers to the comparisons of business function that are same
regardless of business.
 Functional benchmarking -Refers to comparative research and attempts to seek world class
excellence by comparing business performance not only against competitors but also against
the best businesses operating in similar fields and performing similar activities or having
similar problems, but in a different industry
Benefits
 It’s a powerful management tool because it overcomes “paradigm blindness” it can be
summed as “The way we do it is the best because this is the way we have always done it”.
 Benchmarking opens organisations to new methods, ideas, and tools to improve their
effectiveness.
 It helps crack through resistance to change by demonstrating other methods of solving
problem than the once currently employed.

BUDGETTING

 Budget word derived from the old English word Budgettee means a sack or pouch or leather
bag.
 Coined by British Kings and the concept is very old.
 Term budget now refers to the financial papers.
 Budget is defined as a statement of anticipated results during a stipulated period expressed in
financial and non- financial terms.

Definition:
 Budgeting is an operational plan, for a definite period usually a year
 A budget is a tool for planning, quantifying the plans and controlling costs.
-Finkler
 Budget is a numerical description of expected income and planned expenditure for an
organisation for a specific period of time.
 Budget is a financial plan of the government for a definite period.
-Taylor
  Expressed in financial terms and based on the expected income and expenditure.
 Budgeting is a concrete precise picture of the total operation of an enterprise in monetary
terms.
H.M. Donovan
Purpose of Budgeting:
 Mechanism for translating fiscal objectives into projected monthly spending pattern.
 Enhances fiscal planning and decision making.
 Clearly recognizes controllable and uncontrollable cost areas.
 Offers a useful format for communicating fiscal objectives.
 Allows feedback of utilization of budget.
 Helps to identify problem areas and facilitates effective solution.
 Provides means for measuring and recording financial success with objectives of organization
Characteristics of Budgeting:
 Should be flexible.
 Should be synthesis of past, present and future.
 Should be product of joint venture and cooperation of executive/department head at different
level of management.
 Should be in the form of statistical standard laid down in the specific numerical terms.
 Should have support of top management throughout the period of its planning and
implementation.
Importance of Budgeting:
 Needed for planning future course of action and control over all activities in the organization.
 Facilitates coordinating operation of various departments and sectors.
 Helps to weigh values and make decision when necessary.
Principles of Budgeting:
 Should provide sound financial management by focusing on requirement of the
organization.
 Should focus on the objectives and policies of the organization.
 Should ensure the most effective use of financial and non-financial resources.
 Programme activities should be planned in advance.
 Requires consistent delegation for framing and executive budget.
 Should include coordinating efforts of various departments establishing a frame of
reference for managerial decision and evaluate managerial performance.
 Requires an adequate checks and balance against adoption of too high and too low
estimates.
 Must be appropriate to nature of business, services and to the type of budget.
 Prepared under the direction and supervision of administrator or financial officer.
 To be prepared and interpreted throughout the organization.
 Requires review of performance of previous year and adequacy both quantitatively and
qualitatively.
 Provision should be made for flexibility.
Types of Budgeting:
1. Operating budget (Revenues and Expenses): Provides an overview of agency function by
projecting the planned operation for upcoming year. Deals with salaries, medical-surgical
supplies, office supplies, laundry services, books periodicals, recreation and contractual
services.
2. Capital expenditure budget: Related to long range planning. Includes physical changes
(replacement and expansion of plant, major equipments and inventories). They are major
investment and reduce flexibility in budgeting.
3. Cash budget: Planned to make adequate funds available and to use extra funds profitably.
Should not have too much cash on hand during budgetary period.
4. Labor or personnel budget: Estimate cost of direct labor necessary to meet agency
objectives. Determine the recruitment, hiring, assignment, layoff, discharge of personnel.
 Nurse Manager has to decide number of aids, orderlies required during a shift months and
areas.
5. Flexible budget: Some costs are fixed, others changes with volume of business. Some
expenses are unpredictable and can be determined only after change has begun. Periodic
reviews required to compensate for changes.
6. Strategic planning budget: Long range budget for long range planning. Projected for 3-5
years. Programme budget is a part of this budget.
7. Incremental: Based on estimated changes in present operation plus a percentage increase for
inflation, all of which is added to previous year budget.
8. Open ended: A financial plan in which each operating manager presents a single cost
estimate for what is considered optimal activity level.
9. Fixed ceiling budget: The uppermost spending limit is set by top executive before the unit
and divisional manager develop budget proposal for the areas of responsibility.
10. Roll over budget: Forecast programme, revenues and expenses for a period greater than a
year, to accommodate programme larger than annual budget cycle.
11. Performance budget: Allocates functions not divisions (direct nursing care, in service
education, nursing research, quality improvement).
12. Program budget: Where cost are computed for a total program (group total cost for each
service program). Example- MCH, FP, UIP.
13. Zero base budgets: Requires nurse manager to examine, justify each cost of every program
both old and new in every annual budget preparation.
14. Sunset budget: Designed to “self destruct” within a prescribed time period to ensure the
cessation of spend in by a predetermine date.
15. Sales budget: Is starting in budget program, since sales are a basic activity which gives shapes
to other activities. Compiled in terms of quantity and value.
16. Production budget: Aims at securing the economical manufacture of production and
maximizing the utilization of production facilities.
17. Revenue and expense budget: Expressed in financial terms and take the nature of Performa
income statement for future. Shows the item of profits and loss.
18. Cash budget: Prepared by way of projecting the possible cash receipts and payments over
budget period.
Budgeting Process:
 It is a systematic activity that develops a plan for the expenditure of a usually fixed resources
such as money or time during a given period to achieve a desired result.
 The budget process consists of activities that encompass the development, implementation
and evaluation of a plan for the provision of services and capital assets.
Steps
1. Establishment of operational goals and objectives and policies.
2. Goals must be translated into quantifiable management objectives for organizational
units. Departmental goals are made.
3. Formal plan for budget preparation and review including assignment of responsibilities
and timetable is prepared.
4. Departmental budget are revised and master budget is prepared.
5. Financial feasibility of master budget is tested and final document is approved and
distributed to all parties involved.
6. Every head of the office required to prepare budget estimate in respect of salaries of
establishment, contingent expenditure and others. Example- Telephone, office expenses,
rent of building etc
Preparing a budget estimate
Sl.no Income or Actual last year Current year Budget next year
Expenditure

