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Management and leadership


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Management and leadership

  1. 2. I. Definitions <ul><li>A. The process of influencing the actions of a person or group to attain desired objectives. </li></ul><ul><li>B. The process of persuasion and example by which an individual induces a group to take action that is in accord with the leader’s purposes or the shared purposes of all. </li></ul><ul><li>C. A social transaction in which one person influences others. </li></ul><ul><li>D. It is a dynamic, interactive process that involves three dimensions: the leader, the followers and the situation. </li></ul>
  2. 3. II. Qualities/ traits of a leader: <ul><li>A. Intelligence : judgment, decisiveness, knowledge and fluency of speech </li></ul><ul><li>B. Personality : adaptability, alertness, creativity, cooperativeness, personal integrity, self-confidence, emotional balance and control, independence </li></ul><ul><li>C. Abilities: ability to enlist cooperation; popularity and prestige; sociability/interpersonal skills; social participation; tact and diplomacy </li></ul>
  3. 4. III. Types of leaders: <ul><li>A . Formal or appointed – chosen by administration and given official or legitimate authority to act </li></ul><ul><li>B. Informal </li></ul><ul><li>1. Does not have official sanction to direct activities of others; chosen by the group itself </li></ul><ul><li>2. Usually become leaders because of age, seniority, special competencies, an inviting personality or ability to communicate with and counsel others. </li></ul><ul><li>3. Play a valuable role if their behaviour and influence are congruent with the goals of the organization. </li></ul>
  4. 5. IV. Theories of Leadership <ul><li>A. Trait Theory: </li></ul><ul><li>1. Underlying assumption: Leaders are born, not made. </li></ul><ul><li>2. Tasks to be performed by leaders: envisioning goals; affirming values; motivating; managing; achieving workable unity; explaining; serving as a symbol; representing the group; renewing. </li></ul>
  5. 6. <ul><li>B. Behaviour Theories: </li></ul><ul><li>1. McGregor’s Theory X and Theory Y: Leaders must provide followers with: </li></ul><ul><li>1.1 A sense of security </li></ul><ul><li>1.2 A genuine sense of approval </li></ul><ul><li>1.3 Consistent discipline </li></ul><ul><li>1.4 Independence </li></ul><ul><li>1.5 Provision for appeal, an adequate grievance procedure </li></ul>
  6. 7. <ul><li>2. Likert’s Michigan Studies: There are four basic styles/systems of leadership: </li></ul><ul><li>Exploitative-authoritative, benevolent-authoritative, consultative-democratic, and participative-democratic. </li></ul><ul><li>3. Blake and Mouton’s managerial Grid: Two key dimensions are concern for production on the horizontal axis and concern for people on the vertical axis. </li></ul>
  7. 8. <ul><li>4. Kurt Lewin’s Studies: There are three types of leaders: </li></ul><ul><li>4.1 Autocratic- leaders make decisions alone; more concerned with task accomplishment than people; tends to promote hostility and aggression. </li></ul><ul><li>4.2 Democratic- get their followers involved in decision-making; are people-oriented leaders to increased productivity and job satisfaction. </li></ul>
  8. 9. <ul><li>4.3 Laissez-faire- leaders are loose and permissive; foster freedom for everyone and want them to feel good; results in low productivity and employee frustration. </li></ul>
  9. 10. V. Leadership style <ul><li>A. Definition – the way in which a leader uses interpersonal influences to accomplish goals. </li></ul><ul><li>1. May vary from one situation to the other </li></ul><ul><li>2. A leader must adopt a style of leadership that promotes a high level of work performance in a wide variety of circumstances, as efficiently as possible and with little disruption. </li></ul>
  10. 11. <ul><li>B. Behaviours </li></ul><ul><li>1. Authoritarian </li></ul><ul><li>1.1 Range from very rigid to benevolent </li></ul><ul><li>1.2 Functions with high concern for task accomplishment but low concern for people who perform those tasks. </li></ul><ul><li>1.3 Exploitative- uses the efforts of workers to the best possible advantage of the employer. </li></ul><ul><li>1.4 Communications and activities occur in a closed system: managers make all the work-related decisions and workers carry them out. </li></ul><ul><li>1.5 Frequently exercises power, sometimes with coercion. </li></ul><ul><li>1.6 Is firm, insistent, self-assured and dominating with or without intent and keeps at the center of attention. </li></ul><ul><li>1.7 Has little trust in workers and workers in turn fear the manager. </li></ul>
