06 directing

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Mr. CHANNABASAPPA.K.M
UNIT VI-- DIRECTING
2. MOTIVATION
INTRODUCTION
Motivation is an action that stimulates an individual to take a course of action,
which will result in an attainment of goals, or satisfaction of certain material or
psychological needs of the individual. Motivation is a powerful tool in the hands of
leaders. It can persuade convince and propel people to act.
OBJECTIVES:
1. Describe the need for motivation and the concept of
motivation.
2. Describe the measures taken by the nurse manager to
facilitate nurses‟ motivation.
TERMINOLOGIES
 Motive: that which causes oneself to act in a particular way; reason.
 Motivate: cause to act in a particular way; inspire.
 Intrinsic: qualities or values belonging naturally or existing within.
 Extrinsic: qualities or values not belonging to or part of the real nature of the
person or thing; coming from outside
 Affiliation: link or connection made by being attached.
DEFINITION
Motivation is defined as…
Motivation is “ an inner impulse or an internal force that init iates
and directs the individual to act in a certain manner to satisfy a need.”
Motivating force is a need that comes from within an individual,
e. g. to make a l iving, gain status and respect or to remove a s ource of
frustration ( Review of Maslow‟ s Hierarchy of Needs).
Motivation is a process which begins with a need that must be
satisfied by the individual who feels i t . This results in a activity and or
behavior that is intended to satisfy the need. If activ i ty or behavior is
blocked, i t results in frustration.
According to Dalton E. McFurland, “Motivation refers to the way in which urges,
drives, desires, aspirations, striving or needs direct, control or explain the behavior of
human beings”.

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NEED FOR MOTIVATION:
The nurse manager must realize that nurses have different
personalit ies, work habits, and what motivates one nurse may not
motivate others. Meanwhile, some nurses are skilled, confident, and
capable of self- direction and seem to motiv ate themselves, while other
nurses lack self- confidence; they do their jobs poorly and have l i t t le
motivat ion. The nurse manager is responsible to motivate the second
group and to improve their performance.
Researchers have revealed that job performance i s the result of the
interaction of two variables; the ability to perform the task and the
amount of motivation.
Job Performance = Ability + Motivation.
Job dissatisfaction:
Job dissatisfaction contributes to higher turnover rates and
decreased productivity and considerable t ime and money are required to
recruit and select a replacement for someone who leaves the
organization, i t also takes t ime to socialize new employee to th e
organizational culture, which is expensive t ime, beside that, other
employees will need to carry more load to cover the needs, and at last
the kind of interruptions that results from the loss of this employee. For
all those reasons the manager should be concerned about job satis faction
of employee, and to do that there is a need to look at the different
theories.
TYPES OF MOTIVATORS
1) Intrinsic motivation: refers to motivation that comes from within the person,
driving him or her to be productive. It is related to a person‟s level of inspiration.
The motivation comes from the pleasure one gets from the task itself or from the
sense of satisfaction in completing or even working on the task rather than from
external rewards. However, intrinsic motivation does not mean that a person will
not seek rewards. It just means that external rewards are not enough to keep a
person motivated.
2) Extrinsic motivation: it refers to motivation that comes from outside an
individual, i.e. enhanced by the work environment or external rewards such as
money or grades. The rewards provide a satisfaction and pleasure that the task
itself may not provide. An extrinsically motivated person will work on a task even
when they have little interest in it because of the anticipated satisfaction they will
get from the reward. e.g.- reward for a student would obtain good grade on an
assignment or in the class.

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TYPES OF MOTIVATION
1) Achievement motivation
It is the drive to peruse and attain goals. An individual with achievement
motivation wishes to achieve objectives and advance up the ladder of success. Hence,
accomplishment is important for his/her own sake and not for the rewards that accompany
it.
2) Affiliation motivation
It is a drive to relate to people on a social basis. Individuals with affiliation
motivation perform work better when they are complimented for their favourable
attitude and co-operation.
3) Competence motivation
It is the drive to be good at something, allowing the individual to perform
high quality work. Competence/skill motivated individuals seek job mastery, take
pride in developing and in using their problem solving skills and strive to be creative
when confronted with obstacles. They learn from their experiences.
4) Power motivation
It is the drive to influence people and change situations. Power motivated
people wish to create an impact on their organisation and are willing to take risks.
5) Attitude motivation
Attitude motivation is how people think and feel. It is their self-confidence,
their belief in themselves and their attitude to life. It is how they feel about the future
and how they react to the past.
6) Incentive motivation
It is where the people are motivated through external rewards. Here, a person
or team reaps a reward from an activity. It is the type of rewards that drive people to
work harder.
7) Fear motivation
Fear motivation coercions a person to act against will. It is instantaneous and
gets the job done more quickly. Fear motivation is helpful in the short run.
Nature of motivation
Unending process: human wants keep changing & increasing.
A psychological concept: deals with the human mind.
Whole individual is motivated: as it is based on psychology of the individual.
Motivation may be financial or non-financial: Financial includes increasing wages,
allowance, bonus, etc.
Motivation can be positive or negative: positive motivation means use of
incentives - financial or non-financial. E.g. of positive motivation: confirmation,
pay rise, praise etc. Negative motivation means emphasizing penalties. It is based
on force of fear. Eg. demotion, termination.
Motivation is goal-oriented behaviour.
Motivation is an internal feeling of an individual. It can‟t be observed directly; we
can observe an individual‟s action and interpret his behavior in terms of underlying

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motives. This leaves a wide margin of error. Our interpretation may not reveal the
individual‟s true behavior.
Motivation is a continuous process that produces goal directed behavior. The
individual tries to find alternatives to satisfy his needs.
Motivation is a complex process. Individual may differ in their motivation even
though they are performing the same type of job. For example, if two men are
engaged in cutting stones for constructing a temple, one may be motivated by the
amount of wages he gets and the other by the satisfaction he gets by performing the
job.
Motives of an individual changes from time to time even though he may continue
to behave in the same way. For example, a temporary worker may produce more in
the beginning to become permanent. When made permanent, he may continue to
more, this time to get a promotion.
Motivation different from satisfaction. Motivation implies a drive towards an
outcome while satisfaction involves outcomes already experienced.
COMPONENTS OF MOTIVATION
Motivation comprises of three main components:
 Direction
 Effort
 Persistence
We start off by deciding what we want, which is our direction as we know where we
want to go and what we have to achieve. Then we make an effort towards our goal. We
start to do things and we continue our making the efforts for some time and give it
everything that we have. Now comes the part where we have to be persistent with our
efforts and keep doing them.
SOURCES OF MOTIVATION
1) Internal or push forces:
 Needs
 For security
 For self-esteem
 For achievement
 For power
 Attitudes
 About self
 About job
 About supervisor
 About organization
 Goals
 Task completion
 Performance level

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 Career advancement
2) External or pull forces:
a. Characteristics of the job
 Feedback
 Amount
 Timing
 Work load
 Tasks
 Variety
 Scope
 Discretion
 How job is performed
b. Characteristics of the work situation
 Immediate Social Environment
 Supervisor(s)
 Workgroup members
 Subordinates
 Organizational actions
 Rewards & compensation
 Availability of training
 Pressure for high levels of output
REQUISITES TO MOTIVATE
 We have to be Motivated to Motivate
 Motivation requires a goal
 Motivation once established, does not last if not repeated
 Motivation requires Recognition
 Participation has motivating effect
 Seeing ourselves progressing Motivates us
 Challenge only motivates if you can win
 Everybody has a motivational fuse i.e. everybody can be motivated
 Group belonging motivates

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In the initiation, a person starts feeling lacknesses. There is an arousal of need so
urgent, that the bearer has to venture in search to satisfy it. This leads to creation of
tension, which urges the person to forget everything else and cater to the aroused need
first. This tension also creates drives and attitudes regarding the type of satisfaction that is
desired. This leads a person to venture into the search of information. This ultimately leads
to evaluation of alternatives where the best alternative is chosen. After choosing the
alternative, an action is taken. Because of the performance of the activity satisfaction is
achieved which than relieves the tension in the individual.
Creating a motivating climate:-
The manager is expected to provide leadership by way of personal example and
leadership. The amount and quality of work accomplished by managers directly reflect
their motivation and that of their subordinates.
Motivation is the force within the individual that influence or direct behavior.
Because motivation comes within the person, managers cannot directly motivate
subordinates. The humanistic manager can create an environment that maximizes the
development of human potential. Management support, collegial influence, and the
involvement of personalities in the work group can have synergistic effects on motivation.
The leader – manager must identify those components and strengthen them in maximizing
motivation at the unit level. All human beings have needs that motivate them. The leader
focuses on the needs and wants of individual workers and uses motivation strategies
appropriate for each person and situation. McConnel (2005) states that “there is no better
or no useful knowledge for the manager to possess than to know the employees as
individual and know what is important to each of them.
Because the organization has such an impact on extrinsic motivation, it is
important to examine organizational climates or attitude that directly influences worker

