2. Tools For Evaluation Operations
Outline:
Evaluation and control
Principles of controlling
Evaluation as function of nursing management
Control process
Measurement methods
Controlling techniques
3. Evaluating the effectiveness of healthcare operations and system is critical
to continued improvement
success in providing healthcare services.
4. Evaluation and control
Seeing everything is being carried out in accordance with the plan that has been
adopted, the orders that have been given, and the principles that have been laid down.
(Urwick)
5. Principles of controlling
1. Uniformity ensures that controls are related to the organizational structure
2. Benchmarked
3. Exception provides summaries that identify exceptions to standards
7. Control process
Effective control system has 4 elements :
(involves managing people, equipment, technology, information, supplies, structure, and
other resources).
Establish
standards
Measure the
actual
performance
Compere the
performance
Take
corrective
actions
8. Organization control : is the ongoing process of assigning, evaluating, and regulating
resources to meet the goal of the organization.
Nurse manager use staffing reports, budget status reports, and other information to control the
functioning system. These reports are both monitoring devices and feedback to the clinical nurses and
care managers.
10. Controlling should be on facts, because the ultimate purpose of control is to identify
problems that in turn will assist nurse executives and managers to make informed
decisions.
11. Measurement methods that can be used to assess achievement of nursing goals are:
Task analysis quality control
12. Task analysis
In Task analysis, the nurse manager inspects the motions, actions, and procedures laid out
in written guidelines, schedules, rules, records, and budgets.
Task analysis is study of the process of giving nursing care.
13. quality control
• In quality control the nurse manager is concerned with measurement of the quality and
effect of nursing care.
15. Nursing Rounds
Effective controlling technique for nursing managers is
planned nursing round, which can be placed on a
schedule and can include all nursing personal. Rounds
cover issues such as patient care, patient safety,
nursing practice, and unit management.
16. To be effective, the results should be
discussed with appropriate nursing
personal in follow up conference. Part of
the evaluation process takes place as a
result of the communication occurring
during the rounds.
17. Nursing Operating Instructions
Nursing Operating Instructions or policies for evaluation and controlling techniques.
ANA scope and standards for nurse administrators can be developed into a checklist.
for evaluating the management process of nursing services.
ANA standards of clinical nursing can be implemented in several ways.
18. Gantt Chart
Early in the 20th century, Henry L. Gantt
developed the Gantt chart as a means of
controlling production.
The chart, which is usually used for
production activities.
19. Modified Gantt chart that could be applied to a major nursing administration program or
project.
The 5 major activity identified are segments of a total program or project.
Gather data
Analyze data
Developed a plan
Implement the plan
Evaluate and give feedback or modify the plan
20. Critical Control Points & Milestones
Critical Control Points & Milestones have critical control points in production of services.
Line 5 represents evaluation of all other nursing actions.
21. Critical control points tell whether the plan is progressing satisfactorily.
Milestones are segments or phases of specific activities of a project to occur within a
time frame.
Line 5 represents evaluation of all other nursing actions.
22. Program Evaluation And Review Technique
The PERT system has been widely applied as a controlling process in business and
industry.
The PERT uses a network of activities.
23. Program Evaluation And Review Technique
Why should nurse executive use the (PERT) system for controlling?
It establish system for periodic evaluation and control at critical points in the program.
It is proactive and reveals problems.
25. Outline
Definition of care delivery model
Direct and Indirect Patient Care Functions
Traditional Types Of Nursing Care Delivery Systems
Criteria of innovative models of patient care delivery
Leadership and management responsibility.
26. The goals of successful patient care delivery include high-quality and low-cost care and
the achievement of patient clinical outcomes and satisfaction levels.
27. The determination of a nursing care model depends on the identification of organizational
structures, patient care processes, and health care provider roles that are necessary to
achieve care goals.
28. Models of care delivery
Models of care delivery are the operational mechanisms by which care is actually
provided to patients and families (Person, 2004).
A method of organizing and delivering care to patients and families to achieve desired
outcomes.
29. Direct and Indirect Patient Care Functions
Direct Patient Care Functions
• Assessment
• Monitoring
• Prioritizing goals
• Care coordination
• Therapeutic interventions
• Evaluation
• Communication
• Patient education
Indirect Patient Care Functions
• Clinical practice
• Education/research
• Leadership
• Operations
• Personnel management
• Quality improvement
• System coordination
• Other
30. The development of new models is characterized by changes in the health care climate,
including costs, Consumer expectations, patient characteristics, and new medical
information and technology.
31. The appropriate care delivery model is the one that maximizes existing resources while
meeting the objectives of direct and indirect patient care functions (Deutschendorf, 2003).
32. Traditional Types Of Nursing Care Delivery Systems
1. Private duty
2. Functional
3. Team
4. Primary
5. Case management
33. Private Duty Nursing
Private duty nursing, sometimes called case nursing, is the oldest care model in the
United States.
Private duty nursing “one nurse caring for one client. In this model, complete and total
care is provided by one nurse but the nurse carries only one client assignment”.
34. The advantage of private duty nursing was that the nurse’s focus was entirely on one
client’s needs. This fostered closeness in the nurse-client relationship and increased RN
and client satisfaction with care delivery.
The disadvantage was that private duty is a costly model because of its low efficiency.
Nurses had little job mobility and were relatively isolated from colleagues.
35. Two main variations to the basic pattern of private duty nursing developed:
ogroup nursing
ototal patient care.