Budget Actual Proposed Approved

Advantages of budgeting:
 Fixes accountability, assignment of responsibility and authority.
 Encourages managers to make careful analysis of operation.
 Weakness is revealed, corrective measures taken.
 Financial matters can be handled in orderly fashion. Activities are balanced.

Disadvantages of budgeting:
 Converts all aspects of organizational performance in monetary values. Only easy aspects can
be considered and equally important facts such as organizational development may be
ignored.
 May become an end in itself instead of means to end. Budgetary goals may supersede agency
goals.
 Skills and experiences are required for successful budgetary control.
 Time consuming and expensive.

COST BENEFIT ANALYSIS

Is a procedure by which all costs incurred in installing and operating a system are assessed and
converted to money and the ratio is calculated define the relationship of costs and benefits.
CBA is a tool for decision maker as he/she recognises the difficulty in determining the true costs and
benefits of various alternatives.
Cost benefit ratio(Z) is defined as the ratio of the value of benefits of an alternative to the value of the
alternative cost.
Z = Present value of economic benefits
Present value of economic costs
CBA is designed to estimate the social costs and benefits attributable to the projects. Benefits are
expressed in monetary terms to determine whether a given programme is economically sound and to
select the best of several programmes considered.
Techniques of cost benefit analysis
1. Cost of the programme is estimated
2. Outcome is estimated in terms of monetary units
The course of action that gives highest monetary returns for the lowest income is regarded as the best
one.
In the health field however benefits cannot be expressed in monetary terms. Benefits made is
translated such as morbidity and mortality preventing by considering the direct and indirect costs.
Limitations
 Difficult to convert indirect benefits into monetary benefits
 Can lead to confusion in calculation of monetary units.(eg. Intervention to prevent and
control of typhoid in community by providing protected water supply- added benefits not
only typhoid other water borne diseases also is prevented)
 Lead time (interval between the application of the intervention and benefits) is often too
long. Can lead to difficulty in converting the benefits into monetary units.
 Loss of benefit due to rejecting the other programme is not considered.