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morale and motivation. For example organization frequently overtly or covertly reinforce
the image that each employee is expendable and that individual recognition is in some way
detrimental to the employee and his or her productivity within the organization. Just the
opposite is true, because the employees are an organization‟s most valuable asset.
McConnel (2005) maintains that employees want achievement, recognition and
feedback, interesting work, the opportunity to assume responsibility, a chance for
advancement, fairness, good leadership, job security and acceptance and adequate
monitory compensation. All of these create a motivating climate and lead to satisfaction in
the workplace. Nurses who experience satisfaction stay where they are, contributing to
organizations retention.
Some organizations however, erroneously believe that if a small reward results in
desired behavior, then a larger reward will result in even more of the desired behavior.
Thus an employee‟s motivation should increase proportionately with the amount of the
incentive or reward. Organization must be cognizant of the need to offer incentives at a
level where employees value them. This requires that the organization and its managers
understand employees‟ collective value and device a reward system that is consistent with
that value system.
The ability to recognize each worker as a unique person who is motivated
differently and then act upon those differences is a leadership skill. Besides the climate
created by the organization‟s belief and attitudes the unit supervisor or unit manager also
has a tremendous impact on motivation at the unit level.
The interpersonal relationship between an employee and his or her supervisor is
critical to the employee‟s motivation level. We often forget that the only way to achieve
our goals is through the people who work with us. Therefore, although managers cannot
directly motivate they can create a climate that demonstrates positive reward for their
employees, encourages open communication as well as growth and productivity and
recognizes achievement.
Connellan identified the following simple approaches for an effective reward-
feedback system that uses positive reinforcement.
 Positive reinforcement must be specific and relevant to a particular
performance. The manager should praise an employee for a specific task
accomplished or goal met. This praise should not be general. For example,
saying, saying “Your nursing care is good” has less meaning and reward than
“The Communication skills you showed today as an advocate for Mr. Jones
was excellent. I think you made a significant difference in his care”.
 Positive reinforcement must occur as close to the event as possible
 Reinforce any improvement, not just excellence. Both large and small
achievements should be recognized and rewarded in some way.
 Reward should be intermittent.
 Reinforcement of new behaviour should be continuous.

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When rewards lack consistency, there is greater risk that the reward itself will become a
source of competition and thereby lower morale. An attitude prevails that “a limited
number of rewards are available, and an award received by any one else limits the chance
of my getting one; thus I cannot support recognition for my peers. Likewise rewarding one
person‟s behaviour and not the behaviour of another who has accomplished a similar task
at a similar level promotes jealousy and can demotivate. Rewards and praise should be
spontaneous and should be given whenever possible and whenever they are deserved.
Strategies for creating a motivating climate:-
 Have clear expectation for workers, and communicate these expectations
effectively.
 Be fair and consistent when dealing with all employees.
 Be a firm decision maker using an appropriate decision making style.
 Develop the concept of team work. Develop group goals and projects that will
build team spirit.
 Integrates staff‟s needs and wants with the organizations interest and purpose.
 Know the uniqueness of each employee. Let each know that you understand his or
her uniqueness.
 Remove the traditional blocks between the employee and the work to be done.
 Provide experience that provide challenges or “stretch” the employee and allow
opportunities for growth.
 When appropriate, request participation and input from all subordinates in decision
making.
 Whenever possible give subordinates recognition and credit.
 Be certain that employees understand the reason behind decisions and action.
 Reward desirable behaviour; be consistent in how you handle undesirable
behaviour.
 Let employees exercise individual judgment as much as possible.
 Create a trustful and helping relationship with employees.
 Let employees exercise as much control as possible over their work environment.
 Be a role model for employees.
Leadership Roles and Management Function Associated With Creating A
Motivating Work Climate:-
Leadership Roles:
1. Recognize each worker as unique individual who is motivated by different things.
2. Identifies the individuals and collective value system of the unit and implements a
reward system that is consistent with those values.
3. Listen attentively to individual and collective work values and attitudes to identify
unmet collective needs that can cause dissatisfaction

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4. Encourage workers to “stretch” themselves in an effort to promote self growth and self
actualization.
5. Maintains a positive and enthusiastic image as a role model to subordinates in the
clinical setting
6. Encourage mentoring, sponsorship and coaching with subordinates.
7. Develop time and energy to create an environment that is supportive and encouraging
to the discouraging individual.
8. Develop a unit philosophy that recognizes the unique worth of each employee and
promote reward systems that make each employee feel like a winner.
9. Demonstrates through actions and words a belief in subordinates that they desire to
meet organizational goals.
10. Is self- aware regarding own enthusiasm for work and takes steps to motivate self as
necessary.
Management Functions:
1. Uses legitimate authority to provide formal reward system.
2. Uses positive feedback to reward the individual employee.
3. Develops unit goals that integrate organizational and subordinate needs.
4. Maintains a unit environment that eliminates or reduces job dissatisfies
5. Promotes a unit environment that focuses on employee motivators
6. Creates the tension necessary to maintain productivity while encouraging subordinate
job satisfaction.
7. Clearly communicates expectation to subordinates.
8. Demonstrates and communicates sincere respect, concern, trust, and a sense of
belonging to subordinates.
9. Assigns work duties commensurate with employee abilities and past performance to
foster a sense of accomplishment in subordinates.
10. Identifies achievement, affiliation or power needs of subordinates and develops
appropriate motivational strategies to meet those needs.
MEASURES TAKEN BY THE NURSE MANAGER TO FACILITATE NURSES
MOTIVATION: -
The nurse manager while managing the nursing unit will have to choose
a combination of the following measures to facilitate nurses‟ motivation.
1) Act as a Role model ( Set a good example): -
a) Set high standards in the units.
b) Maintain a positive attitude towards the work and staff.
c) Be optimistic; in other words, be aware of how difficult the job is
and how i t can be done.
d) Ask for help when in need.
e) Admit mistakes.

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2) Develop and maintain Good Personal Relations: -
a) Use two- way communication.
b) Be f r iendly, not to criticize staff in front of others and be fair.
c) Keep a sense of humor and avoid getting angry.
d) Try to understand nurses‟ attitudes, l ikes, dislike their experience,
previous t raining, problems in their work and needs.
These measures will help in understanding nurses‟ behavior.
Understanding is the f i rst step toward motivating nurses. Trust comes
with understanding and i t develops slowly based on the respect and
acceptance of the manager. Motivation is based on understa nding and
trust.
Some guidelines for developing trust: -
a) Apply rules equally and consistently.
b) Avoid favoring some nurses over others, be fair.
c) Share information – show respect for ideas and opinions and
confidentiality.
d) Be supportive at all t imes.
3) Post Each Nurse where she can work best: -
The nurse is more l ikely to succeed and be motivated i f her/ his
interests and skills are considered in the assignment. Success is the best
motivator.
4) Use a participative style: -
Participation and sharing informa t ion will motivate nurses since they feel they are
taking part in decisions. Motivation requires more than physical involvement in a job. It
also demands mental and emotional involvement.
5) Guide, encourage and support continuously: -
Guidance means helping nurses in planning, evaluating their work
and in solving work and personal problems. Consider individual
differences, be sensitive to variations in nurses‟ needs, abilit ies and
goals, provide realistic job information, clear instructions and feedback.
Encouragement means helping and reassuring nurses regardless of the
type of problems. Develop a supportive environment by reducing
physical stresses associated with the job. Encourage nurses to make
decisions. Encourage skilled nurses to share their expertise with less
experienced nurses so that both of them are motivated to continue their
role.

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Support means removing obstructions and providing nurses with satisfying work
environment which include personnel and facilities and suitable learning materials needed
to do their job. Also, improving job content to include more planning and self - direction.
6) Reward Good work:-
a) Give recognition for successful achievement of the job. Praise
frequently and informally. It can be in f ront of other staff.
b) Reward includes: Pay increase, promotion, training for
advancement to a higher level within a job.
c) Thank you is a type of reward that helps to increase self -
confidence.
7) Build team work ( Team spirit)
a) Schedule regular meetings.
b) Make nurses feel that their job is important to the success of the
team.
c) Integrate the needs and wants of the staff nurses with those of th e
nursing unit.
d) Think of nurses in the unit as a group and do what is best for
them.
8) Provide continuing education: -
Nurses enjoy learning new knowledge and skills or updating the
existing knowledge and skills or taking new responsibilit ies through
continuing education.
SYMPTOMS OF MOTIVATED NURSES :-
1. Show interest, enthusiasm and have a positive attitude.
2. Believe their work i s important and work hard.
3. Work well with their supervisors and others.
4. Take part willingly in planning, implementing and evaluating their
work.
5. Show responsible behavior.
Strive to f ind the best way to produce optimal job performance.
THEORIES OF MOTIVATION
The word motivation theory is concerned with the processes that describe why and
how the human behaviour is activated and directed. It is considered as one of the most
important areas of study in the field of organizational behaviour. There are two different
categories of motivation theories- the content theories and the process theories.
A) Content theories of motivation
This is also called as the Need theory. It mainly focuses on the internal factors that
energize and direct human behaviour. Some of the need theories are-

