Nursing Administration Book

Nursing Administration Book

For
2nd Year Technical Nursing Students

Prepared by:
Nursing Administration department
Faculty of Nursing
Suez Canal University

Second Term
2023-2024

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Nursing Administration Book

Prepared by Members of Nursing Administration Department:

1 Prof. Wafaa Abdel Azeem Elhosany Professor of Nursing

2 Dr: Fathya Abdelrazik Afifi
Administration, Suez Canal
University
Associate Professor of Nursing
Administration - Suez Canal
University

3 Dr: Nadia Mohammed El-Sayed Associate Professor of Nursing

Administration - Suez Canal
University
4 Dr: Mahitab Mohammed Ahmed Lecturer of Nursing
Administration - Suez Canal
University
5 Dr: Alaa Mohamed Salah Lecturer of Nursing
Administration - Suez Canal
University
6 Dr: Esraa Mohammed Soltan Lecturer of Nursing
Administration - Suez Canal
University

7 Dr: Zainab Mohamed Hassan Lecturer of Nursing

Administration - Suez Canal
University

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Nursing Administration Book

Contents
No. Topics Page No.
1 Introduction to administration 4

2 Planning 10

3 Organizing 23

4 Organizational structure &chart 33

5 Staffing 43

6 Scheduling 50

7 Directing 57

8 Controlling 67

9 Leadership 73

10 Quality 81

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Nursing Administration Book

Introduction to administration
Out lines:

1- Definition of administration.
2- Definition of management.
3- Management process.
4- Principles of management.
5- Management levels

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Nursing Administration Book

Definition of administration:
It is a process to directing or organizing an agency or organizational agency
department to achieve the organizational objective.

*Administrative Nursing Care:

Care comprises those activities that are undertaken on the patient's behalf
but, removed from their environmental, social, financial welfare.

*Administrator:
A manager whose position is located in the next to top layer of organizational
hierarchy.

*Management
-It is an art and science of achieving objectives through others.
-It is the process undertaken by one or more persons to coordinate the activity
of other persons to achieve results
-It is the process of getting things done through the efforts of others people
this often involves the allocation, control of money and physical resources.

*Management Process
-Old Fasion
-New Fasion
(Old Fashion): posd c or b
P→Planning O→Organizing
S→Staffing &scheduling D→Directing
C→Controlling R→Recording & Reporting
B→Budgeting

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Nursing Administration Book

Planning:
Is a process of determining what should be done accomplished & how it
should be realized.
Is a method for accomplishment of objectives or goals.
Organizing:
Is a process of arranging physical facilities, equipment and personnel
to achieve goals and objectives.
Is a process of identifying the work and classifying activities, assignment
of responsibilities, delegate authority.
Staffing:
Is a process of determining and assigning the right personnel to the right job.
Is a process of balancing the quantity of staff available with the quantity and
mix of staff needed by the organization.
It's function is recruitment/ interviewing/ orientation/ scheduling and staff
development.
Directing:
Is the initiation and maintenance of action toward the desired objectives.
The usual function in this phase are motivation/ supervision/ delegation/
staff development/ communication and managing conflict.
Controlling:
Is the measuring and correction of the performance to make sure that
organizational objectives and plans devised to accomplished.
It's function is performance appraisal/ quality control and legal control.

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Nursing Administration Book

Recording:
They are administrative tools to classify and prevent duplication
of information for communication/care planning/ legal documentation/
research / education and auditing.
Reporting:
Is a document form which includes conclusions, finding based on facts.
Is orally or written reports.
Budgeting:
Is numerical expression of expected income and planned expenditures
for an organization for expected period of time.

(New Fashion)
The management process:
Planning → Organizing
↑ ↓
Controlling Directing
Principles of Management:
(1) Division of labor (2) authority
(3) Unity of command (4) Unity of direction
(5) Remuneration of personnel (6) Centralization
(7) Hierarchy of authority (8) Order
(9) Equity (10) Stability of Staff
(11) Initiative (12) Spirit of group
(13) Discipline (14) Subordinate of individual interest

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Nursing Administration Book

Management and Levels of Management:

Top
manag
ererere
r ma

Middle management

First level management

Operating employees

TOP LEVEL

Held by persons who carry the responsibility for the overall operation
of the organization as director of nursing service

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Nursing Administration Book

MIDDLE LEVEL

Held by persons to whom authority is delegated by individuals in the top

level positions as supervisors

FIRST LEVEL

Held by persons who direct the operation of one unit within a department
as head nurse

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Nursing Administration Book

Planning
Outlines:
❖Definition of Planning .
❖Characteristics of good plan.
❖Importance of Planning.
❖Steps of Planning.
❖ Elements of Planning.
❖ Types of Planning.
❖ Planning Hierarchy.
❖ Application of planning by:
1-Staff nurse
2-Head nurse
3-Matron

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Nursing Administration Book

Introduction

Planning is the first step of the management process that allows the
organization to deal with current situation and forecast the future.

Planning is the process of creation choices to attain the desired

outcomes.

In the healthcare field,

The nurse manager must be aware of decision-making process and tools

the organization purpose, philosophy, goals, objectives, budget t

develop an effective plan.

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Definition of planning:

It is a process of deciding in advance what should be done, how , when

and by whom it will be done.

It is a process that includes identifying organization's goals, developing

a comprehensive strategy to achieve those goals, and developing a
comprehensive set of plans to facilitate organizational work.

Planning can be formal or informal:

The characteristics of a good plan are:

Based on a clearly defined objectives.

estigation for activities to set standards of

performance.

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 Importance of planning

1- It achieves our objectives.

2- It saves time and effort.
3- It provides frame work for the organizational objectives.
4- It facilitates control and change.
5- It helps in shaping the future.
6- To build confidence and motivate personnel.
7- It encourages the economical use of resources.
8- It prevents confusion and promotes
cooperation.
9- It helps supervisor to direct subordinate.
10- Help supervisors to identify standard outpatient.

Steps of planning:

1. Analysis and understanding of the situation:

It involves collection, assessment and interpretation of information.

2. Formulation of objectives/goals.
3. Assessment of current organization capabilities-In terms of
resources.
4. Designing alternative course of action and selection.

5. Preparation of implementation plan. i.e. detailed action plan.

6. Control and Monitoring.

7. Evaluation.

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(1) Goals/ Objectives

- Are essential to planning because they outline the future conditions that the
planner considers satisfactory.

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(2) Actions

Are the indicated, preferred ways of achieving the goals.

(3)Resources- are constraints on a course of activity.
(4)Implementation entails assigning and directing workers to carry out the
strategy.

Types of Planning
A- According to usage:

Single use plan:

- Programs designed to be laid out in an orderly fashion, such as a roster,

nursing care plan, or nursing assignment.

Standing repeated use plan

- Policies, philosophy, strategy, and procedure are examples of plans that are
developed to be employed repeatedly when the need arises.

B) According to time span:

1. Long range plan:

Long range plan➔ look three or more years into the future.
It is called Strategic plan or complex organizational plans.
goals and objectives while
considering external environmental elements that have a long-term impact on
operations (5:10 years ).

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 2. Intermediate plan:

- Cover from 1-3 years. Tactile or functional plans are used by (Middle
Level Manager) as Supervisor to demonstrate the top management's
strategy to be carried out.

3. Short range plan:

- Cover from 1 day to 1 year. It is concerned with the efficient, day to day
use of resources allocated to the unit and directed towards the fulfillment
of unit objectives.

- It done by the First Level Manager. such as roster is monthly &

assignment is daily is done by head nurse.