AUDIT
It is an assessment of the management practices, financials and operations of an organisation.
It is an evaluation of a person, organisation, system, process, enterprize, project or product.
Purposes
 It make sure that all the financial statement of concern are presented fairly.
 Audit gives a fair and true picture in accordance with financial reporting framework.
 It enhances the degree of confidence of intended users in financial statement.
Types of Audit
1. External Audit
2. Internal Audit
External Audit:
It is a review of the financial statements or reports of an entity usually a Govt. or business or someone
not affliated with the organisation or agency. This is an independent review of the financial
documents provided to the auditor. The audit is conducted by regularly agency hired by the entity and
the auditors are generally the public accountants.
Purposes:
 To ensure that internal control, processes, guidelines are adequate and in line with the Govt.
requirements.
 To provide an independent and unbiased assessments of an organisation internal governance
and financial matters.
 To verify internal procedures.
 To evaluate the adherence of the organisation to standard and principles.
 To evaluate the adequacy and effectiveness of existing internal control
Types
 Financial – Verification of financial statements.
 Operation – To detect errors in internal control procedures and machines.
 Compliance- To evaluate how employees are abiding by regulations in performing task.

Internal Audit:
It is an independent management function which involves a continuous and critical appraisal of the
functioning of an organisation with a view to suggest improvements and add value to and strengthen
the overall governance mechanisms of the organisation and including the organisation risk
management and internal control system.
Purposes:
 To establish standards and to provide guidance in respect of planning internal audit.
Objectives:
 To suggest improvement to the functioning of the organisation.
 To strengthen the overall governance mechanisms of the organisation including risk
management as well as internal control system.
 To prepare for external audit.
MATERIAL MANAGEMENT
Materials are the major cost factor in an organisation. It is one of the very important function of
management.
Materials may be defined as equipments, apparatus and supplies procured, stocked and utilised by an
organisation. These are the things needed for smooth functioning of an activity in the organisation.
Material management is a scientific technique, concerned with planning, organizing & control of flow
of materials form their initial purchase to destination.
Definition
 Material management can be regarded as the function responsible for the coordination,
planning, sourcing, purchasing, moving storing and controlling materials in an optimum
manner so as to provide service to the consumer at a minimum cost.
 Material management is the management and control of medical surgical clerical,
interdepartmental services and equipments from acquisition to disposition.
- Judith
 Material management is that aspect of management function that is primarily concerned with
the acquisition, control and use of materials needed and the flow of services connected with
the production, process having some predetermined objectives in view.
Aim of Material management
To have
 Right quality of material
 Right quantity of supplies of materials at right time, at the right place for the right cost.
Objectives of Material management
 To ensure the supply of availability of material quality, quantity and at right time and right
place.
 To avoid surplus of materials
 To have appropriate storage and easy to retrieve.
 To ensure distribution to the point of usage whenever required.
 To ensure effective and efficient utilisation of available resources.
 To optimising the use of resources to meet the needs in an efficient manner.
 To obtain correct quality of materials at lowest possible price.
Purpose of Material Management
 To gain economy in purchasing
 To satisfy the demand during period of replenishment
 To carry reserve stock to avoid stock out.
 To stabilize fluctuations in consumption
 To provide reasonable level of client services
 To increase efficiency of health care systems.
 To develop knowledge and skills of health care
 To provide materials in required quantity and quality as when required.

