This document discusses controlling as an ongoing function of management that occurs during planning, organizing, and directing activities. It involves assessing and regulating performance according to plans, instructions, and principles. Controlling opens opportunities for improvement by comparing performance to standards and providing information to motivate better future performance. Evaluation of people and processes is important to ensure quality nursing care, set objectives, establish standards, promote self-monitoring, highlight problems, justify resource use, and provide feedback for improvement. Various principles, tools, methods, and approaches for evaluation and quality assurance in nursing are described.

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PLANNING
ORGANIZING
CONTROLLING DIRECTING

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CONTROLLING

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Controlling
 On-going function of management which
occurs during planning, organizing, and
directing activities.
 Assessing and regulating performance in
accordance with the plans that have been
adopted, the instructions issued, and the
principles established.

4. 4
Controlling
 opens opportunities for improvement and
comparing performance against set
standards.
 provides information about how well
processes and people function so they can
be motivated to perform better in the future

5. Why do we need to evaluate
people & processes ?
Gerald T. Evangelista RN, MAN 5

6. 6
Reasons for Conducting Evaluation
1. Evaluation ensures that quality nursing care is
provided.
2. It allows for the setting of sensible objectives
and ensures compliance with them.
3. It provides standards for establishing
comparisons
4. It promotes visibility and a means for
employees to monitor their own performance.

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Reasons for Conducting Evaluation
5. It highlights problems related to quality care
and determines the areas that require priority
attention.
6. It provides an indication of the cause of poor
quality ( root cause analysis)
7. It justifies the use of resources
( cost-effectiveness)
5. It provides feedback for improvement.

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Principles of Evaluation
1. The evaluation must be based on the
behavioral standards of performance which
the position requires.
2. In evaluating performance, there should be
enough time to observe employee’s
behavior

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Principles of Evaluation
3. The employee should be given a copy of
the job description, performance standards,
and evaluation form before the scheduled
evaluation conference.
4. The employee’s performance appraisal
should include both satisfactory and
unsatisfactory results with specific
behavioral instances to exemplify these
evaluative comments.

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Principles of Evaluation
3. Areas needing improvement must be prioritized to
help the worker upgrade his/her performance.
4. The evaluation conference should be scheduled
and conducted at a convenient time for the rater
and the employee under evaluation, in a pleasant
surrounding and with ample time for discussion.
5. The evaluation report and conference should be
structured in such a way that it is perceived and
accepted positively as a means of improving job
performance.

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Characteristics of an Evaluation Tool
1. Objectivity – means the tool is free from
bias.
2. Reliability – refers to the accuracy or
precision of the tool such that it will produce
the same results if administered twice.
3. Validity – refers to the relevancy of the
measurement to the performance of the
employee.
4. Sensitivity – means that the instrument
can measure fine lines of differences
among the criteria being measured.

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Basic Components of Controlling
1. Establishment of standards, objectives, and
methods for measuring performance
2. Measurement of actual performance
3. Comparison of results of performance with
standards and objectives and identifying strengths
and areas for correction and/or improvement
4. Action to reinforce strengths or successes
5. Implementation of corrective action as necessary

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1.1. Establishment of Standards for
Measuring Performance
Standards - desirable sets of conditions &
performance necessary to ensure the
quality of nursing care services
acceptable to those instrumental (admin) to
or responsible for setting and maintaining
them

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3 types of standards
1. Standards on Structure
 Focus on structure or management system
used by the agency to deliver care.
 E.g. : the number and categories of nursing
personnel; their education; personal and
professional qualities and proficiencies;
their function; physical facilities; and
equipment.

