organizing - nursing management

organizingManagement function

ORGANIZING ORGANIZATION

Structure and process that allows agency to enact its philosophy and conceptual framework to achieve goal

ORGANIZING Process of establishing formal authority Involves :

Setting up the organizational structure Determining the staff needed Developing job description

ORGANIZATIONAL THEORY

•Max Weber – German scientist, Father of Organizational Theory

•Developed Bureaucracy theory•Characteristics of the theory:

▫Clear division of labor▫Well defined hierarchy of authority▫There is impersonal rules and

impersonality of interpersonal relationship▫A system of procedures for work must exist

ORGANIZATIONAL THEORY

•Characteristics of Bureaucracy – cont.▫Systems of rules covering rights and duties

of each position must be in place▫Selection of employment and promotion is

based on technical competence

ELEMENTS OF ORGANIZING

1. Setting up the organizational structure2. Staffing3. Scheduling4. Developing job descriptions

ELEMENTS OF ORGANIZINGA. SETTING UP

ORGANIZATIONAL STRUCTURE

ORGANIZATIONAL STRUCTURE

•The process by which:▫Group is formed▫Its channels of authority▫Span of control▫Lines of communication

CLASSIFICATION OF ORGANIZATIONAL STRUCTURE•FORMAL

▫Highly planned and visible▫Provides framework for defining managerial:

Authority Responsibility Accountability

▫Roles and functions are defined and arrange systematically

▫Different people have different roles▫Rank and hierarchy is evident

CLASSIFICATION OF ORGANIZATIONAL STRUCTURE•INFORMAL

▫Unplanned often hidden▫Generally social ▫With shifting lines of authority and

accountability Had horizontal relationships Composed of small groups of workers with

similar interest

PURPOSE OF ORGANIZATIONAL STRUCTURE

1. Inform members of their responsibilities2. Allows manager and individual workers to

concentrate on specific roles & responsibilities

3. Coordinates all organizational activities4. Reduces the chances of doubt and

confusion concerning assignments5. Avoids overlapping of functions6. Shows to whom and for whom they are

responsible

TYPES OF ORGANIZATIONAL STRUCTURE LINE ORGANIZATION

Each position has general authority over the lower position in the hierarchy

Manager delegates authority to staff associate, who in turn delegates authority to her staff

STAFF ORGANIZATION Advisory to the line structure with no authority to put

recommendations into action Handle details, locate required data Function through influence

FUNCTIONAL ORGANIZATION Each unit is responsible for a given part of the organization’s

workload Has clear delineation of roles and responsibilities which are

interrelated

TYPES OF ORGANIZATIONAL STRUCTURE •AD HOC DESIGN

Modification of bureaucratic structure Use as temporary basis to facilitate

completion of project within formal line of organization

A means of overcoming the inflexibility of line structure

Use a project team or task approach Disbanded after a project is completed

TYPES OF ORGANIZATIONAL STRUCTURE MATRIX DESIGN

Focus on both product and function Function all task required to produce the product Product end result of the function

Has formal vertical and horizontal chain of command

• SERVICE LINE ▫Also called care-centered organization▫Overall goals are determined by the larger

organization, but service line would decide on the process to be used to achieve the goal

TYPES OF ORGANIZATIONAL STRUCTURE •FLAT ORGANIZATIONAL DESIGN

Remove hierarchal layers by flattening the chain of command and decentralizing the organization

More authority and decision making can occur where work is being carried out

ORGANIZATIONAL CHART

•Depict an organization’s structure•A picture of the organization•Defines formal relationship within the

institution•UNBROKEN SOLID LINES

▫Shows relationship of lines of communication and authority Solid horizontal line represent

communication between people with similar sphere of responsibility and power but different functions

ORGANIZATIONAL CHART Solid vertical lines between position denote :

The official chain of command Formal path of communication and authority

•DOTTED OR BROKEN LINE▫Represents staff position▫Staff members provides information and

assistance to the manager but has limited organizational authority

COMPONENTS OF ORGANIZATIONAL CHART1. DIVISION OF WORK

Box represents the individual or sub-unit responsible for a given task of the organization’s work load