- It is called as (operational plan).

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Planning hierarchy

There are many types of planning in most organizations; these plans form
a hierarchy, with the plans at the top influencing all the plans

Planning component at the top of hierarchy is more general and lower

component are more specific.

Vision

Mission

Philosophy

Goals

Objectives

Policies

Procedures

Rules

1. Vision statement:

- It is used to describe future goals or aims of an organization.

- Example:
Mercy hospital will be the leading center for trauma care in the region.

2. Mission (purpose) statement:

-It is a brief statement (Typically no more than 3 or 4 sentences) identifying

the reason that the organization exist.

- It influences the development of an organization's philosophy, goals,

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objectives, policies, procedures and rules.

- Actions taken at all levels of the organization should be congruent with

the stated organization mission.

- Example:
Mercy hospital is a tertiary care facility that provides comprehensive,
holistic care to all state residents who seek treatment. The purpose of
Mercy hospital is to combine high quality, holistic health care with the
provision of learning opportunities for students in medicine, nursing and
allied health sciences.

3. Philosophy statement:

- Philosophy flow from the mission statement and delineates the set of
values and beliefs that guide all actions in the organization.

- It is the basic foundation that directs all further planning toward that
mission.

- Philosophy is operationalized by goals and objectives.

- Example:
The board of directors, medical and nursing staff, and administrators of
Mercy hospital believe that human beings are unique. Each patient is
considered a unique individual with unique needs. Identifying outcomes
and goals, prescribing strategy options, and selecting an optimal strategy
will be negotiated by the patient, physician and health care team.

Goals: -It is can be defined as the desired results toward which effort is
directed
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- It is the aim of philosophy.
- Goals much like philosophies change with time and require periodic
reevaluation and prioritization.

-Goals global in nature, should be measurable and ambitious but realistic.

- Types of goals:

- Strategic goal: are goals set by and for top management of the
organization. They focus on broad general issues.

- Tactical goals: are set by and for middle managers. Their focus is on how
to operationalize actions necessary to achieve strategic goals.

- Operational goals: are set by and for lower level managers. Their
concern is with shorter term issues associated with the tactical goals.

- Example:
All RNs will be proficient in the administration of intravenous therapy.

4. Objectives:

- They are similar to goals in that they motivate people to a specific end
are explicit, measurable, observable and attainable.

- Objectives are more specific and measurable than goals because

- Goals usually have multiple objectives.
- Example:
The objectives of the previous goal may be:
- RNs will complete Mercy hospital course "IV therapy certification"
within one month of beginning employment.

- RNs who score less than 90% on a comprehensive examination in "IV

therapy certification" must attend the remedial 4 hours course "review of
basic IV principles.
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5. Policies:

- Policies are plans reduced to an instructions or statements that direct

organization in their decision making.

- These comprehensive statements derived from organization's philosophy,

goals and objectives.

- They guide the general course and scope of organizational activities.

- They define broad limits and desired outcomes of commonly recurring
situations.

- Policies should be evidence based.

- Example:
- Policy for sick leave or vacation time.
6. Procedures:

- They are plans that establish acceptable ways of accomplishing a specific

task and delineate a sequence of steps of required action.

- Procedures identify the process or steps needed to implement a policy and

are generally found in manuals at the unit level of the organization.

- Example:
Procedural statements regarding how to request vacation or holiday time
on specific unit.

7. Rules:

-Rules and regulations are that define specific action or non action.
- Generally included as a part of policy and procedure statements.
- Rules describe situations that allow only one choice of action.
- Rules are fairy inflexible.
- Existing rules, however, should be enforced to keep morale from breaking
down and to allow organizational structure.

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 Regulation:
Policies produced at a middle-level position in an organization, often
known as departmental policies. They are guidelines that exclusively
apply to certain departments, such as I.C.U. nursing protocols.

Routine:
A policy that specifies when an activity must be completed, such as
taking the temperature of all patients every day at 6 a.m.

A standard:
Is a descriptive professional expression of intended or agreed-upon level
of performance that must be visible, achievable, and quantifiable.

A budget:
Is a numerical depiction of an organization's projected income and
planned expenditures for a specific time period.

Criteria:
Are specified quantifiable factors that show whether or not a standard has
been reached and to what extent it has been satisfied.

Application of planning:
BY STAFF NURSE
Drawn the nursing care plan based on patients' current needs.
Develop time framework (Time Log) for her daily activities
Determine the equipment needed to accomplish designed plan.
Determine equipment needed for the emergency.
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 Determine the time needed to accomplish her special duties.
Update designed plan and re plan for the new patient's problem

BY HEAD NURSE
-Develop time frame for her daily activity for nursing round,
-Participation in medical round, conference, committees.
-Design assignment sheet to distribute work to nursing staff
-Check nursing care plan for professional nurse
-Design nursing care plan for nonprofessional nurse
-Determine number of staff nurse needed to deliver care.
-Determine equipment needed for the unit
-Determine equipment needed for the emergency
-Assess quantity and quality of equipment, supplies in the unit.
-Determine sterilization and housekeeping.
-Assess nursing care given to patient in her unit.
-Review patient's charts daily.

BY MATRON
-Develop the philosophy , objectives , standard , policies for the nursing care
of patients , nursing services.
-Develop nursing standard, job description, policies and procedure for nursing
department.
-Draw the roster (time schedule) for nursing supervisor in hospitals
-Determine the number of staff nurses needed to provide nursing care in all the
shifts.
-Determine time she needs for the overall daily activities to accomplish her
managerial duties as walking round, conference, committees and meeting.
-Plan for educational program for staff development.
-Draw up the disaster plan to maintain safety.
-Determine supplies and equipment's needed for work.
-Participate in determine budget needed
for nursing department.
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 Organizing

Outline:

 Introduction of organizing

 Definition organizing
 Importance of organizing
 Principles of organizing

 Elements of organizing

 Organizational structure

 Organizational chart

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Introduction:

Once manager have set goals and developed workable plan, the next
management function is to organize people and the other resources necessary to
carry out the plan

Definitions

- Deciding how best to group organizational activities and resources.

- The establishment of the authority and relationships with provision for
coordination between them, both vertically and horizontally in the enterprise.

- It is the process of identifying and grouping of work, defining

responsibilities, and coordination of interrelated activities.

Importance of organizing
1. Encourage specialization

2. Eliminating the problems of duplicating and overlapping

3. Bring order and cohesiveness
4. Improve administration
5. Facilitate effective communication
6. Help in providing a balanced emphasis on various activities
7. Help in smooth delegation of authority

Principles of organizing

1. Unity of commands:
Each subordinate should have one superior only.
2. Chain of command (Scalar principle):
- It is the clear line of authority from the top to the bottom of an
organization.

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 - All members of the firms should know to whom they report and who, if
anyone, report to them.

3. Span of control (span of management):

- The number of employees reporting to a manager.

-The fewer the employees supervised, the smaller or narrower the span of
management.

-The span of management in an organization is related to the number of

its organizational levels, which determine the organizational height.

- In a tall organization, there are many levels with narrow spans of

management.

-In a flat organization, there are few levels with wide spans of
management.

Factors influencing the span of control:

1. Competence of superior and subordinates (the greater the
competence, the wider the potential span)

2. Similarity of tasks being supervised (the more similar the tasks, the
wider the potential span)

3. Frequency of new problems (the higher the frequency, the narrower

the potential span).

4. Degree of required interaction (the less required interaction, the

wider the potential span).

