hospital management

1. Managing the process of
care delivery
Presenter: Ruth Christina

2. Objectives
Define directing
Describe the nature of the directing function of nursing
management with relation to the physical act of directing
Make a plan for delegating duties, tasks, and responsibilities.
Make a plan for using management by objectives.

3. Cont…
• Differentiate between content (exogenous) theories of
motivation and process (endogenous) theories of
motivation.
• Describe Maslow’s hierarchy of needs.
• Describe nurse dissatisfaction as it relates to productivity and
the nurse’s role as a knowledge worker
• Describe nurse satisfaction as it relates to applications of
behavioral science.

4. Directing

5. Directing & Nursing Management
• It’s a physical act of nursing management, the interpersonal
process by which nursing personal accomplish the objectives
of nursing.
• Directing is the process of applying the management plans to
accomplish nursing objectives.
• It’s the process by which nursing personnel are inspired or
motivated to accomplish work.

6. Cont.…
• Three of the major elements of directing are embodied in
supervision of nursing personnel:
Motivation
Leadership
Communication

7. Cont.…
• Subordinates are hired as total human beings and have to be
managed as total human beings. Who respond to many
institutions within society.
• Similarities & differences exist between supervisors &
subordinates,with known and conscious needs for
physiological well-being,safety,achievement and human
associations.

8. Cont.…
• Identification of training & education needs of individuals &
establishment of programs to meet such needs.
• Establishment of a system of Performance appraisal to
identify personal competencies; assignments & promotions
based on competency, including performance.
• Development of trust & subsequent delegation of
responsibility & authority for decision-making.

9. A good leader will contribute to create a work
environment with given properties:
• Job that offer a living wage as well as adequate work.
• Group identity and group- purpose, that is, the opportunity
to work with others.
• Pleasant surroundings & coworkers.
• Interesting work.
• Recognition that employees’ work is valued and well done.
• Opportunity for accomplishment & challenge.

10. • Harmony between organizational & individual goals:
oequality of opportunity to be safe & secure
• to achieve differently, and to have choices about shifts:
oto have job enlargement, and to be recognized as an
individual.

11. • Effective directing is the management function where in the
nurse manager acts as facilitator and coach.
• They provide the education needed for primary nurses &
case managers to become leaders and managers.
• Nurse managers teach nursing personnel to manage
themselves in self-managed teams.
• Personnel learn to do planning, self scheduling, personal
management & budgeting;effect change;make decisions &
solve problems;and build teams for research.

12. Nurse managers encourage & inspire their
workers every step of the way.

13. Make a plan for delegating duties, tasks, and
responsibilities.

15. • Delegating, a technique of time management, is a major
element of directing function of nursing management.
• Delegation is a part of management; it requires professional
management training & development to accept the
hierarchical responsibilities of delegation.
Nurse managers need to be able to delegate some of their own
duties,tasks,and responsibilities as a solution to overwork,
which leads to stress, anger and aggression.

16. Ways for Nurse Managers to successfully
delegate
• Train & develop subordinates,it is an investment.
• Give them reasons for the task,authority ,details,opportunity
for growth and written instructions,if needed.
• Plan ahead.It prevents problems.
• Control & coordinate the work of subordinates but do not
peer over their shoulders.To prevent errors.

17. • Develop ways of measuring the accomplishment of
objectives with
communicaton,standards,measurements,feedback and
credit.
• Give clear,consistent messages and behavior to prevent
confusion.

18. Cont…
• Follow up by visiting subordinates frequently.
• Spot potential problems of morale,disagreement and
grievance.
• Expect employees to make suggestions to improve work and
use the feasible ones.

19. • Coordinate to prevent duplication of efforts.
• Solve problems and think about new ideas.
• Encourage employees to solve their own problems, and then
give them the autonomy and freedom to do so.

20. Cont…
• Accept delegation as desirable.
• Specify goals and objectives.
• Know subordinates capabilities’,and match the task or duty
to the employee.
• Be sure the employee considers the task or duty important.
• Agree on performance standards.Relate managerial
references to employee performance.

21. • Take an interest.
• Assess results.
• Expect what is clearly and directly asked for as the deadline
for completing and reporting arrives.
• The nurse manager should accept the fact that employees
will perform delegated tasks in their own style.

22. Cont…
• Give appropriate rewards.
• Do not take back delegated tasks.

23. Make a plan for delegating duties, tasks, and
responsibilities.
Build professional nurses self-esteem by delegating as much of
the authority for nursing practice as possible.
Professional nurses want authority over their practice and can
be educated to perform management tasks related to it.

