03 planning[1]

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Mr. Channabasappa. K .M
UNIT-III
PLANNING
INTRODUCTION
Planning is important for socioeconomic development. it helps to conceive and achieve
results in an atmosphere and spirit of true democratic situation, where in different agencies at
various levels are involved in the policies of the government for welfare of it‟s people.
Planning is an intellectual process of making decisions and it aims to achieve a
coordinated and consistent set of operations aimed at desired objecives.for any work,
planning is very essential.
DEFINITION
Planning is a process of determining the objectives of administrative effort and
devising the means calculated to achieve them.
the firm.
(Millet)
Planning is a process of setting formal guidelines and constraints for the behavior of
(Assoff and Brundinharg)
Planning is the systematic development of action programs aimed at reaching agreed
business objectives by the process of analyzing, evaluating and selecting among the
opportunities which are foreseen
(Certo S.C. 2003).
IMPORTANT OF PLANNING
Planning is considered important because,
 It focuses attention on the objectives or goals of the organization and their
achievement.
 It leads to economy in operation through the selection of the best possible course of
action.
 It helps in controlling the activities by providing measures against which performance
can be evaluated.
 It helps in co-coordinating the operations of organizations since a well considered
plan embraces and unifies all the divisions in an organization.
PRICIPLES OF PLANNING
 Planning is must focuses on purposes. it should always be based on a clearly
defined objectives.
 Planning is a continuous and iterative process which includes series of steps, so
continuing and flexibility should be maintained in planning cycle.

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 Planning should be simple and there should be provision for proper analysis and
classification of actions.
 In planning there should be a good harmony with organization and environment.
 Planning is hierarchical in nature.
 Planning should cover entire organization with all its departments, sectors and
different levels of administration and it should be balanced.
 Planning must be precise in its objectives, scope and nature.
 In planning the provision should be made to use all available resources.
 Planning should be always documented
MISSION OR PURPOSES
 To render quality health care through effective team work.
 To train health professions to become competent, humane and ethical health care
providers, educators and leaders.
 To undertake relevant biomedical and health system researcher, which may serve as
basis for health policies?
 To develop a system of referral network and serve as center for complex health care
problem.
 To attain self sufficiency in resources.
 To be the role model for health care delivery in the country.
NATURE OF PLANNING
1. Planning is goal oriented: Every plan must contribute in some positive way towards
the accomplishment of group objectives.
2. Primacy of planning: Planning is the first of the managerial functions. It precedes all
other management functions.
3. Pervasiveness of planning: Planning is found at all levels of management.
4. Efficiency, economy and accuracy: Efficiency of plan is measured by its
contribution of the objectives as economically as possible. Planning also focus on
accurate forecast.
5. Co-ordination: Planning co-ordinates the what, who, how, where and why of
planning, without co-ordination of all activities, we cannot have united efforts.
6. Limiting factors A planner must recognize the limiting factors (Money, manpower
etc.) and formulate plans in the light of these critical factors.
7. Flexibility: The process of planning should be adaptable to changing environmental
conditions.
8. Planning is an intellectual process: The quality of planning will vary according to
the quality of the mind of the manager.

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CHARACTERISTICS OF PLANNING
1. Planning is goal-oriented.
a. Planning is made to achieve desired objective of business.
b. The goals established should general acceptance otherwise individual efforts
& energies will go misguided and misdirected.
c. Planning identifies the action that would lead to desired goals quickly &
economically.
d. It provides sense of direction to various activities. E.g. Maruti Udhyog is
trying to capture once again Indian Car Market by launching diesel models.
2. Planning is looking ahead.
a. Planning is done for future.
b. It requires peeping in future, analyzing it and predicting it.
c. Thus planning is based on forecasting.
d. A plan is a synthesis of forecast.
e. It is a mental predisposition for things to happen in future.
3. Planning is an intellectual process.
a. Planning is a mental exercise involving creative thinking, sound judgement
and imagination.
b. It is not a mere guesswork but a rotational thinking.
c. A manager can prepare sound plans only if he has sound judgement, foresight
and imagination.
d. Planning is always based on goals, facts and considered estimates.
4. Planning involves choice & decision making.
a. Planning essentially involves choice among various alternatives.
b. Therefore, if there is only one possible course of action, there is no need
planning because there is no choice.
c. Thus, decision making is an integral part of planning.
d. A manager is surrounded by no. of alternatives. He has to pick the best
depending upon requirements & resources of the enterprises.
5. Planning is the primary function of management / Primacy of Planning.
a. Planning lays foundation for other functions of management.
b. It serves as a guide for organizing, staffing, directing and controlling.
c. All the functions of management are performed within the framework of plans
laid out.
d. Therefore planning is the basic or fundamental function of management.
6. Planning is a Continuous Process.
a. Planning is a never ending function due to the dynamic business environment.
b. Plans are also prepared for specific period f time and at the end of that period,
plans are subjected to revaluation and review in the light of new requirements
and changing conditions.
c. Planning never comes into end till the enterprise exists issues, problems may
keep cropping up and they have to be tackled by planning effectively.

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7. Planning is all Pervasive.
a. It is required at all levels of management and in all departments of enterprise.
b. Of course, the scope of planning may differ from one level to another.
c. The top level may be more concerned about planning the organization as a
whole whereas the middle level may be more specific in departmental plans
and the lower level plans implementation of the same.
8. Planning is designed for efficiency.
a. Planning leads to accompishment of objectives at the minimum possible cost.
b. It avoids wastage of resources and ensures adequate and optimum utilization
of resources.
c. A plan is worthless or useless if it does not value the cost incurred on it.
d. Therefore planning must lead to saving of time, effort and money.
e. Planning leads to proper utilization of men, money, materials, methods and
machines.
9. Planning is Flexible.
a. Planning is done for the future.
b. Since future is unpredictable, planning must provide enough room to cope
with the changes in customer‟s demand, competition, govt. policies etc.
c. Under changed circumstances, the original plan of action must be revised and
updated to make it more practical.
COMPONENTS OF PLANNING
 Objectives
Objectives are basic plans which determine goals or end results of the projected
action of an enterprise. By setting goals, objectives provide the foundation upon which
structure of plan can be built.
 Policies
Policies are written statements or oral understanding. Realization of objectives is
made easy with the help of policies, policies provide standing solutions to problem.
 Procedures
Procedures indicate the specific manner in which a certain activity is to be
performed.
 Programme
Programmes are necessary for both repetitive (routine planning)and non-
repetitive (creative planning) course of action.
 Budget
Budgets are plans continuing statements of expected results in numerical items.

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Purpose or
Mission
Objectives
Strategies
Policies: Major or minor
Procedure
Rules
Programs: Major or Minor & Supporting
Budgets: Numberized or dollarized programs
Hierarchy of Organizational Plans
Hierarchy of organizational plans
The planning process cannot be effective unless the types of plans are properly
understood. It is easy to see that a major program, such as one to build and equip a new
factory, is a plan. But a number of other courses of future action are also plans. In fact plan
can encompass any course of future action, which clearly shows that plans are varied. They
are classified and illustrated as a hierarchy.
1. Purpose or Missions
The mission or purpose identifies the basic function or task of an enterprise or agency
or of any part of it every kind of organized operation has, or at least should have if it is to
meaningful, purposes of mission.
In every social system, enterprises have a basic function or task, which is assigned to
them by society.
 The purpose of a business is generally the production or distribution of goods or
services.
 The purpose of the courts is the interpretation of law and their application.
 The purpose of a university is teaching, research, consultancy and training.
While a business may have a social purpose of producing and distributing goods and
services, it can accomplish this by fulfilling a mission of producing certain lines of products.
Hallmark, which has expanded its business beyond greeting cards, defines its mission
as “The social expression business.

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2. Objectives
Objectives or goals are the ends towards which activity is aimed and every organization
strives hard to achieve them. They represent not only the end point of planning of
management i.e. organizing; staffing, leading and controlling are aimed. While enterprise
objectives are the basic plan of the firm, departments also have its own objectives. its goals
naturally contribute to the attainment of a business might be to make a certain profit by
producing a given a line of home entertainment equipments, while the goal of manufacturing
department might be to produce the required number of color television sets of given design.
3. Strategies
The term strategies usually has a competitive implication, managers increasingly use it
to reflect broad area of an enterprise operation.
The term strategies can be explained as
 General programs of action and development of resources to attain comprehensive
objectives.
 The program of objectives of an organization and their changes, with a focus on
resources used to attain these objectives and policies governing the acquisition used
and disposition of these resources.
 The determination of the basic long term objectives of an enterprise, the adoption of
courses of action and allocation of resources necessary to achieve these goals.
A firm also has to decide on its growth goals and its desired profitability. A strategy
might include such major policies as marketing directly rather than through distributors or
concentrating on proprietary products or having a full line of autos, a general motors decided
to have many years ago.
The purpose of strategies then is to determine and communicate, through a system of
major objectives and policies, a picture of the kind of enterprise that is envisaged. Strategies
however do not attempt to outline exactly how the enterprise is to accomplish its objectives.
4. Policies
Policies are also plans in that they are general statements or understanding that guide
or channel thinking in decision making. Not all policies are statements; they are often merely
implied from the actions of managers. The president of a company may strictly follow
perhaps for convenience rather than a policy the practice of promoting from within, the
practice may be interpreted as policy and carefully followed by subordinates.
Policies can be defined an area within which a decision is to be made and ensure that
the decision will be consistent with and contribute to an objective.
Policies ordinarily exist in all levels of the organization, ranging from major company
policies through major department policies to minor policies applicable to the smallest
segment of the organization. They may be related to functions or merely to project.
5. Procedure
Procedures are plans that establish a required method of handling future activities.
They are guides to action, rather than to thinking and they detail exact manner in which
certain activities must be accomplished. They are chronological sequence of required action.