5. Extent of standardized procedures (the more procedures, the wider

the potential span).

4. Division of labor:
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- With division of labor, employees have specialized jobs.
5. Coordination:

- Coordination is the process of linking the activities of the various

departments of the organization.

- Coordination techniques:
1. The managerial hierarchy: Placing one manager in charge of
interdependent departments or units.

2. Liaison roles: It coordinates interdependent units by acting as a

common point of contact. This individual facilitates the flow of the
information among units

3. Task forces: When interdependence is complex and several units are

involved, a single liaison person may not be sufficient. Instead, a task force
might be assembled by drawing one representative from each group. When
the project is completed, task force members return to their original
position.

4. Integrating departments: These are somewhat similar to task forces

but are more permanent. An integrating department generally has some
permanent members as well as members who are assigned temporarily
from units that are particularly in need of coordination.

6. Delegation:
- It is the process by which mangers assign apportion of their total workload
to others.

- Flatter organizations require more than taller organizations.

- Responsibility and authority are delegated down the chain of command.

- Reasons for delegation:

1. Enable manager to get more work done.
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 2. Help in developing subordinates.
3. Improve managerial skills of subordinates.
- Problems in delegation:
1. Manager may not delegate appropriately.
2. Some manager may worry that subordinates will do too well and pose
a threat to their own advancement.
3. Manager may not trust the subordinate to do the job well.

7. Balanced responsibility and authority:

- Each individual is given the authority necessary to meet his responsibility
and is held accountable for meeting them.

8. Flexibility:
- The organization should adopt built-in devices for any change, expansion,
etc.

- The organizational structure shouldn't be rigid.

9. Decentralization and centralization:

- Decentralization is the process of systemically delegation power and

authority throughout the organization to middle and lower level managers.

- Centralization is the process of systemically retaining power and

authority in the hands of the higher level managers.

Factors determine an organization's position on the decentralization-

centralization continuum:

1. The organization's external environment (the greater the complexity

and uncertainty of the environment, the greater is the tendency to
decentralize.)

2. The nature of decision being made (the costlier and the riskier the
decisions, the more pressure there is to centralize)
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 3. The ability of lower manager (if the lower manager do not have the
abilities to make high quality decision, there is likely to be a high level of
centralization).

10. Unity of directions:

- There must be one only plan for a group of activities directed toward the
same goal.

11. Functional definition:

- The duties and responsibilities must be properly defined
- There should not be any duplication or overlapping of activities.
Elements of organizing

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1. Designing the job:

- It is the determination of individual's work related responsibilities.

- The nature starting point for designing jobs is determined the level of desired
specialization.

Job specialization

- It is the degree to which the overall task of the organization is broken down and
divided into smallercomponent part.

- Benefits of specialization:
1. Workers performing small, simple task will become very proficient at task.

2. Transfer time between tasks decreases.

3. When an employee is absent or resigns, the manager is able to train someone
new at relatively low cost.

- Limitation of specialization:
1. Workers may become bored and dissatisfied.
2. There is no challenge or stimulation.
3. Absenteeism rises and the quality of the work may suffer.
- Alternatives to specialization:
- To counter the problems associated with specialization, managers have
sought other approaches to job design.
1. Job rotation is an alternative to job specialization that involves systemically
moving employees from one job to another.

- Jobs that are amenable to rotation tend to be relatively standard and routine.

- It is most often used today as a training device to improve workers skills and
flexibility.

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2. Job enlargement

- It was developed to increase the total number of tasks the workers perform.

- As a result, all workers perform a wide variety of tasks, which reduces the level
of job dissatisfaction.

- They are often offset by some disadvantages:

1. Training costs usually increase
2. Unions have argued that pay should increase because the worker is doing more
tasks.

3. Job enrichment

- It is increasing the degree of the responsibility a worker has over his or her job.

- For example:
1. Encouraging workers to develop new skills.
2. Allowing the workers to decide how to do the work and how to respond to
unexpected situations.

3. Allowing workers to monitor and measure their own performance.

- The idea behind the job enrichment is that increasing workers responsibility
increases their involvement in their jobs and thus increases their interest in the
quality of the service they provide.

4. Job characteristics model

- Every job has five characteristics

1. Skill variety: The extent to which a job requires that an employee uses a wide
range of different skills, abilities or knowledge.

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2. Task identity: The extent to which the worker does a complete or identifiable
position of the total job

3. Task significance: The perceived importance of the task.

4. Autonomy: The degree of control the worker has over how the work is
performed.

5. Feedback: The extent to which the worker knows how well the job is being
performed.

- The higher the job rates on those dimensions, the more employees will
experience various psychological states.

- Experiencing these states, in turn leads to high performance, high motivation,

high satisfaction and low absenteeism and turnover.

2. Grouping job: departmentalization

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- The process of grouping jobs is called departmentalization.
- Common bases of departmentalization: Functional, location, customer
departmentalization.

Functional departmentalization

- The most popular base for departmentalization, especially among smaller

organization.

- It is grouping jobs involving the same or similar activities.

- Advantages:
1. Each department can be staffed by the experts in the functional area.
2. Supervision is also facilitated
3. Coordinating activities inside each department is easier.
Disadvantages:
1. Decision making tends to be more bureaucratic and slower.

2. Employees may begin to concentrate too narrowly on their own units and lose

sight of the total organization system.

3. Establishing reporting relationships:

Through clarifying the chain of command and the span of control.

4. Distributing authorities:

Two specific issues that managers must address when distributing authority are
delegation and decentralization.

5. Coordinating activities

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 Organizational structures

Outline:

• Definition of organizational structure

• Importance of organizational structure
• Types of organizational structure
• Definition of organizational chart
• Steps to draw an organizational chart
• Types of organizational chart

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 Definition:
- The arrangement of position in the organization into work unit or
departments and the interrelationships among these units or departments.

- Determinant of the type of the organizational structure:

- The organizational environment:

If external environment is stable. Managers can make organizing choices that

bring more stability or formality to the organizational structure.

- Technology:

- The more complicated the technology, the more need to flexible structure
to enhance managers' ability to respond to unexpected situations.

- Human resources:

- The more likely skilled organization's workforce and the greater the number
of employee, the more likely an organization is to use a flexible, decentralized
structure.

- Organizational life cycle:

- Progress through which the organizations evolve as they grow and mature.

- As an organization passes from one stage to the next, it becomes bigger and
more decentralized.

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 - Importance of organizational structure:
- It facilitates execution of their mission, goals, reporting lines and communication
within the organization.
- It reveals information about size of the nursing services department.

- It shows the different function in the nursing department.

- It shows span of control of each manager in the nursing department.

- It shows level and layers of supervision and channel of communication.

- It can be used for orientation of newly hired employees.

- Types of organizational structure:

Line (scalar) structure

Is traditional system.

It is hierarchal and resembles a pyramid with the boss on top.

-The approvals and orders in this kind of structure come from top to bottom

It is suitable for small organization.

Advantages:

Easy to orient new personnel.

Responsibility, authority and accountability are clearly defined.

Promote fast decision making.

Efficiency and simplicity of relationships.

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Disadvantage:

Weak integration of different division

Concentration of authority at the top make employee to refer problem to superiors.

Lack of specialized skill &knowledge.

Make adjusting to altered circumstances difficult.

They often produce monotony, alienate workers.

Communication only happens from top to bottom.

Decisions are taken by a single person and can go wrong.

Line/ Staff structure

Line position: A position in the direct chain of command that is responsible for
the achievement of the organization's goals.

Staff position: A position intended to provide expertise, advice and support for
line position.