  11. 12. <ul><li>2. Permissive, ultraliberal or leissez-faire </li></ul><ul><li>2.1 Opposite of the authoritarian leader </li></ul><ul><li>2.2 Wants everyone to feel good </li></ul><ul><li>2.3 Avoids responsibility by relinquishing power to followers </li></ul><ul><li>2.4 Permits followers to engage in managerial activities </li></ul><ul><li>2.5 Assumes that workers are ambitious, responsible, are dynamic, flexible, intelligent and creative. </li></ul><ul><li>2.6 Not generally useful in the highly structured health care delivery system in which organization and control form the baseline of most operations. </li></ul>
  12. 13. <ul><li>3. Democratic, participative or consultative </li></ul><ul><li>3.1 Is people oriented, focusing attention on human aspects and building effective work groups. </li></ul><ul><li>3.2 Interaction between manager and personnel is open, friendly and trusting. </li></ul><ul><li>3.3 There is mutual responsiveness to meeting group goals, with work-related decisions made by the group. </li></ul><ul><li>3.4 Gives workers feelings of self-worth and importance. </li></ul>
  13. 14. <ul><li>VI. Forms of power (ability to impose the will of one person or group to bring about certain behaviors in other persons or groups), a leader /manager may possess : </li></ul>
  14. 15. <ul><li>A. legitimate power - given to the manager by the organization because of the manager’s position in the hierarchy. E.g., director of nursing services, supervisor, head nurse. </li></ul><ul><li>B. Reward power – based on the ability of the manager to control and administer rewards (e.g., promotion) for others for compliance with the leader’s orders or request </li></ul><ul><li>C. Coercive power – founded on the manager’s ability to use punishment on others (e.g., reprimands) for noncompliance with the manager’s orders </li></ul><ul><li>D. Expert power – derived from some special ability, skill or knowledge (e.g., maybe based on a certain attractiveness or appeal of one dialysis nurse) demonstrated by the individual. </li></ul>
  15. 16. <ul><li>E. Referent power – person to another (e.g., the nurse who is consistently supportive or helpful). May also be based on a person’s connection or relationship with another powerful individual. </li></ul>
  16. 17. <ul><li>VII. Components of effective leadership and management: </li></ul><ul><li>A. Understanding of individual strengths, weaknesses and potential </li></ul><ul><li>B. Knowledge of basic ingredients for leadership and management </li></ul><ul><li>C. Systematic use of 7self to get right things done at the right time </li></ul>
  18. 19. I. Definitions <ul><li>A. The art of getting things done through people. </li></ul><ul><li>B. Process that involves the guidance or direction of a group or people toward organizational goals or objectives. </li></ul><ul><li>C. Process with both interpersonal and technical aspects, through which the objectives of an organization are accomplishes by utilizing human and physical resources and technology. </li></ul>
  19. 20. II. Four basic managerial functions: <ul><li>A. Planning - provides the framework for performance. </li></ul><ul><li>B. Organizing – in order to established order and systematically achieve the goals. </li></ul><ul><li>C. Directing – focuses on leading the staff in the most effective manner possible. </li></ul><ul><li>D. Controlling – evaluates performance against established standards. </li></ul>
  20. 21. III. Principles of Management <ul><li>A. Division of work </li></ul><ul><li>B. Authority </li></ul><ul><li>C. Discipline </li></ul><ul><li>D. Unity of command </li></ul><ul><li>E. Unity of direction </li></ul><ul><li>F. Subordination of individual interest to the general interests </li></ul><ul><li>G. Remuneration </li></ul><ul><li>H. Centralization </li></ul><ul><li>I. Scalar chain/line of authority </li></ul><ul><li>J. Order </li></ul><ul><li>K. Equity </li></ul><ul><li>L. Stability of tenure of personnel </li></ul><ul><li>M. initiative </li></ul><ul><li>N. Esprit de corps. </li></ul>
  21. 22. MANAGEMENT PROCESSES AND FUNCTIONS <ul><li>MANAGEMENT PROCESSES – consist of achieving organizational objectives through planning, organizing, directing and controlling human and physical resources and technology. </li></ul>
  22. 23. I. Planning <ul><li>A. Definition : A continuous process of assessing, establishing goals and objectives and implementing and evaluating or controlling them, which is subject to change as new facts are known. </li></ul><ul><li>  </li></ul><ul><li>B. Scope of planning according to level of managers: </li></ul><ul><li>1. Top managers: directors of nursing services, chief nurses, deans </li></ul><ul><li>1.1 Responsible for the overall operations of nursing services </li></ul><ul><li>1.2 Establishes objectives, policies and strategies </li></ul><ul><li>1.3 Represents the organization </li></ul>
  23. 24. <ul><li>2. Middle managers: supervisors, associate/assistant deans </li></ul><ul><li>2.1 Coordinates nursing activities of several units </li></ul><ul><li>2.2 Receives broad, overall strategies and policies from top managers and translate them into specific objectives and programs. </li></ul><ul><li>  </li></ul><ul><li>3. First-line managers: head nurses, primary care nurses </li></ul><ul><li>3.1 Directly responsible for the actual production of nursing services </li></ul><ul><li>3.2 Acts as link between higher level managers and non-managers. </li></ul>