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Procedures often cut across department lines. e.g. in a manufacturing company, the
procedure for handling orders will almost certainly involves the sales department, the finance
department, the accounting department, the production department and the traffic department.
Company policy may grant employees vacation, procedures established to implement
this policy will provide for scheduling vacations to avoiding disruption of work, setting
methods rates of vacation pay, maintaining records to assure each employee of a vacation and
spelling out the means for applying for a vacation.
6. Rules
Rules spell out specific required actions or non actions, allowing no discretion. They
are usually the simplest type of plan.
Rules are different from policies or procedures. It is unlike procedures in that they
guide action without specifying a time sequence. In fact a procedure might be looked upon as
a sequence of rules. A rule however may or may not be part of a procedure but a procedure
governing the handling of orders may incorporate the rules that all orders must be confirmed
the day that are received. This rule allows no deviation from a stated course of action. It does
not interfere with the rest of the procedure in any way, for handling orders. It is comparable
to a rule stating that all fractions of weight of over half an ounce are to be counted as a full
ounce or that receiving inspection must count or weight all materials against the purchase
order.
7. Programs
Programs refer to set of clear instructions in a clear and logical sequence to perform a
particular task. They explain how to carry out a given course of action. They are ordinarily
supported by budgets. The programs may be as major as an airlines program for acquiring a
$400 million fleet of jets or implementation of the 10th five year plan (2002-07) by the
government of India. Or they may be as minor as a program formulated by a single
supervisor to improve the morale of workers in a parts manufacturing department of a farm
machinery company.
All the programs call for coordination and timing as the failure of any part of this
network of support plans means delay for the major programs.
8. Budgets
A budget is a statement of expected results expressed in numbers. In fact, the
operating budget, expressed in terms of revenues and expresses, is often called a profit plan.
A budget may be expressed either in financial terms or in terms of labor hours, unit of
products, machine hours or any other numerically measurable parameters. It may be an
expense budget, it may be capital expenditure budget or it may cash budget.
Although a budget usually implements a program, it may in itself be a program. One
company in extreme financial straits installed an elaborate budgetary control program
designed not only to control expenditure but also to install costs consciousness in
management. One of the major advantages of budgeting is that it makes people plan, because
budget is in form of numbers, it forces precision in planning.

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Source: Koontz, H. and Weihrich, H (2003).
Comparing alternatives to light
of goals sought
Which alternative will give us the
best chance of meeting our goals at
the lowest cost and highest profit
Choosing an alternative
Selecting the course of action we
will pursue
Formulating supporting plan
Such as: plan to buy equipments,
buy materials, hire and train works,
develop a new product
Numbrizing plans by making
budgets
Develop such budget as: Volume
and price of sales, operating
expenses for plans, expenditure for
plans, expenditure for capital
equipments
Budget varies considerably in accuracy, detail and purpose. Some budget vary
according to organizations levels of input, these are flexible budget. government agencies
often develops program budget.
Steps in planning process
Being aware of opportunity
The market Competition
What customers want Over
strengths Our weakness
Setting objectives/goals
Where we want to be and what
we want to accomplish and
when
Considering planning
In what environment internal or
external will our plans operate
Identifying alternatives
What are the most promising
alternatives to accomplishing
our objectives
1. Being aware of opportunities
It provide actual planning and is there for not strictly a part of planning process, an
awareness of opportunities in the external environment as well as within the organizations is
the real starting point for planning. All managers should know where they stand in the light
of their strengths and weakness. Planning requires realistic diagnosis of the opportunity
situation.

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2. Establishing objectives
Establish objective for the entire enterprise and then for each subordinate work unit.
This is to done for long term as well as long term range. Objectives specify the expected
results and indicate the end points of what is to be done. Where the primary emphasis is to be
placed, what is to be accomplished by network of strategies, policies, procedures, rules,
budgets and programmes.
3. Developing premises
Developing premises, certain assumptions about the future on the basis of which the
plan will be ultimately formulated. Planning premises can be classified as under
a) Internal and external premises
Premises may exist within and outside the company. Important premises are
skill of the labor force, other resources and abilities of the organization in the form of
machines, money and methods. External premises include population growth, political
stability, sociological factors and government policies.
b) Tangible and intangible premises
Tangible premises are those which can be quantitatively measured. Population
growth, capital and resources all are tangible premises whose quantitative measurement is
possible.
Political stability, sociologic factors, attitudes, philosophies and behaviour of the
owners of the organization all are intangible premises whose quantitative measurement is not
possible.
c) Controllable and non controllable premises
Because of the presence of uncontrollable factors, there is need for the
organization to revise the plans periodically in accordance with current developments.
Some of the examples of uncontrollable factors are strikes, wars, natural
calamities, emergency, legislation etc. Controllable factors are those which can be controlled
and normally cannot upset well thought out calculations of the organization regarding the
plan. Eg. Are skill of the labour force, attitude and behavior of owners.
4. Determining alternative courses
There is seldom a plan for which reasonable alternatives do not exist and quite often an
alternative that is not obvious proves to be the best. The planner must usually make a
preliminary examination to discover the most fruitful possibilities.
5. Evaluating alternative courses
After seeking out alternative course and examining their strong and weak points. The
next step is evaluating the alternatives by weighing them in the light of premises and goals.
At this step in the planning process that operations research an mathematical as well as
computing techniques have their primary application to the field of management.
6. Selecting course
This is the point at which the plan is adopted the real point of decision making. An
analysis and evaluation of alternative course will disclose that two or more are advisable and
the manager may decide to follow several courses rather the one best course.

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7. Formulating derivative plans
Once the plan has been formulated its broad goals must be translated into day to day
operations of the organization. Middle and lower level managers must draw - up the
appropriate plans, programmes and budgets for their subunits. There are described as
derivative plan.
8. Numberizing plans by budgetin
After decisions are made and plans are set, the final step in giving them meaning
and to numberize them by converting them to budget. If done well, budget become a means
of adding together the various plans and also set important standards against which planning
progress can be measured.
TYPES OF PLANNING
Planning may be classified as,
 Directional planning
It is often called policy planning and is concerned with the broad general direction of
the programme.
Eg:state level planning at directorate or secretarial of states or union.(centre).
 Administrative planning
It is concerned with the overall implementation of the policies developed and with the
mobilization and coordination of the personnel and material available in the
administrative unit for the effectuation of the service.
Eg:Medical superintendent of major hospital are responsible for administrative
planning.
 Operational planning
It is concerned with the actual delivery of the service to the community.
Operational or short range planning is undertaken by middle or supervisory level
personnel.it involves,
 Planning for a few months to a financial year.
 Planning for details budgeting and short range goods and achieved with in given
period.
 Extensional aspect of long range plan.
Eg:Nursing personnel of all level are planning to deliver proper service to the community
either in hospital or community.
 Strategic planning
Usually strategic and long range planning is undertaken by the top level, which
involves,
 →Detail analysis of strength,weakness,oppournities and threats (SWOT)of
organization both internal or external environment.
 →Developing philosophy and formulation of policies and objectives.
 →Allocation of resources on the basis of priority
 →Evaluation of activities to increase efficiency.
 →Providing proper direction to avoid duplication of services.

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Forms of Planning
1.Strategic planning
It involves deciding what the major goals of the entire organization will be and
what policies will guide the organizations in its pursuit of these goals. The organization relies
heavily on external information i.e. estimates of costs, technological developments.
2.Tactical planning
It involves deciding specifically how the resource of the organization will be used
to help an organization to achieve its strategic goals.
Distinction between strategic and tactical planning
Strategic planning Tactical planning
It decides the majority goals and
policies of allocation of resources to
achieve these goals
It decides the detailed use of resources for
achieving each goal
It is done at higher levels of
management
It is done at lower levels of management.
It is long term It is short term.
It is generally based on long term
forecast about technology, political
environment etc.
It is generally based on the past performance
of the organization.
It is less detailed because it is not
involved with the day to day
operations of the organization.
It is more detailed because it is less involved
with the day to day operations of the
organizations.
PLANNING PROCESS
Planning is a process of analyzing and understanding a system, formulating it‟s goals
and objectives, assessing it‟s capabilities, designing alternative courses of action or plans
for the purpose of achieving the goals and objectives ,evaluate the effectiveness of plan,
choosing the preferred plan,intiating the necessary action for it‟s implementation and
monitoring the system to ensure the implementation of the plan and it‟s desired effect on
the system.
Planning cycle may be considered in eight steps,
1. Assessing the planning environment.
2. Data collection and data analysis for bringing out the problems and potentials of
the area.
3. Strategy formulation and setting realistic targets for the plan.
4. Participatory plan formulation.
5. Plan authentication and linking the plan with the plan at the near higher level.
6. Task adoption and plan implementation.
7. Mid term appraisal and making corrections.
8. Evaluation and replanning.