Line and staff structure combines the line structure where information and
approvals come from top to bottom, with staff departments for support and
specialization.

A cooperative relationship must be maintained between line and staff personnel

if goals are to be achieved.

-Staff personnel are purely advisory (consultant or specialist) to the line

structure and has no authority.

It is suitable for small organization.

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Advantages:

Employees are less stressed.

Authority and responsibility are clearly defined.

Efficiency and simple of relationship.

Disadvantage:

May produce monotony, alienate workers. May

create conflict between line &staff.

As staff specialists exist, it is costlier than a simple line organization.

Decision-making may be time-consuming.

Functional structure

- Staff officer are no purely advisory, but have some command authority over
line employee for certain function.

-This is frequently done with advisory positions in areas as (nursing education,

infection control, hospital risk management.)

Advantages:

Right of staff specialist to issue orders in a designed area.

Disadvantage:

Potential conflict resulting from principles of unity of command.

The structure can become very complicated.

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Ad Hoc structure

Group of diverse specialists are temporarily joined to perform an on routine task

of a complex nature and critical importance.

It is a modification of line structure.

Advantages:
Creates flexibility among workers than dose line structure.
Disadvantage:
Decreased strength in the chain of command.

Decreased employee loyalty to the parent organization.

Matrix structure

Employee clearly work for two or more managers.

-It has a formal, vertical and horizontal chain of command.

For example the director of the maternal child care could report both to a vice
president for maternal and woman's services (product manager) and the vice
president for nursing services (function manager).

There are fewer levels of hierarchy and less formal rules.

Advantages:

Facilitate acquisition and development of specialized inputs.

Provide flexibility.

Disadvantage:

Violet unity of command.

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 Expensive.

Dual authority promotes power struggles.

Decision making may be slow.

Organizational chart

Definition:

It is a graphic illustration of the organization's management hierarchy and

departments and their working relationships. Each box represents a position in
the organization and each line indicates the reporting relationships and lines of
communication.

Steps in drawing Chart:-

 Draw chart of present department plan, actual working one.

 Review department function, determine what activities are needed.

 Express department activity in terms position to define responsibility

 Each job title is then enclosed in a box.

 To place these boxes in the chart, review relationship between different departments

 Lines of authority are symbolized by solid and dotted lines.

Advantages of organizational chart:

 Map lines of decision making authority.

 Help people to understand their assignments and those of their coworkers.

 Reveal to manager and new employee how they fit into the organization.

39
  Show formal lines of communication.

Limitation of organizational chart:

 Show only formal relationships.

 Does not indicate degree of authority.

Types :-

(Vertical Chart)

-It shows high-level management at the top with formal lines of authority
down the hierarchy

-It is most common.

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 (Horizontal Chart)

-It shows high level management at the left with lower position to the right.

6. It shows relative length of formal lines of authority

41
 (Circular chart)

-It shows high level management in the center with successive
position in circles.

-It shows the outward flow of formal authority from high level management

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 Staffing
Outline:
 Definitions of staffing
 Steps of staffing.
 Objectives of staffing in nursing
 Factors influencing staffing.
 Types of Staffing.
 Component of staffing.
 Patient care delivery system
 Formula for computing the number of staff needed in the In- patient
areas of hospital

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Introduction

The staffing phase of the management process includes ascertaining that there are
adequate numbers of personnel available to meet daily unit needs and organizational goals.

Definitions of staffing

- It is the manpower planning to have the right person in the right place.
- It is the activities required to insure that an adequate number and mix of health care
team member are available to meet patient need and provide safe quality care.

Recruitment steps

1. Identifying the type and amount of services needed by the agency.

2. Determining the personnel categories that have the knowledge and skills to perform
needed services.

3. Predicting the number of personnel in each job category that will be needed to
meet the anticipated service demands.

4. Obtaining, budgeted positions for the number in each job category needed to
service for the expected types and number of client.

5. Announcing for personnel to fill available positions.

6. Screening interview: Is an opportunity to determine in a general way whether the

candidate is qualified and suitable for the job

7. Selecting and appointing personnel from suitable applicants.

8. Combining personnel into desired configurations by unit and shift.

9. Orienting personnel to fitful assigned responsibilities.

44
10. Assigning responsibilities for client services to available personnel.

11. Continuous staff development for employees.

Objectives of staffing in nursing

 Establish a balance between the nursing staff available with the manpower
required, according to the number of patients and their care needs.

 Improve staff morale, job satisfaction and quality care with decrease in
turnover and vacancies.

 Evaluate staffing practices periodically.

 Utilize skills of manpower to their fullest.
 Provide new employees with orientation period.

Factors influencing staffing

1. The client to be served:

Some dimensions to determine the type and amount of care are diagnosis,
prognosis, age, sex, acuteness of illness, length of stay in hospital, medical therapy
required, physical restrictions of the client, emotional response to the illness and
teaching needs.

2. The hospital:
The physical setup of the hospital like placement of nursing units in one building
or over a wide geographical area , the size of these units, number of private rooms,
location of supportive services.

3. Policies and composition of medical staff:

The absence or presence of interns, time and frequency of ward rounds, amount of
administrative work involved, and amount of non-nursing and nursing activities

45
carried out.

4. Administrative policies:

Administrative policies governing patient and unit management, methods and

frequency of recording and reporting, supervision and the system of evaluation.

5. Presence/absence of clerical assistance:

The clerical responsibilities are taken up by the nursing staff in the absence of a
ward clerk. Most of her nursing hours would be wasted, which otherwise would
be utilized for nursing activities.

6. Factors inherent in the nursing staff:

The qualification, experience, ratio, number of students, stability or frequency of
staff members and policies for clinical assignments

Types of Staffing

1- Basic permanent staffing:

It is determined based on average patient care requirements and nursing tasks to

be performed by level of nursing staff.

2. Supplementary staffing:

It is needed when demands for patient care excess the capability of the basic
staff. It includes:

(A) Borrowing method:

This is a common method of borrowing staff from units that have the most to help
those who have too little number of staff.

(B) Floating Staff:

Group of nurses who are permanent workers but do not belong to any special

46
 unit. They are used to fill patient care activities while absence among the unit
staff increase.

(C) On Call Staff

-It is filled with fixed staff who receives extra pay for being on call whether
or not they are called.

Components of Staffing

1-Staffing plan
Indicate scheme mathematically derived to indicate how many people of what
classification must be hired in order to deliver staffing pattern.

2-Staffing patterns:
Is a plan for how many persons of what job classification should be on duty per each
unit per shift, per day

- Staffing pattern is a relatively permanent document built on several assumptions:-

1) Each unit will continue to admit the same type of patients (similar acuity) in
the same period of time determined for staffing pattern.

2) Patient needs can be averaged- out per unit on a daily basis, and can be
converted into the number of required nursing hours.

3) The converted number of nursing hours will remain relatively constant from
day to day.

Patient classification system

PCS is method and process of determining, validating and monitoring

individual patient care requirements over time in order to assist in such determination
as: unit staffing, patient assignment, budget planning per patient cost of nursing

47
service, and the maintenance of standard of care.

Three basic styles of PCS:

1-Descreptive:
The nurse classify the patient in the category that most closely describes the care
received. This style is a quick check guide. But many administrators have moved
away from this subjective style of PCS.

2-Cheklist-style:
Is acuity table divides descriptions of care routines into activity categories

.Activity levels are described in each category

3-Time Standard or relative value unit:

Systems assign a value unit (usually a measure of time) to various activities of
patient care. Those activities are usually clustered according to categories such as
diet, bathing, and mobility.

