elements of management of critical care unit
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ELEMENTS OF MANAGEMENTOF CRITICAL CARE UNIT
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Functions/Elements of management of
critical care unit
Administration may be defined as all the actionsrationally performed by one person or a number of
persons to fulfill a common purpose set by someone
else of their accomplishment
Prof. Luther Gullick(1937)- summed up certain
principles or elements in the word POSDCORB.
It consist of the initials of a number of words under
each of which some administrative activity has been
classified and named
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POSDCORB
Is of course amade up worddesignedto callattentionto the various functional elements ofadministrationand management
P
lanning Organizing
Staffing
Directing
CO-ordinating Reporting
Budgeting
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Planning
Working out a broad outline, the things that
need to be done and the methods for doing
them to accomplish the purpose set for the
enterprises orofthepurpose in hand
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Organizing
This is the establishment of the formal
structure of authority through which work
subdivisions are arranged , defined and co-
ordinated for the defined objectives
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Staffing
The whole personnel function ofbringing in
and training the staff and maintaining
favorable conditions of work
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Directing
It is the continuous taskofmaking decisions
and embodying them, in specific and
general orders and instructions and serving
as leader of the enterprise
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Co- ordinationg
All important duty of interrelating the
various parts of the work and eliminating of
overlapping and conflict
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Reporting
That is keeping those to whom the executive
is responsible informed as to what is going
on, which thus includes keeping himself and
his subordinates informed through records ,
research and inspection
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Budgeting
All that goes with budgeting in the form of
fiscal planning, accounting and control
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Planning
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Planning- introduction
It is the basic of all managerial function because
the future course of action is determined by
proper planning
A managerorganizes, directs and control to ensure
the accomplishment of predetermined goals
according to plan
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Planning- introduction
Itis a blue print for action
Planningis deciding in advance what is to be done
It includes selection of objectives, policies,
procedures, programmes from among alternatives
Planningis predetermined course of action to
achieve specific goals
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Planning- Definition
Planning is a process of determining the
objectives of administrative effort and
devising the means calculated to achieve
them Millet
It is the determination of course of action to
achieve the desired results.It bridges the gap
from where we are to where we want to go.
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Nature of planning Planning is an intellectual activity, since it
involves vision and foresightedness to decide
things to be done in future
It involves selection among alternatives.
Planning process involve finding of allalternative and selection of best alternative
to achieve specified objective
Planning is a forward duty since themanager attempts to handle future events
effectively throughprocess of planning
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Nature of planning
Planning is related to objectives and everyplan specifies objectives to achieve in future
& steps to reach them
Planning is most basic of all managerial
function
Planning is inevitable at all levels of
administration
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Principles of planning1. Planningmustfocus on purpose
2. Planningis acontinuous process whichincludesseries of steps
3. Planning shouldbesimple
4. In planning,there shouldbea good harmony
with organization and environment5. Planningis hierarchical in nature
6. Planningmustbeprecise in its objectives, scopeand nature
7. In planningtheprovision should be made to useall available resources
8. Planningshould always be documented so thatall the concerned are fully committedto the
implementation ofthe programme
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Components/ elements of planning
1. Objectives
2. Policies
3. Procedures
4. Programmes
5. Budget
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Objectives : They are the basic plan which determine the goal
or end result Policies : Are written statement or oral understanding.
Policies are general statement which may be either verbal or
written. Policyprovides standing solution for problem
Procedures : Indicates the specific manner in which certain
activity is to be performed
Programmes : it is defined as a single use comprehensive plan
designed to implement policy and accomplish the objective
Budget : is the statement of expected results in numerical
terms; ie in rupees, man hours etc
Components/ elements of planning
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Levels of planning
Planning function has to beperformed at all 3 levels of
management ie top level , middle level and lower level
Top level: Management has to devote much more time to
planning & policy making. It is concerned with strategic
plans which are long term in nature covering a life span
of1-5
yrs or 10 yrs.
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Levels of planning
Middle level: Has to formulate short term or
intermediate plan & devote less time to planning and
more time for co- ordination and communication.
Specific plans for different areas of management like
personal, production, marketing are implemented by
middle level managers
Lower level: It is directly concerned with operationalplanning. At this level the first level managers such as
HOD concentrates on daily, weekly and monthly
operations
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Types of planning
1. Directionalplanning
2. Administrativeplanning
3. Operationalplanning
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Directional planning
Is often called as policy planning. It is
concerned with the broad general direction
of programme. Ie. Setting the framework of
intent and philosophy within which the
programme will proceed.
