NURSING LEARDERSHIP AND MANAGEMENTOrganization two or more persons engaged in a systematic coordinated effort to produce goods and services

Components of Health Care Organization: (Getzel and Guba) Nomothetic Dimension Institution, Roles, Expectations Idiographic dimension Individual, Personality and needs disposition

Reasons why people organize: attainment of objectives pooling of resources learning and compensation/service

Types of Organization (General):1. Formal2. Informal

TYPES OF ORGANIZATION (Talcott Parsons) 1. Oriented to ______________________ - Production & distribution of goods & services 2. Oriented to ______________________ - Generation & allocation of power in society 3. INTEGRATIVE ORGANIZATION - Adjustments of conflicts & direction of motivation to fulfill certain expectations 4. PATTERN-MAINTENANCE - Primary function: cultural, educational, expression

Integration and Coordination Arm: Administration, Management, SupervisionCommon to all is the concept of ________________

ADMINISTRATION Over-all direction Over-all machinery Directing the whole enterprise Aims of efficiency, effectivity, economy, productivity

Principles of Administration: Unity of Command Span of Control Delegation of authority Scalar principle Homogeneity of assignment

Managerial Performance and its Dimension: 1. Effectiveness - DOING THE RIGHT THINGCHOOSE APPROPRIATE GOALS & ACHIEVE/REACH2. Efficiency - DOING THINGS RIGHT best use of resources working with minimum effort/expense /WASTE3. EFFICACY - accomplishing the taskPower to make things possible

MANAGEMENT GETTING THINGS DONE THROUGH __________ Process of COORDINATING ACTIONS and ALLOCATING/UTILIZING RESOUCRCES Process of ACHIEVING ORGANIZATIONAL GOALS

Administer = to perform the office = taking the roleManage = to control and direct = method or style when you take the roleElements of Management:1. P2. O3. S4. D5. C

M s in Management/Elements: Money, Men, Machines, Materials, Methods, Moment (time), Manager

MANAGEMENT PRINCIPLES: Management by O Management by E Management by S Management by E

NURSING MANAGEMENT Relates to planning, organizing, staffing directing (leading) and controlling (evaluating) all activities of the nursing system Process of coordinating actions and allocating resources to achieve organization goals of the healthcare delivery system

Levels of Management: 1. Top Level2. Middle Level3. Low level/First line

TEN MANAGERIAL ROLES (Henry Mintzberg) 1. INTERPERSONALa. FIGURE HEADb. LEADERc. LIAISON2. INFORMATIONALa. MONITORb. DISSEMINATORc. SPOKESPERSON3. DECISIONALa. ENTREPRENUERb. DISTURNBANCE HANDLERc. RESOURCE ALLOCATORd. NEGOTIATOR

THEORIES OF ORGANIZATION AND MANAGEMENT: Development of Management

I. Pre Classical Contributors Robert Owen (1771 1868)- advocated concern for the working and living condition of workers Charles Babbage (1792 1871)- Father of Modern Computing Henry Towne ( 1844 - 1924 ) - called for the study of management as a science

II. Classical Viewpoint - EMPHASIZES ________________in finding ways to manage work and organizationEmphasis: Task orientation, effective operation, high individual productivity

A. Scientific management Emphasizes the scientific study of work methods = improve worker efficiency

Frederick W. Taylor ( 1856 - 1915 ) Father of Scientific Management Pioneered time & motion study Study work scientifically to determine the one best way to perform each task Offered the Principles of Scientific Management Central premise: labor and management want increase PRODUCTIVITY

PRINCIPLES OF MANAGEMENT 1. Scientifically study each part of a task and develop the best method for performing the task2. Carefully select workers and train them to perform the task by using the scientifically developed method.3. Cooperate fully with workers to ensure that they use the proper method.4. Divide work and responsibility

Frank and Lilian GILBRETH - THERBLIGS Frank Gilbreth (1868 - 1924) - first to use motion picture films to analyze workers motion Lilian Gilbreth (1878- 1972) - first lady of management

HENRY GANTT (1861 - 1919) developed the Gantt Chart Introduce the task and bonus pay plan

B. Administrative management Focused on principle that can be used by managers to coordinate the internal activity of organization

HENRI FAYOL (1845 - 1925) FATHER OF OPERATIONAL MANAGEMENT THEORY SYSTEMIC MANANGEMENT THEORY Introduced the functional approach to management - focusing on major managerial activities

FUNCTIONS OF MANAGEMENT: PLANNING = EXAMINING FUTURE ORGANIZING = PROVIDING RSOURCES AND BUILDING STRUCTURE to carry out the activities DIRECTING = COMMANDING COORDINATING = UNIFYING & HARMONIZING CONTROLLING = verifying that everything occurs in accordance with plans, instructions, established principles and expressed command.

