CONTROL AND

CO-ORDINATION

CONTROL

DEFINITION
. Controlling is determining what is being
accomplished. That is, evaluating the performance
and if necessary, applying corrective measures so
that performance takes place according to plans
George Terry
Controlling consist of verifying whether every thing
occurs in conformity with the plan adopted,
instructions and principles established
Henry Faol
Control is the process of taking step in getting actual
results and desired results close together.
Philip Kotler

PRE REQUISITES FOR EFFECTIVE

CONTROLLING
plans
Organisational structure

PRINCIPLES OF CONTROL

Principles of assuring of objectives

Principle of efficiency of control:
Principle of future control
Principle of direct control
Principle of reflection of plan
Principle of organizational suitability
Principle of individuality of control
Principle of standard
Principle of critical point control
Exception principle
Principle of action

CHARACTERISTICS OF CONTROL

Managerial function
Circular process
Forward looking
Necessary at all levels of management
The essence of control is action which adjust
performance to predetermined standards
Positive and constructive approach
Wide scope
Tool to achieve organizational goal
Not an interference
Remedial activities

A COMPARISON BETWEEN PLANNING AND

CONTROL

Planning

Control

Provide a sense of direction

Allocates the resources

Anticipate problems
Motivates employees to
achieve goal
Gives emphasis on
impersonal, abstract and long
range problems
It is less structured
Top managers spend much of
time

Evaluation of results is
difficult
Seeks consisted and
integrated programmes

Guides activities toward

organizational goal
Insures the effective utilization of
organizational process
Correct problems
Reward employees for goal
achievement
Give more emphasis on personal,
concrete and immediate
problems.
It is highly structured
Operating employees spend
much time
Results are often soon visible
Seeks to compel events to
confirm to plans

NEED AND IMPORTANCE OF CONTROL

Growing size of business

Changing environment

Inherent part of managerial process

To facilitate the delegation

Efficient uses of resources

Prevent crisis and mistakes

Encourages success

Enhances employee morale.

Promotes coordination

STEPS IN THE CONTROL PROCESS

1.
2.
3.
4.

Establishment of goals and standards

Measurement of performance
Comparing performance against standard
Taking corrective action

Establishment of goals and

standards
Generally performance standards serve
three important purposes
Standards reflect expected and planned
results. They help employees understand
what is expected of them and how their
work will be evaluated.
They provide a basis for finding deviation
from fixed targets
They help reduce the potential negative
effects of goal incongruence

TYPES OF CONTROL
On the basis of management levels
Strategic control
Tactical control
Operational control
On the basis of time of their operations
1. Feedforward or steering control
2. Concurrent control
3. Feedback control

On the basis of activities

Control on policies
Control over organization
Personnel control
Wages and salary control
Production control
Inventory control
Cost control
Office control
Overall control

TECHNIQUES OR METHODS OF CONTROL

General techniques of control

personal observation
Setting examples
Records and reports
Policies and procedures
Charts and manuals
Standing rules and limitations
Written instructions
Censure

TECHNIQUES OR METHODS OF
CONTROL
Disciplinary action
Control unit
social control device
Rewards
Budgets
Accounting
Internal auditing Statistical data
Break even analysis
Self control

II. Special techniques of control

Human asset accounting
Standard costing
Cash flow analysis
Management information system
Cybernetic control system

PROBLEMS AND LIMITATIONS OF CONTROL

Quantifications
Long run result are unpredictable
No control on external factors
Difficulty in setting standards
Difficulty in fixing responsibility
Limits of corrective action
Time consuming

LEADERSHIP ROLES AND MANAGEMENT

FUNCTIONS ASSOCIATED WITH QUALITY
CONTROL

Leadership Roles
1.Encourage followers to actively be
involved in the quality control process.
Clearly communicates expected standards
of care to the subordinates
Encourage the setting of high standards to
maximise the qualities instead of setting
minimum safety standards
Uses control as a method of determining
why goals were not met.