Formula for computing the number of staff needed in the In-patient areas of
hospital

- Number of staff (fulltime) need in department= Total number of nursing

hours need by the given number of patients per year ÷ Actual total number of
nursing working hours per year

To calculate total number of nursing hours needed by the given number of

patients per year:-

1-Caculate total number of patients in each care category

2- Calculate total number of nursing hours need in each category per day

48
= No of patient in each category × Average of nursing hours needed per day

3- Calculate total no of nursing hours needed in all categories per day

4- Calculate total no of nursing hours needed in all categories per year = Total no
of nursing hours per day for all categories × 365

Actual total number of nursing working hours per year:

- Nurse doesn't work all 365 day per year

- Actually working days per year = 365 - 92 (52 day off + 20 vacations days + 10
ill days + 10 vacation days) = 273 day

- Total actual working hours per year = 273 × 8 (average working hours daily) =
2184 hour

- But nurse don't work 365 day, she work only 273

- To calculate no of staff needed to cover the relief of the year:

- Total holidays days by all staff = No of holidays per year × No of full time staff

- No of full time people needed for holidays average = Total holidays ÷

Total days worked by person per year

-Total No of staff needed in department = No of full time staff needed + No of full time
people needed for holiday coverage

49
 Scheduling
Outline:

 Definitions of scheduling.

 Principles of scheduling.

 Systems of developing time scheduling

 Working hours scheduling patterns.

 Various scheduling methods

50
Definitions of scheduling

It is assigning personnel specific days and specific hours of work.

It is one of the elements of staffing, concerned with planning days and hours of
work.

It is a planning pattern of on_ off duties hours for employees in a particular unit
for a given period of time.

Principles of time scheduling:-

1- Provide schedule for 4-8 weeks at a time

2- Head nurse is rarely off duty on Saturday which is the beginning of the

week

3- One day apart must be planned between days off of the HN and the

assistant nurse for adequate reporting.

4- A day off after night shift is given

5- No accumulation of days off, to insure adequate rest and relaxation for

staff members

6- Slight overlapping time should be kept between shifts to provide chance for
shift report.

7- Ensure flexibility to overcome personnel needs such as sick leaves,

vacations, and holidays.

8- Equal distribution of desirable and undesirable work hours

9- Provide a professional nurse on duty at all times during 24 hours period

10- After completing schedule changes should be more limited

51
 11- Percentage of on duty staff in inpatient department in Morning:
Evening: Night should be 45%: 37%: 18% (approximately).

Systems of developing time scheduling

1- Centralized scheduling:

 Most of the staffing decisions are made by a central office or staffing center.
 One individual frequently performs staffing functions for all nursing
departments.

 Although the unit manager continue to have the option of making

adjustments.

Advantages:

 It is more equitable to all employees

 The first level manager is left free to complete other management functions.

Disadvantages:

- Limited flexibility for the workers as it is as unable to easily account for the
worker's interests or special needs.

2. Decentralized scheduling:

- Nurse managers are given authority and assume responsibility to staff their
own units.

Advantages:

 Staff gets more personalized attention.

 Staffing is easier and less complicated when done for a small area instead
of the whole agency.
52
 Each manager learns the responsibility and challenges of scheduling staff.

- Disadvantages:

 The employees may be treated unequally and inconsistency.

 It is time consuming for the managers.

Self-scheduling:

 It is a scheduling system that is coordinated by staff nurses, taking into

consideration policies and variables affecting staffing.

 The number of nurses needed per shift must be determined.

 Self-scheduling saves the manager time.

 It changes the role of the manager from supervisor to coach.

 It increases staff members' ability to negotiate with each other.

 It is associated with increased perception of autonomy, improved

professionalism, increased job satisfaction, more cooperative atmosphere,
improved team spirit, decreased absenteeism, and reduced turnover.

Computerized scheduling:

All data necessary for time planning are fed to the computer and a program for
scheduling is designed based on the fed data. The computerized scheduling is
more effective than the other types.

Working hours scheduling patterns

Eight-Hours shift:

53
 • It is a traditional pattern.

• The 5-day, 40-hour work week.

• The shifts are usually 7AM to 3.30 PM, 3 PM to 11.30 PM, and 11 PM
to 7.30 AM.

Ten-Hour shift:

• A10-hour-day, 4-day work week.

• It also may be a 10-hour-day, 7-day work week (one works for 7 days
and then has 7 days off).

• The main problem is fatigue.

• The long weekends and extra days off are attractions.

Twelve-Hour shift:

• Some work 3 days (36 hours) a week.

• Others work 7 days (84 hours) in 2 weeks.

Advantages:

- Lower staffing requirements.

- Lower cost per patient-day.

- Better continuity of care.

- Job satisfaction and nurse patient relationship are improved.

- Nurses find they have more time to relax and enjoy their days off.

Disadvantages:

54
 • Nurses complain that their social lives suffer on the days they work.

• Increase in minor accidents and medication errors.

• Increase exhaustion and tension.

Various scheduling methods

Alternating or Rotating work shift:

-The frequency of rotating through all 3 shifts varies among institution.

-Some nurses may work all three shifts within 7 days.

-It increases stress and turnover.

-It disrupts development of work groups.

Permanent shift:

• Nurse has fixed shift in work schedule.

• Decrease absenteeism and turnover.

• There is a difficulty to evaluate evening and night shifts.

• Makes it harder for nurses to appreciate the workload or problems of

other shifts.

Cyclic scheduling:

 Basic time patterns for certain number of weeks is established and then
repeated in cyclic.

55
  It allows personnel to know schedule in advance.

 It permits personnel to schedule social events.

 It decreases time spent in scheduling.

 It decreases floating.

 It is rigid.

Block scheduling:

- Means that the work schedule for a unit is planned in a “block” of week,
i.e. days to be worked by staff are blocked together.

- Block scheduling is done for 4-8 weeks at a time

Advantages of block schedule Disadvantages of block

schedule
(1) It can be calculated easily. This type of scheduling does not
provide for maximum level of
(2) It has flexibility in that the
care seven days a week
next block of time does not
necessarily need to follow the
pattern of the preceding block

56
 Directing

Outline:

 introduction
 Meaning of directing
 Definition of directing
 Important of directing
 Function of directing
 ELEMENTS OF DIRECTION

57
INTRODUCTION:

- Directing/Direction is very important and necessary function of

management.

- Management has to undertake various activities like, guide people,

inspired and lead them as well as supervision of their activity is required in
order to achieve desired results.
MEANING:

Directing implies moving into action. It involves issuing orders & instruction&
taking steps to get them carried out property.

It is refer to a continuous task of making contacts with subordinators,

training them, giving them orders, leading and motivating them.

It is the ((doing phase)) of management requiring the leadership and

management skill necessary to accomplish the goals of organization.

IMPORTANCE OF DIRECTING

It initiates Action
It Integrates employees efforts
It is the means of motivation
It facilitates to implement changes
It creates balance in the organization.

ELEMENTS OF DIRECTION

 supervision.
 delegation. motivation.
 staff development.
 communication & understanding

SUPERVISION
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It is day-to-day relationship between a manger and his subordinates, and it
is commonly used to cover the training, direction, motivation,
coordination ,maintenance of disciples.

Purpose of Supervision

1-To provide suitable working condition

2-To promote a spirit of cooperation between employees
3-To maintain maximum standard
4-To orient, train and guide the individuals based upon their needs
development of new skills

5-To ensure that every patient receive good care.