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3 types of standards
2. Process Standards
 Decisions and actions of the nurse relative
to the nursing process which are necessary
to provide good nursing care
 E.g.assessment, plan of care and nursing
intervention

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3 types of standards
3. Outcome Standards
 Measure results of care provided
 E.g.
* changes in the health status of clients served
* changes in the level of their knowledge,
skills, and attitudes
* satisfaction of those served including the
members of the nursing and health team

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1.2. Establishment of Objectives and
Methods for Measuring Performance
- Establishment of objectives -provides
clear direction and communication of
expected levels of achievement

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Commonly used methods for measuring
nursing care are:
1. Task Analysis
 Actions and procedures such as written guides,
schedules, rules, records and budgets are
inspected
 Uses tolls like time studies and checklists

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Commonly used methods for measuring
nursing care are:
2. Quality Control
 Activities & techniques employed to achieve and
maintain the quality of a product, service or
process
 E.g.
* monitoring activity- concerned w/ finding &
eliminating causes of problems- requirements of the
customer are continually met
* level of nursing care and its effects on clients are
assessed

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2. Measuring Actual Performance
 On-going, repetitive process with the actual
frequency dependent on the type of activity
being measured.
 Scheduled in advance, may be done at
periodic but unannounced intervals or may
occur at random
 Purpose - should be clarified & staff should
be informed about the tasks & levels of care
that needs attention

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3. Comparing Results of Performance
with Standards and Objectives
 One of the easiest steps in the control
process
 Performance should match the standards
& objectives

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4. Reinforcing Strengths or Successes
and Taking Corrective Action as
Necessary
 Positive feedback stimulates motivation,
consistently high performance and growth
of the employee
 Corrective actions - applied to improve
performance

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Responsibilities of the Head/Senior
Nurse
1. Instruct subordinates regarding the appropriate
methods and procedures in providing nursing
care.
2. Inform the staff of the likely causes of errors or
defects and the preventive measures necessary.
3. Initiate and/or facilitate any steps necessary to
improve methods, equipment, materials, and
conditions in the work area for which they are
responsible.

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Performance Appraisal
- Control process -employee’s performance is
evaluated against standards
- Most valuable tool in controlling human
resources and productivity
- Reflects how well the nursing personnel have
performed during a specific period of time

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Purposes of Performance Appraisal
1. Determines salary standards and merit
increases
2. Selects qualified individuals for promotion
or transfer
3. Identifies unsatisfactory employees for
demotion or termination

26. Group Discussion
 Why do we need to do
Performance Appraisal ?
Gerald T. Evangelista RN, MAN 26

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Purposes of Performance Appraisal
4. Makes inventories of talents within the
institution
5. Determines training and developmental
needs of employees
6. Improves the performance of work groups
by examining, improving, correcting
interrelationships between members.

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Purposes of Performance Appraisal
7. Improves communication between supervisors and
employees and reach an understanding on the
objectives of the job
8. Establishes standards of supervisory performance
9. Discovers the aspirations of employees and reconcile
these with the goals of the institution
10. Provides “employee recognition” for accomplishments
11. Informs employees “where they stand”

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Factors Contributing to an Effective
Performance Appraisal System
1. Compatibility between the criteria for individual
evaluation and organizational goals.
2. Direct application of the rated performance to
performance standards and objectives
expected of the worker.

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Factors Contributing to an Effective
Performance Appraisal System
3. Development of the behavioral expectations which
have been mutually agreed upon by both the rater
and the worker.
4. Understanding the process and effective utilization
of procedure by the rater.

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Factors Contributing to an Effective
Performance Appraisal System
5. Rating of each individual by the immediate
supervisor.
6. Concentration on the strengths and
weaknesses to improve individual
performance

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Factors Contributing to an Effective
Performance Appraisal System
7. Encouragement of feedback from the rated
employees about their performance needs
and interests
8. Provision for initiating preventive and
corrective action and making adjustments to
improve performance

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Methods of Measuring Performance
- 2 Types:
Informal appraisal - incidental observation of
performance while the worker is engaged in performing
nursing care or by responses made by worker during
conferences
Formal appraisal- accomplished regularly and
methodically by collecting objective facts that can
demonstrate the difference between what is expected
and what was done
a. *essay, checklist, ranking, rating scales, forced-
choice comparison and anecdotal records

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1. Essay
 Writing a paragraph or more about the
worker’s strengths, weaknesses and
potentials.
 Honest statement from someone who
knows the person well
 The drawbacks of this methods are:
 It is difficult to make comparisons because the essays
touch on different aspects of a worker’s performance.
 It may also concentrate on those areas of
performance for which the supervisor has strong
feelings.