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1) Abraham Maslow (1943)
Maslow‟s theory included 5 basic needs in his theory, namely the- The physiological
needs, Safety and security needs, Love needs, self-esteem needs and self-
actualization needs. Maslow suggested that human needs are ordered in a hierarchy
from simplex to complex. Higher level needs do not emerge as motivators until
lower needs are satisfied and a satisfied need no longer motivates behaviour. The
simplest needs are the greatest behaviour motivators until satisfied to the degree
needed for sustaining life. Until then, almost all activities will be focused at this
level.
 Physiological needs: Food, water, warmth, shelter, sleep, medicine and education,
etc. Once the physiological needs are met, the next level becomes predominant.
 Safety and security needs: These are the needs to be free of physical danger and of
the fear of losing a job, property, food or shelter. It also includes protection against
any emotional harm.
 Social needs: Since people are social beings, they need to belong and be accepted
by others. People try to satisfy their need for affection, acceptance and friendship.
After the lower needs are well satisfied, affiliation or acceptance will emerge as
dominant and the person strives for meaningful social relationship.
 Esteem needs : According to Maslow, once people begin to satisfy their need to
belong, they tend to want to be held in esteem both by themselves and by others.
This kind of need produces such satisfaction as power, prestige status and self-
confidence. It includes both internal esteem factors like self-respect, autonomy and
achievements and external esteem factors such as states, recognition and attention.
 Need for self-actualization: Maslow regards this as the highest need in his
hierarchy. It is the drive to become what one is capable of becoming, it includes
growth, achieving one‟s potential and self-fulfilment. It is to maximize one‟s
potential and to accomplish something.
2) Alderfer ERG theory
ERG theory is similar to Maslow‟s hierarchy of needs. The existence (E) needs are
equivalent to physiological and safety needs; relatedness (R) needs to
belongingness, social and love needs. The growth (G) needs to self-esteem and self
actualization- personal achievement and self-actualization. The major conclusions of
this theory are:
In an individual, more than one need may be operative at the same time.
If a higher need goes unsatisfied than the desire to satisfy a lower need intensifies.
When the higher level needs is frustrated; people will regress to the satisfaction of
the lower-level needs. This phenomenon is known as frustration-regression process

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3) Frederick Herzberg Two Factor need theory (1966)
Herzberg felt that job satisfaction and dissatisfaction exists on dual scales. Workers are
motivated by two types of needs/factors-
 Needs relating to the work itself called intrinsic/motivation factors (satisfiers):
challenging aspects of the work, achievement, added responsibility, opportunities for
growth and opportunities for advancement
 Needs relating to working conditions called extrinsic/hygiene factors (dissatisfiers):
salary, status, working conditions, quality of supervision, job security and agency
policies.
According to Herzberg, the hygiene factors must be maintained in quantity and
quality to prevent dissatisfaction. They become dissatisfiers when not equitably
administered, causing low performance and negative attitudes.
The motivation factors create opportunities for high satisfaction, high motivation
and high performance. Absence of motivation factors causes a lack of job
satisfaction.
4) David McClelland(1961)
David McClelland has developed a theory on three types of motivating needs:
 Need for Power
 Need for Affiliation
 Need for Achievement
People with high need for power are inclined towards influence and control. They
like to be at the center and are good orators. They are demanding in nature, forceful in
manners and ambitious in life. They can be motivated to perform if they are given key
positions or power positions.
In the second category are the people who are social in nature. They try to affiliate
themselves with individuals and groups. They are driven by love and faith. They like to
build a friendly environment around themselves. Social recognition and affiliation with
others provides them motivation.
People in the third category are driven by the challenge of success and the fear of
failure. Their need for achievement is moderate and they set for themselves moderately
difficult tasks. They are analytical in nature and take calculated risks. Such people are
motivated to perform when they see atleast some chances of success.
McClelland observed that with the advancement in hierarchy the need for power
and achievement increased rather than Affiliation. He also observed that people who
were at the top, later ceased to be motivated by this drives.

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5) McGregor’s Theory X and Theory Y
Douglas McGregor proposed two different motivational theories- theory X and theory
Y.
He states that people inside the organization can be managed in two ways. The
first is basically negative, which falls under the category X and the other is positive,
which falls under the category Y.
Assumptions of theory X:
 Employees inherently do not like work and whenever possible, will attempt to avoid
it.
 Because employees dislike work, they have to be forced, coerced or threatened with
punishment to achieve goals.
 Employees avoid responsibilities and do not work until formal directions are issued.
 Most workers place a greater importance on security over all other factors and
display little ambition.
Assumptions of theory Y:
 Physical and mental effort at work is as natural as rest or play.
 People do exercise self-control and self-direction and if they are committed to those
goals.
 Average human beings are willing to take responsibility and exercise imagination,
ingenuity and creativity in solving the problems of the organization.
 That the way the things are organized, the average human beings brainpower is only
partly used.
On analysis of the assumptions it can be detected that theory X assumes that lower-
order needs dominate individuals and theory Y assumes that higher-order needs
dominate individuals. An organization that is run on Theory X lines tends to be
authoritarian in nature- “power to enforce obedience” and the “right to command.” In
contrast Theory Y organizations can be described as “participative”, where the aims of
the organization and of the individuals in it are integrated; individuals can achieve their
own goals best by directing their efforts towards the success of the organization
B) Process theories of motivation
Process theories of motivation provide an opportunity to understand thought
processes that influence behaviour. The major process theories are- Vroom‟s
expectancy theory, goal-setting theory and reinforcement theory.
1) Reinforcement theory
B.F. Skinner‟s theory (1969) suggests that an employee‟s work motivation is
controlled by conditions in the external environment, that is, by designing the
environment properly, individuals can be motivated. Instead of considering internal
factors like impressions, feelings, attitudes and other cognitive behaviour, individuals
are directed by what happens in the environment external to them. Skinner states that
work environment should be made suitable to the individuals and that punishments

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actually leads to frustration and de-motivation. Hence, the only way to motivate is to
keep on making positive changes in the external environment of the organization.
Positive behaviour should be reinforced or rewarded as this increase the strength
of a response or induces its repetition. Reinforcers tend to weaken over time and new
ones have to be developed.
Negative reinforcement occurs when desired behaviour occurs to avoid negative
consequences of punishment. Punishment creates negative attitude and can increase
costs.
2) Expectancy theory of Vroom
This theory postulates that most behaviours are voluntarily controlled by a person and
are therefore motivated. It focuses on people‟s effort-performance expectancy, or a
person‟s belief that a chance exists for a certain effort to lead to a particular level of
performance. This theory states that motivation depends on three variables-
 Attractiveness: the person sees the outcome as desirable.
 Performance-reward linkage: the person perceives that a desired outcome will
result from a certain degree of performance.
 Effort-performance: the person believes that a certain amount of effort will lead
to performance.
3) J. Stacy Adams Equity theory
Third process theory and focuses on fair treatment. Persons believe that they are
being treated with equity when the ratio of their efforts to rewards equals those of
others. Equity can be achieved or restored by changing outputs, attitudes, the reference
person, inputs or outputs of the reference person or the situation. People have a
tendency to use subjective judgment to balance the outcomes and inputs in the

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relationship for comparisons between different individuals. Accordingly,
4) Jeremy Bentham’s “The Carrot and the Stick Approach”
English philosopher, Jeremy Bentham ideas developed his ideas in the early
years of the Industrial Revolution, around 1800. Bentham‟s view was that all people
are self-interested and are motivated by the desire to avoid pain and find pleasure. Any
worker will work only if the reward is big enough, or the punishment sufficiently
unpleasant. With this view, the „carrot and stick’ approach was built into the
philosophies of the age.
This metaphor relates to the use of rewards and penalties in order to induce
desired behaviour. It came from the old story that to make a donkey move, one must
put a carrot in front of him or dab him with a stick from behind. Despite all the
research on the theories of motivation, reward and punishment are still considered
strong motivators.
In almost all theories of motivation, the inducements of some kind of „carrot‟
are recognized. Often this is money in the form of pay or bonuses. Even though money
is not the only motivating force, it has been and will continue to be an important one.
The trouble with the money „carrot‟ approach is that too often everyone gets a carrot,
regardless of performance through such practices as salary increase and promotion by
seniority, automatic „merit‟ increases, and executive bonuses not based on individual
manager performance.

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The „stick‟, in the form of fear–fear of loss of job, loss of income, reduction of
bonus, demotion, or some other penalty has been and continues to be a strong
motivator. It often gives rise to defensive or retaliatory behaviour, such as union
organization, poor-quality work, executive indifferences, and failure of a manager to
take any risks in decision-making or even dishonesty. However, fear of penalty cannot
be overlooked. Whether managers are first-level supervisors or chief executives, the
power of their position to give or with hold rewards or impose penalties of various
kinds gives them an ability to control, to a very great extent, the economic and social
well-being of their subordinates
5) Goal-setting theory of Edwin Locke
This theory is based on goals as determinants of behaviour. The theory states that
when the goals to be achieved are set at a higher standard than, employees are
motivated to perform better and put in maximum effort. The more specific the goals,
the better the results produced. The goals must be achievable, and their difficulty level
must be increased only to the ceiling to which the person will commit. Goal clarity and
accurate feedback increases security. It revolves around the concept of “Self-efficacy”
i.e. individual‟s belief that he or she is capable of performing a hard task.
6) Arousal/ Cognitive Evaluation theory
Focuses on internal processes that mediate the effects of conditions of work on
performance.
This theory states, a shift from external rewards to internal rewards results into
motivation. It believes that even after the stoppage of external stimulus, internal
stimulus survives. It relates to the pay structure in the organization. Instead of treating
external factors like pay, incentives, promotion etc and internal factors like interests,
drives, responsibility etc, separately, they should be treated as contemporary to each
other. The cognition is to be such that even when external motivators are not there the
internal motivation continues.
7) Attitude theory
Focuses on favourable attitudes of job satisfaction and job involvement leading to
high performance.
8) Attrition/self-efficacy theory
Focuses on explanations for events or behaviour. Perceptions of self efficacy and
self esteem affect performance.
Motivational theories for BetterNursing Management
The needs of an individual are important motivators. These make the person work with
enthusiasm & interest. The significant individual needs are:

18
* Need for Power: Which results in a strong desire to influence staff, stimulate them to
work, making them achieve positions of leadership e.g. making the nursing supervisor
wholly responsible to take care of whole ward.
* The need for achievement results in a desire to do something better or more efficiently
than others. People with a high need of achievement have an intense desire for success &
equally intense fear of failure. They want to be challenged, prefer to assume personal
responsibility to get work done and like to work for long hours. Training and orientation
(refresher) course increase this need. All the staff working in a particular area should be
given equal chance to attend the refresher courses related to that particular area.
* Need for affiliation: - Some people derive pleasure from being loved and tend to avoid
the pain of being rejected by social group. They enjoy social relationships, intimacy,
empathise and help others in trouble. There is close intimacy when a staff nurse is allowed
to plan and decide patient care along with ward supervisor.
In order to satisfy the employees, a manger can also use Maslow's Motivation Theory in
these ways:
* Improving physical working conditions to satisfy needs e.g. grilled door and escorts to
secure the nursing staff at night, providing rest rooms for lunch and dinner.
* Increasing the level of training, development and skill in order to meet the self esteem
needs e.g. uniform, leave facilities, vacation to nursing students. If these facilities are
inadequate it harms their self esteem.
* Having congenial social group and peer group interaction to fulfill affliation needs.
* Placing the person in position which match their self concept to fulfill the self
actualization need.
Job Design
Job design is another motivator to satisfy, signify and give value to employees
encouraging them to perform well.
Koul Jyoti conducted a study on job satisfaction of 126 staff nurses of different hospitals
in J&K State and showed that only 8% were highly satisfied. Maximum satisfaction was
found for the work itself and with the competency of supervision. The areas of best
satisfaction were concerned with material rewards and individual agency. The older age
group and experienced persons were found more satisfied.
Work Environment
There are many conditions in the environment which could possibly effect the motivation
of staff. It is seen by Behaviour Modification Theorist that employees perform positively
if environment is favourable which is made by pay/ reward policies, democratic leadership
style, peer group interaction etc.

19
To effect the performance of employees, their input (e.g. efforts, training, experience,
skill, education, seniority) should be equitable to their output e.g. pay, rights, benefits, job-
status, status symbol's (vacation, clothing, satisfactory superior).
The employees feel inequity if unrewarded or if given undesirable placement. The
employees always respond to the environment & these responses influence their
behaviour. A nursing Manager can accomplish this by using following motivational
techniques.
* Positive Reinforcement: Annual reward for better performance in the form of money,
recognition, praise, promotion etc. Give reward to the most clean and best patient care
ward on Annual days.
* Avoidance Learning: Some staff nurses improve their behaviour in order to avoid
criticism of Nursing. Superintendent or to avoid any disciplinary action against her.
* Punishment: Nursing Superintendent, for example, can withhold reward or promotion so
as to change the behaviour of staff. Scolding in front of others or humiliating should be
avoided.
* Be sure to tell a person she / he is doing wrong and what type of behaviour is desired
e.g. RT feeding given with force by use of piston should be corrected and demonstrated so
that goes with gravity.
* Making the staff participate in different activities which give them affiliation, acceptance
and recognition, e.g. in conferences, Nurses'-Day, Hospital Annual Day etc.
* Giving feeling of personal responsibility or keeping interactions. The newly appointed
staff should be left independent but be observed closely.
* Warmth, support and identity motivate the staff to perform better. Every staff member
has her own potential. Respect their individual capabilities. Don't scold if she is
performing badly in other field. Let her develop potential gradually.
PROBLEMS IN APPLYING MOTIVATION THEORIES
This article presents a non-exhaustive account of some problems in applying motivational
theories to the actual conditions of the workplace. It should give readers a general idea of
some of the less effective and more effective methods for motivating employees.
 Reward vs. Punishment
It is generally conceded that while rewards can offer workers a variety of incentives which
can not only motivate them to work harder but also produce feelings of good-will towards
management, punishment often functions only to cultivate feelings of hostility between
managers and workers, which can directly and negatively effect productivity.

20
 Personal Satisfaction vs. Financial Satisfaction
One of the most successful ways of fostering a productive and motivated workforce is to
ensure that workers are satisfied with their jobs, not just with their pay. It is interesting to
note that people are quite often more concerned with how much they like their job than
they are with how much money they actually make. Making employees feel important in
the workplace can make them feel like part of the team, which makes them feel personally
invested in the health of a business.
 Persuasion vs. Coersion
By appealing to a worker's sentiments and reason a manager can persuade a worker to
take initiative and build their morale, which are internal drivers of motivation. However,
by appealing to fear and coercion a manager may actually cause a decline in internal
motivation, leaving instead feelings of hostility or anxiety which can negatively effect
production.
 Knowing Your Workers
Understanding what is important to an individual is endemic for understanding how to
motivate that person effectively. Is an individual motivated by the opportunity to develop
professionally or by the possibility of making more money? Does he or she want more
responsibility or more clearly defined responsibilities? Is it important that he or she see the
end-product of their work or not? Usually, employees are not motivated by just one thing,
which can make it difficult to determine the best strategy for motivation.
 Involvement
One of the top things leading workers to feel productive and motivated in the workplace is
knowing that they have a good management team. When people feel close to their
managers they oftentimes do not want to disappoint, and may even feel the desire to win
approval. By being invested in workers, managers can get workers to feel reciprocally
invested in their workplace and their work. Fostering motivation in the workplace is first
and foremost about fostering good management practices.
METHODS FOR MOTIVATING EMPLOYEES
1. Job rotation: This is also known as cross training. It can be effective for
employees that perform repetitive tasks in the job. This allows the employees to
learn new skills by shifting them from one task to another.
2. Job enlargement: is a motivation technique used for employees that perform a
very few and simple tasks. It increases the number and variety of tasks that the
employee performs, resulting in a feeling of importance
3. Job enrichment: this method increases the employees control over the work being
performed. It allows the employees to control the planning, execution and
evaluation of their own work, resulting in freedom, independence and added
responsibility.

21
4. Flexible time: this allows the employees to choose their own work schedule to a
certain extend.
5. Job sharing: a less common method but very effective in preventing boredom. It
allows employees to share two different jobs
6. Employee involvement: people want to feel like they are a part of something.
Letting the employees to be more active in decision-making related to their job
makes them feel valued and important to the company and increases job
motivation.
7. Variable pay programs: merit based pay, bonuses, gain sharing, and stock
ownership plans are some good motivators for employees. They should be offered
as an incentive or reward for outstanding performance.
CREATING A MOTIVATING CLIMATE
As the organisation has an impact on intrinsic and extrinsic motivation, it is
important to examine organisational climates or attitudes that influence workers
morale and motivation. Employees want achievement, recognition and feedback, the
opportunity to assume responsibility, a chance for advancement, fairness, good
leadership, job security and acceptance and adequate monetary compensation. All
these create a motivating climate and lead to satisfaction in the work place.
e.g. nurses who experience satisfaction stay where they are, contributing to
organisation‟s retention.
STRATEGIES TO CREATE A MOTIVATING CLIMATE
1. Have a clear expectation for workers and communicate effectively.
2. Be fair and consistent when dealing with all employees.
3. Be a firm decision maker.
4. Develop a team work/team spirit.
5. Integrate the staffs needs and wants with the organization‟s interest and purpose.
6. Know the uniqueness of each employee.
7. Remove traditional blocks between the employee and the work to be done.
8. Provide opportunities for growth.
9. Encourage participation in decision-making.
10. Give recognition and credit.
11. Be certain that employees understand the reason behind decisions and actions.
12. Reward desirable behaviour.
13. Allow employees exercise individual judgement as much as possible.
14. Create a trustful and helping relation with employees.
15. Let employees exercise as much control as possible over their work environment.

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CONCLUSION
Nearly all the conscious behavior of human being is motivated. The internal needs
and drives lead to tensions, which in turn result into actions. A manager requires to create
and maintain an environment in which individuals work together in groups towards the
accomplishment of common objectives. A manager cannot do a job without knowing what
motivates people. The building of motivating factors into organizational roles, the staffing
of these roles and the entire process of leading people must be built on knowledge of
motivation. It is necessary to remember that level of motivation varies both between
individuals and within individuals at different times. Today in the increasingly competitive
environment, maintaining a highly motivated workforce is the most challenging task. The
art of motivation starts by learning how to influence the behavior of the individual. This
understanding helps to achieve both, the individual as well as organizational objectives.
BIBLIOGRAPHY:
1. Dr.B.T.Basvanthappa ,Nursing Administration,Jaypee Brothers,New Delhi.
Page no:110-113.
2. S.K.Mangal”Advanced Educational Psychology,2nd edition,Prentice Hall of
IndiaPrivateLtd.New Delhi.
Pageno:147-153
3. Bessie L.Marquis and Carol J Hutson.Leadership and Management functions in
nursing., 6th edition .New Delhi :Wolters Kluwer:2009
Pageno:422-432
4. www.wikipedia.com
5. www.slideworld.com

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3. COMMUNICATION MEANING, PROCESS,PRINCIPLES
AND TECHNIQUES, TYPES, ADVANTAGES,
DISADVANTAGES,
INTRODUCTION:
Nurse Managers are required to be aware of the techniques that can help them ensure
effective management of educational/service unit. Communication is one of the most
important activities in the nursing management. It is the foundation upon which the
manager achieves organizational objectives.
Terminologies:
Decode: to translate a code into its original language.
OBJECTIVES:
 To explain about the meaning and importance of effective communication.
 Discuss the elements and characteristics of communication.
 To explain about the techniques of communication.
 Discuss the channels of managerial communication.
MEANING OF COMMUNICATION:
Communication is a process of change. In order to achieve the desired result, the
communication necessarily be effective and purposive.
DEFINITION OF COMMUNICATION:
Communication is a process in which a message is transferred from one person
to other person through a suitable media and the intended message is received and
understood by the receiver.
IMPORTANCE OF COMMUNICATION:
Promotes motivation:
Communication promotes motivation by informing and clarifying the employees
about the task to be done, the manner they are performing the task, and how to improve
their performance if it is not up to the mark.
Source of information:
Communication is a source of information to the organizational members for
decision-making process as it helps identifying and assessing alternative course of actions.
Altering individual’s attitudes:

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Communication also plays a crucial role in altering individual‟s attitudes, i.e., a well
informed individual will have better attitude than a less-informed individual.
Organizational magazines, journals, meetings and various other forms of oral and written
communication help in moulding employee‟s attitudes.
Helps in socializing:
Communication also helps in socializing. In today‟s life the only presence of another
individual fosters communication. It is also said that one cannot survive without
communication.
Controlling process:
Communication also assists in controlling process. It helps controlling organizational
member‟s behavior in various ways. There are various levels of hierarchy and certain
principles and guidelines that employees must follow in an organization. They must
comply with organizational policies, perform their job role efficiently and communicate
any work problem and grievance to their superiors. Thus, communication helps in
controlling function of management.
ELEMENTS:
There are seven elements of communication:
Source idea
Message
Encoding
Channel
Receiver
Decoding
Feedback
Source idea:
The Source idea is the process by which one formulates an idea to communicate to
another party. This process can be influenced by external stimuli such as books or radio, or
it can come about internally by thinking about a particular subject. The source idea is the
basis for the communication.
Message:
The Message is what will be communicated to another party. It is based on the source
idea, but the message is crafted to meet the needs of the audience. For example, if the
message is between two friends, the message will take a different form than if
communicating with a superior.
Encoding:
Encoding is how the message is transmitted to another party. The message is
converted into a suitable form for transmission. The medium of transmission will

25
determine the form of the communication. For example, the message will take a different
form if the communication will be spoken or written.
Channel:
The Channel is the medium of the communication. The channel must be able to
transmit the message from one party to another without changing the content of the
message. The channel can be a piece of paper, a communications medium such as radio, or
it can be an email. The channel is the path of the communication from sender to receiver.
An email can use the Internet as a channel.
Receiver:
The Receiver is the party receiving the communication. The party uses the channel
to get the communication from the transmitter. A receiver can be a television set, a
computer, or a piece of paper depending on the channel used for the communication.
Decoding:
Decoding is the process where the message is interpreted for its content. It also
means the receiver thinks about the message's content and internalizes the message. This
step of the process is where the receiver compares the message to prior experiences or
external stimuli.
Feedback:
Feedback is the final step in the communications process. This step conveys to the
transmitter that the message is understood by the receiver. The receiver formats an
appropriate reply to the first communication based on the channel and sends it to the
transmitter of the original message.
CHARACTERISTICS OF COMMUNICATION:
1. Clarity:
* One of the most essential characteristics of an impressive communication is "Clarity".
* Use Simple and Sound words, so that listeners can grab it easily.
* Be clear in your thoughts, jumbled and confused mind cannot deliver a good and clear
saying.
* Avoid using any technical terms, try to explain in laymen language.
* Use Examples to explain & support complex scenarios.
* Work a little bit on your accent and pronunciation.
2. Aim or Goal:
* At every stage of your talk/communication, don't forget your "Aim or Goal".
* Try to deduce an acceptable stuff by judging Pros & Cons impartially.

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* Communicate with a broad and practical mind.
3. Precision:
* Be precise & exact in your approach. Neither be too deep nor be too short.
* Include some good facts acknowledging your topic.
4. Avoid Repeatability, unless required so.
5. Linkage :
* Try to maintain a logic link between your sayings.
* Don't put two opposite faces of coin at a same time.
* Deliver in a structured & planned way.
6. Globalization and Localization:
* Try to explain the broader aspects but not on the cost of local values.
* Aggregation of local values should result into global and broader aspects.
7. Style of Expressing:
* Control various speech parameters like pitch, tone, intensity etc. according to the
environment.
* Don't be too fast or too slow.
* Light Humor at the right time is always accepted.
* Look straight & forward. Keep a light smile on your face.
* Avoid using words that show arrogance.
* Feel what you say.
* Avoid being too formal, be natural and practical.
8. Know and Analyze the audiences.
9. Do a good Homework.
10. Dress properly:
* 25% confidence and 25% Respect from audiences comes automatically, if you have
dressed up well.
* Be neat, clean, ironed and polished irrespective of the fact that you have dressed up
formally or informally.
* Do a good hair styling; avoid any casual or unethical looks.

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PROCESS OF COMMUNICATION:
All of the manager‟s functions involve communication. The communication process
involves six steps.
Ideation encoding transmission receiving decoding
response
Response decoding receiving transmission encoding
Ideation:
The first step, ideation, begins when the sender decides to share the content of her
message with someone, senses a need to communicate, develops an idea or selects
information to share. The purpose of communication may be inform, persuade, command,
inquire or entertain.
Encoding:
Encoding is the second step, involves putting meaning into symbolic forms. Speaking,
writing or non verbal behavior. One‟s personal, cultural and professional biases affect the
goals and encoding process. Use of clearly understood symbols and communication of all
the receiver needs to know are important.
Transmission:
The third step, transmission of the message, must overcome interference such as
garbled speech, unintelligible use of words, long complex sentences, distortion from
recording devices, noise and illegible handwriting.
Receiving:
The receiver‟s senses of seeing and hearing are activated as the transmitted message
is received. People tend to have selective attention (hear the message of interest to them
but not others) and selective perception (hear the parts of the message that conform with
what they want to hear) that cause incomplete and distorted interpretation of the
communication. Sometimes people tune out the message because they anticipate the
content and think they know what is going to be said. The receiver may preoccupied with
other activities and consequently not be ready to listen.
Decoding:
Decoding of the message by the receiver is the critical fifth step. Written messages
allow more time for decoding, as the receiver assesses the explicit meaning and
implications of the message based on what the symbols mean to her. The communication
process is depend on the receiver‟s understanding of the information.

28
Response or feedback:
It is the final step. It is important for the manager or sender to know that the
message has been received and accurately interpreted.
PRINCIPLES OF COMMUNICATION:
 Communication should be conviction.
 Communication should be appropriate to situation.
 Communication should have objective and purposes.
 Communication should promote total achievement of purposes.
 Communication should represent the personality and individuality of the
communication.
 Communication involves special preparation.
 Communication should be oriented to the interest and needs of the receiver.
 Communication through personal contact.
 Communication should seek attention.
 Communication should be familiar.
TECHNIQUES TO IMPROVE THE COMMUNICATION:
 Listening
 Broad openings
 Restating
 Clarification
 Reflection
 Focusing
 Sharing perceptions
 Silence
 Humour
 Informing
 Suggesting
Listening:
An active process of receiving information. The complete attention of the nurse is
required and their should be no preoccupation with oneself. Listening is a sign of respect
for the person who is talking and a powerful reinforce of relationships. It allows the
patients to talk more, without which the relationship cannot progress.
Broad openings:
These encourage the patient to select topics for discussion, and indicate that nurse is
there, listening to him and following him. For e.g. questions such as what shall we discuss

29
today? “can you tell me more about that”? “And then what happened?” from the part of
the nurse encourages the patient to talk.
Restating:
The nurse repeats to the patient the main thought he has expressed.it indicates that
the nurses is listening. It also brings attention to something important.
Clarification:
The person‟s verbalization, especially when he is disturbed or feeling deeply, is not
always clear. The patients remarks may be confused, incomplete or disordered due to their
illness. So, the nurses need to clarify the feelings and ideas expressed by the patients. The
nurses need to provide correlation between the patient‟s feeling and action. For example “I
am not sure what you mean “? “ could you tell me once again?” clarifies the unintelligible
ideas of the patients.
Reflection:
This means directing back to the patient his ideas, feeling questions and content.
Reflection of content is also called validation. Reflection of feeling consists of responses
to the patient‟s feeling about the content.
Focusing:
It means expanding the discussion on a topic of importance. It helps the patient to
become more specific, move from vagueness to clarity and focus on reality.
Sharing perceptions:
These are the techniques of asking the patient to verify the nurse understands of
what he is thinking or feeling. For e.g. the nurse could ask the patient, as “you are smiling,
but I sense that you are really very angry with me”.
Theme identification:
This involves identifying the underlying issues or problem experienced by the
patient that emerges repeatedly during the course of the nurse-patient interaction. Once we
identify the basis themes, it becomes easy to decide which of the patient‟s feeling and
thoughts to respond to and pursue.
Silence:
This is lack of verbal communication for a therapeutic reason. Then the nurse‟s
silence prompts patient to talk. For e.g. just sitting with a patient without talking, non
verbally communicates our interest in the patient better.
Humor:

30
This is the discharge of energy through the comic enjoyment of the imperfect. It
is a socially acceptable form of sublimation. It is a part of nurse client relationship. It is
constructive coping behavior, and by learning to express humor, a patient learns to express
how others feel.
Informing:
This is the skill of giving information. The nurse shares simple facts with the
patient.
Suggesting:
This is the presentation of alternative ideas related to problem solving. It is the
most useful communication technique when the patient has analyzed his problem area, and
is ready to explore alternative coping mechanisms. At that time suggesting technique
increase the patient‟s choices.
TYPES OF COMMUNICATION:
Communication
On the basis of relationship on the basis of flow on the basis of
expression
Formal informal vertical horizontal verbal non
verbal
Downward upward oral written.
ONE-WAY V/S TWO WAY COMMUNICATION:
One-way communication:
The flow of communication is one way from the communicator to the audience.
Example receive method.