Basic Principles of Material Management

 Effective management and supervision; it deals on material functions of; planning,
organizing, staffing, controlling, report and budgeting.
 It should be based on sound purchasing method
 Skillful and hard poised(determined) negotiation
 Effective purchase system
 Should be simple
 Simple inventory control program
 Must not increase other costs

Functions of Material Management

 Material planning & budgeting
 Purchasing
  Inventory control
 Cost reduction Value analysis
 Receiving & inspection
 Stocking & distribution
 Disposal.
Elements of Material Management
 Material planning
 Purchasing
 Receiving & warehousing
 Store keeping
 Inventory control
 Value analysis
 Standardization
 Production control
 Transportation
 Material handling
 Disposal scarp

PROCEDURE

Demand estimation:
 Based on the data of past levels of performance and on plans, capital equipment, supplies to
be procured during the year ahead can be projected department wise. This is the materials
budget which should be prepared annually.
 Important in budgetary control and reduction of material cost is the concept of
standardisation. This involves grouping together similar items depending on their use so as to
choose one of these more universally acceptable for the purpose.
 Estimation of right amount of each material is the most crucial factor for maximising
availability with minimum wastage. Materials in a hospital may be requisitioned : For an
urgent / immediate use on a one – time basis or repeatedly and continuously to replenish the
stock ; As a single unit or a bulk requirement.
 The greater the crisis situation and immediate need for the item and the smaller the quantity
required, the greater will be the procurement price and the incidental cost of purchase. Bulk
price can be affected with maximum price discounts through demand forecasting.
Procurement
 Most organizations have a detailed set of rules and regulations regarding the procedure
for ordering for materials. An effective procurement system aims at purchasing of items
of acceptable quality, in appropriate quantities, at the minimum price and within the
available time.
 Purchases may be made by the individual department of the hospitals or by a single
purchase department. Centralised purchasing has the advantages in that quantity discounts
are possible because of standardization and bulk orders. There is better management
control as all aspects of purchase can be screened by the administration.
 A group of hospitals having common interest (e.g. locates in the same region), may also
get together and constitute an agency to effect bulk purchases on their behalf.
Receipt, inspection, acceptance and payment
Procedure for receipt, inspection and acceptance of supplies:
 While taking delivery from the road transporters, railways, customs, check containers for
deficiency and damages.
 If packing is damaged, insist on „open‟ delivery, checking quantity of packages, individual
items, weights, etc. against packing slip / challan.
 Any damage / loss should be registered immediately through a „claims‟ statement.
 Cross check with purchase order
 On receipt of the hospital checks supplies for discrepancies in quantity, quality, product
specifications etc.
 Record shortages, incorrect damaged material, out dated supply and take action accordingly.
 Carry out all necessary documentation, day book of receipt, goods inward note, purchase
register and bin card.
 Notify indenters of special purchase requisition regarding arrival of materials.
Procedure for payment:
 On accepting the goods and certifying correctness, send the bills to the accounts department
for payment.
 Before releasing payment, the account department should ensure that the bills bears proof of
receipts of goods, certification of acceptance and completion of purchase documentation.
Inventory control or storage and distribution
 It is the process of having the necessary equipment and supplies available at the
appropriate time. It means stocking adequate number and kind of stores, so that the
materials are available whenever required and wherever required. Scientific inventory
control results in optimal balance
 Storage and Preservation are an important part of the storekeeping function.
 When materials remain idle in the store these materials should be taken care of and