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Administrative planning
Is concerned with implementation of the
policies developed and with the mobilization
and co- ordination of the personnel and
material available in the administrative unit
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Operational planning
It is concerned with the actual delivery
service to the community
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Planning process in health service
Health planning is an orderly process of
defining health problems, identifying correct needs
and surveying the resources to meet them ,
establishing priority goals that are realistic and
feasible and projecting administrative action to
accomplish thepurpose oftheproposedprogramme
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Steps ofPlanning process in health service
1. Analysis ofthehealth situation
2. Establishing objectives andgoals
3. Assessment ofresources
4. Fixingpriorities
5
. Write up the formulated plan
6. Programming and implementation
7. Evaluation
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Benefits of planning
It focuses attention on objectives: Laying down
objectives is the first step in planning. If the
objectives are lay down clearly the execution of
planning also be directed towards this objectives
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Benefits of planning
Ensures economical operation: Planning involves
lot of mental exercise which is directed towards
achieving efficient operation in the enterprise. It
helps better utilization of resources & thus
minimizing the cost
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Benefits of planning
It reduces Uncertainty: Planning reduce uncertainty
of future because it involves anticipation of future
events
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Benefits of planning
It facilitates control: Planning helps the managers
to perform their function of control
Encourages innovation and creativity: It helps for
innovative and creative thinking among managers
because many new ideas come to the mind of
managers while planning
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Benefits of planning
It improves motivation: A good planning
system ensures participation of all
managers and workers which improves
their motivation
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Disadvantages of planning
1. Itdepends upon facts and information
2. Planningmay leadto internal inflexibilities
and procedural rigidity
3. Itis time consuming and expensive
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Organization
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Introduction Is an essential part ofhuman life. We are born
in organization, educated in organization and
spend most of our time working for
organization
Organization is a process of dividing and
combining efforts of a working group formaking such joint efforts more productive,
effective and fruitful
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Definition
Organization is the form of every human association
for the attainment of common purpose and the process
ofrelating specific duties or functions in a whole
-J.D.Mooney
Organization is a formal structure of authority through
which work subdivisions are arranged, defined and co-
ordinated for the defined objective.
-LutherGullick
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Importance of organizing
1. Focus on objectives andfacilitate the attaining of
objectives.
2. Arrangement of positions and jobs withinthe
hierarchy.
3. Define responsibilities and line of authority ofall
levels.
4. Creating relationships thatwill minimize friction
.
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Basic elements of formal organizations
1. Centralizationanddecentralization.
2. Delegation ofauthority.
3. Span of control (supervision).
4. Division of service.
5. Departmentation.
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Centralization and decentralization:
it refers to the level at which most of the decisions are made
within the organization.
Centralization
Concentration of decision-making and action at high-level
management.
Decentralization
Consistent delegation of authority to the lower levels where
the work is performed
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Centralization
Advantages
1.ProvidePower and
prestige for manager.
2.Promote uniformity of
policies, practicesdecisions.
3.Minimize duplication
of functionis.
4.Extensive controlling
procedures and practices
arenot required.
Disadvantages
1.Neglected functions for
mid. Level,andless
motivated bedside
personnel.2. Nursing supervisor
functions as a link
officerbetweennursing
director and first-line
managementinstead of
acting as a manager .
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Decentralization-Advantages
Raise morale and promote interpersonal
relationships.
Relieve from the daily administration.
Bring decision-making close to action.
Develop Second-line managers.
Promote employees enthusiasm and
coordination.
Facilitate actions by lower-level managers.
Improves coordination, especially forservices.
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Decentralization- Disadvantages:
Top-level administration may feel it woulddecrease their status.
Managers may not permit full and maximumutilization ofhighly qualifiedpersonnel.
Increased costs. It requires more managers andlarge staff.
It may lead to overlapping and duplication ofeffort.
It may lead to lack of uniformity and loweringof standards in decision -making.
Emergency decision may not bepossible.
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Basic elements of formal organizations
2. Delegation of authority.
Delegation:
Process of assigning work from a top
organizational level to a lower one or from
superior to subordinate, and giving that
person the authority to accomplish them.
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The delegation process
Allocation ofduties.
Delegation ofauthority.
Assignment ofresponsibility.
Creation ofaccountability.
Accountability: subordinates must be held
answerable to theircarried out duties.
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Factors determining degree of authority
delegation:
1. Organizations size.
2. Importance ofduty ordecision.
3. Taskcomplexity.
4. Organizational culture
5. Qualities of subordinates.
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Main principles of delegation
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Barriers to successful delegation
Lack of superiors ability to direct the
subordinates.
Lack ofconfidence in subordinate.
Absence ofcontrol.
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Major causes of managers refusal to
delegate
Tendency to do things personally.
Desire to dominate the knowledge,
information, and/orskills.
Unwillingness to accept risks of wrongs
R f b di t id
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Reasons for subordinates avoidance
of accepting delegation
Decision-making is a hard mental work,and
people seekways ofavoidingit.
Fear of criticism formistakes.
Lack of necessary information and
resources to do agoodjob.
Overload of work.