14 PRINCIPLES OF MANAGEMENT 1. DIVISION OF WORK 2. AUTHORITY 3. REMUNERATION 4. INITIATIVE5. UNITY OF COMMAND 6. Subordination of Individual Interest to the General Interest7. UNITY OF DIRECTION8. Scalar chain9. EQUITY 10. CENTRALISM/DECENTRALISM11. STABILITY OF PERSONNAL TENURES12. ORDER 13. DISCIPLINE14. ESPRIT DE CORPS

Chester Barnard (1896- 1961) - Acceptance Theory of Authority Authority does not depend as much on person of authority who give the orders, it depends on the willingness of those who receive the order to comply

James Mooney (1884 - 1957) - 4 Universal Principles of Organization1. Coordination and synchronization of activity for goals achievement2. DIVISION OF LABOR = Functional effect in the performance of ones job description3. SCALAR PROCESS4. AUTHORITY

Luther GulLick & Lyndall Urwick Suggested a classification of activities in different function of management; in many aspect similar to those suggested for industrial management function Developed the acronym POSDCORB (7 Administrative Activities) PLANNING = outlining of things to be accomplished and methods ORGANZING = establishment of a formal structure of authority STAFFING = RECRUITMENT & TRAINING DIRECTING = MAKES DECISIONS, GIVING ORDER COORDINATING = BRINGING TOGETHER Reporting and Communicating BUDGETING = FISCAL PLANNING, ACCOUNTING & CONTROL

C. Bureaucratic Management

MAX WEBER - Father of Organization Theory

CHARACTERISTICS: IDEAL BUREAUCRACY 1. Specialization of labor 2. Formal rules and procedure 3. Impersonating4. Hierarchy5. Career Advancement

III. Behavioral Viewpoint

A. Early Behaviorists

Hugo Munsterberg - Father of Industrial PsychologyExplained that psychologist could help industry in 3 major areas: 1. Studying jobs and findings, ways of identifying individuals who are best suited to the particular jobs2. Identifying psychological condition under which individual are likely to do their best work 3. Finding ways to influence individuals to behave in manners that are congruent with management interests

Mary Parker Follett (1868-1933) Management as ________________________ Organization should present on the principle of POWER WITH rather than POWER OVER POWER WITH= CONFLICT RESOLUTION = INTEGRATION = SATISFY BOTH PARTIES INTEGRATIVE UNITY = OPERATE AS A FUNCTIONAL WHOLE MANAGERS & WORKERS = PARTNERS

B. Hawthorne studies

GEORGE ELTON MAYO Father of Human Relations Movement provide physical needs of the workers, overtime pay, rest day, day off Hawthorne studies at Hawthorne Plant of Western Electric Co. in Cicero, Illinois together with F. J. Roethlisberger and William J. Dickinson Hawthorne Effect human factors like attention, care and recognition and not just physical work environment influence productivity

C. Human Relation Movement Emphasized concern to workers Brought into focus a view of workers as social creatures, variety of needs to be met SOCIAL INTERACTION and NEED TO BELONG Advocate importance of TRAINING, COMMUNCATION and GROUP DYNAMICS

Major theorist: Abraham Maslow Hierarchy of Needs Douglas McGregor Father of Motivational Theory Theory X and Y Two sets of assumption of human nature Theory X ______________Management style Traditional view of direction and control Use of authority coercive, autocratic, arbitrary Economic rewards major motivator of human behavior Theory Y _____________ Management style Integration of individual and operational goals Views human nature positively Frederick Herzberg Two Factor Theory

D. Behavioral ScienceEmphasizes _______________________ as the basis for developing theories about human behaviour Beliefs: Management is not strictly a technical process Management cant be haphazard Management should not be elicited through authority

IV. Quantitative Viewpoint Focuses on the use of MATHEMATICS, STATISTICS and INFORMATIVE AIDS to support managerial decision - making and organization effectiveness Quantitative method for help in deploying resources in the most effective way Operations research Operations management Management information science

V. Contemporary Viewpoint

A. Systems theory Approach to solving problems within a framework of inputs, transformation, process, output and feedback System analysis has been used primarily to manage TRANSFORMATION PROCESSES and in the technical PLANNING and DECISION MAKING aspects of management All organizations ARE OPEN SYSTEM THAT interact with their environment

B. Contingency theory SITUATIONAL APPROACH means IT DEPENDS appropriate action depends of the particular parameters of the situation Task of the manager is to identify: WHICH TECHNIQUE will in a particular SITUATION under a particular CIRCUMSTANCES at a particular TIME, BEST contribute to the attainment of management goalsC. Quality Viewpoint QUALITY - how will a product or service does what it is supposed to do TOTAL/CONTINUOUS QUALITY MANAGEMENT- aimed at continually improving product and services quality so as to achieve the high levels of customer satisfaction and build stronger customer loyalty. W. Edward Deming (1900-1993) - godfather of the quality movement