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2. Checklists
 Is a compilation of all nursing performance
expected of a worker.
 The appraiser’s task is to mark the
appropriate column whether the worker does
or does not show the desired behavior.

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3. Ranking
 The evaluator ranks the employees
according to how they fared with
coworkers with respect to certain aspects
of performance or qualifications.

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3. Rating Scale
 Includes a series of items representing the
different tasks or activities in the nurse’s
job description or the absence or presence
of desired behaviors and the extent to
which these are possessed.

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4. Forced-choice Comparison
 The evaluator is asked to choose the
statement that best describes the nurse
being evaluated.
 The items are so grouped that the
evaluator is forced to choose from
favorable as well as unfavorable
statements and to counter the tendency
towards leniency by some evaluators.

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5. Anecdotal Recording
 Describes the nurse’s experience with a
group or a person, or in validating technical
skills and interpersonal relationships.
 Should include:
 a description of the particular occasion
 a delineation of the behavior noted including answers to
the questions who, what, why, when, where, and how,
and
 The evaluator’s opinion or assessment of the incident or
behavior

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QUALITY ASSURANCE
 Is the estimation of the degree of excellence
in patient health outcomes and in activity and
other resource outcomes.
 Is the measurement of the actual level of
service provided plus the efforts to modify
when necessary the provision of these
services in light of the results of such
measurements (Williamson).

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QUALITY ASSURANCE
 Purpose: assure the consumer of a specified
degree of excellence through continuous
measurement and evaluation
 Quality is the “degree of excellence” and
assurance means “formal guarantee of a
degree of excellence”
* assures patients that an acceptable
standard of care will be provided them*

42. Group Sharing
What are the Quality assurance
initiatives in your respective
institution/s ?
Gerald T. Evangelista RN, MAN 42

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Principles underlying Quality
Assurance Efforts
1. All health professionals should collaborate
in the effort to measure and improve care
2. Coordination is essential in planning a
comprehensive quality assurance program
3. Resource expenditure for quality assurance
activities is appropriate

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Principles underlying Quality
Assurance Efforts
4. There should be focus on critical factors
such as functions and activities that
promise to yield the greatest health and
financial benefit to reveal significant findings
5. Quality patient care is accurately evaluated
through adequate documentation

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Principles underlying Quality
Assurance Efforts
6. The ability to achieve nursing objectives
depends upon the optimal functioning of the
entire nursing process and its effective
monitoring
7. Feedback to practitioners ( end-user of
processes) is essential to improve practice

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Principles underlying Quality
Assurance Efforts
8. Peer pressure provides the impetus to
effect prescribed changes based on the
results of assessment and needed
improvement on the quality of care
9. Reorganization in the formal organizational
structure may be required if assessment
reveals the need for a different pattern of
health care

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Principles underlying Quality
Assurance Efforts
10. Collection and analysis of data should be
utilized to motivate remedial action

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Performance Evaluation
- Focuses on the worker
- Asks questions about how well the worker
satisfies the requirements of his or her job
within the organization

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Quality Assurance
- Focuses on the care and service the patient receives
than on how well the professional performs the
duties that the position requires.

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Approaches to Developing Quality
Assurance Criteria
1. Structure Approach
- Includes the physical setting, instrumentalities and
conditions through which nursing care is given
such as the philosophy and objectives, the
building, organizational structure, financial
resources, and equipment.
2. Process Approach
- Includes the steps in the nursing process in
compliance with established standards of nursing
practice.