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Assessing
planning
environment
Data collection
and data
analysis
Strategy
formulation
target setting
Participatory
plan
formulation
Plan
authenticati-on
Evaluation
e and
replanning
Mid term
appraisal and
making
correction
Task
adoption
and plan
implementa
ti-on
ADVANTAGES OF PLANNING
 Planning leads to more effective and faster achievements of any organization.
 Planning gives strength to the business or service for its continuous growth and
steady prosperity.
 Planning secures and ensures unity of purpose, direction and effort by focusing
attention on objectives. it avoids duplication of services.
 Planning has unique contribution towards the efficiency of other managerial
functions.
 Planning provides the basis for control in an organization.
 Planning serves as an integral part of other administrative functions. it ensures
order and control and determines appropriateness and flasibility of actions in
terms of cost effectiveness and quality control.
DISADVANTAGES OF PLANNING
 It depends up on facts and information ,reliable information is not possible.
 Planning may lead to internal inflexibilities and procedural rigidities.
 It is a time consuming and expensive process.

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2. PROGRAM EVALUATION AND REVIEW TECHNIQUE (PERT)
Meaning
The program evaluation & review technique (PERT) was developed by the Special
Projects Office of the U.S. Navy and applied to the planning &control of the Polaris Weapon
system in 1958. It worked then, it still works; and it has been widely applied as a controlling
process in business & industry.
Definition
“PERT is a network system model for planning and control under uncertain conditions.
It involves identifying the key activities in a project, sequencing the activities In a flow
diagram, and assigning the duration of each phase of the work.”
PERT recognizes that certain tasks must be completed before the total project can be
completed and furthermore ,that subtasks must be completed before others can be started.
The key events are identified, labeled or numbered and labeled on the flow chart. The
activities that cause the progress from one event to another are indicated by arrows, with
the direction of the arrow showing the direction of the work flow.
Program Evaluation & Review Technique includes:
1. The finished product or service desired
2. The total time & budget needed to complete the project or program.
3. The starting date & completion date.
4. The sequence of steps or activities that will be required to accomplish the project
or program.
5. The estimated time & cost of each step or activity.
Steps for accomplishing the project are:
a) The optimistic time: This occasionally happens when everything goes right.
b) The most likely time: It represents the most accurate forecast based on normal
developments.
c) The pessimistic time: This is estimated on maximum potential difficulties.
Calculation of the “critical path”, the sequence of the events that would take the greatest
amount of time to complete the project or program by the planned completion date. The
reason this is the critical path because it will leave the least slack time.
PERT also deals with the problem of uncertainty with respect to time by estimating the
time variances associated with the expected time of completion of the subtasks. Three
projected times are determined.
►Optimistic time (to), which estimates the completion time without complication.
►The most likely time (tm), which estimated the completion time with normal problems.
►Pessimistic time (tp), which estimates the completion time given numerous problems.
The expected time (te) = to+4(tm)+tp
6

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2 6
9
1
3
5 8 10
4 7
PERT model indicate that ,subtask 1 must be completed before 2,3 and 4 can be
done.2,3 and 4 before 5, 5 before 6 and 7.6and 7 before 8,6 before 9,8and 9 before 10.
If the optimistic time is 2 weeks, the most likely time 4 weeks, and the pessimistic
time 6 weeks, the expected time is,
te=2weeks+4(4 weeks)+6 weeks = 24 weeks = 4 weeks
6 6
USES
Why should nurse managers use the PERT system for controlling?
1. It forces planning and shows how pieces fit together.
2. It does this for all nursing line managers involved.
3. It establishes a system for periodic evaluation & control at critical points in the
program.
4. It reveals problems & is forward- looking.
5. PERT is generally used for complicated & extensive projects or programs.
6. Many records are used to control expenses and otherwise conserve the budget.
These include personnel staffing reports, overtime reports, monthly financial reports and
others. All these reports should be available to nurse managers to help them monitor,
evaluate, and adjust the use of people and money as a part of the controlling process.
Modern and Philips enlist the advantages of PERT:
1) It encourages logical discipline in planning, scheduling and control of project.
2) It encourages more long range & detailed project planning
3) It provides a standard method of documenting and communicating project plans,
schedules, and time and cost- performance.
4) It identifies the most critical elements in the plan, thus focusing management attention
.i.e. most constraining on the schedule.
5) It illustrates the effects technical procedural changes on overall schedules.

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3. GANTT CHARTS
Early in this century Henry L. Gantt developed the Gantt Chart as a means of
controlling production. It depicted a series of events essential to the completion of a project
or program . It is usually used for production activities.
Figure shows a modified Gantt chart that could be applied to a manager nursing
administration program or project. The 5 major activities that the nurse administrator has
identified are segments of a total program or project.
It could be applied to a project such as implementing a modality of primary nursing or
implementing case management.
These are possible nursing actions for a project:
1. Gather data
2. Analyze data
3. Develop a plan
4. Implement the plan.
5. Evaluation, feedback, and modification
Figure is an only an example .Application of these controlling process by nurse managers
would be specific to the project or program, and the time elements for the various activities
would vary with each. Also these 5 major activities with estimated completion times. The
nurse manager‟s goal is to complete each activity or phase on or before the projected date.
Gantt chart are highly developed schedules that allow one to visualize multiple tasks
that have to be done. A Gantt chart is a grid with colums labeled tasks.
Assigning responsibility ,and time frame which may be
minuts,hours,days,weeks,monhs,years or decades, depending on the longevity of the project.
A line is drawn through the time frame which a task is in process. An „x‟ is put at the point
where that task is completed.
A person is told on Monday that a report is due Friday at 4 pm.The person needs to
collect information ,type the report on the computer, revise the report and submit it. The
person will use 3 days to collect the information and 1 day to type or word process it,
incubates the ideas over night, do any revision needed Friday morning and submit the report
Friday afternoon.
Task Responsible Mon Tue Wed Thu Fri
Collect
information
ME _ _ _
Type
report
ME X
Revise
report
ME X
Submit
report
ME X

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4. Management by objectives
Crucial to management process is planning (which involves decisions about a course of
action: what needs to be done, which sources are available, and who will take the necessary
action).
The management process also involves evaluation, (through a mechanism of checks and
balances), to ensure control over long range and short range plans.
Definition: Objectives may be used as a basis upon which a formal evaluation is made in the
management system known as management by objectives (MBO).
The purpose of using goals or objectives is to
 Set out clearly what direction your work should take and what specific
accomplishments (outcomes) are expected within a given period of
time.
 In other words the objectives serve first as a guide to the planning of
your work and later as a guide to evaluating your work.
 Problem solving is done to deal with a specific problem or situation.
 Setting goals is done to plan future work.
The essentials of this approach (MBO) are quite simple:
 thorough collection of data and definition of the needs of the work situation
 Set meaningful goals written in the form of objectives, and
 Evaluating how well the objectives have been met.
Thoughts:
 MBO is both a philosophy and a method of management encompassing planning and
evaluation.
 Introduced by Peter Drucker in 1954, MBO was designed to improve employee
morale and productivity.
 It incorporates the assessments of both the employee and the organisation.
 MBO is an excellent method to appraise the performance of RN in a manner that
promotes individual growth and excellence in nursing.
 MBO is a management system in which each member of the organisation effectively
participates and involves himself. (This system gives full scope to the individual
strength and responsibility).
 It creates self control and motivates the manager into action before somebody tells
him to do something.
MBO is popularised in USA by George Odiorne.
According to him, MBO is a system where in the superior and the subordinate
managers of an organisation jointly identify its common goals, define each individuals major
area of responsibility in terms of the result expected of him and use these measures guides for
operating the unit and assessing the contributions of each of its members.
Prof. Reddin defines MBO as, “the establishment of effective standards for
managerial positions and the periodic conversion of those into measurable time bound
objectives linked vertically and horizontally and with future planning.

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Features of MBO:
1. An attempt is made by the management to integrate the goals of an organisation and
individuals. This will lead to effective management.
2. MBO tries to combine the long range goals of organisation with short range goals.
3. Management tries to relate the organisation goals with society goals.
4. It pays consistent attention to refining, modifying and improving the goals and
changing the approaches to achieve the goals on the basis of experience.
5. It increases the organisational capability of achieving the goals at all levels.
6. MBO‟s emphasis is not only on goals but also on effective performance.
7. A high degree of motivation and satisfaction is available to employees through MBO.
(Recognises the participation of employees in goal setting process).
8. Encourages a climate of trust, goodwill and a will to perform.
Key concepts:
 MBO results in better organisational planning.
 MBO provides a mechanism for establishing measurable goals through an
organisation.
 MBO emphasizes self control rather than managerial control of employee behaviour
and stresses team work.
 Employees establish individual standards of performance and expected outcomes
based on organisational goals.
 Goals are formulated at all levels: organisational, departmental, unit and individual.
 MBO is a three step process:
 writing clear, concise, measurable objectives;
 developing a plan to meet the objectives and
 evaluating the plan at predetermined times and taking corrective action if
necessary.
Aims of MBO:
 To identify goals, aims, objectives of the organisation.
 To attempt to achieve the defined goals by giving individual managers, supervisors
and other sub goals or targets related to major goals.
 To make assessment of the degree of achievement of goals or target set.
 To give advice if requested or if it seems necessary, to the subordinates to help keep
him on right track. (A fair degree of security should be given and the subordinates
should not be left in ignorance of his performance).
Leadership and management styles:
 MBO provides a foundation for participative management. (Subordinate are also
involved in goal setting).
 MBO can be used with either an authoritarian or participative mgmt style. (When
individuals and work groups set their own objectives, the result is usually a greater
degree of acceptance of the objectives and a high level of motivation to meet the
goals).
 The participative style also encourages self direction and professional growth,
employee development and achievement.