D. Participative Approach (Theory Z) Williams Ouchi Humanistic nature that focuses on finding better ways to motivate people in order to increase worker satisfaction therefore productivity

7 S BASIC CRITERIA SUPRAORDINATE GOALS: hold organization togetherSTRATEGY: method of doing thingsSTRUCTURE: physical plant and facilitiesSYSTEM: coherence of all parts for common goalSTAFF: concern for the right peopleSKILLS: developing and training peopleSTYLE: manner of handling people

ELEMENTS OF NURSING MANAGEMENT:

1. PLANNING most basic and fundamental activity of the management process ALL OTHER FUNCTIONS DEPENDS DETERMINING IN ADVANCE (Ws) Mental process of DECISION MAKING and FORECASTING = Estimating the future continuous process of assessing, establishing goals and objectives, implementing and evaluating them

Involves the CHOICE OF GOALS & OBJECTIVES along with: GOALS future target or end result; general statement of purpose OBJECTIVES concrete or more specific statement MISSION & VISION Mission - purpose or fundamental reasons for existence Vision outlines future role and function PHILOSOPHY- statement of beliefs and values POLICIES general guide STRATEGIES PROGRAMS & PROJECTS PROCEDURES- series of related steps RULES - speaks out specific action to be taken or not taken in a given situation STANDARDS - Agreed-on level of performanceWHY, HOW and CAN of PLANNINGWHAT to do?WHY do it? WHERE to do it? WHEN to do it? WHO to do it? HOW to do it? HOW MUCH?For WHOM?CAN?

Modes of planning:1. Reactive2. Inactivism3. Preactivism4. Interactive or proactive

Principles of Planning: Always based on and focused on VISION, MISSION, PHILOSOPHY and clearly defined objectives Continuous process Pervasive within the entire organization Utilizes all available resources Precise in scope Time-bound Projected plans documented

Purpose/Importance/Reason of Planning: Sets STANDARDS to facilitate effective CONTROL Gives DIRECTION & leads SUCCESS OF GOALS Reduces IMPACT OF CHANGE and COPE WITH CRISIS Reduces WASTE and REDUNDNACY Provides for EFFECTIVE USE OF RESOURCES COST EFFECTIVE Gives MEANING to WORK

PLANS means devised for attempting to reach a goal2 Kinds of plans:1. Single-usea. Programsb. Project2. Standinga. Policyb. Procedurec. Rule

Types of Planning: According to Structure of Organization Centralized Decentralized

According to SCOPE/COVERAGE & LEVEL Strategic Tactical Operational

According STABILITY Master or Strategic Contingency

Components of Planning: 1. Environmental scanning/analysis2. Setting the mission, vision, philosophy, goals, objectives3. Setting plans: procedures, rules4. Proper Programming or Time management5. Prepare Budget and allocate resources

Situational Analysis: SWOT AnalysisS

W

O

T

FISCAL PLANNING - process of QUANTITATIVE planned original activities for a given period of time SYTEMATIC FINANCIAL TRANSLATION OF A PLAN - tool for planning and controlling COST and EXPENSES COST CONTAINMENT: effective and efficient delivery of services while generating needed revenues for continued organizational productivity

BUDGETING Budget quantitative statements prepared through the budgeting process; financial roadmap and plan Financial statement summary of major aspects of an organizations financial status

Types of Budgeting:1. Centralized2. Decentralized

Types of Budget:1. Fixed2. Variable3. Controllable4. Uncontrollable

Nursing Budget plan for ALLOCATION OF RESOURCES based on preconceived needs for a proposed series of PROGRAMS to DELIVER PATIENT CARE during 1 fiscal year Hospital Budget financial plan to meet future service expectation, TO PROVIDE QUALITY CARE at MINIMUM COST

Components of Budget Plan:1. REVENUE: INCOME management generates during planning period2. EXPENSE: expected activity in operational financial terms for a given period of time3. CAPITAL BUDGET: outlines the PROGRAMMED ACQUISITIONS, DISPOSALS and IMPROVEMENTS in the PHYSICAL ACTIVITY4. CASH BUDGET: MONEY RECEIVED, CASH RECEIPTS and DISBURSEMENT

TYPES OF BUDGET EXPENDITURE: MANPOWER/PERSONNEL BUDGET- Largest expenditure OPERATING BUDGET- Reflects expenses that change in response to service CAPITAL EXPENDITURE BUDGET - purchase of lands, buildings, and major equipments

TIME MANAGEMENT - technique for allocating ones TIME through setting of goals assigning priorities identifying and eliminating wasted time, and using managerial techniques to reach goals efficiently

TIME MANAGEMENT PRINCIPLES: Communicating, Planning, Delegating

PARETO PRINCIPLE (Vilfredo Pareto) on Time Management: 20 % focused efforts results in 80 % outcomes 80 % unfocused efforts results in 20 % outcomes KEY: focus effort on the activities that will get maximum results

