NURS420 Leadership and Management in Health

Care

Topic 5
Vision, Mission, Policies, Procedures

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 Learning Outcomes
• At the end of the week’s activity, students shall
be able to:
• List the components of planning hierarchy;
• Discuss the components of planning hierarchy-
mission statement, vision, philosophy,
objectives, policies, procedures, standards and
rules

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 Strategic Planning
• “Strategic planning is a management tool used
by organizations to stay focused on the
mission, to set priorities, and to foster growth
and development.” Cynthia M. Howe

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 Strategic Planning as a Management Process

• Includes the following steps:

 Clearly define the purpose of the organization
 Establish realistic goals and objectives consistent
with the mission of the organization
 Identify the organization’s external constituencies
or stakeholders, then determine their assessment of
the organization’s purpose and operations
 Clearly communicate the goals and objectives

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Strategic Planning as a Management Process
 Develop a sense of ownership of the plan
 Develop strategies to achieve the goals
 Ensure the most effective use of resources is
made
 Provide a base from which progress can be
measured
 Provide a mechanism for informed change as
needed
 Build a consensus about where the organization is
going
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 Mission Statement
• It is the highest priority in the hierarchy
of planning because it influences all the
other planning components in the
pyramid.
• Is a brief statement outlining the reason
an organizations exists, and addresses its
position regarding ethics, principles, and
standards of practice.
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 Mission Statement
• Is a brief statement of purpose of an
organization and its future aim or
function.
• The mission statement should be short,
concise, and clear.
• This describes what it will be, and what
it should be .

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 Mission Statement
• An organization’s mission reflects the
purpose and direction of the health care
agency or a department within it.
• This influences the development of
philosophy ,objectives, policies,
procedures and standards.

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 Mission Statement
• It has three elements:
– A mission statement is no longer than a
couple of sentences.
– It states the unit’s purpose using action
words.
– It should be simple and from the heart

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 Mission Statement
• The mission of the nursing department should
mesh with the mission of the institution.
• Examples:
• The purpose of in service education
department is to orient staff to the job and
provide educational programs to improve the
quality of staff work.
• The purpose of burn unit is to provide quality-
nursing care to patients suffering from burns.
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 Vision Statement
• A unit vision statement describes how the
mission of the unit within an organization
will be actualized.
• Is are always future oriented while
mission statements provide the foundation
for organizational planning, an example of
a vision statement would be “To become
an exemplar for healthcare in the region”

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 Vision Statement
• Includes four elements:
– A vision statement is written down.
– It is written in present tense, using action
words, as if it were already accomplished.
– It covers a variety of activities and spans
broad time frames.
– It addresses the needs of providers, patients,
and environment in a balanced manner that
anchors it to reality
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 Philosophy
• Organizational
– Flows from the mission statement and
defines the set of values and beliefs that
guide all actions of the organization, it
is the basic foundation that directs all
further planning toward the mission, a
philosophy statement can usually be
found in policy manuals and are
available upon request.

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 Philosophy
• A philosophy is a statement of beliefs
based on core values—inner forces that
give us purpose.
• A unit’s mission and vision is most
authentic if it is developed based on the
philosophy or core beliefs of the work
team.
• A unit’s core beliefs or values should be
incorporated into the unit’s mission and
vision statements. 14
 Philosophy
• Flows from the purpose/ mission statement and
delineates the set of values and beliefs that
guide all actions of the organization.
• Organizational philosophy helps to develop
nursing philosophy at unit level as well as
nursing service as a whole.The nursing service
philosophy addresses nursing beliefs, nursing
care,quality,quantity scope of nursing and
nursing goals
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 Philosophy
• Nursing
• The concepts of holistic care, education, and
research, as well as the quality, quantity, and
scope of nursing services
• Societal
• Sets of beliefs that guide their behavior, called
values.
• Individual
• Shaped by the socialization processes
experienced by that person.
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 Philosophy
• Value criteria:
– It must be freely chosen from among
alternatives only after due reflection
– It must be prized and cherished
– It is consciously and consistently repeated
(part of a pattern)
– It is positively affirmed and enacted

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 Philosophy
• Each nurse-leader should encourage self-
awareness in their employees through
examination of their value system and
understanding the role that it plays in
decision making and resolving conflict.

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 Philosophy
• Example of Nursing Service
• The philosophy of nursing department at hospital (x)
is based on respect for individual’s dignity and work.
• We believe that all patients have the rights to receive
effective nursing care. This care is a personal service
that is based on patient’s needs and their clinical
disease. Recognizing the obligation of nursing to
help restore patients to the best possible state of
physical, mental and emotional health to maintain
patients sense of spiritual and social well being.
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 Goals and Objectives
• The work unit develops broad strategies
that span the next three to five years, and
then develops annual goals and objectives
to meet each of these strategies.
• Goals are written as specific aims or
targets that the unit wishes to attain
within the time span of one year.
• Objectives are the measurable steps to be
taken to reach each goal.
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 Goals
– The ends toward which the organization is
working, it is the aim of the philosophy, it is
what makes the philosophy operational
– The desired result toward which effort is
directed
– Measurable and ambitious, but realistic, just
like the criteria we use in our nursing care
plans to identify pt. outcomes