Positive incentives maybeinadequate.
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Authority
The right to take final decisions, to act or to
command action of others
It moves in a downward direction.
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Types of authority
1. Ultimateauthority.
2. Legal authority.
3. Technical authority.
4. Operational authority.
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Ultimate authority:
It deals with the original source from which
one derives the right to take actions.
Thus, in the health sector, the ministry of
health has ultimate authority
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Legal authority
Means that an individual is legally permitted
by the virtue of the position to take an action;
a hospital director delegates to director of
nursing service to act on behalf of the
department
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Technical authority
It refers to a person who is a recognized
expert in some particular field.
This does not necessarily mean that it is
derived from position.
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Operational authority
Is giving someone permission to assure
certain responsibilities through delegation of
authority.
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Responsibility:
The obligation involved when one accepts an
assignment.
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Types of organizational relationshipsThe line relation
Presents levels of hierarchy, superior-subordinate
relationships, and provides the framework for the
organization.
The superior has the right to give orders and
demand accountability. Each member knows from
whom he/she receives orders and to whom he/she
reports
It is showed by a solid line in the organizational
chart
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Types of organizational relationships
Staff relation
Has no command, personnel have only the
right to advise, assist, support those in the
line authority in the performance of their
duties, it is line showed by a dotted line inthe organizational chart.
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Line & Staff Relationships
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Number of subordinates that can be
adequately supervised by one supervisor.
Basic elements of formal organizations
Span ofControl:
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Dimensions of span of control
1. Narrow span of control.
2. Wide span of control.
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Narrow span of control
Themanagersupervises a small numberofworkers
Narrow span of control
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Narrow span of control.
Advantages:
Close supervision.
Close control.
Fast communicationbetween subordinates and
superiors.Disadvantages:
Superiors tendto gettoo much involved in
subordinates work.
Many levels of management.
High costs dueto many levels.
Wid f t l
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Wide span of control
The manager supervises a large number of workers
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Wide span of controlAdvantages:
Superiors are forced to delegate.
Clear policies must be made.
Subordinates must be carefully selected.
Disadvantages:
Tendency of overload superiors to take most
or all decisions. Dangerofsuperiors loss of control.
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T ll Fl t O i ti
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Tall versus Flat Organizations
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Factors determining the span of control
The competence of both the supervisor and the
subordinate.
The degree of interaction between the units orpersonnel
being supervised.
Other duties of the top manager. Lower-level managers
have a wider range of span than top-level manager.
The similarity or dissimilarity of activities being
supervised.
The nature of work(stability, complexity, etc complexity,
etc).
Basic elements of formal organizations
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g
4. Division of service
Dividing large activities to be distributed among severalpeople.
Advantage:
Allow an employee to master a taskwith a maximum
skill, a minimum time and effort.
Disadvantages:
Creates many different, narrow jobs, which need
effective managerial coordination.
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Itis theprocess of grouping activities into
administrative units.
Basic elements of formal organizations
5) Departmentation
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Types ofDepartmentation
1. Departmentation by services: activities are grouped
according to similarities of skills needed to
accomplish the goal, i.e. medical, surgical and
pediatric units. It is simple and commonly used.
2. Departmentation by time: activities that need
coverage twenty four hours a day, seven days a
week (e.g. acute care settings), or activities
coverage for eight to twelve hours a day for five orsix days a week (e.g. preventive services) at the
most.
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Types ofDepartmentation
3.D
epartmentation by degree of acuteness of illnessof the patients: fiveprogressivepatientcare (PPC),
i.e. Intensive Care Unit, Intermediate Care Unit,
Self-Care Unit, Long-TermCare Unit, and Home
Care Unit.
4. Departmentation by function: This method places
all the resources and authority under one
manager, e.g. laundry, pharmacy, dietary services.
Types of Departmentation
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Types ofDepartmentation
5. Departmentation by location: activities that are used
with wide geographic activities in a given locationthat are grouped and assigned to a manager, i.e.
inpatient department, outpatient department, and
administrative department.
6. Departmentation by patient: making sense when
service is important and the welfare of the patient
is of primary interest, i.e. sex: male, female, age:
geriatric, pediatric, economic status: paying, freeunit.
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I t d ti
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Introduction
Once the plan is decided and organization
structure is created then next step in the
managementprocess is to fill the various post
created in the organization. This is
managerial function of staffing.
I t d ti
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Introduction
Staffing is the management activity that provides
for appropriate and adequate personnel to
fulfill the organizations objectives.
The nurse manager decides how many and what
type of personnel are required to provide care
forpatients.
St ffi d fi iti
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Staffing- definition
Selecting the personnel to carry out these
actions and placing them in positions
appropriate to their knowledge and skills
P f t ffi
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Purpose of staffing
To ensure the right number, right type ofpeople are working on the right job at right
time and right place.