2. ORGANIZING Establishing a formal structure that provides the coordination of resources to accomplish objectives, established policies & procedures, and determines position qualification and description. Systematic arrangement of the elements of management

Components of Organizing:1. Organizational structure2. Organizational chart3. Job analysis4. Staffing5. Scheduling

IMPORTANCE OF ORGANIZING: Promotes collaboration & negotiation among the individual in the group Creates clear-cut lines of authority & responsibility in an organization

Principles of Organizing:1. Unity of command 2. Span of control 3. Delegation of Authority 4. Homogeneity of Assignment 5. Scalar Principle/Chain of Command

ORGANIZATIONAL DESIGN and STRUCTURE

ORGANIZATIONAL DESIGN - formal, guided process for integrating the people, information, and technology of an organization

Refers to the process by which: a group is formed, its formal working relationship its channels of authority span of control lines of communication

ORGANIZATIONAL STRUCTURE formal mechanism through which the organization is managed framework within which people act, the basic plan which the manager draws up to help in achieving the objective

ELEMENTS OF ORGANIZATIONAL STRUCTURE Designing jobs and detailing of work Forming departments or work units Creating a hierarchy Forming a span of control Coordinating and integrating activities

TYPES OF ORGANIZATIONAL STRUCTURE 1. Informal structure Unplanned and covert Consist of personal and social relationships It is not reflected in the organizational chart People with little or no formal status or position may gain recognition Unofficial personal relationship Has its own channel or communication called the _____________________, where information is disseminated faster than in the formal system of communication2. Formal Planned and made public Describes position, the responsibilities of those occupying the position, and the working relationships among the various units or departments

Two basic forms: Hierarchic or bureaucratic model/Pure Line A straight forward, direct chain of command pattern Emphasizes SUPERIOR-SUBORDINATE RELATIONSHIP Provides clear authority- responsibility relationship between workers at all levels. Emphasizes clear-cut work specialization & role separation Adaptive or organic model/Adhocracy More free form, open, flexible, and fluid Several types: free form, collegial management, project management, task forces, and matrix organization Greater recognition is given to the informal structure and the group is encourage to improve its own norms and standards It is staff by independent and self-reliant people Management is participative

MATRIX STRUCTURE a structure that superimposes a horizontal set of divisional reporting relationships into a hierarchical functional structure. Employees who work within a matrix report to matrix bosses. Management can apply specialized skills to solve a problem Interdisciplinary coordination is encouraged. Disadvantage: May result in confusion because personnel receive orders from the bosses.

Types of authority: 1. LINE AUTHORITY - functions is to command & control; solid line2. STAFF AUTHORITY - separated from the chain of command to permit specialization; Dashed/BROKEN line Types of Hierarchical Structure:1. Tall structure/Centralized VERTICAL/PYRAMIDAL MANY LEVELS NARROW SPAN OF CONTROL CENTRALIZE DECISION MAKING DELAY DECSIONS MANY LEVELS OF COMMUNICATION STIFFED SUPERVISION 2. Flat structure/Decentralized HORIZONTAL FEW LEVELS WIDE SPAN OF CONTROL DECENTRALIZE DECISION MAKING SPEED IN DECISION SIMPLIFIED COMMUNICATION DEVELOP AUTONOMY & ABILTIES

ORGANIZATIONAL CHART - line diagram that depicts the broad outlines of an organizations structure, shows how parts of the organization are linked

USES OF ORGANIZATIONAL CHARTS outlines administrative control for policy making and planning evaluate strengths and weaknesses of present structure shows the relationship with other departments and agencies orient new personnel to the organization

Lines of Communication and Authority: Square/Rectangle/Box - position and placement Straight/Unbroken/Broad connecting lines - represent communication between individuals or departments; line function Solid Vertical line- lines of authority & accountability; demonstrate the chain of command Solid Horizontal lines - communication between people with similar spheres of responsibility and power but different function Broken lines - lines of coordination; staff function communication with no direct authority

TYPES OF ORGANIZATIONAL CHART Vertical/tall/pyramidal All units fan out from the head Depicts the chief executive from the top with lines of authority flowing down the hierarchy Has small/narrow span of control Most effective when managers desire better coordination & effective communication Clearly defines the relationships between & among the different levels in the organization. Horizontal/FLAT depicts the manager at the top with a wide span of control levels of management are not shown in a flat chart fewer levels of control communication in this structure is direct, simple and fast with minimal distortions of messages since the distance between top and lower levels is shorter Circular/ concentric chart Top manager is at the center, those in the middle or lower levels of management are in concentric circles. Shows the outward flow of formal authority which is from the center moving outward. Structure minimizes or reduces the implications of status or positions Represents a conceptual rather than a functional view of the organization