6-To develop each staff member to highest potential.

Components of Supervision:-

Supervision is a kind of planning and teaching it involves:-

1-advising 2-guiding

3-helping 4-correcting

5-encourageing 6-inspecting

9-making assignment and

10-observation
Principles of Supervision:-

 It is based on the needs of the individual.

 Good supervision is cooperatively planned.
 In good supervision is democratic in nature.
 It stimulates the staff to continuous self-improvement.
 It respects the individuality of staff members.
 Orders and commands should be given in very rare cases.
 Avoid playing favorites.

59
 Helps create a social, psychological, physical atmosphere.

Categories of Supervision:-

A-ON SITE

- Is physically present or immediately available while the activity is being

performed

-It generally occur in the acute

B-OFF SITE

-In which the nurse has ability to provide direction through various means
of written, verbal and electronic communication

-May occur in home health setting and long term care facilities.

Technique of Supervision:-

Observation
Short informal conferences
Formal conferences

Techniques of observation

1-learn to see what you look at

2-learn to see the situation as it is
3-Consider each person as an individual
4-Try to be objective about what you see
5-look for relationship between what you see and what are the overall
situation appear.

6-be interested in what you see

7-learn to listen
8-observe during round
9-obseve continuously
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10- observe during reports

11- observe after all care has been given

Short informal conferences

-It refers to no specific regular time for holding these conferences. The
head nurses go around the ward while nurses are in action. She can raise
question about the condition of patient and work.

(Formal conferences) It include:

Assignment conference*
*Patient centered conferences
*Development of nursing care plan

1)-ASSIGNMENT CONFERENCES:
- Provide an opportunity to impact information about patient care
- In which staff members make decision about how they will work together.
(2)-PATIENT CENTERED CONFERENCES:
-Discuss patient need
-Define solutions to patient care problems

- Summarized nursing measures that are used for all who care for patient
- These management techniques promote communication among staff
- Involve them in learning more about patient care through planning and
evaluating patient care.

Delegation

Definition of Delegation:-

- It is the process of assigning work from a supervisor to subordinates and

giving them power , authority and responsibility to accomplish the
assigned work.

- It is the assigning part of the job to someone else

61
- Delegation for authority &responsibility only
but, accountability is not delegated.
- Authority is the right to make decision, issue orders, and use resources.
- Responsibility is the obligation to achieve objectives by performing
required activities.

- Accountability is the evaluation of how well individuals meet their

responsibilities.

Basic Principles of Delegation:-

1- A clear cut outline of duties, responsibilities and relationship should be

2- Authority should be delegated within specially defined limits to avoid

stepping on other's right.

3- Define objectives and suitable measure for determining performance.

4- Every manager should be completely accountable for the methods and
results of the work assigned too.

Delegation by Nurse Manager Effectively:-

1-Accept and understand the need, important and value of delegation.

2- Understand her responsibility and authority.
3- Determine the portion of authority that she want to delegate.
4- Specific goal and objective of the delegated task.
5- Know subordinates capability and limitation &matches them to the task
being delegated

7- Define clearly the standard of accountability.

8- Ensure that the subordinates understand the tasks delegated to them
9- Train subordinates, give them authority, details ,opportunity for written
instructions if needed.

10- Assesse results, accept the fact that subordinates will perform
delegated tasks
62
Motivation
Definition of Motivation:-

-It is an essential element of the direction task .

-It is the force that energize, direct, sustain person's effort.
-It a process that occurs internally to influence and direct our behavior to
satisfy needs.

-Need
Feed Satisfaction or Dissatisfaction

Importance of Motivation:-

1- Improves communication between people.

2- Increases interpersonal relationship.
3- Improves performance and productivity.
4- Improves job satisfaction, self-esteem and creativity.
5- Accomplishment of organizational goals.
6- Increase moral of the individual.
7- help person to forget the past failure.

Types of Motivation: -

Positive Motivation
1-Financial
2-Non Financial

Motivating Factors: -

1- Health status:-
Continual motivation require physical and psycho motor energy
2- Self-concepts:-
A person's perception of his / her capabilities influences that person's
63
motivational capacity

3- Organization:-
Adequate staff members, sufficient equipment and available supplies affect
motivation

4- Opportunities available:-
When the opportunities to learn and grow in the work situation is lacking,
motivation is stifled

5- Leadership style:-
Using leadership style appropriate to specific situations and staff members
' experience levels is appositive motivator.

6- Peer relationship:-

Dissatisfying peer relationships can result in job dissatisfaction and

resignations.

Characteristics of Sound Motivation:

-It should be a permanent feature of an organization.

-It should be well understood by all employees.
-It should be equitable.
-It operations should be evident to all
-It should be directly related to efforts

Following strategies must be used in motivation

1) Have clear expectation to workers.
(2)Be fair consistent when dealing all employees
(3) Develop the concept of teamwork.
(4) Integrate staff need and wants
(5) Remove traditional block between
employees

64
 (6) Give subordinate recognition
(7) Create a trustful

Staff Development

Definition of Staff development:-

-Is activities that taken place to upgrade the nursing personnel

performance. Consisted of two components in-service education
&continuing education.

-is a planned learning experience within and outside the agency in order to
help a person perform more effectively

Components of Staff Development

In-service education Continuing education
-Is the learning activities that done -Is the learning activities that are
inside the organization. granted to the employee outside the
organization.
-Is not concerned with salary raise or
promotion. -Is concerned with certification and can
be used to improve the salary rate or
-Aim at improving the employee
changing the personnel position
performance.
(promotion)
-Has 3 types of programs:
e.g.: conference
1.orientation program

2.skill training program post graduate education

3.leadership, management
program

65
Communication

-It is a complex, dynamic process that involves a sender and a receiver, and
message.

-It is a process of exchanging information, ideas, thoughts, feelings and

emotions through speech, signals, writing, or behavior.

66
 Controlling

Outline:

1. Definitions of controlling
2. Importance of controlling
3. Controlling process
4. Elements of controlling
5. Techniques of controlling

67
Definitions

is verifying whether everything occurs in conformity with the plan adopted,

the instructions issued, and principles established.

Control is the use of formal authority to assure the attainment of the

purpose of action to the fullest extent possible.

Control is the process by which managers assure that resources ( human &
physical) are obtained and used effectively and efficiently in the
accomplishment of the organizational objectives.

Purpose of Controlling

1- Developing effective organizational plans through continues

measurement of progress , feedback.

2- Assuring the organizational efficiency

3- Helping supervisors in problem identification and applying the
appropriate corrective action.

4- Having sufficient qualities of staff.

5- Know whether the operation is economical.
6- Determining if desired performance has been achieved.

The elements of control:

The four basic elements in a control system:

(1) The characteristic or condition to be controlled
(2) The sensor
(3) The comparator
(4) The activator

The first element:

68
The characteristic or condition of the operating system which is to be
measured.

-The characteristic can be the output of the system during any stage of
processing or it may be a condition that is the result of the system.
The second element

The sensor:
Is a means for measuring the characteristic or condition.
The third element:

The comparator:
- Determines the need for correction by comparing what is occurring with
what has been planned.

- Some deviation from plan is usual and expected, but when variations are
beyond those considered acceptable, corrective action is required.
The fourth element:

The activator
Is the corrective action taken to return the system to expected output

Process of Controlling:

1. Setting Objectives and performance standards.

2. Measurement of actual performance.

3.Comparing actual performance with standards.
4. Analyzing deviations.
5. Correcting deviations (Taking Corrective Action).