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Drawbacks are:
 Knowledge is imposed.
 Learning is authoritative.
 Little audience participation.
 No feedback.
 Does not influence human behavior.
Two way communication:
In this both the communicators and the audience take place. The process of
communication is active and democratic. It is more likely to influence behavior than one
way communication.
FORMAL V/S INFORMAL COMMUNICATION:
Communication has been classified into formal (follows lines of authority) and
informal (group line) communication.
Formal communication:
It is officially organized channels of communication and it is delayed
communication. It is generally used for all practices purposes. This authoritative, specific,
accurate and reaches everybody. The medium of formal communication may be
department meeting, conferences, telephone calls, interviews, circular etc.
Informal network:
Gossip circles such as friends internet group, like minded people and casual groups.
Communication is very faster here. The informal channels may be more active. It follows
grapewine route. It may be a fact but more in native of rumor. It does not reach every one
informal communications are quite fast and spontaneous.
Physiological communication:
It is a stimulus received by the body immediately the brain receives the information
and transmits to the respective organs through the nervous, where it has to be passed.
Psychic communication:
Extra sensory perception occurs, i.e something which will occur in future. The
person pertains and predicts that in advance is called psychic communication.
Serial communication:
Person to person the message will be passed line a chain. Sender passes the message
to one person, then that receiver passes information to other and so on.

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Symbolic communication:
Good communication requires awareness of symbolic communication, the verbal
and nonverbal symbolism used by others to convey meaning.
Visual communication:
The visual forma of communication comprise charts and graphs, pictograms, tables,
maps, posters etc.
VERBAL V/S NONVERBAL COMMUNICATION:
The traditional way of communication has been by word of mouth language is the
chief vehicle of communication. Through it, one can interact with other can be passes
through. Direct verbal communication by word of mouth may be loaded with hidden
meanings. The important aspects if verbal communication are as follows.
Vocabulary:
Communication is unsuccessful if senders and receivers cannot translate each
others word and phrases when a nurses cases for a client who speaks another language an
interpret may be necessary.
Denotative and connotative meaning:
A single word has several meaning. Individuals who use a common language
share the denotative meaning, baseball has the same meaning for everyone who speaks
English, but code denotes cardiac arrest primarily to health care providers.
The connotative meaning is the shade or interpretation of a word‟s meaning
influences by the thoughts, feelings or ideas people have about the word.
Pacing:
Conversation is more successful at an appropriate speed or pace nurse should
speak slowly enough to enunciate clearly. Pacing is improved by thinking before.
Adoptability:
Spoken messages need to be altered a according with behavioural due from the
receiver.
Intonation:
Tone of voice dramatically affects a meaning. The nurse must be aware of voice
line to avoid sending unintended messages.

33
Clarity and brevity:
Effective communication is simple, brief and direct. Clarity is achieved by
speaking slowly, enunciating clearly and using, repeating important parts of a message
also clarifies communication.
Brevity is achieved by using short sentences and words that expresses an idea
simply and directly.
Credibility:
Credibility means worthiness of belief, trustworthiness and reliability.
Time and relevance:
Timing is critical in communication. Even though message is clear, poor timing
can prevent it from being effective. Often the best time for interaction is when a client
express an interest in communication. If message are relevant of important to the situation
at hand, they are more effective.
Oral communication:
Oral communication is a transmitting message orally either by meeting the person
through artificial media of communication such as telephone and intercom systems.
Written communication:
It is transmitting message in writing. Written communication can be followed when
a record of communication is necessary.
NON VERBAL COMMUNICATION:
Communication can occur even without word. Non-verbal communication is
message transmission through body language without using words. It includes bodily
movements, positive, facial expression. Silence is non verbal communication. It can speak
louder than words.
Personal appearance:
Nurse learn to develop a general impression of clients health and emotion status
through appearance and clients develop a general expression of the nurse‟s
professionalism and caring in the same way personal appearance includes physical
characteristics, facial expression, manner of dress and grooming first impressions are
largely based on appearance.
Poster and gait:
Poster and gait are forms of self expressions. The way people sit, stand and more
reflect attitudes, emotion and self concept and health status.

34
Facial expression:
The face is the most expressive part of the body. Facial expression convey emotion
such as surprise, fear, anger, happiness and sadness. People can be unaware of the
messages their expression convey doing procedure and the client may interpret. This is
anger or disapproval.
Eye contact:
Maintaining eye contact during conversation shows respect and willingness to
listen, lack of eye contact may indicate anxiety, discomfort or lack of confidence in
communicating.
Hand movements and gestures:
Hands also communicate by touch, slapping or caring another‟s head
communicates obvious feelings.
MECHANICAL COMMUNICATION:
By using mechanical devices the communication will be sent. For e.g. internet,
radio, T.V. etc.
ADVANTAGES OF COMMUNICATION:
Oral communication:
 It is face to face system and hence can be clarified.
 There is an opportunity to ask questions, exchange ideas and clarify meaning.
 It can develop a friendly and co-operative spirit.
 It is easy and quick.
 It is flexible and hence effective.
 It has permanent record for future reference.
 It is less likely to be misunderstood.
 It will have adequate coverage and accuracy.
 Suitable for communicating lengthy messages.
 It is an authoritative communication.
DISADVANTAGES OF COMMUNICATION:
Oral communication:
 The spoken words may be misunderstood.
 The facial expression and tone of voice of the communicator may misled the
receiver.
 Not suitable for lengthy communication.

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 It requires the art of effective specificity
 It has no record for future reference.
 It requires skill and education for understanding.
 It is also one way communication and hence may not be effective.
 There is no opportunity for the subordinates to ask questions and exchange
ideas.
 It may not communicate all aspects.
STRATEGIES OF COMMUNICATION:
Think before you speak:
Think about the purpose of your communication. What do you hope to accomplish
with your words or actions? Are your comments about something you are responsible for
doing, such as parenting or managing someone or about an activity you are doing
together with the other person? Or, is it an opinion about something that is not your
business, maybe even something that the other person has already asked you to stop
discussing?
"Before you speak, ask yourself: Is it kind? Is it necessary? Is it true? Does it improve on
the silence?" . Also, think about the structure of your communication.
Listening:
The most effective leaders know when to stop talking and start listening. This is especially
important in three particular situations: when emotions are high, in team situations and
when employees are sharing ideas.
First, listening is crucial when emotions are high. Extreme emotions, such as anger,
resentment and excitement, warrant attention from a personal and a business standpoint.
On a personal level, people feel acknowledged when others validate their feelings.
Managers who ignore feelings can create distance between themselves and their
employees, eroding the relationship and ultimately affecting the working environment.
Questioning:
Many leaders need information but aren't sure how to get it. Similarly, their employees
may have information but don't know how to impart it. Managers can open the lines of
communication by asking good questions. Note that different kinds of questions yield
different kinds of results. Here is a short primer on questioning:
* Closed questions are those that elicit yes/no answers. These are beneficial when a
manager simply needs to check the status of an issue. Has the report been completed? Do
you know what to do? Can you get that to me by Friday? These are examples of closed
questions that are perfectly appropriate in the right situations.

36
* Open questions are those that elicit longer responses. They are useful almost anytime a
manager wants more than a yes/no answer--for instance, when seeking input from others,
looking for information about a particular topic or exploring a problem. What do you think
would be the best way to go about this? How are you doing on that project? What went
wrong? These kinds of questions give others the chance to give all of the information they
have and to avoid the innumerable consequences that can come when leaders make
assumptions without becoming well-informed.
* Personal questions have a special role in leadership. Inappropriate personal questions
can alienate employees. Asking direct reports if they are dating anyone or why they
haven't bought a house can be perceived as prying, even if the questions are well intended.
Appropriate personal questions, however, can create a sense of camaraderie between
employee and boss.
Asking whether employees had a nice weekend, inquiring about their families or following
up on common interests all help people connect on a personal level. That relationship
leads to a greater commitment as well as a more pleasant environment.
Using Discretion:
Knowing when not to speak as a leader is just as important as speaking. Managers must
understand that the moment they don a new title, they become a leader--one whom others
look to for guidance, direction and even protection. Good leaders adopt a policy of
discretion, if not confidentiality, with their employees. Only then can they develop the
trust that is so vital to productivity.
Confidential situations may arise in a number of areas, personal and professional. Here are
some topics that may warrant discretion:
* An employee is having a direct conflict with another employee.
* An employee is concerned about another employee's conduct.
* An employee's performance has dropped substantially.
* An employee has a health issue or personal problem.
* An employee wants genuine advice on how to excel but doesn't want to be seen as
cozying up to the boss.
Directing
Notice that directing comes last on the list of communication strategies. It may not be the
least important, but it is definitely one to use less often. Many managers direct their
employees because they believe it's the only way to get things done. It is not.
But directing has its place. Directing means giving directions clearly and unequivocally,
such that people know exactly what to do and when. It is best used in times of confusion,
or when efficiency is the most important goal. Although it can be effective, directing also

37
Subordinates
Subordinates
can lead to complacency on the part of employees who may adopt an "I just do what they
tell me" attitude. Use it sparingly
CHANNELS OF MANAGERIAL COMMUNICATION:
There are four levels of managerial communication:
Downward communication.
Upward communication.
Lateral communication.
Diagonal communication.
Downward communication:
This is the traditional and most used communication, where the management gives
orders to the subordinates at the bottom level to carry out the orders as per the
organizational hierarchy.
All the written and oral communication which are carried out from the top
management to the employees by various means in order that the employees carry out
their duties in the organization in achieving its goals.
Upward communication:
Upward communication in the management levels from staff, lower and middle
management personnel and continuous up to the organizational hierarchy. It provides a
means for motivating satisfying personnel by encouraging employees input.
Management
Subordinates Subordinates
Management