Job Analysis - procedure for determining the duties and skill requirements of a job and the kind of person who hired for it

2 Products of Job Analysis:1. JOB ________________ - list of a jobs duties, responsibilities, reporting relationships, working conditions, and supervisory responsibilities2. JOB ________________ - list of a jobs human requirements, that is the requisite education, skills, personality, etc

JOB TITLE: position and qualificationJOB RELATIONSHIP: degree of supervisionPERFORMANCE DESCRIPTION: duties and responsibilities

STAFFING - process of determining and providing human resources to fill the roles designated in the organization Process: Recruitment ENLISTING personnel Selection Induction, Orientation, Socialization (INDOCTRINATION) Training and development Transfer - shifts of person from one job organizational level or location to another Promotion Lateral Demotion Separation Resignation Lay off Discharge Retirement

PATIENT CLASSIFICATION SYSTEM - method of grouping/categorizing patients according to the amount and complexity of their nursing care requirement that can be clinically observed by the nurse (Lewis & Carini)1. DESCRIPTIVE2. CHECKLIST OF NURSING TASK3. TIME-BASED (NURSING CARE HOURS)

PATIENT CLASSIFICATION SYSTEM CATEGORYCategory 1: MINIMAL CARE/SELF-CARE Patient are capable of carrying out all activities of daily living as long as the nurse provides necessary equipments and supplies .Category 2: MODERATE CARE/INTERMEDIATE CARE Given to patient who are moderately ill or are recovering from the immediate effect of serious illness/operation Category 3: MAXIMUM/TOTAL/COMPLETE Given to patient who need close attention throughout shift Given to patient who requires nursing to initiate, supervise, and perform MOST of their activities or who require FREQUENT and COMPLEX medication and treatmentCategory 4: INTENSIVE/CRITICAL/HIGHLY SPECIALIZED Given to ACUTELY ILL patients who have high level of nurse dependency, including those requiring intensive therapy /INTENSIVE nursing care are in CONSTANT DANGER OF DEATH

DETERMINING STAFFING NEEDS: FTE (Full-Time Equivalent) = 40 hours per week = 1.0 FTE5 days a week, a hours a day, 40 H per week, for 52 weeks each year (total of 2,080 H) NHPPD- Nursing hours per patient day Standard measure that quantifies the nursing time available to each patient per nursing staff member For example, for a 24 hours period, a unit has 20 patients, with 5 nursing staff available on each shift 5 staff per shift x 3 shifts = 15 total staff 15 staff x 8 hours per shift = 120 nursing hours available for 20 patients 6 hours per patient

CLIENT CARE DELIVERY SYSTEM Assignment System for Staffing Patterns of Nursing Care Nursing Care Modality

1. CASE NURSING TOTAL PATIENT CARE ONE- to-ONE RN-to-client ratio OLDEST METHOD Provision of CONSTANT CARE for a SPECIFIED PERIOD OF TIME or while he/she is on duty MANY NURSES few patients Common to private duty nurses, ICU, educational purposes CASE METHOD 2. FUNCTIONAL NURSING TASK-ORIENTED METHOD PARTICULAR NURSING FUNCTION is assigned to each staff member Efficient with MANY PATIENT , FEW NURSES Based on concept of DIVISION OF LABOR NO NURSE is responsible for total care of any patient EFFICIENCY: accomplishment of most work in the shortest amount of time3. TEAM NURSING DECENTRALIZATION at the unit level Goal achievement through GROUP ACTION PROVIDE PATIENT CENTERED CARE Feature: NURSING CARE CONFERENCE TL: RN = responsible for coordinating the total care of a block of patients Team members: RNs & LPNs Size of team: 3-5 nursing staff for 10 - 20 patients in general hospital units 4. PRIMARY NURSING RELATIONSHIP-BASED NURSING TOTAL CARE is responsibility of one nurse Principle of decentralization of authority = primary AUTHORITY for all decisions about the nursing process is centered entirely on RN FOCUS ON PATIENT PRIMARY NURSE: responsible for the nursing care of patient 24 HOURS a day FROM ADMISSION TO DISCHARGE Small group: 4-6 PATIENTSAAACC

5. DISTRICT NURSING Geographic assignment of patient Group of staff to work with a group of patient into SAME LOCALS Modification of TEAM and PRIMARY NURSING6. CASE MANAGEMENT episode rather than unit based7. MANAGE CARE unit based

SCHEDULING - defined as the time table indicating planned WORK DAYS, DAYS OFF and SHIFTS of nursing personnelPurpose: appropriate coverage of the job to be done and equitable of workers Types:1. Centralized Scheduling - MASTER STAFFING PATTERN that is carried out by 1 person2. Decentralized Staffing - Middle and lower level managers have the authority and responsibility3. Self-Scheduling - 4. Alternating/Rotating Work Shift5. Permanent shift6. Block or Cyclical Scheduling - staffing pattern repeat itself every 4 - 6, 7 - 12, weeks7. Variable staffing - CENSUS BASED