Setting Objectives and performance standards:

The control process begins with planning and the establishment of

performance objectives. Performance objectives are defined and the
standards for measuring them are set.

69
Measuring Actual Performance:
The supervisor collects data and measures the activities of nursing
management, compares standards with actual care.
Comparing results with objectives and standard:

-The supervisor must check and appraise performance against these

standards to determine whether it meets the expected standards or not

Taking Corrective Action

Taking any action necessary to correct or improve things.

Types of Control

1. Preliminary Sometimes called the feed forward controls; they are

accomplished before a work activity begins. They make sure that proper
directions are set and that the right resources are available to accomplish
them.

2. Concurrent Focus on what happens during the work process. Sometimes

called steering controls, they monitor ongoing operations and
activities to make sure that things are being done correctly.
3. Post action Sometimes called feedback controls; they take place after an
action is completed. They focus on end results, as opposed to inputs and
activities.

4-Internal Controls: Allows motivated individuals to exercise self-control.

The potential for self-control is enhanced when capable people have
clear performance objectives and proper resource support.

5-External Controls: It occurs through personal supervision and the use of

formal administrative systems. Managers take direct action to control
the behavior of employees
Controlling Techniques:

70
Direct Supervision and Observation:

'Direct Supervision and Observation' is the oldest technique of controlling.

The supervisor himself observes the employees and their work. This
brings him in

solved during supervision. This technique is most suitable for a small-

sized business.

Financial Statements:

- All business organizations prepare Profit and Loss Account

- It gives a summary of the income and expenses for a specified period.
-They also prepare Balance Sheet, which shows the financial position of
the organization at the end of the specified period.

- Financial statements are used to control the organization.

- The figures of the current year can be compared with the previous year's
figures.

- They can also be compared with the figures of other similar

organizations.

Break Even Analysis:

- Break Even Analysis or Break Even Point is the point of no profit, no
loss.

- It means that, any sale below this point will cause losses and any sale
above this point will earn profits.

- The Break-even analysis acts as a control device.

Management by Objectives (MBO):

MBO facilitates planning and control. It must fulfill following

requirements:-

71
- Objectives for individuals are jointly fixed by
the superior and the subordinate.
- Periodic evaluation and regular feedback to evaluate individual
performance.

- Achievement of objectives brings rewards to individuals.

Management Audit:

- Management Audit is an evaluation of the management as a whole.

- It critically examines the full management process, i.e. planning,
organizing, directing, and controlling. It finds out the efficiency of the
management.

- To check the efficiency of the management, the company's plans,

objectives, policies, procedures, personnel relations and systems of control
are examined very carefully.

- Management auditing is conducted by a team of experts.

Self-Control:
- Self-Control means self-directed control.
-A person is given freedom to set his own targets, evaluate his own
performance and take corrective measures as and when required.

-Self-control is especially required for top level managers because they do

not like external control.

-The subordinates must be encouraged to use self-control.

72
 Leadership

Outline:

 Definition of leadership, Leader, and Manager.

 Differences between Leaders and Managers.

 Quality of good leader.

 Relation between leadership and empowerment

 Responsibilities group leader.

 Types of leadership styles.

73
Introduction of leadership:

Leadership occurs any time a person attempts to influence

behavior, opinions, or believes of persons or group.

It is combination of personality traits, learned leadership skills,

characteristics of situation.

Leaders may have no formal authority but influence others.

Definition of leadership:

It is the ability to influence others to attain high standards of

performance and achieve organizational goals.
Definition of Leader:

1. Is anyone who uses interpersonal skills to influence others to

accomplish a specific goal.
2. The leader is important in building links- creating connection-
among an organization's members to promote high level of
performance outcomes.

Definition of Manager:

Is an individual employed by an organization that is responsible and

accountable for efficiently accomplishing goals of the organization.

Differences between Leaders and Managers:

Managers:
 Have formal position within the organization.

 Have a legitimate source of power.

 Carry out specific functions, duties, and responsibilities.

74
 Emphasis control, decision-making, decision analysis, and
results.
 Manipulate people, the environment, money, time, and
other resources to achieve organizational goals.
 Have a responsibility and accountability.

 Direct willing and unwilling subordinate.

 Have a short-range view

 Ask how and when

 Have eyes on bottom line

 Accept status quo

 Do things right

Leaders:

 May not be part of the formal organization.

 Obtain their power through influence.

 Have a wider variety of roles than do managers.

 Focus on group process, information gathering, feedback,

and empowering others.
 Emphasize interpersonal relationship.

 Direct willing followers

 Have goals that may or may not reflect the

organization goals .
 have a long-range view

 ask what and why

75
  have eyes on horizon

 challenge status quo

 do the right thing

Quality of good leader:

A leadership style is a leader's style of providing direction, implementing

plans, and motivating Autocratic leader

Keeps firm, close control over followers by keeping close of policies and
procedures given to followers. These leader emphasis on the professional
relationship, direct supervision
Advantages:

Less time consuming in emergency or crisis.

76
 Useful when employee is less experience and leader more skillful.

Some people feel secure in fixed rules .

Disadvantages;

Less commitment.

Doesn't encourage initiative or cooperation between group members

that make frustration and confusion.
Decrease creativity rate.

Decrease feeling of responsibility and become more hostile and

apathy.
Decrease job satisfaction.

2. Democratic
The leader shares the decision-making with subordinate to promote the
interests of them and practice social equality. This style of leader makes
discussion, argument, sharing of ideas and encouragement of people to feel
good about their involvement.
Advantages:

Encourage all employees to participate in decision making.

Greater commitment that increase job satisfaction.

Decision made effectively.

Increase creations.

Good relationship between employee and leader.

Security from open discussion.

Increase feeling of responsibility.

Disadvantages:
77
  Lack of efficiency when there is lack of maturity and skills.

 Time consuming.

 Ineffective in emergency.

3. Laissez-faire or "hands off"

The leader delegates tasks to employees while providing little or no
direction.
Laissez-faire leaders allow followers complete freedom to make decisions
concerning the completion of the work through providing all materials
necessary to accomplish their goals, but does not directly participate in
decision making unless the followers request his assistance.
Advantages:

Increase creativity rate

Increase job satisfaction when employees are highly skilled.

Increase employees trust on themselves.

Increase autonomy .

Disadvantages:

Followers feel insecure at the unavailability of a leader.

The leader cannot provide regular feedback to their followers.

No unity of action that decrease productivity.

4. Transformational
A transformational leader is not limited by their follower's perception.
Their main objective is to work to change, or transform their followers'
needs, and redirect their thinking. There are three identified characteristics
of a these leader:
78
 Charismatic leadership- have a broad knowledge of field, self-
promoting, high energy level, and willing to take risk and stimulate
their followers to think independently
Individualized consideration

Intellectual stimulation

5. Transactional
The transactional leaders focus on motivating followers through a system
of rewards and punishments. There are two factors which form the basis
for this system;
Contingent Reward Provides rewards, (materialistic or
psychological), for effort and recognizes good performance.
Management-by-Exception allows the leader to maintain the status
quo. The leader intervenes when subordinates do not meet
acceptable performance levels and initiates corrective action to
improve performance. Management by exception helps reduce the

workload of managers being that they are only called-in when

workers deviate from course.
A transactional leader establishes and standardizes practices that will help
the organization reaches to maturity, goal-setting, and efficiency of
operation, increasing productivity.
A transactional leader is:
1. Negatively affected when the emotional level of team member is
high.
2. Positively affected when the emotional level of team member is low.