Is active in communicating quality control findings

and their implications to other health professionals
and consumers
Act as a role model for followers in accepting
responsibility and accountability for nursing actions
Distinguishes between clinical standards and
resource utilization standards , ensuring that
patients receive at least minimally acceptable levels
of quality care.
Supports /actively participates in research efforts to
identify and measure nursing sensitive patient
outcomes

Management
Functions

.Establishes clear cut measurable standards of
care and determines the most appropriate
methods to care and determines the most
appropriate method for measuring if those
standards have been met.
Selects and uses process, outcome , and
structure audits appropriately as quality control
tools.
Access appropriate sources of information in data
gathering for quality control
Determines discrepancies between care provided
and unit standards and seeks further information
regarding why standards were not met.

Management Functions
Uses quality control findings in determining
needed areas of staff education or coaching
Keeps abreast of current government ,
accelerating body , and licensing regulations
that affect quality control.
Actively participates in state and national
benchmarking and Best Practices initiatives
Continually assesses the unit or organizational
environment to identify and categorize errors
that are occurring and proactively reworks the
process that led to the errors

QUALITY ASSURANCE

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
Quality assurance is a management system designed to give
maximum guarantee and ensure confidence that the service provided is
up to the given accepted level of quality, the standards prescribed for that
service which is being achieved with a minimum of total expenditure.
-British Standards Institute

QUALITY ASSURANCE

Objectives
To successfully achieve sustained improvement in
health care, clinics need to design processes to meet the
needs of patients.
To design processes well and systematically monitor,
analyze, and improve their performance to improve
patient outcomes.
A designed system should include standardized,
predictable processes based on best practices.
Set Incremental goals as needed.

QUALITY ASSURANCE

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.

QUALITY ASSURANCE
Principles
Customer focus
Leadership
Involvement of people
Process approach
Continual improvement
Factual approach to decision making
Mutually beneficial supplier relationship

Approaches
General approach
Specific approach

General approach
Credentialing
Licensure
Accreditation
Certification
Recognition
Academic degree

Specific approach
Audit
Direct observation
Appropriateness evaluation
Peer review
Bench marking
Supervisory evaluation
Self-evaluation
Client satisfaction
Control committees
Services
Staging
Sentinel

Areas of QA
Outpatient department
Emergency medical services
In- patient services
Specialty services
Training

Quality tools
Chart audits
Failure mode and effect analysis:
prospective view
Root- cause analysis: retrospective view
Flow charts
Pareto diagrams
Histograms
Run charts
Control charts

Quality assurance cycle

PERFORMANCE APPRAISAL
DEFINITION

performance appraisal is a systematic, periodic and so far as humanly

possible, an impartial rating of an employees excellence in matters pertaining to
his present job and to his potentialities for a better job

Edwin flippo

The performance of an employee is compared with the job standards. The job
standards are already fixed by the management for an effective appraisal.

Performance appraisal is a record of progress for apprentices and regular

employees, as a guide in making promotions, transfer or demotions, as a guide in
making lists for bonus distribution, for seniority consideration and for rates of pay,
as an instrument for discovering hidden genius, and as a source of information that
makes conferences with employees helpful.

scott, clothier and spriegal,

OBJECTIVES OF APPRAISAL.
1. To determine the effectiveness of
employees on their present jobs so as to
decide their benefits.
2. To identify the shortcomings of
employees so as to overcome them through
systematic guidance and training.
3. To find out their potential for promotion
and advancement.

PURPOSES AND BENIFITS

1.To provide backup data for management decisions
2. To serve as a check on hiring and recruiting practices
and as validation of employment tests.
3. To motivate employees by providing feedback about
their work.
4. To discover the aspirations of employees and to
reconcile them with the goals of the organization,
5. To provide employees with recognition for
accomplishments.
6. To improve communication between supervisor and
employee, and to reach an understanding on the
objectives of the job.