SHIFT DISTRIBUTION: AM = 45%, PM =37%, NIGHT = 18%

STAFF BURN OUT Syndrome of: EMOTIONAL EXHAUSTION, DEPERSONALIZATION and REDUCED PERSONAL ACCOMPLISHMENT

3. DIRECTING DOING PHASE OF MANGEMENT ADMINISTRATIVE IN NATURE/ACTIVATING PHASE Issuance of assignment, orders and instructions that permit the worker to understand what is expected of him or her, and the guidance and overseeing of the worker so that he or she can contribute effectively and efficiently to the attainment of organizational objectives

ELEMENTS OF DIRECTING Leadership Motivation Delegation Supervision Communication COORDINATION COLLABORATING

LEADERSHIP use of ones skills to __________________ others to perform the best of their ability process whereby an individual guides, directs, influences or controls the thoughts, feelings and behavior of others (Koontz) Ability To Influence Others To Seek Defined Objectives Ability To Move Others, persuade Others A Function And Not A Role Or Title DIMENSIONS OF LEADERSHIP: Leader, Follower and Situation

Factors to Consider in the Choice of Leadership Style: Managers leadership style and expectationsFollowers characteristics and expectationsWork Situation Leader-member relations = how well they get along Task structure/accomplishment = nature of job Position power = extent of power; how legitimate

KINDS OF INFLUENCE (Kipnis & Schmidt) ASSERTIVENESS INGRATIATION - Individual makes another FEEL IMPORTANT ACTING HUMBLY OR FRIENDLY BEFORE MAKING A REQUEST RATIONALITY- convincing of the MERITS OF A DETAILED PLAN, which is supported with reasoning or logic BLOCKING - Hostile influence, with THREAT of or ACTUAL CUTTING OFF FROM COMMUNICATIONOR INTERACTION COALITION - COLLECTIVE influence, BACK HER UP for request SANCTION - PUNISHMENT in case the non-cooperation and REWARD on case of cooperation, BEHAVIOR BASED EXCHANGE- OFFERING A FAVOR or PERSONAL SACRIFICE as an incentive from the performance of the request UPWARD APPEAL- Obtaining SUPPORT FROM THE HIGHER UP to push someone into action.

ELEMENTS OF LEADERSHP: AUTHORITY - _______________TO DO or ACT, right to GIVE ORDERS and COMMANDPOWER - _______________ TO DO or ACT; the CAPABILITY of doing or accomplishing something

TYPES OF POWER: LEGITIMATE POWER - often termed AUTHORITY from the organization REFERENT POWER - through charisma and personal characteristics REWARD POWER - through providing rewards or promises of reward to other EXPERT POWER - through possession of special knowledge, skills or ability COERCIVE POWER - through fear, threat or coercion and is usually acquired through position power. CONNECTION POWER - from coalition of individuals working together INFORMATION/KNOWLEDGE - from controlling or possessing information needed by others in the organization

LEADERMANAGER

May not be part of formal org. Have ASSIGNED POSITION

Does right things Do things right

Power through __________ _______________ power

Focus on PEOPLE and RELATIONSHIP Focus on SYSTEM and STRUCTURE

Direct willing follower Direct willing and unwilling

Change and innovation Status quo

Long term Short term

Ends Means

Inspiring and MOTIVATING Problem solving

Wider variety of roles Specific roles and function

Operates outside org. rules Operated within

Rely on TRUST Rely on CONTROL & RULES

Leadership Behaviors1. Initiating structurea. Job-centeredb. Concerned for production2. Considerate leader behaviora. Employee-centeredb. Concern for people

MANAGERIAL GRID - Robert Blake and Jane Mouton Two key dimensions of managerial behaviors are depicted on grid: Concern for production (horizontal axis) Concern for people (vertical axis) Five basic management styles:1. Impoverish (1,1)2. Authority Obedience (9,1)3. Organization-man/Middle of the Road (5,5)4. Country-Club (1,9)5. Team/Dynamic (9,9)

THEORIES OF LEADERSHIP: Trait Theory develop characteristics 3 traits: Personality, Intelligence and Ability Great Persons Theory leaders are born not made, inherent Charismatic theory Situational Leadership 1. FIEDLERS CONTIGENCY THEORY - Fred Fiedler3 aspects of a situation that structures the leaders role: Leader-member relations Task structure Position power 2. PATH GOAL THEORY Robert J. House leaders can change and adapt their leadership styles CONTIGENT TO THE SUBORDINATE they are leading or the ENVIROMENT in which that subordinates work1. Directive leadership 2. Supportive leadership3. Participative leadership4. Achievement-oriented leadership3. LIFE CYCLE THEORY - Paul Hershey and Kenneth Blanchard MOST appropriate leadership styles from the LEVEL OF MATURITY of followers TASK SITUATION & LEVEL OF GROUP MATURITY GROUP MATURITY: psychological and job maturity and involves COMMITMENT and COMPETENCE to perform required tasks Four basic leadership styles: 1. Telling (high directive and low supportive) - DIRECTING2. Selling (high directive and high supportive) - COACHING3. Consulting/Participating (high supportive and low directive) - SUPPORTING4. Delegating (low supportive and low directive)4. VROOM AND Yettons normative decision model V.H. Vroom and P.W. YettonAppropriate amount of employee participation when making decisions Autocratic Consultative Group