  24. 25. <ul><li>C. Reasons for planning: </li></ul><ul><li>1. Increases the chances of success by focusing on results, not on activities </li></ul><ul><li>2. Forces analytic thinking and evaluation of alternatives, therefore improving decisions </li></ul><ul><li>3. Establishes a framework for decision making consistent with top management objectives. </li></ul><ul><li>4. Orients people to action, instead for reaction. </li></ul><ul><li>5. Includes day-to-day and future –focused management. </li></ul><ul><li>6. Helps avoid crisis management and provide decision-making flexibility. </li></ul><ul><li>7. Provides a basis for managing organizational and individual performance. </li></ul><ul><li>8. Increases employee involvement and improves communication. </li></ul><ul><li>9. Is cost-effective </li></ul>
  25. 26. D. Stages/Phases of Planning: <ul><li>1. Develop the purpose or mission statement (idea statement of shared values and beliefs), the creed/ philosophy (sense of purpose and reason behind organizational structure), goals (statements of intent derived from the purposes of the organization, usually stated broadly and in general terms) and objectives (specific aims, purposes or targets that will have to be accomplished/carried out). </li></ul><ul><li>  </li></ul>
  26. 27. <ul><li>2. Collect and analyze data: </li></ul><ul><li>2.1 Internal forces that define the work and affect employees, clients, stockholders and creditors: technological advances, threats, opportunities to improve growth and productivity. </li></ul><ul><li>2.2 External forces, e.g., competition, communities, government and political issues, legal requirements, marketing and public relations, trends in the physical and social work environments, communication. </li></ul>
  27. 28. <ul><li>3. Assess strengths (opportunities that will facilitate effectiveness and achievement of goals and objectives) and weaknesses (threats that will impede achieving goals and objectives). </li></ul>
  28. 29. <ul><li>4. Write realistic and general statements of goals. </li></ul><ul><li>  </li></ul><ul><li>5. Identify strategies to achieve specified goals. </li></ul><ul><li>  </li></ul><ul><li>6. Develop a timetable for accomplishing each objective. </li></ul><ul><li>  </li></ul><ul><li>7. Provide guidelines for developing operational and functional plans. </li></ul><ul><li>  </li></ul><ul><li>8. Put the plans to work/implement. </li></ul><ul><li>  </li></ul><ul><li>9. Provide for formative evaluation reports before, during and after the plan is implemented. </li></ul>
  29. 30. E. Budget as a tool for planning <ul><li>1. Definition: An operational management plan stated in terms of income and expense, covering all phases of activity, for a future division of time. </li></ul><ul><li>  </li></ul><ul><li>2. Types: </li></ul><ul><li>2.1 Operating budget – includes services to be provided and goods the unit expects to consume or use during the budget period. E.g., cost of supplies (linen, syringes, needles) and small equipment in a ward. </li></ul><ul><li>2.2 Capital expenditure – consist of itemized list of current capital assets (cardiac monitors, dialysis machines and other large equipment which are expensive). </li></ul><ul><li>2.3 Personnel budget – consist of the number of various nursing and support personnel required to operate a specified unit and the money allocated for them. </li></ul>
  30. 31. <ul><li>3. Procedure: </li></ul><ul><li>3.1 Determine the productivity goal </li></ul><ul><li>3.2 Forecast workload (the number of patient days expected for the specific unit) </li></ul><ul><li>3.3 Budget patient-care hours (expected number of hours devoted to patient care for the forecasted patient days). </li></ul><ul><li>3.4 Budget patient-care hours and staffing schedules. </li></ul><ul><li>3.5 Plan non-productive hours – e.g., leaves, holidays. </li></ul><ul><li>3.6 Chart productive time (time spent on the job in patient care administration of the unit, orientation, meetings, etc.) and non-productive time. </li></ul><ul><li>3.7 Estimate costs of supplies and services. </li></ul><ul><li>3.8 Anticipate capital expenses. </li></ul>
  31. 32. II. Organizing <ul><li>A. Definition : The grouping of activities for the purpose of achieving objectives, the assignment of each grouping to a manager with authority for supervising the group, and the defined means of coordinating appropriate activities with other units, horizontally and vertically, that are responsible for accomplishing organizational objectives. </li></ul><ul><li>B. Purposes of organizing: </li></ul><ul><li>1. To sustain the philosophy, achieve the vision and accomplish the mission and objectives of the organization. </li></ul><ul><li>2. Will show the part each person will play in the general social pattern as well as the responsibilities, relationships and standards of performance. </li></ul>