38
Subordinates Subordinates
Nursingdepartment
Medical department
Surgical
Medical
Pathology
Lateral communication:
Lateral or horizontal communication is referred to the communication which takes
place between the departments or personnel on the same level of the hierarchy.
Diagonal communication:
Diagonal communication occurs between two individuals or departments that are
not on the same level of the hierarchy.
Surgical unit Pediatrics
Laboratory x-ray laundry
CSSD
Common means are: unit in-charge ordering diet for the patient, X-ray department informs
appointments given to patients in a particular unit, etc.
Management
Management
Medical unit

39
BARRIERS OF COMMUNICATION:
Communication barriers create problem of misunderstanding and conflict between
men who live together in the same community, who work together on the same job and
even between men living in the distinct parts of the world who have never seen one
another.
Following are the main barriers to overcome:
1.Due to organization structure:
The breakdown or distribution in communication sometimes arises due to:
1. Several layers of management;
2. Long lines of communication;
3. Special distance of subordinates from top management;
4. Lack of instructions for passing information to the subordinates;
5. Heavy pressures of work at certain levels of authority.
2.due to status and position:
1. the attitude exhibited by the supervisor are sometimes a hurdle in two way
communication. One common illustration is non listening habit. A supervisor may guard
information for:
a. consideration of prestige, ego and strategy.
b. underrating the understanding and intelligence of subordinates.
2. prejudice among the supervisors and subordinates may stand in the way of a free
flow of information and understanding.
3. the supervisors particularly at the middle level may sometimes like to be in good
books of top management by:
a. not seeking clarification on instructions which are subject to different
interpretations; and
b. acting as screen for passing only such information which may please the boss.
3. semantic barriers:
Semantic is the science of meaning. Words seldom mean same thing to two person.
Symbols or
Words usually have a variety of meaning arid the sender and the receiver have to choose
one meaning from among many. If both of them choose the same meaning,
communication will be perfect. But this is not so always because of differences in formal
education and specific situations of the people. Strictly one cannot convey meaning, only
one can do it to convey words. But the same words may suggest quite different meaning to

40
different people, e.g. „profits‟ may mean to management efficiency and growth, whereas
to employees it may suggest excess funds piled up through paying inadequate wages.
4. Tendency to evaluate:
A major barrier to the communication is the natural tendency to judge the statement
of the person or other group. Every one tries to evaluate others from his own point of view
or experience. Communication requires an open mind and willingness to see things
through the eyes of others. Some intelligent brains even complimented him on his
excellent style of imagination.
Heightened emotions:
Barriers may also arise but in specific situations, e.g. emotional reactions,
physical conditions like noise or insufficient light, past experience, etc. when emotions are
strong, it is most difficult to know the frame of mind of the other person or group.
Lack of ability to communicate:
All persons do not have the skill to communicate. Skill in communication may
come naturally to some, but an average man may need some sort of training and practice
by way of interviewing and public speaking, etc.
Inattention:
The simple failure to read bulletins, notices, minutes and reports is a common
feature. With regard to failure to listen to oral communications, it has been seen that non
listeners are often turned off while they are preoccupied with other affairs, like their
family problems.
Unclarified assumptions:
This can be clarified by an illustration. A customer send a message that he will
visit a vendor‟s plant at particular time on some particular date. Then he may assume that
vendor will receive him and arrange for his lunch, etc. whereas vendor may assume that
the customer was arriving in the city to attend some personal work and would make a
routine call at the plant. This is an unclarified assumption with possible loss of goodwill.
Resistance to change:
It is the general tendency of human-being to maintain status quo. When new
ideas are being communicated, the listening apparatus may act as a filter in rejecting new
ideas. Thus, resistance to change is an important obstacle to effective communication.
Sometimes, organizations announce changes which seriously affect the
employees, e.g. shifts in timings, place and order of work, installation of new plant, etc.
changes affect people in different ways and it may take sometime to think through the full

41
meaning of the message. Hence, it is important for the management not to force changes
before people are in a position to adjust to their implications.
Closed minds:
Certain people who think that they know everything about a particular subject
also create obstacles in the way of effective communication.
THEORIES OF COMMUNICATION:
Relatedto management:
 The decibal theory
 The sell theory
 The minimet theory
The decibal theory:
It argues that the best way to get the message across is to state one‟s point loudly and
frequently.its effectiveness over a period of time is nil, but many of us still need to be
reminded that shouting only makes poor communication louder.
The sell theory:
It lays down that the total burden of communication is on the communicator while
the receiver is passive and pliable. One of the problem created by this approach is that it
tends to increase the barriers between the individuals and thus reduces the chances of
hearing each other.
The minimet theory:
It assumes that the receiver probably is not much interested in what is being
communicated. By telling an individual what he needs to know, he will have little to
object and little to question.
JOURNAL ABSTRACTS:
This paper discusses the importance of communication in a business organization.
Written in 2007; 1,417 words; 3 sources; APA; $ 47.95
Paper Summary:
In this paper, the author discusses the importance of communication from the
management level to the employee level in a corporate environment. The paper cites
how the approach to communication has changed over years within businesses. Also
described are the types of communication within an organization. This includes
approaches to communication and actual technologies, such as the Internet. The
author also notes that effective communication helps to keep employees motivated
and involved.

42
From the Paper:
"Communication is a major problem in many organizations as employees feel they
do not know what exactly is happening within the firm. Especially in today's
corporate environment where 'change' is the only predictable factor, it is extremely
important to have an internal communication strategy in order to ensure smooth flow
of relevant information within the firm. When changes are being planned, the
importance of communication is heightened. The employers should take the staff
into confidence and explain clearly why improvement measures are being
implemented. Internal communication is important because various surveys and
studies reveal that employees are seriously concerned about lack of access to
relevant information. However the type of information they need may differ from
person to person. "
BIBLIOGRAPHY:
 BT.Basavanthappa, “nursing administration”, 2nd edition, (2009), jaypee
publication, p.no:240-250.
 Rebecca Samson, leadership and management in nursing practice and
education”, Jaypee publication p.no:46-48.
 http/www.hospital administration.com.
 http/www. Busness management.com.

43
4. PUBLIC RELATIONS
INTRODUCTION:
Public relation is an essential and integrated component of public policy or service. The
professional public relation activity will ensure the benefit to the citizens, for whom the policies or
services are meant for. An effective public relations can create and build up the image of an
individual or an organization or a nation. At the time of adverse publicity or when the organization
is under crisis an effective public relations can remove the "misunderstanding" and can create
mutual understanding between the organization and the public.
OBJECTIVES:
On completion of the seminar the participant will be able to:
 Explain public relation concept and its importance.
 Explain the importance of organizational image.
 Develop public relation programmes in the hospital.
 Explain about the methods of maintaining public relation in the community.
 Tell about the public relation in an educational institution.
 Understand the role of dean in public relation.
TERMINOLOGIES:
(1) Fortitude: Happening by chance.
(2) Composite: Made up of different part or material.
(3) Humility: Quality of being humble
(4) Persuasive: Able to give good reason for doing something.
DEFINITION OF PUBLIC RELATION:
According to John Millet,
“Public relation are knowing what the public expects and explaining how
administration is meeting these desires….”.
According to J.L MeCamy,
“Public relation in Government is the composit of all the primary and secondary
contacts between the bureaucracy and citizens and all the interactions of influences and attitudes
established in these contracts”.
According to W.T. Parry‟
“Public relation means the development of cordial, equitable and therefore mutually
profitable relations between a business industry organization and the public it serves”.
According to Rex Harlow,
“Public relations are the process whereby an organization analyses the needs and
desires of all interested parties in order to conduct itself more responsively towards them”.

44
NEED OF PUBLIC RELATION:
Not many years ago, management decisions took no consideration of public attitudes but
today management cannot ignore the views of employees, and the community in making – policy
decisions. It has been estimated that eighty per cent of the problems confronting management have
public relations implications. Management has to foresee the impact of policy decisions on the
opinion of the public.
There is normally four distinct reasons for ever increasing necessity of public relations:
(1) Increased governmental activities.
(2) Population explosion creating communication problems.
(3) Increased educational standards resulting in rise in expectations.
(4) Progress in communication techniques.
Well-executed public relations will
 Increase visibility for the hospital, employees, programs and services.
 Position the hospital as a health care leader and authority within the community
or region.
 Expand awareness of the hospital‟s entire range of programs and services.
 Enhance the hospital‟s image.
 Aid in recruitment and retention of employees.
 Support efforts to raise funds for new programs and services or assist with the
passage of levies and bonds.
 Act as a foundation when negative news about the hospital occurs.
 Boost employee morale.
Functions of public relation:
 Public Relation is establishing the relationship among the two groups
(organization and public).
 Art or Science of developing reciprocal understanding and goodwill.
 It analyses the public perception & attitude, identifies the organization
policy with public interest and then executes the programmes for
communication with the public.
ELEMENTS OF PUBLIC RELATIONS:
A planned effort or management function.
The relationship between an organization and its publics.
Evaluation of public attitudes and opinions.
An organization‟s policies, procedures and actions as they relate to said
organization‟s publics.
Steps taken to ensure that said policies, procedures and actions are in the public
interest and socially responsible.
Execution of an action and or communication programme.
Development of rapport, goodwill, understanding and acceptance as the chief end
result sought by public relations activities.
FORMS OF PUBLIC RELATION:
Public relation is a general term that may include many other “relations” with different
audiences, strategies and tactics. For example:
Employee relations:
It is a function of public relations that includes responding to employee concerns and
informing and motivating staff. Some tactics used for employee relations may include new