18
 The manager is responsible for employee development through setting standards of
quality performance, providing well timed feedback and giving sufficient rewards.
 A department does not work at cross purpose with another department. (In other
words each department‟s objectives are consistent with the objectives of the whole
organisation).
 The manager focuses on employee‟s measurable objectives rather than on their
personal characteristics.
Steps in MBO:
 Employee or supervisor meet and agree on the principles, duties and responsibilities
of employee‟s job.
 The employee sets short term goals and target dates in cooperation with the manager
or supervisor.
 Both parties agree upon the criteria that will be used for measuring and evaluating the
accomplishment of goals.
 Regularly more than once in a year, the employee and supervisor meet to discuss the
progress.
 The manager‟s role is supportive assisting the employee to reach goals by
coaching/counselling.
 During appraisal process, the manager determines whether the goals have been met by
the employee.
 The entire focus is on outcome/results and not upon the personal traits.
Process of MBO:
The MBO process is characterised by the balance of objectives of the organisation and
individual. The process of MBO is given below:
1. Defining organisational objectives: initially, organisational objectives are framed by
the top level employees of an organisation. Then it moves downwards. The definition
of organisational objectives states why the business is started and exists. First, long
term objectives are framed. Short term objectives are framed taking into account the
feasibility of achieving the long term objectives.
2. Goals of each section: objectives of each section, department or division are framed
on the basis of overall objectives of the organisation. Period within which these
objectives should be achieved is also fixed. (Goals or objectives are expressed in a
meaningful manner).
3. Fixing key result areas: eg, profitability, market standing, innovation etc., fixed
based on organisational objectives and arranged on a priority basis. It indicates the
strength of the organisation.
4. Setting subordinate objectives or targets: the objectives of each subordinate or
individual are fixed. There should be a free and frank discussion between the superior
and his subordinates. Subordinates are induced to set standards themselves by giving
an opportunity.
5. Matching resources with objectives: The objectives are framed on the basis of
availability of resources. If certain resources (technical personnel or raw material) are

19
not adequately available, the objectives of an organisation are changed accordingly.
So there is a need for matching resources with objectives. Next the available resources
should be properly allocated and utilized.
6. Periodic review meetings: the superior and the subordinates should hold meetings
periodically in which they discuss the progress in the accomplishment of objectives.
The fixed standards may be changed in the light of the progress. But the basic
conditions do not change.
7. Appraising of activities:
 At the end of the fixed period for achieving the objectives, there should be a
discussion between the superior and subordinates. (The discussion is related
with subordinates performance against the specific standards).
 The superior should take corrective action. The superior should identify the
reasons for failure of achieving the objectives.
 The problems faced by the subordinates should be identified and steps should
be taken to tackle such problems.
8. Reappraisal of objectives: an organization is living in a dynamic world. (There are a
lot of changes with in a short period). The survival and growth of a modern business
organisation largely depends upon putting up with the changing conditions. So the top
level executive should review the organisation‟s objective to frame the objectives
according to the changing situation.
MBO Process Cycle

20
Advantages :
 MBO is a well known approach to plan and evaluate the work done in organizations.
 It is usually described as a tool for managers.
 MBO can be used by any individual or group at any level of organisation.
 It can be used as a total system of management throughout the organisation including
financial management. (but this requires a real commitment to the purposes and
philosophy of MBO that does not always occur).
 If it has been used as a total management system at all levels within the organization,
 the objectives should actually be set before individual departments are
even organized.
 The objectives set at various levels throughout the organisation, and
 then determine how work should be organized and what work has the
highest priority.
 They serve as a planning guide and encourage goal directed behaviour rather than
random activity. (They can also help people avoid getting so caught up in the daily
routine that they lose sight of their long term goals).
 It helps the managers to understand their role in the total organisation.
 Systematic evaluation of performance is made with the help of MBO. (MBO gives the
criteria of performance. It helps to take corrective action).
 Delegation of authority is easily done with the help of MBO. (The responsibility of a
worker is fixed through MBO).
 Decision is taken by the management very quickly. (The reason is that each worker
knows the purpose of taking a decision and does not oppose the decision).
 The practice of MBO helps the manager attend to job enrichment. (MBO motivates
the workers by job enrichment and makes the job meaningful).
 It can direct attention and energy where they are most needed and in this way, help
people to set priorities and be more productive.
 The mutually agreed upon objectives become a means for communicating expected
standards of work and help each staff member sort out what needs to be done. (Well
written objectives can clearly communicate what everyone is expected to
accomplish).
Disadvantages:
 Depending on the way in which it is used, MBO can be either a useful management
system or just another imposition on the staff‟s time and energy
 MBO can be a meaningless exercise if the objectives are not used after they are
written. (The quality of the objectives usually deteriorates under such circumstances,
leading to further illusionment and eventual abandonment of the system).
 The objectives will become an overly demanding and rigid standard, appearing to
staff as a punishment rather than as a guide.
 When MBO is used in an authoritarian manner, it becomes an additional set of
controls over employees and is quickly perceived as such.
 The objectives may become a source of unrealistic demands, especially if goals are set
higher and higher each year.

21
 They may also become a threat when used as an evaluative tool without initial
discussion and acceptance by the employee.
 MBO can be rigid and confining and can result in unfair evaluations.
 The program can also become an empty, time consuming routine (if the objectives are
not meaningful or if people do not take them seriously and use them).
Problems and limitations of MBO:
1. Considerable training required.
2. Costly and good monitoring system is needed.
3. Wrong targets may be selected.
4. An individual may accept target i.e., difficult to achieve.
5. Less attention to valuable parts.
6. People may feel guilty, less flexible.
7. Changing objectives quickly could be difficult.
8. MBO fails to explain the philosophy; most of the executives do not know how MBO
works, what is MBO and why is MBO necessary and how participants can benefit by
MBO.
9. MBO is time consuming process. Much time is needed by senior people for framing
the MBO. It leads to heavy expenditure. Sometimes managers are frustrated over
MBO. MBO requires heavy paper work.
10. MBO emphasises only on short term objectives and does not consider long term
objectives.
11. The status of subordinates is necessary for proper objectives setting. But this is not
possible in the process of MBO.
12. The objectives are set without considering the available resources.
Guidelines for setting effective objectives:
1. Objectives are framed only by the participants who are responsible for implementing
them.
2. All the objectives should support the overall objectives of the organisation.
3. Objectives should be simple and clearly defined.
4. Objectives should be specific and time bound.
5. Objectives should be attainable ones.
6. Objectives should result in the motivation of workers.
7. A periodic review of objectives is necessary for proper implementation.
8. Objectives should have the characteristics of innovation.
9. The number of objective for each management member should be a reasonable one.
Four or five objectives is a reasonable number.
10. Objectives should be ranked on the basis of their importance.
Application to nursing:
 Most health care organisations operate under some form of MBO because it provides
an effective and consistent method of performance evaluation.
 a procedure, a technique, and a method for nurse managers who seek ways to
challenge themselves and their staff to see and contribute to the overall mission of the

22
organization. MBO is energizing and demanding. It is work. It is accountability made
real.
 MBO is adaptable to the nursing service setting. Managers responsible for nursing
service units can take from the strategies of the MBO system the elements of
formulation of goals and objectives, development of action plans, and
implementation necessary to increase the accountability; and the output of the work
rendered.
 Nurses should be aware of their organizational mission, purpose and goals and their
departmental and unit goals when developing their own objectives.
 MBO places great emphasis on the attributes of values clarification and
accountability.
 In determining plans and aspirations, the nurse manager develops a written list of
objectives and priorities and time frames for accomplishing the objectives. In this list,
objectives should be realistically stated and should encourage personal and
professional growth by promoting increased self awareness, accountability,
satisfaction and productivity.
Writing objectives:
Most of your objectives will be congruent with the goals of the system in which you
are working. But when changes are needed, your objectives may be deliberately in conflict
with some of your team‟s organisational goals.
The time set for completing the objectives depends on the nature of the work being planned,
the proportion of the work day set aside to work on the objectives. And other factors that will
affect the speed with which the work can be done. Common time frames used in most health
care organizations are one month, three months, six months and one year.
When objectives are used as a part of a formal system of management, they are
written not only for individual employees but also for larger work groups, including
committees, departments and the organisations as a whole.
Examples of individual and group level objectives:
Level Objective
individual staff nurse complete a course in infection control in the home health care
setting.
Nursing team review all cases for the past 6 months in which occurrence of
infection is documented.
Nursing supervisors update all policies and procedures r/t infection control.
Home health agency reduce incidence of infection in current agency caseload.
congruence between these different levels of objectives is sometimes difficult to achieve.
Individual objectives:
If your organisation uses MBO, you may be given a set of objectives, asked to write
your own objectives, or asked to write them with your immediate supervisor.
The first method increases motivation and encourages self management.