  32. 33. <ul><li>C. Organizational structure </li></ul><ul><li>  </li></ul><ul><li>1. Definitions: </li></ul><ul><li>1.1 Process or way a group is formed, its channels of authority, span of control and lines of communication. </li></ul><ul><li>1.2 Mechanism through which work is arranged and distributed among the members of the organization so that the goals can be logically achieved. </li></ul><ul><li>2 . Characteristics of organizational charts: </li></ul><ul><li>2.1 Division of work in which each box represents an individual responsible for a given part of the organization’s work load. </li></ul><ul><li>2.2 Chain of command, with lines indicating who reports to whom and by what authority. </li></ul><ul><li>2.3 The type of work performed, indicated by the labels or descriptions for the boxes. </li></ul><ul><li>2.4 The grouping of work segments, shown by the clusters of work groups. </li></ul><ul><li>2.5 The levels of management, which indicate individual and entire management hierarchy, regardless of where an individual appears on the chart. </li></ul>
  33. 34. <ul><li>3. Forms: </li></ul><ul><li>3.1 Hierarchical/line organization </li></ul><ul><li>3.1.1 The oldest and simplest form </li></ul><ul><li>3.1.2 Associated with the principle of chain of command, bureaucracy and a multitiered hierarchy, vertical control and coordination levels differentiated by function and authority and downward communications. </li></ul><ul><li>3.1.3 Have direct responsibility for accomplishing the objectives of a unit. </li></ul><ul><li>3.1.4 Has authority for direct supervision of employees </li></ul><ul><li>3.2 Staff organization </li></ul><ul><li>3.2.1 Assists the line in accomplishing the primary objectives of the unit. </li></ul><ul><li>3.2.2 Provides advice and counsel. </li></ul><ul><li>3.2.3 Includes clerical, personnel, budgeting and finance, staff development, research and specialized clinical consulting. </li></ul>
  34. 35. <ul><li>3.3 Free-form/matrix </li></ul><ul><li>3.3.1 Superimposes a horizontal program over the traditional vertical hierarchy. Personnel from functional departments are assigned to a specific program or project and become responsible to two bosses – a program manager and the functional department head. </li></ul><ul><li>3.3.2 Actually an interdisciplinary team of core and extended members </li></ul><ul><li>3.3.3 E.g., “task force”, “ad hoc committee” </li></ul><ul><li>3.3.4 The expert is the authority that leads the team. </li></ul>
  35. 36. <ul><li>D. Patient Classification System (PCS) </li></ul><ul><li>1. Definition : Method of grouping patients according to the amount and complexity of their nursing care requirements. </li></ul><ul><li>  </li></ul><ul><li>2. Purposes for classifying patients: </li></ul><ul><li>2.1 For staffing. Perceived patient needs can be matched with available nursing resources. </li></ul><ul><li>2.2 For program costing and formulation of the nursing budget. </li></ul><ul><li>2.3 For tracking changes in patient care needs. </li></ul><ul><li>2.4 To determine values for the productivity equation: output divided by input. </li></ul><ul><li>2.5 To determine quality. </li></ul>
  36. 37. <ul><li>3. Types of patient classification systems: </li></ul><ul><li>3.1 Descriptive – narrative description of various degrees of care required by a particular patient. </li></ul><ul><li>3.1.1 Checklist – lists down patient problems according to patient acuity. </li></ul><ul><li> Self care </li></ul><ul><li> Minimal care </li></ul><ul><li> Moderate care </li></ul><ul><li> Extensive care </li></ul><ul><li> Intensive care </li></ul><ul><li>3.1.2 Time –based – lists patient needs according to level of acuity and ascribes the amount of nurse-time needed to meet the needs. </li></ul><ul><li> Minimal </li></ul><ul><li> Partial </li></ul><ul><li> Acute </li></ul><ul><li> Complex </li></ul>
  37. 38. E. Staffing and scheduling <ul><li>1. Types of staffing </li></ul><ul><li>1.1 Centralized staffing system – done by the nursing director who develops a master plan for nursing personnel; an impersonal approach. </li></ul><ul><li>1.1.1 Advantages: </li></ul><ul><li> Conserves time </li></ul><ul><li> Easier to handle need for help in time of illness, absence or emergency with qualified personnel </li></ul><ul><li> Less frequent requests for special privileges </li></ul><ul><li> Compatible with computerization </li></ul><ul><li>1.1.2 Disadvantages </li></ul><ul><li> Denies head nurse the right to make staffing decisions </li></ul><ul><li> Minimal opportunity for personal contact with staff </li></ul><ul><li> Limited knowledge of workers abilities, interests and needs </li></ul><ul><li> Limited knowledge of nursing care needs in other departments. </li></ul>