24. Nurse managers will determine what authority to delegate
through communication with clinical nurses.
Authority should be commensurate with assigned
responsibility. As professional nurses gain individual self-
esteem , organizational self-esteem follows. Employees
respond to participation in decision-making and gain
satisfaction with their jobs and the organization.

25. • Organizational self-esteem will be built by: managerial
interest in employees’ well-being, status and contributions,
and concern and support for their personal problems,
personal development,and comfort.
• Job variety from delegation that provides job
enlargement,autonomy,significant work and use of skills and
abilities the employees value.

26. • Delegating that enlarges an employee’s job develops his or
her sense of responsibility,general understanding,and job
satisfaction.
• As part of a successful knowledge base,professional nurses
learn effective strategies for managing tasks,including
increased work loads,establishing priorities,and delegating
responsibility.

27. • A climate or work environment that bolsters cohesiveness
and trust
• Management’s faith in and recognition of the rewards of
self-direction.

28. Techniques for delegating
• Nurse manager at all levels,from nurse executive to
department or unit head and from unit head to clinical
nurse,can prepare lists of duties that can be delegated.
• Delegation includes authority to approve,recommend or
implement.
• The list of duties should be ranked by time required to
perform them and their importance to the institution.
• One duty should be delegated at a time.

29. Make a plan for using management by
objectives.

30. Procedure & Process
Training:
• The training for the MBO process should begin with the
nurse managers of the enterprise.
• Managers will learn the characteristics of the process,the
objectives of initiating an MBO program,the procedures to
be used,and the methods of evaluating the program’s
effectiveness.
• During this training program,nurse managers can simulate
the procedures to be used.

31. Cont…Training
• Once nurse managers are trained, all nursing employees are
given similar training.
• Employees will be made aware of the necessity for writing
and working toward their personal objectives as they seek to
achieve those of the organization.
• They will be taught the value of synergism of personal &
organizational objectives and will be asked to bring their
written lists of objectives to the first meeting with their
superior.

32. First Meeting
Should be held in quiet surrounding,with sufficient time for
discussion.
The nurse manager should put the employee at ease.Most
survival and safety needs of nurses are reasonably satisfied.
Nurses’ social,ego,and self fulfillment needs are predominent
at this time.

33. Cont… First Meeting
As the nurse presents each personal objective,the nurse
manager relates it to an objective of the enterprise.
Thus,the manager creates the conditions for fulfilling the
nurse’s needs,including the removal of
obstacles,encouragement of growth,and provision of
guidance.

34. Cont... First Meeting
• During first meeting the nurse manager & clinical nurse set
goals that are specific,promote team work,are
measureable(in the sense that they can be quantified or
described qualitatively),and are attainable.
• Goals should involve enough risk to challenge but not
defeat.They should include objectives that are routine,solve
problems ,are creative or innovative,and result in personal
development.

35. Cont... First Meeting
• At the end of the first meeting,both the nurse manager and
clinical nurse should be satisfied with the written
objectives.Each will have a copy of these objectives.The
nurse manager and the clinical nurse will part with an
understanding of mutual expectations how future meetings
will progress and will have set a time for the next meeting.

36. Actions
• Between meetings,employees perform work that
meets their agreed-on objectives and summarize their
accomplishments.

37. Second Meeting
• Conditions for the second MBO meeting will be the same as for the
first meeting.The meeting will provide a time for evaluation of
results,review,appraisal,and the setting of future goals.
• The employee should be encouraged to spell out gratifying and
exhilarating experiences,do self examination and relate his or her
thoughts about work.

38. Cont…Second Meeting
• The nurse manager should listen and make the employee
feel safe while helping them to have a person-to-
organization fit.
• The manager examines his or her own reactions with our
criticizing the employee,which helps build trust and
confidence as well as an ethical relationship.
• In doing so,the manager & employee establish an
organizational climate for personal & organizational
achievement.

39. • MBO should include appraisal of managers by subordinates,
subordinates will appraise how well the manager helps
employees do their jobs,supports them,assists with
problems and demonstrates proficiency and visibility.
• Both nurse manager and employee should exit the second
meeting with a sense of accomplishment.This does not mean
the employee will not be made aware of deficiencies or
shortcomings.

40. • Deficiencies or shortcomings will be recognized in the form
of needed additions or changes,increased progress and even
deletions.All will be tied to patient care and organizational
development. The feedback process tells the employee what
is expected and when an error has been made.