Forces affecting leadership Styles:

1-Forces within the leader;

79
  His / her values

 His or her quality to be good leader

 Extent of power

 Degree of confidence about group members

 Degree of comfort in leader ship role

 Feeling of security in uncertain situations

2- Forces within the group members:
 size of group

 commitment of acommon goal

 Readiness for responsibility

 Degree of maturity

 Tolerance for ambiguity

 Readiness to share in decision making

3- Forces within the Situation;

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 Quality
Outline:

 Introduction
 Definitions
 Three aspects of quality
 Dimensions of quality.
 Perception of quality by the health care triad
 The importance of quality.
 Deming’s 14 points of quality

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Introduction

Quality is the result of a carefully constructed culture; it has to be the fabric

of the organization-not part of the fabric, but the actual fabric. It is not hard
for a modern management team to produce quality if they are willing to
learn how to change and implement.

Definitions

Quality:

- The ability of a product/service to satisfy stated or implied needs.

- Doing the right things right the first time and every time.

Brown 2001
- Freedom from deficiencies and product features (fitness for use)

Juran in 1989

Health care quality:

-The degree to which health services for individuals and populations

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

-The proper performance (according to standards) of interventions that are

known to be safe, affordable to the society, and have the ability to produce
an impact on morbidity, mortality, disability and malnutrition.

Steps of quality concepts development

1. Quality control: Quality control is a process that is used to ensure a certain

level of quality in a product or service.

- Most often, it involves thoroughly examining and testing the quality of

products or the results of services.

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- The goal of the quality control team is to identify products or services that
do not meet standards of quality.

2. Quality assurance:

- Quality assurance is used to ensure that a product is manufactured or

service is delivered in the right way.

- Quality assurance focuses on enhancing and improving the process that

is used to create the end result, rather than focusing on the result itself.
3. Quality management:

Management activities and functions involved in determination of quality

policy and its implementation through means such as quality planning and
quality assurance (including quality control).

4. Quality improvement (QI):

It is systematic process of organization wide participation and partnership

in planning and implementing continuous improvement methods to
understand, meet or exceed customer needs and expectation and improving
patient outcomes.

5. Total quality management (TQM):

- A real and meaningful effort by an organization to change its whole

approach to business in order to make quality a guiding factor in everything
the organization does.

-It is a management philosophy that emphasizes a commitment to

excellence throughout the organization.

6. Continuous quality improvement:

- CQI is a philosophy that encourages all health care team members to

continuously ask: “How are we doing?” and “Can we do it better?"

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 - It does not respect existing standards
- It is continually demanding new ones.
Three aspects of quality

1. Measurable quality: can be defined objectively as compliance with, or

adherence to, standards.

2. Appreciative quality: is the comprehension and appraisal of excellence

beyond minimal standards and criteria, requiring the sometimes even non-
articulate judgments of skilled, experienced practitioners and sensitive,
caring persons.

3. Perceptive quality: is that degree of excellence that is perceived and

judged by the recipient or the observer of care rather than by the provider
of care.

Perception of quality by the health care triad

1. Quality from the community point of view:

- A service that is available all the time.
- Easily accessible.
- Feeling of comfort.
- Politeness of health providers.
- Relieves symptoms and prevents illness
2. Quality from the health team point of view:
- Technical skills.
- Availability of resources.
- Suitable work conditions and environment.
- Achieving the target outcome.
3. Quality from the health manager point of view:
- Best service.
- With least possible cost.
- And achieving best outcome.

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Dimensions of quality Appropriateness:
- The degree to which the care/intervention is relevant to the patient’s
clinical needs, given the current state of knowledge.

- It is concerned with doing the right things in accordance with the purpose.

1. Access to service:
- The degree to which appropriate care/ intervention is obtainable to meet
the patient’s need.

- It means that health care services are unrestricted by geographic,

economic, social, cultural, organizational, or linguistic barriers

2. Competency:
- The degree to which practitioner adheres to professional standards of care
and practice.

- It refers to skills, capability, and actual performance of health providers,

managers, and support staff.

3. Continuity:

- The degree of coordination of needed healthcare services for a patient or

specified population among all practitioners and across all involved
organization over time.

- It means that the client receive the complete range of health services that
he or she needs, without interruption, cessation, or unnecessary repetition
of diagnosis and treatment.

4. Effectiveness:
- The degree to which care is provided in correct manner to achieve the
desired outcome.

- It is concerned with doing things right.

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5. Efficacy:
- The potential, capacity, or capability of the care to produce the desired
effect or outcome, as already shown, e.g., through scientific research
(evidence-based) findings

- The power of a procedure or treatment to improve health status.

6. Efficiency:
- Efficient services provide the greatest benefit within the resources
available.

- It is the relation between outcomes and the resources used to deliver care.
- It is concerned with the delivery of a maximum number of units‖ of health
care for a given unit of health resources.

7. Caring and respect:

The degree to which patients are involved in the decision and the provider’s
reaction in the meantime to the patient needs and expectations.

8. Safety:
- The degree to which the organization environment is free from hazard.
- It is concerned with minimizing risks of adverse outcome for both patient
and provider as a result of healthcare intervention.

9. Timelines:
The degree to which needed care and services are
provided to the patient at the most beneficial or necessary time.
10. Prevention/Early Detection:
The degree to which interventions, including the identification of risk
factors, promote health and prevent disease.

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The importance of quality
Business success may simply be the extent to which your organization can
produce a higher-quality product or service than its competitors are able to
do at a competitive price.

1. The number of defects is likely to decrease.

2. The organization will be able to produce more units with fewer resources.

Deming's 14 points

1. Create constancy of purpose toward improvement of product and

service.
2. Adopt the new philosophy that it is possible for things to be done right
the first time through effective training.
3. Cease dependence on inspection to achieve quality.

4. Instead, minimize total cost. Move toward a single supplier for anyone
item, on a long-term relationship of loyalty and trust.
5. Improve constantly and forever every process for planning, production,
and service.
6. Institute training on the job.

7. Develop the leadership in the organization.

8. Drive out fear by encouraging employees to participate actively in the

processes.
9. Promote teamwork: Foster interdepartmental cooperation, and break
down barriers between departments.
10. Eliminate slogans, exhortations and targets for the work forces.

11. Eliminate numerical quotas for the work force and numerical goals for
management.
12. Remove barriers that stifle pride in workmanship: Poor management,

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inadequate instructions and faulty equipment get in the way of continuous
improvement.
13. Institute a vigorous program of education and self-improvement for
everyone.
14. Put everyone to work to accomplish the transformation.

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References:
 Envisioning a Healthier Future, Caroline D. Bergeron, Mary E. Northridge ,Am J
Public Health. 2015 April; 105(4): 612. Published online 2015 April. doi:
10.2105/AJPH.2015.302609 PMCID: PMC4358207

 A Framework for Describing Health Care Delivery Organizations and

Systems, Ileana L. Piña, MD, MPH, corresponding author Perry
D. Cohen, PhD, David B. Larson, MD, MBA, Lucy N. Marion, RN, PhD, MN,
Marion R. Sills, MD, MPH, Leif I. Solberg, MD, and Judy Zerzan, MD, MPH
2015 April. doi: 10.2105/AJPH.2014.301926,
 AHRQ. Consumer Assessment of Healthcare Providers and Systems.
2014. Available at: https://www.cahps.ahrq.gov. Accessed April 22, 2014.
 Vera Whole Health | Posted September 10, 2020 | Posted in Advanced
Primary Care, Employers, Multiemployer Groups, Payers

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