  38. 39. <ul><li>1.2 Decentralized – middle and lower/first levels of management determine staffing; more personal approach </li></ul><ul><li>1.2.1 Advantages: </li></ul><ul><li> Head nurse accountable for staffing decisions </li></ul><ul><li> Scheduling based on knowledge of personnel and direct needs </li></ul><ul><li> Greater control of activities; can rearrange schedule quickly as needed </li></ul><ul><li> Fresh ideas generated for improvement of system </li></ul><ul><li>1.2.2 Disadvantages </li></ul><ul><li> Time consuming </li></ul><ul><li> Sometimes results in lack of sufficient numbers of qualified personnel necessary to meet unforeseen needs </li></ul><ul><li> Increased number of requests for special privileges </li></ul>
  39. 40. <ul><li>2. Methods of staffing pattern: </li></ul><ul><li>2.1 Conventional – centralized-decentralized combination; oldest and most common </li></ul><ul><li>2.2 Cyclical – staffing pattern repeats itself every 4-6 weeks or 7-12 weeks, etc. </li></ul><ul><li>2.2.1 Forty hours/4 days – 40 hours a week is worked in 4 days </li></ul><ul><li>2.2.2 Seven days off, 7 on – a 10 hour day is worked for 7 days, followed by 7 days off </li></ul>
  40. 41. <ul><li>3. Criteria for nursing staffing patterns depend on: </li></ul><ul><li>3.1 existing organizational structure and standards </li></ul><ul><li>3.2 Availability of job descriptions or performance responsibilities which spill out precise job content, including duties, activities to be performed, responsibilities and results expected from the various roles by the organization. </li></ul>
  41. 42. F. Modalities of Patient Care <ul><li>1. Primary nursing – distribution of nursing so that the total care of an individual is the responsibility of one nurse, not many nurses. The primary nurse is assigned to care for the patient’s total needs for the duration of the hospital stay. </li></ul><ul><li>1.1 The primary nurse has responsibility for the nursing care of the patient 24 hours a day from admission till discharge. </li></ul><ul><li>1.2 Assessment of nursing care needs, collaboration with patient and other health professionals, and formulation of the plan of care are all in the hands of the primary nurse. </li></ul><ul><li>1.3 Execution of the nursing care plan is delegated by the primary nurse to a secondary nurse during others shifts. </li></ul><ul><li>1.4 The primary nurse consults with nurse managers </li></ul><ul><li>1.5 Authority, accountability and autonomy rest with the primary nurse. </li></ul><ul><li>1.6 Disadvantages: expensive </li></ul>
  42. 43. <ul><li>2. Team nursing – under the leadership of a professional nurse, a group of nurses work together to fulfil the full functions of professional nurses. </li></ul><ul><li>2.1 The team leader has the responsibility for coordinating the total care of a block of patients. </li></ul><ul><li>2.2 The intent is to provide patient-centered care </li></ul><ul><li>2.3 Provides the best care at the lowest cost </li></ul>
  43. 44. <ul><li>3. Case method – provides to one-to-one RN-to-client ratio and constant care for a specified period of time. Examples are private duty and intensive care </li></ul><ul><li>3.1 Functional method – the oldest nursing practice modality </li></ul><ul><li>3.1.1 Best described as a task-oriented method in which a particular nursing function is assigned to each staff nurse. One registered nurse is responsible for giving medications, one for treatments, one for managing IV, etc. </li></ul><ul><li>3.1.2 No one nurse is responsible for total care of any patient. </li></ul><ul><li>3.1.3 It accomplishes the most work in the shortest amount of time. </li></ul><ul><li>3.1.4 Disadvantages: </li></ul><ul><li> Decreases nurse’s accountability and responsibility </li></ul><ul><li> Makes the nurse-client relationship difficult to establish </li></ul><ul><li> Gives professional nursing low status in terms of responsibility for patient care. </li></ul>
  44. 45. III. Directing <ul><li>A. Definition: Issuance of assignments, orders and instructions that permit the worker to understand what is expected of him and the guidance and overseeing of the worker so that he can contribute effectively and efficiently to the attainment of organizational objectives. </li></ul><ul><li>B. Major elements of directing: </li></ul><ul><li>1. Delegating – effective management competency by which nurse managers get the work done through their employees. </li></ul><ul><li>2. Motivating </li></ul><ul><li>3. Leading </li></ul><ul><li>4. Communicating </li></ul>
  45. 46. <ul><li>C. Change Process </li></ul><ul><li>1. Definition: Purposeful, designed effort to bring about improvement in a system, with the assistance of a change agent. </li></ul><ul><li>  </li></ul><ul><li>2. Theories of Change </li></ul><ul><li>2.1 Reddin’s Theory – suggested seven techniques by which change can be accomplished: </li></ul><ul><li>2.1.1 Diagnosis </li></ul><ul><li>2.1.1 Mutual setting of objectives </li></ul><ul><li>2.1.3 Group emphasis </li></ul><ul><li>2.1.4 Maximum information </li></ul><ul><li>2.1. 5 Discussion of implementation </li></ul><ul><li>2.1.6 Use of ceremony and ritual </li></ul><ul><li>2.1.7 Resistance interpretation </li></ul>