2. CHAIN OF COMMAND Lines indicate who reports to whom and by what

authority3. TYPE OF WORK TO BE PERFORMED

Indicated by labels or description for the boxes4. GROUPING OF WORK SEGMENTS

Shows the cluster of work group5. LEVELS OF MANAGEMENT

Indicate individual and entire management hierarchy

LEVELS OF MANAGERSTOP LEVEL MIDDLE LEVEL

FIRST LEVEL

Examples Chief Nursing OfficerChief Executive OfficerChief Financial officer

Unit supervisorDepartment headDirector

Charge nurseTeam leaderPrimary nurse

Scope of responsibility

Organization as a whole as well as external influences

Focus on integrating unit level day-to-day needs with organizational needs

Primarily on day-to-day needs at unit level

Primary planning focus

Strategic planning

Combination of long term and short range planning

Operational planning

Communication flow

Top-down Upward and downward

Often upward

ADVANTAGES AND LIMITATIONS OF ORGANIZATIONAL CHARTADVANTAGES LIMITATIONS

• Maps lines of decision making authority

• Helps people understand their assignment and their coworkers

• Reveals to managers and new personnel how they fit into the organization

• Contribute to sound organizational structure

• Shows formal lines of communications

• Shows only formal relationships

• Does not indicate degree of authority

• Show things as they are supposed or used to be rather than as they are

• Possibility exist of confusing authority with status

PRINCIPLES OF ORGANIZING

1. UNITY OF COMMAND2. SCALAR PRINCIPLE OR HIERARCHY3. HOMOGENEOUS ASSIGNMENT or

DEPARTMENTATION4. SPAN OF CONTROL5. EXCEPTION PRINCIPLE6. DECENTRALIZATION/PROPER

DELEGATION OF AUTHORITY

PRINCIPLES OF ORGANIZING UNITY OF COMMAND

Responsible to only one superior One person/one boss employee have one manager to whom

they report and to whom they are responsible Indicated by vertical line between position on the

organizational chart

SCALAR HIERARCHY/CHAIN OF COMMAND Authority and responsibility flow in clear unbroken lines from

highest to lowest position Those having the greatest decision making responsibility are

located at top , those with least responsibility at he bottom

HOMOGENEOUS ASSIGNMENT/DEPARTMENTATION Workers performing similar assignment are group together

for a common purpose

PRINCIPLES OF ORGANIZING SPAN OF CONTROL

Number of workers that a supervisor can effectively damage

Top level – 1:6 of supervisor Base – 1:10

EXCEPTION PRINCIPLE Recurring decisions handled in a lower level

managers Problems involving unusual matters referred

to higher level

PRINCIPLES OF ORGANIZING

•DECENTRALIZATION/PROPER DELEGATION OF AUTHORITY▫Process of conferring specified decision

making to the lower level of organization

ORGANIZATIONAL CULTURE

•A systems of symbols and interactions unique to each organizations

•The way of thinking, behaving and believing that the members of a unit have in common

•The total of an organization’s :▫Values▫Language▫Traditions▫Customs &▫Sacred cows

ORGANIZATIONAL CLIMATE

•How employees perceive an organization•The view of the organization by an

individual

REQUIRMENT FOR EFFECTIVE ORGANIZATION•STRUCTURE should:

▫be clearly defined employee know where they belong where to go for assistance

▫enhance and not impede communication▫facilitate decision making that results in the

greatest work performance

•Goals should be build the fewest possible management levels and have the shortest possible chain of command

REQUIRMENT FOR EFFECTIVE ORGANIZATION•Staff should be organized in a manner

that encourages informal groups to develop sense of community and belonging

•Nursing service should be organized to facilitate development of future leaders

ELEMENTS OF ORGANIZING B. STAFFING

STAFFING

•Process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patient’s demand

•Purpose: to provide nursing unit with appropriate and acceptable numbers of workers to perform the nursing task required

FACTORS AFFECTING STAFFING• Type, philosophy and

objective of hospital & nursing service

• Population served• Number and severity of

illnesses of patient• Availability and

characteristics of nursing staff

• Administrative policies- rotation, weekends & holiday duty

• Standards of care desired • Layout of various nursing

units and resources available within the department

FACTORS AFFECTING STAFFING• Budget• Professional activities and

priorities in non patient activities

• Teaching program expected hours of work/annum of employee

• Pattern of work schedule

PATIENT CARE CLASSIFICATION SYSTEM•A method of grouping patient according

to the amount and complexity of the nursing care requirement and nursing skill and time required