looked after properly. Otherwise these materials may get perished due to natural chemical
reaction like rusting by moisture, melting by heat etc and also may get affected by insets,
rats etc.
 The department stores should be conveniently located to facilitate easy receipt of
materials from suppliers and easy dispatch of supplies to the wards and departments. The
materials should be adequately protected from fire, pests, water sewage etc.
 Actions to protect the materials from various adverse effects:
1. Store must be of adequate space.
2. Divide the store in to homogenous sections with separate areas mark for different
groups of items e.g. stationary, furniture etc
3. No material should be stocked on the floor as it may be affected by dampness,
white ants etc.
4. Categorize items in a group based on their generic name/ application, store
similar items contiguously. Eg : a. Stationery, Electrical, Civil Engineering,
Cleaning and Similar items may be stocked in the steel racks. b. Medicine items
may be stocked in the fridge. c. Perishable items may be stored in the cold
 rooms. d. Explosive, film, and fuse items may be stored in the AC room. e.
Attractive items may be stored in shelves under lock and keys.
5. Keep heavy items as low and as near to the door as possible for easy retrieval.
Light items may be placed on top shelves
6. Daily and periodical cleaning should be carried out.
7. Daily and periodical verification of stock should be carried out to ensure
correctness of stock.
8. Proper method of handling should be followed to avoid damages to the
materials.
9. Preservation materials should be applied to protect the items.
10. Hazardous materials should be segregated and stocked in a separate store house
away from other store houses.
11. Safety precautions should be taken and safety appliances should be provided.
12. First-in, first-out principle to be followed
13. Follow two bin or double shelf system, to avoid Stock outs
14. Reserve bin should contain stock that will cover lead time and a small safety
stock
Maintenance and repair:
 Proper maintenance of equipment, furniture, and fixtures not only ensure their almost
continuous availability for use but also an extended life and productivity for the items, thus
resulting in lower material costs.
 Time and costs of maintenance can be reduced by consideration of following factors during
purchase :-
a) Durability:- Since the equipment will be handled by multiple users provide for an
element of over specification so that the item is more sturdy than that available for
single person use in the home environment.
b) Periodical disinfections: The external surface of the items should be washable and it
should provide for sterilization by moist heat, formalin vapour, spirit or other
disinfectants
c) Repair ability:- Go for items which are more easily repairable.
d) Spare parts availability:- Standardization of items and choosing those easily available
in the market ensures easy availability of spare parts required for repair and
mainaintence.
e) Operation and service manuals: When purchasing sophisticated equipment it is
essential to obtain the operating and service manuals so that repairs can be attended to
by the hospital maintenance department without relying on the supplier.
f) Service contracts:- Better terms for service are possible by negotiating service
contracts for maintenance prior to purchase of the equipment. Such contracts should
specify minimum number of preventive maintenance over hard schedules, service
charges etc.
g) Stand by units: Since the hospital work must carry on even when the equipment is
down, wherever possible it is necessary to provide for replacements to tide over the
period of repair .
Disposal/ condemnation:
Indents are often improperly examined and unofficial inventory builds up in wards / departments
because of hoarding of supplies. Thus the nursing supervisors should periodically inspect the stocks
attached to each ward and arrange for return of excess stock/equipment. Each hospital should also
have a condemnation to review used materials that are to be disposed off. At times it is possible to
recycle or reuse materials or find some other use for the item. If no further use can be found for
disposables, used consumables and damaged equipments, it may still have value as scrap.