RENSIS LIKERT LEADERSHIP SYSTEMS:AUTHORITATIVE

SYSTEM IEXPLOITIVE AUTHORITATIVESYSTEM II BENEVOLENT AUTHORITATIVE

DECISION MAKING:ALL at TOP MOST at TOP

MOTIVATIONCoercion & threat Economic rewards and ego motives

COMMUNICATIONDownward Most downward; selected

CONTROL ALL at Top Primarily TOP

PARTICIPATIVE

SYSTEM IIICONSULTATIVE DEMOCRATICSYSTEM IV PARTICIPATIVE DEMOCRATIVE

Some at LOW DispersedGroup process

+ others such as desire for new experiences Economic with GROUP participation

Up and down; cautious All directions; open, frank

Top but idea solicited Shared

CONTEMPORARY LEADERSHIP THEORIES: TRANSACTIONAL TRANSFORMATIONAL

Hierarchy Networking

Competitive Cooperative

Task focus Process focus

Exchange posture Promote employee development

Identify needs of follower Attend to needs and motives of followers

Exchange foe expected performance Influence change in perception

Caretaker Role model

Set goals for employees Individualized consideration

Focus on day-to-day operation Provide sense of direction

LEADERSHIP STYLES: Open System democratic, participate Closed System authoritarian Permissive System ultra liberal, laissez-faire

Autocratic Democratic Laissez-Faire

Maintains strong control Maintain less control No control

Give orders Offer suggestions Non directive

Make decisions Give suggestions Relinquishes decision making to other

Leader does planning Participative No plans

Directive Participative Passive, uninvolved; inactive

Foster dependency Foster independence Fosters chaos

Good quantity and quality of output but little autonomy, creativity and motivation Works when members are knowledgeable, skilful ; may be tedious and less efficient Can work with very mature, autonomous workers but is more likely to be efficient and unproductive

Filipino Styles of Leadership: dynamic, not static blend of autocratic and democratic

CHANGE PROCESSCHANGE - substituting one thing for another, experiencing a shift in circumstances that causes differences or becoming different from before. Nurses often act as CHANGE agents PARTICIPATIVE

Stages of Change: (Force Field Analysis Kurt Lewin)1. Unfreezing2. Change3. Freezing/Moving on

Types of change: Personal, Professional, Organizational

Quantum Leadership - Porter OGrady and Malloch (2003)CHANGE dominates the climate, control not an issue

Group Dynamics - study of groups, general term for GROUP PROCESS Refers to the understanding of the behaviour of people in groups

Stages of Group Development:1. Forming2. Storming3. Norming4. Performing5. Adjourning

MOTIVATION Force that ENERGIZES BEHAVIOR GIVES DIRECTION TO BEHAVIOR Underlies the TENDENCY TO PERSIST

NEED/CONTENT THEORIES - contend that we behave the way to do because we have internal needs that are attempting to fulfilSpecify what motivates individuals (i.e. the content of needs) Hierarchy of needs theory (Maslows) ERG theory Clayton Alderfer Existence Needs Relatedness needs Growth Two-factor theory Frederick Herzberg Hygiene Motivating Acquired needs theory David McLeland Need for Achievement Need for Power Need for Affiliation

COGNITIVE/PROCESS THEORIESAttempt to isolate the thinking patterns that we use in whether or not to behave in a certain wayFocus the thought processes associated with motivation Expectancy Theory(Victor Vroom) Equity (J. Stacy Adams) Goal Setting Theory (Edwin Locke and Gary Latham) Reinforcement Theory (B.F. Skinner)

DELEGATION - authorizing another person to act in your stead

4 Rights of DELEGATION (Hansten, 1998) TASK: should be within the scope of the persons practice and consistent with the job description PERSON: should have appropriate license or certificate, an appropriate job description and demonstrated skill COMMUNICATION: should be clear, complete and correct FEEDBACK: should ask for input, get persons recommended solution to problem, and recognize persons effort

ASPECTS OF DELEGATION AUTHORITY = RIGHT to make decisions, carry out activities, give COMMAND and direct RESPONSIBILITY = OBLIGATION to carry out duties and achieve goals related to a position; WHAT MUST BE DONE ACCOUNTABILITY = LIABILITY

SUPERVISION - SUPERVIDE = OVERSEE or VIEW DIRECTLY Overseeing the activities of others It consist of inspecting the work of another, and either approving or correcting the adequacy of performance It is the active process of directing, guiding and influencing the outcome of a persons performance of an activity.