23
The second is non participative, discourages self management, reduces motivation, and
primarily be a means of control.
Whether or not you have an employer who uses MBO, you can develop your own objectives
to guide career planning and professional growth.
The following is an example.
Imagine that you have begin working in a new position in a critical care unit. For the
first few weeks, your primary objectives would be to learn the new job and become acquinted
with the people with whom you are working and the organization in which now you are
working.
At the end of 3 months, you feel more comfortable with the work that you are doing
and have also become familiar with the informal ways of working within this particular
organisation. At this point you can either go along with the routines of the job and accept
whatever changes in assignment are made for you or you can decide on the direction you
would like to see your career take and set objectives for yourself that will take you in that
direction.
If you decide to set your own course, there are several Q‟s to ask yourself:
1. How can I improve my practice?
2. What do I want to gain from this position?
3. What do I want to be doing a year from now?
4. What do I want to be doing five years from now?
The specific objectives that you write will depend on your answers to these questions,
your overall goals, and your current position.
Both short term and long term objectives are helpful.
For eg., you may want to learn how to assemble, use, and adjust the new respirator that is
going to be used on your unit within the next month. This would be short term objective.
You may also want a protocol for the use of the new respirator by the end of the month,
implement full use of the respirator in 3 months, and complete an evaluation of its
effectiveness in 6 mts or a year.
Long term goals may need to be broken down into steps.
For eg., a year from now you may want to have completed a course to become a critical
specialist in critical area.
You can develop a timeline to follow in working toward this long term objective as follows.
 1 month: obtain information about courses and programs available.
 3 months: complete application to selected program.
 6 months: begin course in critical care nursing.
 1 year: complete first course.
It may take more than one year to complete your LT objective or goal to complete an entire
clinical specialist program.
The short term objectives serves as check points on your way to your long term objective.
Work group objectives:
As the leader or manager of a variety of working groups, you will also find objectives
useful as guides for planning and evaluating the work of these groups.
The criteria for writing objectives are the same but their scope and content will differ. The
following objectives wd be appropriate for a task force or committee:

24
 1 month: Invite a speaker on home care services to the next meeting.
 3 months: select a method for surveying the availability of home care services in the
community.
 6 months: survey the availability of home care services in the community.
 1 year: prepare a report on the availability of home care services in the community.
It is also important for the health care teams to develop a set of objectives, b/c they can very
easily become immersed in their daily routines and lose sight of future goals or directions for
improvement and change.
The following list is one example:
1. Increase the no of complete discharge plans.
2. Invite people from other agencies to client oriented conferences.
3. Plan, organize and initiate a support group for families of developmentally disabled
children.
4. Design a new crash cart system to decrease current response time.
5. Revise outpatient chemotherapy procedures to decrease waiting time and increase
patient comfort.
Implementing objectives:
Once the objectives and timeframes have been determined, the next step is to carry
out the work indicated. The objective itself defines the general action and the expected
outcome but does not tell you exactly how to go about carrying out the action.
For eg., the health care team objective of including people from other agencies in client
oriented conferences tells you that people should be invited but it does not tell you exactly
which people, how many people, how to extend the invitation.
Evaluating outcomes:
Evaluation of accomplishments is based on the degree to which this outcome was met.
This outcome may/ may not have been very specifically described in the objective.
For eg, one of the health care team objectives was to increase the number of completed
discharge plans. If 25% of the discharge plans were completed before setting this goal, then
an outcome of 50% now completed would indicate that the objective had been met. However
if the objective stated that all (100%) of the discharge plans would be complete, then a 50%
completion rate would not have fulfilled the objective.
The degree to which the individual or work group has control over all of the factors that
affect the fulfilment of the objective is a source of concern.

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5. VENTURE PLANNING
Venture Planning is a personal assessment of your feelings and the feasibility of a
venture. Venture Planning answers the question, should I be doing this and why? The
Venture Feasibility process examines seven key factors in any venture.
Venture Planning
It is not about writing a Business Plan. Sometimes a business plan is not needed.
Venture Planning does not require detailed funding, source analysis, professional opinions,
entity formation or detailed market analysis. Venture Planning is development of a means of
comparing various business models, usually through financial modeling to answer the
following questions:
 Which venture concept produces the most sales, the best margins, the highest net
profit and the lowest breakeven?
 Which model requires the least investment by entrepreneurs and others?
 Which concept requires equity as opposed to debt financing?
 Which produces the highest "Return on Investment" and the best liquidity?
 Which model requires the entrepreneur to give up the least equity?
Identify and quantify the risks involved with execution of each model.
Venture Formation involves all of the following stages:
 Idea - Concept Development - Venture Development - Monitoring Progress -
Initiating New Changes - Venture Feasibility Analysis - Business or Operational Plan
- Budget vs. Actual - New Plans.
There are four keys to good venture planning:
 Focus on one venture at a time in one business area at a time.
 Discover the opportunity first, and then evaluate how to exploit it.
 Develop three cases good, bad & likely for each scenario of a venture concept.
 Identify what type of venture you want. Each type has an entirely different model,
implementation and end result. Each demands a different entrepreneurial approach
and each requires different management and style.
There Are 11 Keys to a Good First Venture
1) Founder's alignment with the mission.
2) Guaranteed or qualified customers.
3) Lifestyle of High Profit smaller business.
4) Routine concept.
5) Available product.
6) Advantageous Cash Flow.
7) Supportive local environment.
8) Neutral State and Federal Environment.
9) Equity Control.

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10) Relevant Experience.
11) Low Overhead.
Emerging venture areas in nursing that needs planning
There often occurs a crisis situation in the healthcare set- up when nurses try to
defend existing models of practice instead of embracing change. In order to gain successful
planning of good ventures, we should examine the existing realities (traditional), and analyze
and adapt to the changing context of nursing practice. Some of the traditional realities are;
 Institution based care
 Process oriented
 Procedure driven
 Based on mechanical and manual intervention
 Provider driven
 Treatment based
 Reflective of late stage intervention
 Based on vertical clinical relationships
According to Porter-O’ Grady (2003), the emerging realities for nursing practice for this
century will be;
o Mobility based on multiple settings
o Outcome driven
o Best- practice oriented
o Emphasized by technology and minimally invasive intervention
o User driven
o Health based
o Geared for early intervention
o Based on horizontal clinical relationships
Functions of good nurse manager
A nurse manager‟s functions include the following;
 The nurse administrator needs to know the plans and programs of the health facility
administrator and of other departments in which personnel contribute to the joint
effort of providing health care services.
 Should be a participatory , voting member of all committees of the institution
including those dealing with budgeting, planning, credentialing, auditing, utilization,
infection control, patient care improvement, library or any other committees
concerned with nursing services, nursing activities and nursing personnel.
 Should develop a marketing operational plan based on the overall view of the agency
problems and activities.
 Marketing plan should include gathering and analysis of data related to product or
service
 Operational plan consist of pinpointing possible strengths, weaknesses, problems and
opportunities.
 Before launching a venture, a control plan is made to measure performance of
implementation of venture within a time frame.

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 Selected and trained personnel will be assigned to compare expected results with
actual results for making corrections in all elements of plan and its implementation in
future.
Practical planning actions
Practical day-today planning actions to the nurse administrator include the following
1. At the beginning of each day make a list of actions to be accomplished for the day
2. Plan ahead for meetings
3. Identify developing problems
4. Review the operational and management plan
5. Review the appropriate portions of the division operational and management plan
6. Plan for discussion of ideas
7. Suggest similar practical planning actions to other nurse managers

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6. PLANNING FOR CHANGE
Change occurs over time, often fluctuating between intervals of change then a time of
settling and stability. Change management entails thoughtful planning and sensitive
implementation, and above all, consultation with, and involvement of, the people affected by
the changes. If you force change on people normally problems arise. Change must be
realistic, achievable and measurable. These aspects are especially relevant to managing
personal change.
Definition
 Planning: “Planning refers to thinking ahead of time and formulation of preliminary
thoughts”.
 Planned change: “Planned change entails planning and application of strategic
actions designed to promote movement towards a desired goal”.
 “Planned change is a change that results from a well thought out and deliberates effort
to make something happen. It is the deliberate application of knowledge and skills by
a leader to bring about a change”.
Tappen, 1995
 Change agent: “A change agent is one who generates ides, introduces the innovation,
and works to bring about the desired change”.
Change agent
A change agent is someone who deliberately tries to bring about a change or
innovation, often associated with facilitating change in an organization or institution. To
some degree, change always involves the exercise of power, politics, and interpersonal
influence. It is critical to understand the existing power structure when change is being
contemplated.
A change agent must understand the social, organizational, and political identities and
interests of those involved; must focus on what really matters; assess the agenda of all
involved parties; and plan for action. The change agent should have the following qualities;
 The ability to combine ideas
 The ability to energize others
 Skills in human relations
 Integrative thinking
 Flexibility modify ideas
 Persistent, confident and has realistic thinking
 Trustworthy
 Ability to articulate a vision, and
 Ability to handle resistance.
Assumptions regarding change
 Change represents loss. Even if the change is positive, there is a loss of stability. The
leader of change must be sensitive to the loss experienced by others.
 The more consistent the change goal is with the individual‟s personal values and
beliefs, the more likely the change is to be accepted. Likewise the more difficult the
goal is from the individual‟s personal values; the more likely it is to be rejected.
 Those who actively participate in change process feel accountable for the outcome.