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Approaches to Developing Quality
Assurance Criteria
3. Outcome Approach
- Identifies desirable changes in the patient’s
health status such as modification of
symptoms, signs, knowledge, attitudes,
satisfaction, skill level, and compliance with
the treatment regimen

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Quality Assurance Methods
- The purpose of quality assurance
programs in nursing is to measure and
improve the quality of nursing delivered
in the agency.
- Several methods used are:

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1. Nursing Audit Committee
- Composed of a representative from all
levels of the nursing staff: a member of
the Training Staff, Supervising Nurse,
Head/Senior Nurse, and a Staff Nurse
- The team usually designates a day within
the week to be the audit day.

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2. Patient Care Audits
- May be concurrent or retrospective
- Concurrent audit is one in which patient care is observed
and evaluated. It is given through:
a .review of the patient’s charts while the patients are still
confined in the hospital.
b. observation of the staff as patient care is given;
c. inspection of patients and/ or observation of the effects of
patient care where the focus is on the patient. This is done
during rounds or patient interview.
- Retrospective audit is one in which patient care is evaluated
through:
a. a review of discharged patients’ charts
b. questionnaires sent to or interviews conducted on
discharged patients

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3. Peer Review
- Patient care audits done by peers
evaluating another’s job performance
against accepted standards.

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4. Quality Circle
- is one of the most publicized approaches
to quality control introduced by the
Japanese.
- A group of workers doing similar work who
meet regularly, voluntarily, on normal
working time, under the leadership of their
supervisor, to identify, analyze, and solve
work-related problems and to recommend
solutions to management.

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Utilization of Results
- The nursing staff in the unit is given a
feedback on the results of the quality
assurance study.
- This may be oral or written and is directed
to the staff who administers the care or
their immediate supervisors.

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Utilization of Results
- Positive feedback reinforces desirable
performance. Consistent positive findings
deserve a commendation from the nursing
service.
- Negative feedbacks should tactfully be
conveyed in a face-to-face situation so
that assessment results may easily be
clarified.

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Control of Resources
- Part of the control process is the periodic
review of the utilization of materials and
supplies in the various nursing units.
- Consumption of supplies and materials
should be proportionate to the number of
patients served, be these in the form of
dressings, treatments done, injections given
and other materials.

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Discipline
- Is a constructive and positive means by
which employees take personal
responsibility for their own performance
and behavior (Self discipline).

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Factors influencing self-discipline
1. A strong commitment to the vision, philosophy,
goals and objectives of the institution.
2. Laws that govern the practice of all professionals
and their respective codes of conduct.
3. Understanding the rules and regulations of the
agency.
4. An atmosphere of mutual trust and confidence.
5. Pressure from peers and organization

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Disciplinary Approaches
- A sound disciplinary program must be
tailored to the objectives of the institution.
- This should include:
- a set of disciplinary policies and procedures
- a uniform application of disciplinary rules
- a disciplinary committee, and
- an orientation program for all new employees where
expectations of appropriate performance and behavior
are emphasized.

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Successful implementation of
disciplinary action is characterized by:
1. Promptness
2. Fairness
3. Impartiality
4. Nonpunitiveness
5. Advance warning
6. Follow-through

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Disciplinary Action
- Should be progressive in nature such as
counseling and oral warning, written
warning, suspension, and dismissal.

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1. Counseling and Oral Warning
- are best given in private and in an informal
atmosphere.
- The employee is counseled regarding
expectations of improved behavior/performance,
ways of correcting the problem and a warning that
a repetition of the same offense may warrant
further disciplinary action.

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2. Written Warning
- is the second step in disciplinary action.
- is preceded by an interview similar to the oral
warning.
- The employee must be told after the interview that
he will be given a written warning.
- This includes:
- The statement of the problem
- Identification of the rule which was violated
- Consequences of continued deviant behavior
- The employee’s commitment to take corrective action
- Follow-up action to be taken

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3. Suspension
- is given after an evidence of oral and written
warnings.

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4. Dismissal
- is invoked only when all other disciplinary
efforts have failed.

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