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 Objectives
• Objectives are defined as the identified
outcomes directing activity toward achieving
the purpose of the organization
or unit.
• Are written, behavior-specific statements
of desired outcomes.
• Identify how and when the goal is to be
accomplished, they are more specific and
measurable than goals in this regard 22
 Objectives
• Specific ,
• Observable ,
• Measurable,
• Realistic and explicit.
• Are stated in terms of results to be
achieved and focus on the production of
health care services to clients.
• Are concrete statements describing the
major accomplishments nurses desire to
achieve. 23
 Objectives
• Process objectives
– Are written in terms of the method to be
used, an example of a process objective
might be “100% of nurses will teach their
pts how to use the call bell within 30 mins
of admission, and request return
demonstration”

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 Objectives
• Result-focused objectives
– Specify the desired outcome, an
example of this would be “ All post-op
pts will perceive a decrease in their
pain after the administration of pain
medicine”

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 Major Areas Of Objectives
• Organization and use of all resources
• Social responsibility
• Staging
• Requisition of supplies and equipment
• Planning educational program’s
• Innovation
• Marketing
• Evaluation of care
• Evaluation of performance
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 Policies
• Is a guideline that has been formalized.
• It directs the action for thinking about and
solving recurring problems related to the
objectives of the organization.
• Many policies come from JCAHO (Joint
Commission Accreditation of Healthcare
Organizations)

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 Policies
• Serve as guides
• Help coordinate plans
• Control performance
• Increase consistency of action
• Should be written
• Usually are general in nature
• Refer to all employees
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 Policies
• Implied policies
– Not written or verbally expressed, and
usually developed over time and follow a
precedent; for example a hospital may have
a policy that employees should be
encouraged and supported in their activity in
regional, community, and national
healthcare organizations

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 Policies
• Expressed policies
– Delineated verbally or in writing
– May include a formal dress-code, a
policy for sick leave or vacation time,
and disciplinary procedures
• Examples:
• annual leave, working hours, shifts, vacations,
maternity leave.
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 Procedures
• Are step-by-step directions and methods
for actions to follow in common
situations.
• Procedures are descriptions of how to
carry out an activity.
• Establish acceptable ways of
accomplishing a specific task by
outlining a set of activities in sequence
with rationale.
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 Procedures
• Provide step-by-step methods
• Are written in detail
• Provide guidelines for commonly
occurring events
• Provide a ready reference
• Guide performance of an activity

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 Procedures
• Should include the following:
• A statement of purpose
• Identification of who performs activity
• Steps in the procedure
• A list of supplies and equipment needed
• Example:
• The unit manager must provide a clearly written
procedural statement regarding how to request
vacation time
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 Standards
• As a desired quantity, quality/ or level of
performance with reference to a criterion
against which performance is measured.
• Nursing profession has designated
generic standards of nursing practice.
• Standards are foundation upon which all
other measures of QA are based.

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 Rules and Regulations

• Plans that define specific action or non-action

• Describe situations that only allow one choice
of action
• Least flexible
• Because rules are the least flexible type of
planning, there should be as few rules as
possible, however existing rules should be
enforced to keep morale from breaking down

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 Overcoming Barriers to Planning
• Omitting Goals or Objectives
• The organization can be more effective if movement
within it is directed at specified goals and objectives
• Lack of Flexibility
• The plan must be flexible to reach a goal, and allow
for readjustment as unexpected events occur
• Lack of Communication and Buy-in
• Manager should include in the planning process
people and units that could be affected by the course
of action
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 Overcoming Barriers to Planning
• Unrealistic Expectations
• Plans should be specific, simple, and
reasonable
• Over- & Under-Planning
• Know when and when not to plan
• Failure to Execute the Plan
• Have built-in evaluation checkpoints

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Forces Effecting Long-Term Plans
• Changes in the future of the healthcare
organization:
– Change in information technology
• Will result in elimination of duplication and
provide immediate access of information
– Change in patient demographics
• The increasing number of seniors (baby
boomers) will create enormous demands on the
healthcare system

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Forces Effecting Long-Term Plans
– Change in economics
• Cost of drugs is highest in the world
– Changes in providers
• Nurses will continue to decrease in
supply and some physician specialties
will increase in supply

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Other factors influencing the future
• The healthcare industry will be moving away
from:
• Illness care to wellness care
• Revenue building to cost management
maximizing utilization of limited resources
• Professional independence towards managed care
• Quality outcomes their patients experience
• Continuity of provider to continuity of patient
information
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 References
• Marquis, B.L. and Huston, C.J. (2012).
Leadership Roles and Management Functions
in nursing: Theory and application 7th ed.
Philadelphia, PN: Lippincott. Pg. 36-42
• Huber, D. L. (2010). Leadership and Nursing
care Management (4th ed). Philadelphia, PN:
Saunders. Pg.390-395
• Kelly, P. (2012). Nursing Leadership &
Management 3rd ed. Clifton Park, NY:
Thomson Delmar Learning. Pg. 5-11 41