41. • The process will be repeated at intervals,with dates and
times agreed on at each meeting.
• At the end of an appraisal period,a performance results
contract will be signed by both the employee and the
supervisor and sent to the personal department to be
included in the employee’s record.
• The performance appraisal can be used to identify
promotion potential and to determine merit pay increases.

42. Organizational Development(OD)
• Management by objectives is needed for organizational
development(OD) and vice versa.
• Organizational development allows the organization to be managed
against goals and for results.
• OD occurs as management skills and organizational processes are
applied to shape and develop the conditions for human effectiveness.
These are:

43. Management Skills for OD
Interpersonal competence: The individual has high
expectations,respect for others,honest r/s,freedom to act and
a team orientation.
Meaningful goals: The goals are
understandable,desirable,attainable,and synergistic.The
individual influences the goals.

44. Cont….
Helpful systems: Users understand and control systems
because systems are goal oriented and provide feedback.Users
adapt to and adopt systems.
Achievement and Self-actualization: As the organization
grows,the individual grows.People are committed to goals are
highly motivated,and have high trust and minimal
dissatisfaction.

45. Theories of Motivation
• Differentiate between content (exogenous) theories of motivation
and process (endogenous) theories of motivation.
Motivation is a concept used to describe both the extrinsic conditions
that stimulate certain behavior and the intrinsic responses that
demonstrate that behavior in human beings.The intrinsic response is
sustained by sources of energy, termed motives often described as
needs,wants,or drives.All people have motives.Motivation is measured
by observable and recorded behaviors.Deficiencies in needs stimulate
people to seek and achieve goals to satisfy these needs.

46. Theories of Motivation
Theories of Motivation have been classified into two
Content theories
Process theories

47. Content theories
• Focus on factors or needs within a person that
energize,direct,sustain and stop behavior.
• The most widely recognized work in motivation theory is that
of Maslow.Although not universally accepted,because of its
lack of scientific evidence or research base,Maslow’s work is
universally known.
Many managers attempt to use Maslow’s work as they turn to
a human behavior approach to management.

48. Process theories
• Process theories provide a description and analysis of how
behavior is energized,directed,sustaines and stopped.

50. Describe Maslow’s hierarchy of needs.
• Maslow’s theory of motivation is a positive one and is based
on a holistic-dynamic theory.
• At the base of a needs system are the physiologic needs,
based on homeostasis, a condition of constancy of body
fluids,functions,and states.
• The constancy is maintained automatically by uniform
interaction of counteracting processes. It should be noted
that human beings do not just eat;they eat selectively to
maintain homeostasis.

51. Cont.…
• Higher needs emerge as lower ones are satisfied.When the
physiological needs are satisfied,they no longer motivate the
human being.
Example:A starving person will steal food and perform other
acts that threaten the person’s safety.The dominance of a
physiological need changes the individual’s philosophy for the
future.

52. Cont….
• Safety needs are the second group in the hierarchy.Among
these are security,protection,dependency,and
stability;freedom from anxiety,chaos,and fear,need for
order,limits,structure,and law;and strength in the protector.
• Satisfaction of these needs influences a person’s values and
philosophy of life.

53. Cont….
• Once a physiological and safety needs have been
satisfied,the needs for love,affection and belongingness
emerges.Most nurses in practice today have had their
physiological and safety needs satisfied.Now they want to be
part of a group or family with
love,acceptance,friendliness,and a feeling of belonging.

54. Cont….
Two categories emerge under the fourth set of needs,the
esteem needs .All people share these needs .
• First,they desire strength,achievement ,adequacy,mastery
and competence,confidence before the world, independence
and freedom.
• Second,they desire reputation or prestige,status,fame ,and
glory,dominance,regonition,attention,importance,dignity or
appreciation.

55. Cont….
• A person whose self-esteem is satisfied has feelings of self-
confidence,worth,strength,capability,adequacy,usefulness,an
d being needed in society.
• For self-esteem to be stable and healthy,it must be based on
known or deserve respect.The reason for self-esteem must
be known an recognized by its recipient.
• Finally,at the pinnacle of the hierarchy of needs is the
emotional gold,that is the need for self-actualization.

56. • Self-Actualization needs - realizing personal potential, self-
fulfillment, seeking personal growth and peak experiences.

58. Task I
• Describe nurse dissatisfaction as it relates to productivity and
the nurse’s role as a knowledge worker

59. Task II
• Describe nurse satisfaction as it relates to applications of
behavioral science.