45
employee education, employee award programs and recognitions, new-hire press releases and
newsletters to name a few.
Community relations:
It is the function of actively planning and participating with and within a community for the
benefit of the community and the hospital. Tactics within this category include community events,
volunteer activities and co-sponsorship opportunities with other community organizations.
Community relations may also include fundraising and development activities.
Government relations:
It is a function of relating to government officials and agencies about issues that impact the
hospital and its audiences. Hill climb events in Olympia, letter writing campaigns, and op-ed
placements in the newspaper are often part of government relations.
Media relations:
It is often considered synonymous with public relations, is the function of working with the
media to communicate news. Media relations can be active – seeking positive publicity for a
newsworthy topic at the hospital – or reactive – responding to a news inquiry about a positive or
negative story of interest to the media and its readers or viewers.
PUBLIC RELATION PLAN FOR A HOSPITAL:
Every hospital should have a current public relations plan that outlines goals and desired
outcomes for a period of three to five years. Once a general PR plan is in place, periodic planning
and updating is critical. The plan and its updates will not only help guide employees responsible for
public relations work, but will result in an effective tool to communicate with the board and other
staff. Following are the key elements of an effective PR plan:
Goals:
Public relations goals help direct the strategies and tactics in future public relations endeavors.
The goals should clearly support hospital mission statement. While a mission statement may include
what the hospital wants to accomplish, a public relations goal should be focused on what you want
the public to think and know about the hospital
Examples:
 General Washington Hospital is a community leader committed to providing high
quality health care for the people of Carter, Key and Kangley counties.
 Highland Valley Medical Center provides superior primary care services in a
comfortable, safe environment for people in the Highland Valley region.
 Ivy River Hospital, with its friendly, helpful physicians and nurses, is the most
dependable health care service provider in the state.
Objectives:
Objectives help determine specific outcomes from your public relations efforts. Objectives
should be clear and concise, and include timing.
Examples:
 Increase awareness of the technology and medical advances used at the hospital within
Evergreen County over the next six months.
 Build the reputation of the hospital in the next three to four years as a cornerstone of the
community that provides health care services, jobs and community leadership.
 Encourage renewed interest in specialty hospital services such as childbirth classes over the
next two years.

46
Target Audiences:
Detail the groups of people that are important to inform or influence, and why.
Examples:
 Patients: They purchase health care services and generate revenue for the hospital.
 Physicians: They use hospital facilities and generate revenue for the hospital. They control
where patients go for care in the hospital or outside of the community.
 Media: They write both positive and negative stories about the hospital, its staff and
services. They have considerable influence and access to all of the hospital‟s target
audiences.
Other audiences to consider may include employees, board members, community leaders, local
government officials, state legislators, vendors and suppliers.
Tactics:
It‟s easy for busy hospital professionals to think about tactics first, but it is critical to have a
solid strategy in place. Only pursue the tactics that will help achieve the goals. Here are some “best
uses” for specific tactics.
 Brochure/Collateral – To inform patients and community members about programs and
services provided at the hospital for promotional use only. It may be provided to media for
background, but not to be used instead of effective media tools, such as press releases or fact
sheets.
 Direct mail – To help create awareness for programs or services with target audiences.
Message is controlled.
 Letters – Good for personal or business communication. Adjustable length (1-2 pages).
 Postcards – Good for event invitations or welcome cards. Inexpensive postage.
 Direct mail packages – Good for inclusion in new neighbor welcome packages or
community coupon envelopes. Consider including brochures or inserts. Costs are typically
part of an advertising or sponsorship package. Production of materials likely not included.
 Specialty mailings – Good for awareness efforts, such as a child safety campaign sponsored
by the hospital. Mailing may include a magnet with safety tips and local emergency contact
information.
Distribution Methods:
How you distribute materials is often as important as what the organization send. It is a
good idea to know which methods the target audiences, especially reporters, prefer.
 Mail – Good to use when timing is less sensitive (one to three days). Good for newsletter
mailings, new neighbor welcome packets, media kits, and other materials that are difficult to
fax or e-mail. Mail can also be certified to verify receipt or insured to avoid loss.
 Fax – Good for timely communication (faster than mail). Good for press releases, event
reminders, and some forms of newsletters (such as weekly news notices). Less effective for
documents with images or graphics.
 E-mail – Good for timely and direct communication with an individual. Good for press
releases, media reminders, media personnel questions, and pitch letters. Access to e-mail
and electronic document size can be limitations.
 Face-to-face meetings – Best way to make a personal connection. It allows for detailed
explanation of a point-of view or complicated subject. Best way to demonstrate excitement,
concern, tolerance, empathy, etc.
 Phone conference call – Allows for personal contact when face-to-face is not possible.
Good for back-and-forth communication. Inexpensive method for communicating with large
groups in different locations (cities/states).

47
 Web site – Web pages allow interested parties to pull information thereby facilitating
distribution. Directing people to a web site may be done through mailings, publicity or other
notices.
 Newsletter – To regularly update a variety of target audiences about the happenings at the
hospital. Good way to establish and maintain community support for the hospital and
services.
 Public service announcement (PSA) – To create awareness of a problem or issue through
radio or television.
 Press release – To distribute straightforward news to the media.
 Press kit – To provide extensive information about a topic. It may precede an event or new
program launch.
 Press conference – To disseminate time sensitive and critical news to multiple media
contacts at once. It should be rarely used.
 Special event – To make a personal connection with target audiences in a positive
environment. It is good way to recognize people for good work or launch new programs of
facilities.
 Speaking engagement – To reach a target audience, establish the speaker as an expert and
build credibility for the speaker and the hospital.
 Video – To communicate messages with emotion through visuals. It is good for town
meetings, new employee education, fundraising projects, special events, etc.
 Web site – To provide 24-hour access to information about the hospital. It may include
health information or links to health information depending on site design. It is good for
general information about the hospital, its services and staff.
Budgets:
Public relations budgets may come in a variety of ways. It may be pre-determined and passed
down from the overall hospital budget. It may include general guidelines but is open to the tactics
decided upon. It may be non-existent, in which case the tactics will need to rely on investments in
staff time, instead of materials. All of these factors will determine where budgeting fits into the
overall public relations planning. Regardless of where budgeting fits into the plan, consider the
following:
Nothing is free ------- Consider all of the direct and indirect costs. Even a press release, one
of the least expensive tactics, has a price tag, the time spent writing and editing the release,
the paper it is printed on and the postage it‟s mailed with at a minimum.
Don’t underestimate time investments-------- Every public relations activity has time
investments and opportunity costs and don‟t just consider the time investments for the PR
staff. Administrative oversight and involvement, interview source preparation and even
volunteer efforts all play into the opportunity costs of public relations. When planning and
prioritizing projects, consider all necessary staff time and what else they would be doing
with their time if not promoting the hospital.
Shop around--------- When producing brochures or printed materials; be sure to get more
than one estimate. Printing shops with more capacity at certain times may discount their
rates.
Evaluate options--------- Another way to save money when producing materials is to
consider design options. For example, two-color brochures are far less expensive than their
four color counterparts. Specialty work, such as die-cuts for holding business cards or
layered stair-steps for handouts, are nice features, but may carry a hefty price tag. Designers
and printers can be allies in determining options. Just be sure to have your budget in mind.

48
Be prepared for the unexpected opportunities---------Reserve 10 to 15 percent of the overall
public relations budget for unexpected activities. There may be some great opportunities to
do events, community outreach activities or other projects that you didn‟t anticipate.
METHOD OF IMPROVING PUBLIC RELATION IN HOSPITAL:
There are certain other aspects which need careful consideration which are described in
brief as under.
General:
High quality patient care by the hospital is the theme of any public relation programme. No
amount of smile, cheers and propaganda will compensate for bad administration and poor
professional care in the hospital.
Physical facilities:
Well planned hospital with sufficient waiting area for the patient and its relation in the
hospital, optimum floor space for each department of t e hospital, logical layout of the department
and work areas, provision of adequate facilities like toilets, public utility services like canteen,
drinking water facility and so on go a long way in improving the image of the hospital.
Staff:
In a hospital the staff consists of variety individuals drawn from different status of the society
with different levels of education and background. Imbibing a team spirit in all these groups of
people for the patient care will lead to a general satisfaction foe the patients in the hospital.
Name Labels and Uniform:
All functionaries should wear uniforms and name labels. This creates initial good impression
on patients and reflects good administration. It also infuses among the employees a pride and sense
of belonging to the institutions. These also help in identifying the staff by name and their status.
These are particularly useful in OPD and ancillary departments.
Importance of Color:
Color affects many of our moods and emotions. Proper choice of color can transform
depressing and monotonous atmosphere into pleasing and exciting one. It stimulates employee‟s
productivity. Hospital is one area where color can be used with measured success not only in
appearance but for the psychological uplifting which it brings to patients.
Operating facility:
The operating efficiency in an organization like, hospital is the outcome of its soundness of
objectives, policies, procedures, programmes and standing orders. The clear cut policy and
procedure in writing and their periodic promulgation to the staff specially, clear order regarding
organizational structure, defining their duties, authorities and accountability of the staff.
The speciality clinics:
The speciality clinics if located proximally are one of the concentrated areas of the OPD
services. It will facilitate mutual interaction of the functionaries and effective protocol among the
various specialities and will in turn save great deal of effort for the patient to move around for
multiple consultations, as and when necessary.

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