  46. 47. <ul><li>2.2 Lewin’s Theory – change involves three stages </li></ul><ul><li>2.2.1 Unfreezing stage – nurse is motivated by the need to create change </li></ul><ul><li>2.2.2 Moving stage – the nurse gathers information </li></ul><ul><li>2.2.3 Refreezing stage – changes are integrated and stabilized as part of the value system </li></ul><ul><li>  </li></ul><ul><li>2.3 Roger’s Theory – involves five phases: </li></ul><ul><li>2.3.1 Awareness </li></ul><ul><li>2.3. 2 Interest </li></ul><ul><li>2.3.3 Evaluation </li></ul><ul><li>2.3.4 Trial </li></ul><ul><li>2.3.5 Adoption </li></ul><ul><li>  </li></ul><ul><li>2.4 Havelock’s Theory – involves six phases: </li></ul><ul><li>2.4.1 Building a relationship </li></ul><ul><li>2.4.2 Diagnosing the problem </li></ul><ul><li>2.4.3 Acquiring the relevant resources </li></ul><ul><li>2.4.4 Choosing the solution </li></ul><ul><li>2.4.5 Gaining acceptance </li></ul><ul><li>2.4.6 Stabilization and self-renewal </li></ul>
  47. 48. <ul><li>2.5 Lippitt’s Theory – involves seven phases: </li></ul><ul><li>2.5.1 Diagnosing the problem </li></ul><ul><li>2.5.2 Assessing the motivation and capacity for change </li></ul><ul><li>2.5.3 Assessing the change agent’s motivation and resources </li></ul><ul><li>2.5.4 Selecting progressive change objectives </li></ul><ul><li>2.5.5 Choosing the appropriate role of the change agent </li></ul><ul><li>2.5. 6 Maintaining the change </li></ul><ul><li>2.5.7 Terminating the helping relationship </li></ul><ul><li>  </li></ul><ul><li>2.6 Spradley’s Model – involves eight steps: </li></ul><ul><li>2.6.1 Recognize the symptoms </li></ul><ul><li>2.6.2 Diagnose the problem </li></ul><ul><li>2.6.3 Analyze alternative solutions </li></ul><ul><li>2.6.4 Select the change </li></ul><ul><li>2.6.5 Plan the change </li></ul><ul><li>2.6.6 Implement the change </li></ul><ul><li>2.6.7 Evaluate the change </li></ul><ul><li>2.6.8 Stabilize the change </li></ul>
  48. 49. <ul><li>3. Steps in the Change Process (Douglas, 1992). Figure 1 </li></ul><ul><li>  </li></ul>
  49. 50. <ul><li>4. Evaluate overall results of the change . </li></ul><ul><li>Evaluate as is, alter, delete parts, or decide to discontinue the plan </li></ul><ul><li>D. Conflict Resolution </li></ul><ul><li>1. Definition: Conflict exists when an inner or outer struggle occurs regarding ideas, feelings or action. </li></ul>
  50. 51. <ul><li>2. Types of conflict: </li></ul><ul><li>2.1 Conflict within the individual/intrapersonal – occurs when the leader is confronted with two or more incompatible demands. </li></ul><ul><li>2.2 Conflict between organizations – restricted to issues pertaining to competition </li></ul><ul><li>2.3 Conflict within health organizations/interpersonal and intergroup – major sources are: </li></ul><ul><li>2.3.1 Differences between management and staff </li></ul><ul><li>2.3.2 Need to share resources </li></ul><ul><li>2.3.3 Interdependence of work activities in the organization </li></ul><ul><li>2.3.4 Differences in values and goals among department and personnel regarding delivery of nursing care. </li></ul>
  51. 52. <ul><li>3. Approaches to conflict resolution – the style used depends on the nurses values regarding work production and human relationships. </li></ul><ul><li>3.1 Competition and power – if the nurse’s primary concern is work accomplishment, with little regard for staff relationships. </li></ul><ul><li>  </li></ul><ul><li>3.2 Smoothing – a more diplomatic method nurse has high concern for relationships and a secondary concern for work accomplishment. </li></ul><ul><li>  </li></ul><ul><li>3.3 Avoidance – low regard for both relationships and work accomplishment, nurse does not take a position regarding the conflict. “If we don’t talk about the problem, it will go away.” </li></ul>
  52. 53. <ul><li>3.4 Compromise – each side makes concessions. Is moderately assertive and cooperative but produces a lose-lose situation because each side give up something in order to gain something. Is a weak resolution method. </li></ul><ul><li>3.5 Collaboration – a constructive process in which the parties involved recognize that conflict exists, confront the issue and openly try to solve the problem that has arisen between them. The outcome is integrative problem solving. </li></ul>