36. Group nursing
Group nursing was an early alternative model that combined private duty concepts
with hospital staff nursing.
The plan was to re-organize private duty from individual to group practice, both inside
and outside the hospital.
37. The advantages included shorter hours for nurses, order and regularity in hospital
staffing, slightly cheaper rates for clients, and responsibility for the total care of several
clients for the nurse.
38. Total patient care
Total patient care “a case method for organizing nursing care in which nurses are
responsible for total care of a client for the hours in which that specific nurse is present”
(Glandon et al., 1989; Hegyvary, 1977).
The term total patient care has come to mean the assignment of each client to a nurse
who plans and delivers care during a work shift.
Total patient care described as a “form of primary nursing”
39. Advantages are the intensity of focus with shift-only responsibility
Disadvantages are lack of communication and continuity of care for the client over time.
40. Functional nursing
Functional nursing “work allocation by functions or tasks, such as passing medicine,
changing dressings, giving baths, or taking vital signs” (McCloskey et al., 1991).
Tasks are divided based on the complexity of judgment and technical knowledge and a
variety of workers.
41. Advantage
the advantage of being efficient for taking care of the tasks related to handling a large
number of clients and using workers with varying skill levels.
there was little confusion about roles and duties.
Disadvantage
Client satisfaction dropped under this kind of care delivery system. Clients felt that they
could not identify who was their nurse caregiver.
42. Team nursing
Team nursing is a care model that uses a group of people led by a knowledgeable nurse.
Team nursing “the assignment of a group of clients to a small group of workers under the
direction of a team leader. Each team member provides most of the care to his or her
assigned clients, although some tasks (e.g., medications) may be assigned separately.
43. Why it is designed?
Team nursing is designed to make use of each member’s capabilities to meet the nursing
needs of his or her group of clients. It is a delegation of care to a designated team of staff
members
44. Advantages
each member’s particular capabilities can be used to the maximum.
This model supports group productivity and the growth of team members.
Communication is vital.
It takes a skilled RN to be a team leader.
45. Primary Nursing
Primary nursing began in the 1970s
Primary nursing the assignment in a hospital of
each client to a primary nurse who plans, delivers,
and monitors care under a 24-hour responsibility
from admission to discharge (McCloskey et al.,
1991).
46. Autonomy, authority, and accountability in the primary nurse’s role are basic to
primary nursing.
This increases continuity of care and consistency in assignments
The 24-hour accountability is for the supervision and delegation of client care.
47. The advantages of primary nursing include a focus on the client’s needs, greater nurse
autonomy, and greater continuity of care.
Higher quality of nursing care, higher levels of nurse satisfaction.
The disadvantages of primary nursing Total accountability may create burnout, and a
poorly prepared RN may feel threatened by primary nursing.
48. Case Management
Case management as a nursing model of care evolved in the late 1980s.
Managed care has been described as “the systematic integration and coordination of
the financing and delivery of health care” (Grimaldi, 1996, p. 6).
49. Case management is frequently associated with the use of structured care methodologies
(SCMs).
SCMs are streamlined interdisciplinary tools used to “identify best practices, facilitate
standardization of care, and provide a mechanism for variance tracking, quality
enhancement, outcomes measurement, and outcomes research”
50. Current Models
Nursing shortages and health care re-form have had a strong impact on the creation of
current and evolving types of patient care delivery models.
Concepts of accountability, cost containment, effectiveness, seamless continuum of care,
integration, multidisciplinary collaboration, new roles, alteration in skill mix, and new
assignment systems are key components. All seek to reconfigure nursing’s work within
resource constraints, care needs, and current ideas about professional nursing practice.
51. Current Models
Patient-centered care “the re-design of patient care in the acute care setting so that
hospital resources and personnel are organized around the patient’s health care needs”
(Maehling, 1995, p. 62).
52. The advantage of patient focused care redesigns is that they center systems and services
closer to the patient. This strong customer focus may increase patient satisfaction and
conserve resources.
53. implicit in these redesign efforts is a series of
significant work group and culture changes
affecting the financial operations and cost structure
of hospitals. It also requires a commitment for
initial allocation of resources to achieve ultimate
financial and clinical outcomes.
54. Innovative And Future Models
Criteria identify innovative models of patient care delivery (Kimball et al., 2007):
Primarily adult patients were served.
Nurses served as primary caregivers.
Acute care hospitals were involved.
Technology, support systems, and new roles were integrated.
Quality, efficiency, and financial outcomes were improved.
55. LEADERSHIP AND MANAGEMENT
Managers must have a broad vision to facilitate the design of
care delivery models that meet the objectives of cost
containment, patient satisfaction, quality, and safety outcomes
over the course of the care cycle.
56. Nursing leaders are in the perfect position to lead the changes essential in care delivery
redesign.
57. Nurse leaders are responsible for creating the formal business plan, which includes
quantitative analysis of costs and benefits with revenue and expense calculations.
58. The effective nursing leader must ensure consistent and frequent communication about
changes while enlisting input from the bedside caregivers.
59. Mentoring staff to participate in the creation of new care delivery methods is an aspect of
effective leadership.
60. Considers structure and process variables that impede and facilitate care delivery
Enables professionals to deliver quality and cost-effective care
61. References
Diane L. Huber, 2010,Leadership And Nursing Care Management, Diane L. Huber,
Saunders, an imprint of Elsevier Inc.
Roussel, l. (2006). management and leadership for nurse administrators (4th edition
ed.).