•CLASSIFICATION:▫Level I: Self Care or Minimal Care▫Level II: Moderate or Intermediate Care▫Level III: Total, Complete or Intensive

Care▫Level IV: Highly Specialized Critical Care

PATIENT CARE CLASSIFICATION SYSTEM•LEVEL I: Minimal Care or Self care

▫Can take a bath on his own▫Perform ADL on his own▫Patient about to be discharge▫Non=emergency cases▫Do not exhibit unusual symptoms▫Requires little treatment

PATIENT CARE CLASSIFICATION SYSTEM•LEVEL II: Intermediate or Moderate Care

▫Needs assistance in bathing, feeding or ambulating for short periods of time

▫Extreme symptoms have subsided or yet to appear

▫Have slight emotional needs▫With IVF or BT▫Semi-conscious▫Have some psychosocial or social problem▫Periodic treatment, observation

PATIENT CARE CLASSIFICATION SYSTEM•LEVEL III: Intensive, Total, Complete Care

▫Completely dependent on nursing personnel▫On continuous O2 therapy▫With chest or abdominal tubes▫Requires close observations

•LEVEL IV: Highly Specialized Critical Care▫Needs continuous treatment & observations▫VS q 15 minutes▫Hourly I & O▫Significant changes in Doctor’s order

PATIENT CARE CLASSIFICATION SYSTEM

LEVELS OF CARE NCH NEEDED /DAY

RATIO OF PROF. TO NON-PROFESSIONALS

LEVEL I 1.5 55:45

LEVEL II 3.0 60:40

LEVEL III 4.5 65:35

KLEVEL IV 6.07 or higher

70:3080:20

PERCENTAGE OF PATIENT AT VARIOUS LEVEL OF CARE/TYPE OF HOSPITAL TYPE OF HOSPITAL

MINIMAL CARE

MODERATE CARE

INTENSIVE CARE

HIGHLY SPECIALIZED CARE

PRIMARY 70 25 5 -

SECONDARY

65 30 5 -

TERTIARY 30 45 15 10

SPECIAL TERTIARY

10 25 45 20

COMPUTING FOR NUMBER OF NURSING PERSONNEL NEEDED•Ensure that there is sufficient staff to:

▫Cover all shifts▫Off duties▫Holidays▫Leaves▫Absences▫Time for staff development

COMPUTING FOR NUMBER OF NURSING PERSONNEL NEEDED

•RA 5901: Forty-Hour Week Law▫Employees working in 100 bed capacity

and up will work only 40 hours a week▫Applied also to employees working in

agencies with at least 1 million population•Employees working on less than 100 bed

capacity or in agencies located in the community with less than 1 million population will work 48 hours a week

STAFFING FORMULA

1. Categorize the number of patients according to the levels of care needed.

▫ Multiply total number of patient by % of patient at each Level of Care

250 patients x .30 = 75 patients needing minimal care

250 patients x .45 = 112.5 patient needing moderate care

250 patients x .15 = 37.5 patients need intensive care

250 patients x .01 = 25 patients needed highly specialized nursing care

Staffing formula2. Find the number of NCH needed by patients at

each level of care per day A. find the number of patients at each level by the

average number of NCH needed/day B. get the sum of NCH needed at various level

▫ 75 patients x 1.5 NCH needed at Level I = 112.5▫ 112.5 patients x 3 NCH needed at Level II = 337.5▫ 37.5 patients x 4.5 NCH needed at level III= 168.75▫ 25 patients x 6 NCH needed at Level IV = 150

_______total 768.75 NCH/day

STAFFING FORMULA

3. Find the total NCH needed by 250 patients per year▫ total NCH needed/day x total number of

days in a year 768.75 x 365 days/year = 280,593.75 NCH/year

4. Find the actual working hours rendered by each nursing personnel per year▫8 hours x 213 working day/year = 1,704

working hours/year

STAFFING FORMULA5. Find the total number of nursing personnel

needed▫A. total NCH per year = 280,593.75 = 165 TNP

working hrs/year 1,704Find the number of reliever▫B. total Nsg. Personnel x 0.15 (For those working

40 hours a week) = 165 x 0.15 = 25▫ total Nsg. Personnel x 0.12 (For those working