  53. 54. <ul><li>E. Decision Making </li></ul><ul><li>1. Definition: A systematic, sequential process of choosing among alternatives and putting the choice into action. </li></ul><ul><li>2. Steps in decision making: </li></ul><ul><li>2.1 Identify the problem </li></ul><ul><li>2.2 Prioritize the problem </li></ul><ul><li>2.2.1 Deal with problems in the order in which they appear </li></ul><ul><li>2.2.2 Solve the easiest problems first </li></ul><ul><li>2.2.3 Solve crisis problems before all others </li></ul><ul><li>2.3 Gather and analyze information related to the solution - involves defining, through a series of activities, the specifications to be met by the solution. </li></ul><ul><li>2.4 Evaluating all alternatives </li></ul><ul><li>2.5 Selecting an alternative for implementation </li></ul>
  54. 55. <ul><li>F. Communication </li></ul><ul><li>1. Definition: The process whereby a message is passed from sender to receiver with the hope that the information exchanged will be understood as the sender intended. </li></ul><ul><li>2. Importance: Communication is the foundation on which nursing management achieves organizational objectives. </li></ul><ul><li>3. Guidelines for effective communication/basic elements of the communication process. </li></ul>
  55. 56. <ul><li>3.1 Sender (the source of information and initiator of the communication process chooses the type of message and the channel that will be most effective, e.g., memo, telephone, computer) and receiver (the person who receives the sender’s message and translates it into a form that has meaning). </li></ul><ul><li>3.2 Message – the content of the communication </li></ul><ul><li>3.3 Encoding – translating the message into words, gestures, facial expression and other symbols that will communicate the intended meaning to the receiver. It is important to remember that: </li></ul><ul><li>3.3.1 Words mean different things to different people </li></ul><ul><li>3.3.2 The message should be encoded in the simplest terms </li></ul><ul><li>3.3.3 If complex, the message should be expressed in several ways </li></ul><ul><li>3.3.4 The language used should reflect the personality, culture and values of the receiver. </li></ul>
  56. 57. <ul><li>3.4 Transmitting – the channel used to communicate a message. i.e., what form it will take. Maybe verbal, nonverbal or instructional media (e.g., charts, tapes, films). </li></ul><ul><li>3.5 Decoding – the receiver perceives and interprets the sender’s message into information that has meaning. Is affected by the receiver’s experiences, personal interpretations of the symbols used, expectations and mutuality of meaning with the sender. </li></ul><ul><li>3.6 Action – the behaviour taken by the receiver as a result of the message sent, received and perceived; the process of doing or performing something; it is behaving or functioning in a certain way. </li></ul><ul><li>3.7 Feedback – senders and receivers exchange information and clarify the meaning of the message sent. Two-way communication occurs when a receiver acknowledges a message and then sends meaningful feedback to the sender. Maybe direct or indirect, both verbal and nonverbal. </li></ul>
  57. 58. <ul><li>4. Management Functions and Communications </li></ul><ul><li>4.1 Downward communication – flows from top management levels to the lower levels in the organizational hierarchy. E.g., memos. </li></ul><ul><li>4.2 Upward communication – from staff and lower and middle management personnel up to the top management levels in the organizational hierarchy. </li></ul><ul><li>4.3 Horizontal communication – communication that flows between functional units; connects people on the same level. Messages usually relate to coordinating activities, sharing information and solving problems. </li></ul>
  58. 59. <ul><li>5. Barriers to effective communication: </li></ul><ul><li>5.1 Physical barriers – environmental factors that prevent or reduce opportunities for the communication process to occur. E.g., physical distance, distracting noise </li></ul><ul><li>5.2 Social-psychologic barriers – blocks or inhibitors in communication that arise from the judgements, emotions and social values of people. E.g., lack of trust in the sender. </li></ul><ul><li>5.3 semantics – the interpretation of messages through signs and symbols. E.g., misinterpretation of meaning, inability to speak effectively, poor listening habits. </li></ul>
  59. 60. <ul><li>6. Team Building </li></ul><ul><li>6.1 Definition: A process for developing work group maturity and effectiveness; the most widely used human resource development technique. </li></ul><ul><li>6.2 Emphasizes interactive group processes or the “how” of effective group behaviour. </li></ul>
  60. 61. IV. Controlling/Evaluating <ul><li>A. Definitions: </li></ul><ul><li>1. The process by which managers attempt to see that actual activities conform to planned activities. </li></ul><ul><li>2. The management function in which performance is measured and corrective action is taken to ensure the accomplishment of organizational goals. </li></ul>
  61. 62. <ul><li>B. Basic components: </li></ul><ul><li>1. Establishing standards, objectives and methods for measuring performance </li></ul><ul><li>2. Measuring actual performance </li></ul><ul><li>3. Comparing results of performance with standards and objectives and identifying strengths and area for correction. </li></ul><ul><li>4. Acting to reinforce strengths or successes and taking corrective action as necessary. </li></ul>