29
 Timing is important in change. With each successive change in a series of changes,
individual‟s psychological adjustment to the change occurs more slowly. And for this
reason the leader of change must avoid initiating too many changes at once.
The key principles driving the elements of the Change Management are:
1. Targeted Commitment Levels
2. Executive Ownership
3. Visible, sustained sponsorship
4. Deployment/Implementation Support and Monitoring
5. Employee Support
6. Post Deployment Preparation
STAGES OF PLANNED CHANGE
Lewin (1951), identified 3 phases through which the change agent must proceed
before a planned change becomes part of the system. These changes are;
Unfreezing: - in this phase, the change agent unfreezes the forces that maintain a status quo.
It is the responsibility of the change agent- after thorough and accurate assessment- to
convince the people for the need to change. It is also possible that the people themselves are
discontented and aware of a need to change.
Moving: - in this phase agent identifies plans and implements appropriate change strategies
that the driving forces exceed restraining forces. Whenever possible the change should be
implemented gradually.
Refreezing: - in this phase, the change agent assists in stabilizing the system change so that it
becomes integrated and remains so.
PLANNED CHANGE
Identify the problem or opportunity: - opportunities demand change as the problems, but
most managers overlook these opportunities. Change is often planned to close performance
gap, a discrepancy between the desired and the actual state of affairs.
Collect data: - once the problem or opportunity is clearly defined, the change agent collects
data needed. This step is important to the later success in the planned change.
Analyze data: - collecting good data is important, but it‟s as important to analyze the data in
to useful information to make important decisions.
Plan the change strategy: - anxiety about the change should be minimized. There is a need
to plan the resources required and establish feedback mechanism to evaluate the progress in
the change by setting goals with specific time frames and identifying indicators for
evaluation.
Implement change: - the plans are put in to motion. Interventions are designed to gain
necessary compliance. The change agent create supportive climate, acts as energizer, obtain
and provide feedback and overcome resistance.
Evaluate effectiveness: - the established operational indicators are monitored and the extent
of success and failure is determined and explained.

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Stabilize the change: - to assure permanency of change, though continuous feedback,
reinforcement, and providing the necessary policies, procedures, standards, etc.
Strategies for planned change
In general, three categories of change models exist: empirical-rationale, power-
coercive, and normative-educative model. (Bennis, Benne and Chin [1969], The planning of
change)
1. Rationale- empirical:
This strategy emphasizes reason and knowledge. People are considered rational
beings and will adopta change if it is justified and in their self- interest. Here the change
agent‟s role is communicating the merit of the change to the group. If the change is
understood by the group to be justified and in the best interest of the organization, it is likely
to be accepted. This strategy is useful when little resistance to change is expected. It is
assumed that once if the knowledge and rationales are given, people will internalize the need
for change and value the result.
2. Normative- re-educative:
This is based on the assumption that group norms are used to socialize individuals.
The success of this approach often requires a change in attitude, values, and/ or relationships.
This strategy is most used when the change is based on culture and relationships within the
organization. The power of the change agent, both positional and informal, becomes integral
to the change process.
3. Power- coercive:
This approach is based on power, authority, and control. Desired change is brought
about by political or economic power. It requires that the change agent have the positional
power to mandate the change. The outcome of change is often based either on follower‟s
desire to please the leader or fear of the consequences for not complying with the change.
This strategy is effective for legislated changes, but other changes using this strategy are
often short- lived.
Barriers to change and strategies to overcome
It is important to identify all potential barriers to change, to examine them
contextually with those affected by proposed change, and to develop strategies collectively to
reduce or remove the barriers.
Change requires movement, which as physics indicates, is a kinetic activity that that
requires energy to overcome resistance.
Barrier Discussion Strategy
Desire to remain in
our comfort zone
Those who become increasingly attached to a
familiar way of doing things (comfort zone)
often view change as an unwelcome
disruption.
Rational- empirical
strategies

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Inadequate access to
information
Lack of information, inability to read and
understand the available resources.
Rational- empirical
strategy
Lack of shared vision Lack of widespread involvement, input, and
ownership of change will cripple a change
effort.
Normative- re-
educative strategy
Lack of adequate
planning
Involving individuals in planning gives a sense
of control and decreases their resistance to
change.
Rational- empirical
and normative- re-
educative strategies
Lack of trust Trust in the change agent and ability of self to
bring about change is necessary.
Rational- empirical
and normative- re-
educative strategies
Resistance to change Co-operation and involvement of the whole
team will only bring effective and lasting
changes.
Normative- re-
educative strategy
Poor timing or
inadequate time
planned
Poor timing and lack of planning can fail to
bring desired change.
Introducing change
at a time when
people are ready to
change guarantees
success
Fear that power,
relationships, or
control will be lost
Every change represents potential for loss to
someone.
Normative- re-
educative strategy
Amount of personal
energy needed for
change may be great
Sometimes change is desired, but people are
not willing to do what is necessary to effect
the change.
Slow the change
process and give
time to catch- up
and energize
Types of changes
Hohn (1998) identified four different types of change: Change by exception, Incremental
Change, Pendulum Change and Paradigm Change.
 Change by Exception: This occurs when someone makes an exception to an existing
belief system. For instance, if a client believes that all nurses are bossy, but then
experiences nursing care from a much modulated nurse, they may change their belief
about that particular nurse, but not all nurses in general.
 Incremental Change: A change that happens so gradually, that an individual is not
aware of it.
 Pendulum Changes: Are changes that result in extreme exchanges of points of view.
 Paradigm Change: Involves a fundamental rethinking of premises and assumptions,
and involve a changing of beliefs, values and assumptions about how the world
works.

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Change Theories in Nursing
Change theories are used in nursing to bring about planned change. Planned change
involves, recognizing a problem and creating a plan to address it. There are various change
theories that can be applied to change projects in nursing. Choosing the right change theory is
important as all change theories do not fit every change project. Some change theories used in
nursing are Lewin‟s, Lippitt‟s, and Havelock‟s theories of change. The characteristics of
change theories are;
 Problem identification
 Plan for innovation
 Strategies to reduce innovation
 Evaluation plan
Kurt Lewin’s change theory:
The theoretical foundations of change theory are robust: several theories now exist,
many coming from the disciplines of sociology, psychology, education, and organizational
management. Kurt Lewin (1890 – 1947) has been acknowledged as the “father of social
change theories” and presents a simple yet powerful model to begin the study of change
theory and processes. He is also lauded as the originator of social psychology, action
research, as well as organizational development.
"Unfreezing" involves finding a method of making it possible for people to let go of an old
pattern that was counterproductive in some way. In this stage, the need for change is
recognized, the process of creating awareness for change is begun and acceptance of the
proposed change is developed
"Moving to a new level" involves a process of change--in thoughts, feelings, behavior, or all
three, that is in some way more liberating or more productive. The need for change is
accepted and implemented in this stage.
"Refreezing" is establishing the change as a new habit, so that it now becomes the "standard
operating procedure." Without some process of refreezing, it is easy to backslide into the old
ways.The new change is made permanent here.
Lewin also created a model called “force field analysis” which offers direction for
diagnosing situations and managing change within organizations and communities.
According to Lewin‟s theories, human behavior is caused by forces – beliefs, expectations,
cultural norms, and the like – within the "life space" of an individual or society.
These forces can be positive, urging us toward a behavior, or negative, propelling us away
from a behavior.
“Driving Forces”- Driving forces are those forces affecting a situation that are pushing in a
particular direction; they tend to initiate a change and keep it going. In terms of improving
productivity in a work group, pressure from a supervisor, incentive earnings, and competition
may be examples of driving forces.
“Restraining Forces”- Restraining forces are forces acting to restrain or decrease the driving
forces. Apathy, hostility, and poor maintenance of equipment may be examples of restraining
forces against increased production.
“Equilibrium” - This equilibrium, or present level of productivity, can be raised or lowered
by changes in the relationship between the driving and the restraining forces. Equilibrium is
reached when the sum of the driving forces equals the sum of the restraining forces.

33
Lippitt’s phases of change theory:
Lippitt’s theory is based on bringing in an external change agent to put a plan in
place to effect change. There are seven stages in this theory. The first three stages correspond
to Lewin's unfreezing stage, the next two to his moving stage and the final two to his freezing
change. In this theory, there is a lot of focus on the change agent. The third stage assesses the
change agent‟s stamina, commitment to change and power to make change happen. The fifth
stage describes what the change agent‟s role will be so that it is understood by all the parties
involved and everyone will know what to expect from him. At the last stage, the change agent
separates himself from the change project. By this time, the change has become permanent.
The seven phases shift the change process to include the role of a change agent through the
evolution of the change.
• Phase 1:Diagnose the problem
• Phase 2:Assess the motivation and capacity for change
• Phase 3:Assess the resources and motivation of the change agent(commitment the
change, power, and stamina)
• Phase 4:Define progressive stages of change
• Phase 5: Ensure the role and responsibility of the change agent is clear and understood
(communicator, facilitator, and subject matter expert.
• Phase 6:Maintain the change through communication, feedback, and group
coordination
• Phase 7:Gradually remove the change agent from the relationship, as the change
becomes part of an organizational culture.
Havelock's change model:
Havelock's change theory has six stages and is a modification of the Lewin's theory
of change. The six stages are building a relationship, diagnosing the problem, gathering
resources, choosing the solution, gaining acceptance and self renewal. In this theory, there is
a lot of information gathering in the initial stages of change during which staff nurses may
realize the need for change and be willing to accept any changes that are implemented. The
first three stages are described by Lewin's unfreezing stage the next two by his moving stage
and the last by the freezing stage.
John P Kotter's 'eight steps to successful change'
John Kotter's highly regarded books 'Leading Change' (1995) and the follow-up 'The
Heart Of Change' (2002) describes a helpful model for understanding and managing change.
Each stage acknowledges a key principle identified by Kotter relating to people's response
and approach to change, in which people see, feel and then change: Kotter's eight step change
model can be summarized as:
 Increase urgency - inspire people to move, make objectives real and relevant.
 Build the guiding team - get the right people in place with the right emotional
commitment, and the right mix of skills and levels.
 Get the vision right - get the team to establish a simple vision and strategy focus on
emotional and creative aspects necessary to drive service and efficiency.