Purposes of Supervision: Inspect, evaluate and improve work performance Provide suitable working conditions for the staff Orient, train and guide individual staff member

Principles of Supervision: Is focused on improvement of the work rather than on upgrading the worker Is based on the needs of individuals that have been cooperatively determined Is cooperatively planned. Objectives, methods of supervision and criteria for judging success in the attainment of goals are jointly established

COMMUNICATION - transfer of information and understanding from one person to another. IDEATION ENCODING TRANSMISSION RECEVING DECODING RESPONSE/FEEDBACK

Systems: Chain, Wheel and Y system, Circular, All Channel

LINES OF COMMUNICATION Downward - __________________ line of communication is from superior to subordinate Upward - Emanates from subordinates and goes upward Lateral (Horizontal) - between departments, peers or personnel on the same level of hierarchy Most frequently used in ___________________ activities Diagonal - Occurs between individuals or departments that are not on the same level of hierarchy Common when communication often flow in all directions at the same time

4. CONTROLLING process of regulating organizational activities so that actual performance conforms to expected organizational standards and goals

Components of Controlling: Performance Appraisal compare an individuals job performance against standard or objective Quality Assurance doing it right Evaluation Monitoring AUDIT - systematic and official examination of a record, process, structure, environment, or account to evaluate performance STRUCTURE PROCESS OUTCOME

PATIENT CARE AUDIT patient care is observed and evaluate; patient care satisfaction surveys

CONCURRENT: observed and evaluated through rounds and interview; patient is still in the hospital; while patient is receiving service RETROSPECIVE: discharge; questionnaires; review of chart; after receiving care PROSPECTIVE: attempt to identify how future performance will be affected by current interventions

NURSING CARE AUDIT - examination documentation of quality nursing care review of clinical records of client

Discipline INVENTORY - stock of various supply items kept on hand to provide a service to users, to feed a production, to provide goods for sale or demand while waiting for further deliveries Periodic/Physical Inventory Perceptual ROUNDS Reports

QUALITY IMPROVEMENT SYSTEMATIC PROCESS improve outcome based on customer needs PROACTIVE doing the right thing overall management approach rather than single program doing the right thing Meet customers needs

STRATEGIES FOR QUALITY IMPROVEMENT PDCA cycle - PLAN, DO, CHECK, ACT WHAT trying to accomplish HOW - change is an improvement WHAT changes will result in improvement PLAN: develop a change, test, activity aimed for improvement DO: carry change, test out small scale CHECK: study results to evaluate what was learned and what can be predicted ACT: adopt the change, send through cycle again, under different conditions, abandon the idea FOCUS methodologyF ocus on an opportunity for improvement O rganize a teamC larify the current processU nderstand the degrees of change neededS elect a solution for improvement Benchmarking Measuring and comparing results Key work process vs. best performers Collaborative and ongoing measurement process Identify gaps in performance and options for improvement

Regulatory requirements Sentinel Events monitoring Balanced scorecard concept

DISCIPLINE - management actions taken to enforce the organizations standards and regulationsPunishment by one in authority; retribution for an offense, especially in a subordinateTypes: PREVENTIVE DISCIPLINE CORRECTIVE DISCIPLINE PROGRESSIVE DISCIPLINE 1. Counselling2. Verbal Warning3. Written Reprimand4. Short Suspension5. Long Suspension6. Termination

____________________ - situation existing when there are differences of opinion or opposing views among persons, groups, and organizations

Causes of Conflict: Organizational change Different set of values Threat to status Contrasting perceptions Lack of trust Personality clashes

TYPES OF CONFLICT Intrapersonal Interpersonal Organizational Intragroup within group Intergroup between two or more groups

Organizational conflict may be: VERTICAL HORIZONTAL

ROLE AMBIGUITY occurs when the expectations for a role are not clear ROLE CONFLICT occurs when 2 or more individual in different position within the organization below that certain actions/responsibilities belong exclusively to them

STAGES OF CONFLICT: 1. LATENT2. PERCEIVED3. FELT4. MANIFEST

Getzels & Guba Conflict Model: AVOIDER Low task low relations lose- lose outcome Withdrawing, Denying, Passive TOUGH BATTLER task centered low relations win-lose outcome Competing, Forcing, Coercion, Aggressive Compromiser Balance Middle Ground No clear outcome Friendly Helper Low task, high relation Lose-win outcome Accommodating, Cooperating, Smoothing, Self-Sacrificing, Non-assertive Problem Solver/Dynamic/Team High task, high relation Win-win outcome Assertive, Confronting, Collaborating, Assertive