The quatity of human resources to achieve
their goal depends upon the quality of human
workforce
El t / f ti f t ffi
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Elements/ functions of staffing
Manpower planning: involves estimation of size and
make up of personnel required
Recruitment : concerned with finding out of
applicants for job vacancies
Selection: involving the choice of best qualified fromamong the job seekers to fill the job vacancies
Placement: of selected people in appropriate
position
Training and development of employees: to enablethem to do their jobs more efficiently
Appraisal of performance: to design rewards,
promotion, transfer etc
1 Steps in manpower planning
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1.Steps in manpower planning
1. Strategic plans
2. Humanresource planning
a. Forecasting human resource needs
b. Forecastingpersonnel availability
c. Designing and implementing personnel selection
policies andprocedures
Strategic plans
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Strategic plans
After developing the policies the
administrators design health resource
planning requirement and budget to fit withotherplans
Human resource planning
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Human resource planning
Itincludeforecasting thedemand for andsupply for required personnel.
This planninghave 3 majorsteps
a. Forecasting human resource needs
b. Forecastingpersonnel availability
c. Designing and implementing personnel selection
policies andprocedures
Forecasting human resource needs
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Forecasting human resource needs
This include forecasting of retirement ,
transfer, termination, resignation etc
Also include analysis of turnover to maintain
the existingpersonnel
Forecasting personnel availability
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Forecasting personnel availability
The human resource inventory provide informationabout the organizations present personnel
After completing the inventory, the organization
prepares a catalogue indicating the detailed skills,
abilities and needs of the work force
Thus personnel inventory permits managers to matchthe organizations present strength and weakness
against future needs and requirements
2 Recruitment
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2.Recruitment
Involves seeking and retracting a pool of
people from which required candidates for
job vacancies can be chosen
Recruitment is a process of searching for
prospective employees & stimulating and
encouraging them to apply for a job in the
organization
Sources of Recruitment
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Sources ofRecruitment
Internal: Whenever new vacancies arises
people from within the organization will be
promoted or will be transfered
External : When the organization has
exhausted internal sources or find it unsuitable
external sources can be used
Process of recruitment
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Process of recruitment Job analysis- it is the systematic and scientific study
of a job in order to determine the nature andcharacteristic of job and the knowledge, experience
and skills requiredfor the successful performance of
the job
Job description- it follows jo b analysis. It is anorganized, written and factual statement of the job
contents in the form of duties.
Job specification- Is the formal statement of the
minimum acceptable human qualities required for
the successful performance ofthe job
3 Selection
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3.Selection
It is theprocess ofchoosing a candidate from
the pool of applicants created by recruiting
The selection is done after the candidate
proceed through a series of step that
compose selection process
It is a negative process
Steps in staffing procedure
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Steps in staffing procedure1. Preliminaryinterview
2. Applicationblank
3. Employmenttest
4. Employmentinterview
5. Physical examination
6. References
7. Final Approval
REJECTIO
N
Steps in staffing procedure
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Preliminary interview- done in reception counters
Application blank- briefwritten resume . Itprovide
data about the candidate
Employment test- designed to measure selected
aspect ofthe candidate
Employment interview- personal or face to faceinterview
Physical examination
References- before final selection; the prospective
employer likes to investigate into the details of the
candidate from the reference provided by the
applicant
Final Approval
4 Placement
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4. Placement
Selected candidates are posted in appropriate
job.
It involve assigning specific job and work
places to the selected candidate
5 Training and development of employees
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5. Training and development of employees
The selection of the best person for the job isthe first step in staffing
The selected persons must be trained to
build up an effective work force
Training is the process of increasing
knowledge and skills of an employ for doing
particular job
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Directing
Directing
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Directing
The function oftelling people what to do and
seeing that they do it to the best of their
ability
Definition
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Definition
The heart of administration is directing
function which involves determining the
course giving orders and instruction and
providing the dynamic leadership
M.E. Dinok
Directing
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Directing Once theplans are formulated the organization
structure is designed and competent persons
are placed at various positions and the
organization is ready to go into action. The
actual actions begins when orders and
instructions are given to the employees andsteps are taken to get them executed.
This is the managerial function ofdirecting
Directing
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Directing
It is the managerial function of instructing,
guiding, supervising, inspiring and influencing
people towards the achievement of
predetermined objective
Directing is basically human resource
management
Importance of direction
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Importance of direction Direction initiates action-
It bridges the gap between the managerial decisionand actual execution bypeople.
It is the integrated team function ofmanagement
Direction made itpossible to achieve the mission orthe objective ofthe organization
Direction facilitates the introduction of change
in an organization
People have a tendency to change in an
organization. They need direction to accept and
implement changes in the right direction for the
betterment ofan organization
Principles of direction
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Principles of direction
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8/3/2019 Elements of Management of Critical Care Unit
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