34
 Communicate for buy-in - Involve as many people as possible, communicate the
essentials, simply, and to appeal and respond to people's needs. De-clutter
communications - make technology work for you rather than against.
 Empower action - Remove obstacles, enable constructive feedback and lots of
support from leaders - reward and recognize progress and achievements.
 Create short-term wins - Set aims that are easy to achieve - in bite-size chunks.
Manageable numbers of initiatives. Finish current stages before starting new ones.
 Don't let up - Foster and encourage determination and persistence - ongoing change -
encourage ongoing progress reporting - highlight achieved and future milestones.
 Make change stick - Reinforce the value of successful change via recruitment,
promotion, and new change leaders. Weave change into culture.
General considerations for planning change
 Secure and maintain commitment to change
 Define and communicate desired end state
 Identify critical success factors
 Establish targets and prioritize activities
 Develop a theme
 Understand why the change is desired/ required
 General considerations for planning change
 Secure and maintain commitment to change
 Define and communicate desired end state
 Identify critical success factors
 Establish targets and prioritize activities
 Develop a theme
 Understand why the change is desired/ required
Nurse Leader (manager) as role model for Planned Change
 Implement a comprehensive and coordinated change management program: Discover,
develop, detect.
 Identify “change agents” and engage people at all levels in the organization.
 Ensure the message comes from the top, and executives and line managers are
“walking the talk.”
 Make change visible with new tools and/or environment.
 Ensure clear, concise, and compelling communication.
 Integrate change goals with day-to-day activities, e.g., recruiting, performance
management, and budgeting.
 Address short-term performance while setting high expectations about long-term
performance.
 Help management avoid attempts to short circuit the change management process.

35
 Foster change in people‟s attitudes first, then focus on change in processes, then
change in the formal structure.
 Manage both supporters and champions, as well opponents and possible detractors.
 Accept that all people go through the same steps – some faster, some slower – and it
is not possible to skip steps.
 Build a safe environment that enables people to express feelings, acknowledge fears,
and use support systems.
 Acknowledge and celebrate successes regularly and publicly!
Mistakes by a leader manager
 Fail to provide visible support and reinforce the change with other managers.
 Do not take the time to understand how current business processes would be affected
by change.
 Delayed decision-making, which leads to low morale and slow project progress.
 Are not directly or actively involved with change project.
 Fail to anticipate the impact on employees.
 Underestimate the time and resources needed
 Abdicate ownership of the project to another manager.
 Fail to communicate both the business reasons for the change and the expected
outcome to employees and other managers
 Change the project direction mid-stream
 Do not set clear boundaries and objectives for the project
CONCLUSION
Change is an inevitable in any organization with advancement of science and
technology and revolution in information systems, a nurse manager is constantly confronted
with new challenges. Change should not be viewed as a threat but as a challenge or chance to
do something new and innovative. Change should only be implemented for good reasons.
BIBLIOGRAPHY:
1) Dr. Rebecca Samson (2009), “leadership and management in nursing practice and
education” jaypee brothers medical publishers (p) Ltd; Bangalore.
2) http://changingminds.org/disciplines/change_management/planning_change/planning_
change.htm
tp://books.google.co.in/books?id=EUZj3K2lwT0C&pg=PA53&lpg=PA53&dq=planni
ng+new+venture-+

36
7. INNOVATIONS IN NURSING
INTRODUCTION:
The scope of change in health care has been enormous and the rate at which change
occurs continues to accelerate. Today‟s technology and therapeutics were inconceivable even
a few decades ago. The growth of health care profession has been influenced by those new
technologies and therapeutics, but there are many new technologies and therapeutics and
other influencing factors and forces.
Innovations can occur at all levels of an educational organization. Nursing education
has growth through innovations.
MEANING OF INNOVATION:
The term innovation means a new way of doing something. It may refer to
incremental, radical, and revolutionary changes in thinking, products, processes, or
organizations. A distinction is typically made between invention, an idea made manifest, and
innovation, ideas applied successfully.
(Mckeown, 2008)
Innovation is generally considered as successful introduction of a new thing or
method. Innovation is the embodiment combination or synthesis of knowledge in original,
relevant, valued new practice, process or service.
The term innovation in nursing may refer to both radical and incremental changes in
thinking, in thing, in process or in services. Invention that gets out into world is innovation.
The goal of innovation in nursing is positive change to make someone or something better.
DEFINITION
Innovation is commonly defined as the “introduction of something new”. a new way
of doing something.
“Innovation is change that creates a new dimension of performance” many successful
innovations improve on an existing product to make it faster, cheaper or more efficient.
PETER DRUCKER
According to BAREGHEH EL(2009)
“Innovation is the multi-stage process whereby organizations transforms ideas into new
improved products, service or process in order to advance, compete and differentiate
themselves successfully in their market place. An innovation can result in new product or an
enhancement of an existing product such as adding a new feature to the product.

37
AIM OF INNOVATION:
The aim of innovation is positive change, to make someone or something better.
Innovation leading to increased productivity is the fundamental source of increasing wealth in
an economy.
GOALS OF INNOVATIONS:
1. Improved quality
2. Creation of new markets
3. Extension of the product range
4. Reduced labour costs
5. Improved production processes
6. Reduced materials
7. Reduced environmental damage
8. Replacement of products/services
9. Reduced energy consumption
10. Conformance to regulations
These goals vary between improvements to products, processes and services and dispel a
popular myth that innovation deals mainly with new product development. Most of the goals
could apply to any organisation be it a manufacturing facility, marketing firm, hospital or
local government.
Sources of Innovation:
Manufacturer innovation – where an agent (person or business) innovates in order
to sell the innovation.
End-user innovation - where an agent (person or company) develops an
innovation for their own (personal or in-house) use because existing products do not meet
their needs.
TYPES OF INNOVATIONS:
Four types of innovations widely accepted are as follows-
 Product innovations;
Change in things (products/services) which an organization offers.
 Process innovations:
Changes in the way in which things are created and delivered
 Position innovations:

38
Change in the context in which the products and services are introduced.
 Paradigm innovations:
Change in the underlying mental models which frame what the organization does.
INNOVATION PROCESS:
The innovation process has four steps.
 Idea creation:
The first step in process of innovation is idea creation. Thus an idea regarding
new thing or the new way of doing something forms the base of any
innovation.
 Initial experimentation:
After the idea has been used found out it is initially used on the trial basis in
organization. The effects or the change is then evaluated.
 Feasibility determination;
Once the effects have been evaluated on the practice it‟s feasibility is
determined. It includes finding out it‟s cost effectiveness, availability,
accessibility, and universality.
 Final application
Thus after the innovation is evaluated on all aspects, it is applied to the
discipline, if found effective.
INNOVATIVE PROCESS IT INCLUDES
Critical thinking
Addressing the unmet needs
For innovation spend time for brainstorming
Introducing something new product or service
Solving the problem
QUALITIES OF AN INNOVATOR: (20) qualities of an innovator.
 Challenges status qua
 Self motivated

39
 Curious
 Actively explores their environment
 Investigate new possibilities
 Entertains the fantastic
 Takes risks
 Peripatetic
 Self accepting
 Makes new connections
 Tolerates ambiguity
 Committed to learning
 Balances intuition and analysis
 Situationally collaborative
 Formally articulates
 Resilient
 Persevering
 Flexible/adaptive
 Reflective
 Playful and humorous.
DIFFUSION OF INNOVATIONS
Once innovation occurs, innovations may be spread from the innovator to other
individuals and groups. This process has been proposed that the life cycle of innovations can
be described using the 's-curve' or diffusion curve. The s-curve maps growth of revenue or
productivity against time. In the early stage of a particular innovation, growth is relatively
slow as the new product establishes itself. At some point customers begin to demand and the
product growth increases more rapidly. New incremental innovations or changes to the
product allow growth to continue. Towards the end of its life cycle growth slows and may

40
even begin to decline. In the later stages, no amount of new investment in that product will
yield a normal rate of return.
The s-curve derives from an assumption that new products are likely to have "product
Life". i.e. a start-up phase, a rapid increase in revenue and eventual decline. In fact the great
majority of innovations never get off the bottom of the curve, and never produce normal
returns.
Innovative companies will typically be working on new innovations that will
eventually replace older ones. Successive s-curves will come along to replace older ones and
continue to drive growth upwards. In the figure above the first curve shows a current
technology. The second shows an emerging technology that current yields lower growth but
will eventually overtake current technology and lead to even greater levels of growth. The
length of life will depend on many factors.
INNOVATION IN NURSING:
About ways to innovate the service or any procedures is then any unmet need in your
working place to improve operations .New innovation in nursing of teaching from traditional
classroom setting ,technology based setting and clinical setting and culturally diversity in
the classroom and the use of multimedia and video technique.
When we think of innovation system, we need to move beyond the focus which includes:
 regulatory bodies
 political organization
 public research
 financial institution labor force soul
FACTOR NEEDED FOR INNOVATION:
1. A definite purpose: to be success, there should be definite aim and purpose. Work
out objectives and it should be clear.
2. Initiative
3. Knowledge of facts
4. Self confidence
5. Persistent efforts.