PURPOSES AND BENIFITS

7. To help supervisors observe their subordinates more closely,
and to give supervisors a stronger part to play in personnel
management and employee development
8. To establish standards of job performance.
9. To improve organizational development by identifying training
and development needs to employees and designing objectives
for training programmes based on those needs,
10. To earmark candidates for supervisory and management
developments
11. To help the organisation to determine if it is meeting its goals.

The principal obstacles to effective performance

appraisal

1.Lack of support from top management.

2. Resistance on the part of evaluators because:
a. Performance appraisal demands too much of
supervisors efforts in terms of time, paperwork, and
periodic observation of subordinates performance.
b. Supervisors are reluctant to play god by judging others.
c. Supervisors do not fully understand the purpose and
procedures of performance appraisal.
d. Supervisors lack skills in appraisal techniques.
e. Performance appraisal is not perceived as being
productive.

3. Evaluation biases and rating errors, which result in

unreliable and invalid ratings.
4. Lack of clear, objective standards of performance.
5. Failure to communicate purposes and results of
performance appraisal to employees.
6. Lack of a suitable appraisal tool.
7. Failure to police the appraisal procedure effectively.

PRINCIPLES OF PERFORMANCE
APPRAISAL
1. Single employee is rated by two ratters. Then, the
comparison is made to get accurate rating.
2. Continuous and personal observation of an employee
is essential to make effective performance appraisal.
3. The rating should be done by an immediate superior
of any subordinate in an organization.
4. A separate department may be created for effective
performance appraisal.

5. The rating is conveyed to the concerned employee. It helps in

several ways. The employee can understand the position where he
stands and where he should go.
6. The plus points of an employee should be recognized. At the
same time, the minus points should not be highlighted too much,
but they may be hinted to him.
7. The management should create confidence in the minds of
employees.
8. The standard for each job should be determined by the
management.
9. Separate printed forms should be used for performance
appraisal to each job according to the nature of the job.

KINDS OF PERFORMANCE APPRAISAL

Ranking method
if there are ten workers in the working group, the most efficient worker is
ranked as number one and the least efficient worker is ranked as number
ten
Advantages
a. Each employee or worker can be compared with the other person.
b. A small organization can get maximum benefits through the ranking
method.

Disadvantages
a. A big organization is not able to get sizable benefits from the ranking
method.
b. Ranking method does not evaluate the individuality of an employee.
c. It lacks objectivity in the assessment of employees.

Paired Comparison Method

Advantages

a. This method is suitable for big organizations.

b. Individual traits are evaluated under this method.

Disadvantages
a. The understanding of this method is difficult one.
b. It involves considerable time.

Other PA methods
Forced distribution method
Grading
Checklist
Forced choice method
Critical Incident method
Field review method
Essay evaluation method

Types of appraisal interview

1. Tell and sell interview
2.Tell and listen interview
3.Problem solving interview.

Key behaviors for an appraisal interview

1. Put the employee at ease
2. Clearly state the purpose of the appraisal interview
3. Go through the ratings one by one with the employee.
4. Draw out the employee reactions to the ratings.
5. Decide on specific ways in which performance areas
can be strengthened.
6. Set a follow up date.
7. Express confidence in the employee.

LIMITATIONS OF PERFORMANCE
APPRAISAL
1. The performance appraisal methods are unreliable.
2. If an employee is well known to an employer, the performance
appraisal may not be correct.
3. The inability of supervision to appraise an employee does not
bring out the accurate performance appraisal.
4. Some qualities of an employee can not be easily appraised
through any performance appraisal method.
5. A supervisor may appraise an employee to be good to avoid
incurring his displeasure.
6. Uniform standards are not followed by the supervisors in the
performance appraisal.