PROCUREMENT
Is the sourcing and purchasing of goods and services for business use. It is also defined as the process
of obtaining goods and services from preparation and processing of a requisition through to receipt
and approval of the invoice for payment.
Procurement is defined as a systematic act of acquiring items that requires preparation, processing of
demand of supplies and equipment as well as obtaining the receipt and getting the approval of the
payment from the management.
Procurement process is a method by which items are purchased from external suppliers. It involves
managing the ordering receipt, review and approval of items from suppliers. A procurement also
specifies how the supplier relationship will be managed to ensure a high level of service is received.

Objectives of procurement system

 Acquire needed supplies as inexpensively as possible
 Obtain high quality supplies
 Assure prompt and dependable delivery
 Distribute the procurement workload to avoid period of idleness and overwork
 Optimize inventory management through scientific procurement procedures

Procurement process
 Need recognition- recognise the need for procuring the materials from the department either
from internal or external sources. The item may be one that needs to be reordered, or it may
be a new item for the unit.
 Specific need- determine specifications for the item required to be procured. Take help of
suppliers to visit the department or from engineering department.
 Source options- determine from where to obtain the product. The hospital might have an
approved vendor list. If not search for a supplier using purchase orders or a variety of other
orders such as magazines, internet or sales representatives etc.
 Price and terms- investigate all relevant information to determine the best price and terms for
the product. Usually look for three suppliers before it make a final decision.
 Purchase order- the purchase order is used to buy materials between the buyer and seller. It
specifically defines the price, specifications and terms and conditions of the product or
services and any additional obligations.
 Delivery- the purchase order must be delivered personally, email or other electronic means.
The recipient then acknowledges receipt of the purchase order.
 Expediting or follow up- Expedition of the purchase order addresses the timelines of the
service or materials delivered.
 Receipt and inspection of purchases- once the sender supplier delivers the product the
materials is checked for quality, quantity as per the order placed.
 Invoice approval and payment- three documents must match when an invoice requests
payments -the invoice itself the receiving document and the original purchase order. Any
discrepancies must be resolved before the bill is paid by the finance department.
 Record maintanence- in case of audits, the department must maintain proper records. These
include purchase records to verify any tax information and purchase orders to confirm
warranty information. Purchase records reference further purchase as well.
Methods in Procurement Process
 Open tender- public procurement method
 Restricted or limited tender-restrict/limit the request for tender
 Negotiated procurement –without formal advertising and formal price competition
 Direct procurement- manufacturing firms
 Rate contract- contract for a specified rate
 Spot purchase-contract of buying or selling a commodity
PURCHASING
Means to buy various materials by paying money or its equivalent from the suppliers.
Purchasing process may vary from organisation to organisation. But the major fundamental remains
the same. In this process materials are bought and acquired using standardised specifications
Purchasing process
Requisition----- find supplier and place order--------- send orders
Steps of purchasing
1. Requisition- identify the need, what to buy and how much of it and when it is needed to
deliver.
2. Supplier selection- identify supplier, price and lead time.
3. Purchase order- raise purchase order and send to supplier
4. Fulfilment- supplier procures the items and send to buyer
5. Order receipt- items are checked for quality and quantity as per the order placed.
6. Supplier invoice/ payment- supplier send the invoice which is processed by the finance
department before the supplier is paid.
Principles of purchasing
 Purchasing is based on the need assessment
 Aim of purchasing is right quality, right quantity, right prices, right sources and at right time
to the right place with the right mode of transportation and right attitude.
 Centralise the purchase system
 Back up of a good system management.

Storage
 Store must be of adequate space
 Materials must be stored in an appropriate place in a correct way
 Group wise and alphabetical arrangement helps in identification and retrieval
 First-in, first-out principle to be followed
 Monitor expiry date
 Follow two bin or double shelf system, to avoid stock outs
 Reserve bin should contain stock that will cover lead time and a small safety stock.
Issue and use
Can be centralized or decentralized

INVENTORY CONTROL
It is the process by which inventory is measured and regulated according to predetermined norms such
as economic lot size of order, safety stock, minimum level, maximum level, order level etc.
It means stocking adequate number and kind of stores, so that the materials are available
whenever required and wherever required. Scientific inventory control results in optimal balance.
Inventory control is the process of maintaining the optimum needed quantity that is sufficient for the
smooth functioning of the organisation.
Objectives of inventory control
 To supply the materials in time.
 To reduce or minimise investments in inventories
 To minimise the idle time by avoiding stock out and shortages
 To avoid shortage of stock
 To minimise the loss due to deterioration, damage of stock.
 To meet unforeseen future demand
 To average out demand fluctuations
 To balance various inventory costs such as carrying costs, order cost etc.
How to achieve inventory control
Inventory control can be achieved through
1. Purchasing items at economic price at proper time and in sufficient quantity.
2. Provision of suitable and secured location with sufficient space
 3. Inventory identification system
4. Upto date and accurate record keeping
Steps in inventory control
 Fixing minimum quantities or points of ordering and maximum quantities on all materials
 Arranging a method for allocation of materials and orders that are in process.
 Creating stores accounts that will control the store room

Functions of inventory control

 To provide maximum supply service, consistent with maximum efficiency and optimum
investment.
 To provide cushion between forecasted and actual demand for a material

Principles of inventory management

 Determination of quantity of order.

 Determination of reorder point of record level

Inventories classification

ABC analysis- ABC analysis helps us in segregating the items from one another and tells us how
much valued the items is and controlling it to what extent is in the best interest of the organization. It
is the analysis of stores items on cost criteria. It has been seen that a large number of items consume
only a small percentage of resources and vice versa.

 A items- Represents high cost centre

 B items- intermediate cost centre
 C items- low cost centre.

It is the process of classifying items by using values as measure.

The ABC method of inventory control

Also called as Pareto analysis. In ABC analysis, the entire lot of inventory is classified into three
groups based on their annual value and not on their individual cost given as:

Class A: High value items, which accounts for major share of annual inventory value. Stricter control
must obviously be applied on these items right from the initial stages of estimating requirement,
fixing the minimum stocks, lead time.