41
NeedFor Creativity and Innovation in Nursing
 Creativity is needed because change is constant.
 Creativity always results in novel solutions.
 These solutions usually have implication or application beyond their immediate uses.
 New products and new methods are fruits of creativity.
 Creativity helps for modern scientific and psychological changes in nursing.
 A constant flow of new ideas is need to procure new products services, process,
procedures and strategies for dealing with changes occurring in every sphere of
endeavor.
 Creativity helps the nurse to acquire move education and autonomy.
 Helps the nurse to establish independent business enterprises.
Innovative retention strategies for nursing staff
FUSZARRDS innovative teaching strategies in nursing says that nurse educators are
constantly seeking creative innovative strategies for teaching in the classroom or in the
clinical setting .the innovative method of teaching today include:
 Self learning
 Critical thinking
 Lecture
 Debate
 Role playing
 Reflective practice.
 Expressive techniques
 Teaching sensitive subjects
 The concept of innovation in nursing education has been addressed on faculty and
defined “using knowledge to create ways and services that are new.”
 In this way students on nursing education perception of innovation are limited and it
is unclear how undergraduate and graduate students conceptualize innovation learning
experiences.
 This project explored students perception of their experiences with instructor defined
innovative teaching and learning strategies into four types of nursing education.
HOW TO STUDENTS APPLY INNOVATIVE TEACHING STRATEGIES?
Comprehensive evaluation is needed to determine the effectiveness of innovation in
nursing education as well as student responses to new method of teaching.

42
 The project discussed here centers on the perception of nursing students in four types
of nursing program. It serves as a call to encourage further implementation and
 Evaluate of innovative educational strategies.
 Background nursing education is in the midst of transformation influenced by a
number of factors including wide spread use of technologies ,the serious shortage of
nurse faculty and the realization today‟s are diverse group with multiple learning
styles.
 Faculties are challenged to capture the attention of the learner to focus on what the
learner knows and to engage students in their own individual learning experiences.
 Simply imparting information through lectures through is not sufficient.
 To create ways and services that is new in order to transform system.
 It need long term challenging assumptions and values the outcome of innovation in
nursing is excellence in nursing practice.
 The development of a culture that supports risk.
INNOVATIONS IN THE NURSING EDUCATION:
According to the U.S. Department of Education (2006) many of the nursing colleges
and universities have not embraced opportunities of newer teaching methods and content
delivery.
Nursing education today has changed radically through researches done recently.
Some of the key points include
The emphasis on memorization is changing towards understanding.
Newer techniques of teaching like simulation, problem solving are becoming
popular means of delivering knowledge related to nursing because of their
effectiveness.
Variety of audiovisual aids and a widespread use of computers have made
education easier and more effective.
Curriculum in nursing education is changing drastically from simple nursing
centered criteria to more complex and comprehensive one.
There is significant increase in quality of education because of more availability
of skilled personnel for instructing in nursing.
Preparation of global nurses
Transnational acceptance

43
Ensuring a promising career
Emergence of new specialists
Increased opportunities for higher studies
Diminishing government role
THE NEW TEACHING STRATEGIES INCLUDE:
Technological including the use of simulative new delivery method such as e nursing
education,
 Various teaching learning strategies
 Preferred learning styles and approaches.
Students of nursing student‟s perceptions are limited to the educator‟s role. Teaching
behaviors, clinical experience and the difference between undergraduate and graduate
students in the use of technology. No studies were found that addressed that nursing
student‟s perception of faculty defined innovative learning experience.
 The purpose of this study to attempt to understand the definition of innovation and
viewed and describe by nursing students. The perception of this students can help
conceptualize innovation and lead to creation of new strategies that take into account
unique programmed culture, values, bahaviors and believes.etc.
 In nursing education the need exists for innovation to prepare nurses to change
environments and practice in new environments.
 According to nursing and health magazines of nursing education prospective by
murray joyce p.stated that the latest report from the institute of medicine on pt safety
keeping patients safe.
 Transforming the work environment of nurses is another effort to improve the quality
of health care.
INNOVATION IN NURSING PRACTICE:
Task RelatedActions by Nurse Managers Which Help To Developand Maintain
Creative Climate:
1. Providing freedom to experiment without fear of reprimand.
2. Maintaining a moderate to amount of work pressure.
3. Providing challenging yet realistic work goals.
4. Emphasizing a low level of supervision in performance tasks.

44
5. Delegating responsibilities.
6. Encouraging use of a creative problem solving process to solve unstructured
problems.
7. Encourage participation in decision-making and goal setting.
8. Providing immediate and timely feedback and task performance.
9. Providing the resources and support needed to get the job done.
Managing creativity
The nurse manager can encourage creativity through interpersonal relationship that
establishes trust.
Nurse Manager can plan to nourish activity in nursing personal by.
 Noting creative abilities of these persons who develop new methods and
techniques.
 Providing time and opportunity for people to do creative work. This can be
planned during the performance appraisal process.
 Recognizing that those who are masters or experts in nursing worth in clinical
practice, teaching, research and management.
 Recognizing that those who are masters or experts in nursing worth in clinical
practice, teaching, research and management.
 Encouraging nursing personnel to become involved in nursing endeavors‟ at work
in the community in professional organizations, as well as under taking other
activities that increased knowledge and skills.
 Encouraging risk taking and acceptance of personnel responsibility.
 Planning for innovation
 Measuring and rewarding management
 Tailoring information
 Expanding research and development in tools and techniques.
INNOVATIONS ACROSS THE CONTINUUM OF CARE / CLINICAL
INNOVATIONS:
Innovations in clinical practices occur across the continuum of care. Advances in
medical equipments and technology have formed a significant driver in changes in clinical
practice, demanding new skills and techniques as well as new ways of working.
Some of the innovations affecting nursing practice include following

45
 Developments in stem cell transplantation
 Newer technologies of sample collection and blood transfusion
 Apheresis
 Nuclear amplification test
 Development in nuclear medicine
 Forensic medicine innovations
 Automation in clinical laboratory
 Innovations in imaging technologies.
 Newer software assisting in recording, planning care, hospital administration, etc
Innovative approaches to problem solving
There are five main approaches to problem solving
i. Routine
ii. Scientific
iii. Decisional
iv. Creative
v. Quantitative
These approaches are strategies for problem solving and any approach may be
suitable for given situation.
Routine approach
This approach deals with problem solving on traditional methods
a. What has always been in the past, when such situation occurred? If we do now the
same way we may succeed.
b. There are standard operating procedures (SOP) in the many department of the
hospital. These SOPs tell that should be in a particular situation. How is it done? Who
does it? When will it be done? Step by step approach to deal with the problems.
c. Another way of problem solving based on the traditional methods is, to have regards
for the superior officer‟s opinion and orders. Whatever they direct, instruct or order,
presume that they are correct and follow it 100%.
Scientific approach
The first step in this approach is to identify the problem. Second step is preliminary
observation regarding the proposed scheme. Then we have to derive solution to the problems.
With the use of current knowledge and with controlled experiments investigate the
proposition. The data so collected are classified and analyzed. On the basis of analysis a

46
tentative solution is drawn. The solution so derived is implemented in that situation. After
implementation it is evaluated for its relevance.
Decisional approach
This is one of the most popular and common approach to deal with the problems. First
of all we have to state as to what is the desired result. After making definition of the problem,
various possible alternative of problem are sorted out. Then each alternative is evaluated from
the point of view of its suitability and relevance. The best alternative is selected and
implemented in a given situation. For any given situation several decisions can be made.
Creative approach
First step is to define the problem and decision makers study the information, people
and facilities involved and concentrate on interactions and outputs form the inputs. Creativity
and innovation of idea is given due consideration. This method uses the ability to develop
new ideas and implement them. The core theme is to create and apply new ideas. It present
new way of achieving the desired result without being prejudice.
Quantitative approach
Problem solving is done by construction of mathematical models. First define the
problem and construct the mathematical model and derive a solution from the model.
Evaluate the model as well as the solution drawn from the model and implement the solution
to solve the problem. the computer is of great help, when the mathematics is complex and
calculation are of large volume.
FORSEEN FOR BETTER NURSING SERVICE ADMINISTRATION IN THE NEXT
MILLENIUM:-
 Accountability.
 Autonomy of professional activities.
 Awareness of C.P.A.
 Independent nursing practices.
 Renewal of licenses based on education and examination.
 Specialty nursing
 Nursing care audit.
 Qualitative nursing care.

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