POTENTIAL ERRORS OF
APPRAISAL
1. Leniency error: the tendency of a manager to over
rate staff performance.
2. Recency error: the tendency of a manager to rate an
employee based on recent events rather than over the
entire evaluation period.
3. Halo error: the failure to differentiate among various
performance dimensions when evaluating.
4. Ambiguous evaluation standards problem: the
tendency of evaluators to place differing connotations
on rating scale words

NURSING AUDIT
Definition
"Nursing audit refers to assessment of the
quality of clinical nursing".
Elison

The audit is a means by which nurses

themselves can define standards from their
point of view and describe the actual
practice of nursing.
Goster Walfer

Purposes of Nursing Audit

1. Evaluating Nursing care given
2. Achieves deserved and feasible quality of nursing
care
3. Stimulant to better records
4. Focuses on care provided and not on care provider
5. Contributes to research

Methods of Nursing Audit

Retrospective view
The concurrent review

Method to Develop Criteria :

1. Define patient population.
2. Identify a time framework for measuring outcomes
of care,
3. Identify commonly recurring nursing problems
presented by the defined patient population,
4. State patient outcome criteria,
5. State acceptable degree of goal achievement,
6. Specify the source of information.
7. Design and type of tool

Audit as a Tool for Quality Control

1. Outcome audit
2. Process audit
3. Structure audit

Advantages of Nursing Audit :

Can be used as a method of measurement in all areas of
nursing.
functions are easily understood
Scoring system is fairly simple
Results easily understood
Assesses the work of all those involved in recording
care
May be a useful tool as part of a quality assurance
programme in areas where accurate records of care are
kept.

Disadvantages of the Nursing Audit :

Appraises the outcomes of the nursing process, so it is not
so useful in areas where the nursing process has not been
implemented
Many of the components overlap making analysis
difficult
It is time consuming
requires a team of trained auditors
deals with a large amount of information
only evaluates record keeping. It only serves to improve
documentation

COORDINATION

DEFINITION
Coordination is the orderly synchronisation of efforts to
provide the proper amount, timing and directing of
execution resulting in harmonious and unified actions to a
stated objectives.
Newman
Coordination is the balancing and keeping the team together
by ensuring a suitable allocation of working activities to the
various members , and seeing that these are performed with
due harmony among members themselves.
Brech
Coordination is the integration of several parts into an
orderly whole to achieve the purpose of undertaking

NEED FOR COORDINATION

Diverse and specialised activities
Empire building
Personal rivalries and prejudices
Conflicts of interest

TECHNIQUES OF COORDINATION
Communication
Orderly plans
Supervision
Leadership
Departmentation
Direct contact

Internal coordination
Planning
Organisation
Direction
Control

External coordination
Three interested parties
Other organizations.
Government regulations
Technological advancement

HINDRANCE TO COORDINATION
The uncertainty of the future, as to the behaviour of the
individuals and of people
The lack of knowledge, experience, wisdom and character among
leaders and their confused conflicting ideas and objectives
Lac of administration skills and technique.
The vast number of variables involved and competencies of
human knowledge , particularly to men and life.
The lack of orderly methods developing, considering, perfecting
and adopting new ideas and programs.
Size and complexities personalities and political factors. The lack
of leaders with wisdom and knowledge pertaining to public
administration.

REFERENCES
Basavanthappa BT. Nursing Administration.2 nd edition. New
Delhi; Jaypee Brothers Medical publishers: 2009
Marquis BL,Huston CJ. Leadership roles and Management
function in Nursing.New Delhi;Wolter Kluwer Pvt Ltd:2009
Sakharkar BM. Principles of Hospital Administration and
Planning. 2nd edition.New Delhi; Jaypee Brothers Medical
publishers: 2009
http://www.currentnursing.com/nursing_management/coordina
tion.html
http://www.currentnursing.com/nursing_management/coo
rdination.html

DEFINITION
. Controlling is determining what is being
accomplished. That is evaluating the performance
and if necessary, applying corrective measures so
that performance takes place according to plans
George Terry
Controlling consist of verifying whether every thing
occurs in conformity with the plan adopted,
instructions and principles established
Henry Faol
Control is the process of taking step in getting actual
results and desired results close together.
Philip Kotler