  62. 63. <ul><li>C. Nature and Purposes: </li></ul><ul><li>1. Establishes trust and commitment to the system by all personnel through the use of an effective communication system. </li></ul><ul><li>2. Clarifies organization and individual objectives </li></ul><ul><li>3. Presents uniform and fair standards with precise definitions of each standard, goal and objective. </li></ul><ul><li>4. Compares expectancy with performance </li></ul><ul><li>5. Improves organization development by providing information for decision making on staffing, system for delivery of care and quality of care. </li></ul><ul><li>6. Promotes growth and development of personnel. </li></ul>
  63. 64. <ul><li>D. Control Mechanics </li></ul><ul><li>1. Standards of care </li></ul><ul><li>1.1 Yardsticks for gauging the quality and quantity of services. </li></ul><ul><li>1.2 Established criteria of performance, planning goals, strategic plans, physical or quantitative measurements of products, units of service, labor, hours, speed, cost, capital, revenue, program and intangible standards. </li></ul><ul><li>1.3 An acknowledged measure of comparison for quantitative or qualitative value, criterion or norm, a standard rule or test on which a judgement or decision can be based. </li></ul>
  64. 65. <ul><li>2. Total quality Management (TQM) – a work ethic involving everyone in the organization. The client is the focus </li></ul><ul><li>2.1 Elements: </li></ul><ul><li>2.1.1 Decentralization </li></ul><ul><li>2.1.2 Participatory management – making decisions at lower level in the organizational hierarchy. </li></ul><ul><li>2.1.3 Matrix management – free form organizational structures </li></ul><ul><li>2.1.4 Management by Objectives (MBO) – every person or group in a work setting has specific, attainable and measurable objectives that are in harmony with those of the organization . </li></ul><ul><li>2.1.5 Statistical analyses </li></ul><ul><li>2.1.6 Team building </li></ul><ul><li>2.1.7 Quality circles – participatory management technique that use statistical analysis of activities to maintain quality products. </li></ul><ul><li>2.1.8 Theory Z – (consensual decision-making) – the leadership style is a democratic one which includes decentralization, participatory management, employee involvement and an emphasis on quality of life. </li></ul>
  65. 66. <ul><li>2.2 Quality assurance – defines performance measurements and compares actual processes and outcomes to clinical and satisfaction indicators. </li></ul><ul><li>2.3 Quality control – involves performance management and maintenance and includes systematic methods of ensuring conformity to a desired standard or norm. </li></ul><ul><li>2.4 Quality improvement – concerned with performance development and is ongoing, involved with fixing now, preventing future costly mistakes and fostering breakthroughs. </li></ul>
  66. 67. <ul><li>3. Nursing Audit – an examination, a verification or an accounting of predetermined indicators. The three basic forms are: </li></ul><ul><li>3.1 Structure audit – focuses on the setting in which care takes place: </li></ul><ul><li>Physical facilities, equipment, caregivers, organization, policies, procedures and medical records. Are measured by means of checklists. </li></ul><ul><li>3.2 Process audit – implements indicators for measuring nursing care to determine whether nursing standards are met. Generally task-oriented. </li></ul><ul><li>3.3 Outcome audit – evaluates nursing performance in terms of establishing client outcome criteria; may either be concurrent or retrospective. </li></ul>
  67. 68. <ul><li>E. Control Techniques </li></ul><ul><li>1. Nursing rounds – cover issues like patient care, nursing practice and unit management. </li></ul><ul><li>2. Nursing operating instructions – policies which become standards for evaluation as well as controlling techniques. </li></ul><ul><li>3. ____ charts – depict a series of events essential to the completion of a project or program. </li></ul><ul><li>4. Critical control points and milestones – specific points in a master evaluation plan at which the nurse judges whether the objectives are being met, qualitatively and quantitatively. </li></ul><ul><li>5. Program Evaluation and Review Technique (PERT) - uses a network of activities, each of which is represented as a step on a chart. Includes time measurement, an estimated budget and calculation of the critical path (the sequence of events that would take the longest time to finish). </li></ul><ul><li>6. Benchmarking – technique whereby an organization seeks out the best practices in its industry so as to improve its performance. It is a standards=, or point of reference, in measuring or judging quality, values and costs. </li></ul><ul><li>  </li></ul>