A items:

1. Rigorous value analysis

2. Rigid estimates

3. Strict and close watch

4. Management of items should be done at top management level

5. Centralized purchasing and storage

Class B: Medium value items, which do not belong to either of the classes and not so strict control
procedures, need be followed in regard to the items in this group.
B items

1. Moderate controls

2.Purchase based on rigid requirement

3.Reasonably strict watch and control

4. Management be done at middle level

Class C: Low values items, but are required in large quantities and consists of various types and
varieties like clips, washers. It needs only a simple and inexpensive system of control in which some
of the routine may be relaxed.

C items

1. Ordinarily control measures

2. Purchased based on usage estimates

3. Controls exercises by store keeper

4. Management be done at lower levels.

5.Decentralized (delegated) purchasing

VED ANALYSIS

In VED Method (vital, essential and desirable) , each stock item is classified on either vital, essential
or desirable based on how critical the item is for providing health services. The vital items are stocked
in abundance, essential items are stocked in medium amounts and desirable items we stocked in small
amounts. Vital and essential items are always in stock which means a minimum disruption in the
services offered to the people.

Vital:

Items without which treatment comes to standstill: i.e. non- availability cannot be tolerated. The vital
items are stocked in abundance, essential items and very strict control.

Essential:

Items whose non availability can be tolerated for 2-3 days, because similar or alternative items are
available. Essential items are stocked in medium amounts, purchase is based on rigid requirements
and reasonably strict watch.

Desirable:

Items whose non availability can be tolerated for a long period. Desirable items are stocked in small
amounts and purchase is based on usage estimate.

Sl.no Types Description

1. ABC analysis Type of inventory categorization method in which inventory is divided
into three categories, A, B, and C, in descending value. A has the highest
value items, B is lower value than A, and C has the lowest value.
2. VED analysis stands for Vital Essential Desirable
3 HML analysis Materials are classified according to their unit value as high, medium and
low
4 XYZ analysis X items are those whose stock values are high, while Z items are those
whose values are low and Y falls in between the two categories
5 FSN analysis Movement analysis forms the basis for this classification. The items are
classified as fast moving, slow moving and non-moving based on their
consumption pattern
6. SDE analysis Classification methods are based on source of supply. SDE classification
is a system where materials are sorted out as scarce to obtain, difficult to
obtain and easy to obtain.
7 GOLF analysis Classification is based on the availability and nature of supplies.
Government, Ordinarily, Local and Foreign
8 SOS analysis Raw materials can be classified into Seasonal and Off season items

Advantages

 Delivery on time
 Possibility of discount for bulk purchase.
 Unforeseen circumstances can be handled to some extent.
 Workers and machinery need not be idle.

Disadvantages

 Working capital is tied up.

 More space is required.
 Increase in insurance charges.
 Increase in overhead expenses.
 Increase in charges for damage, pilferage, replacement etc.
 Increase in charges for obsolescence.

DOCUMENTATION

Documentation is one of the important responsibilities of nurses which aim at facilitating

communication and decision making.

RECORDS

Records are defined as legalised administrative tools that are formally applied permanently to
document the provided nursing care

Purpose of Keeping Records

1. Communication.
2. Aids to diagnose
3. Education
4. Documentation of continuity.
5. Research
 6. Legal documentation
7. Individual case study

Types of Records
1. Patients clinical record.
2. Individual staff records
3. Ward records
4. Administrative records

REPORTS
A report is a system of communication aimed at transferring essential information necessary for safe
and holistic patient care.

Purposes
 To communicate progress of patient
 To prepare staff members for their daily work
 To provide quality and continuity of care
 To act as an aid in planning
 To coordinate care given by several people.
 To act as an aid in studying health condition
Types
 Oral
 Report between head nurse and assistant.
 Report of staff nurse to charge nurse.
 Report of charge nurse to physician
 Report of charge nurse to supervisor
 Report of supervisor to nursing director
 Written
 Census reports
 Reports on mistakes and accidents
 Interdepartmental reports