48 hours a week)▫Add no. of relievers to no. of nursing personnel

needed▫165 + 25 = 190 nursing care personnel needed

STAFFING FORMULA6. Categorize as to professional and non-professional

personnel▫ Ratio of professional to non-professional in tertiary

hospital is 65:35 190 x .65 = 124 professional nurses 190 x .35 = 66 nursing attendants

7. Distribute by shift▫ 124 nurses x .45 = 56 nurses on AM shift▫ 124 nurses x .37 = 46 nurses on PM shift▫ 124 nurses x .18 = 22 nurses on night shift

STAFFING FORMULA

7. Distribute nursing attendants/ shift▫ 66 nursing attendant x .45 = 30 nsg.

Attendant AM shift▫ 66 nursing attendant x .37 = 24 nsg.

Attendant PM shift▫ 66 nursing attendant x .18 = 12 nsg.

attendant

ELEMENTS OF ORGANIZINGC. SCHEDULING

SCHEDULING

•SCHEDULE▫TIMETABLE SHOWING PLANNED WORK

DAYS AND SHIFT OF NURSING PERSONNEL

•OBJECTIVE OF SCHEDULING▫TO ASSIGN WORKING DAYS AND OFF

DAYS TO NURSING PERSONNEL SO THAT ADQUATE PATIENT CARE IS ASSURED

FACTORS TO CONSIDER IN MAKING A SCHEDULE

•THE DIFFERENT LEVELS OF NURSING STAFF

•ADEQUATE COVERAGE FOR 24 HOURS, SEVEN DAYS A WEEK

•STAGGERED VACATION AND HOLIDAYS•WEEKENDS•LONG STRECHES OF CONSECUTIVE

WORKING DAYS•EVENINF AND NIGHT SHIFT•FLOATERS

ASSESSING SCHEDULE SYSTEM

•ABILITY TO COVER THE NEEDS OF THE UNIT

•QUALITY TO ENHANCE THE NURSING PERSONNEL’S KNOWLEDGE, TRAINING AND EXPERIENCE

•FAIRNESS TO STAFF•STABILITY•FLEXIBILITY

TYPES OF SCHEDULING•CENTRALIZED SCHEDULE

▫1 PERSON, USUALLY CHIEF NURSE OR HER DESIGNATE ASSIGNS THE NURSING PERSONNEL

•DECENTRALIZED SCHEDULE▫THE SHIFT AND OFF DUTIES ARE

ARRANGED BY SUPERVISING NURSE OR HEAD OR SENIOR OF A PARTICULAR UNIT

•CYCLICAL SCHEDULE▫COVERS A NUMBER OF WEEKS AND IS

REPEATED THEREON

ELEMENTS OF ORGANIZINGD. DEVELOPING JOB

DESCRIPTION

JOB DESCRIPTION

•STATEMENT THAT SETS THE DUTIES AND RESPONSIBILITIES OF A SPECIFIC JOB

•INCLUDES:▫CHARACTERISTIC OR QUALIFICATION

OF INDIVIDUALS TO PERFORM JOB RESPONSIBILITIES

CONTENTS OF JOB DESCRIPTION•IDENTIFYING DATA

▫POSITION▫DEPARTMENT

•JOB SUMMARY•QUALIFICATION REQUIREMENTS•JOB RELATIONSHIP – SOURCE OF

WORKER•SPECIFIC AND ACTUAL FUNCTIONS

AND ACTIVITIES

USES OF JOB DESCRIPTION• FOR RECRUITMENT AND SELECTION OF

QUALIFIED PERSONNEL• FOR ORIENTATION OF NEW PERSONNEL• FOR JOB PLACEMENT, TRANSFER OR

DISMISSAL• AID IN EVALUATING PERFORMANCE OF

EMPLOYEE• FOR BUDGETARY PURPOSES• FOR DETERMINING DEPARTMENTAL

FUNCTION AND RELATIONSHIP TO HELP DEFINE THE ORGANIZATIONAL STRUCTURE

USES OF JOB DESCRIPTION

•FOR CLASSIFYING LEVELS OF NURSING FUNTIONS ACCORDING TO SKILL

•TO IDENTIFY TRAINING NEEDS•AS BASIS FOR STAFFING•TO SERVE AS CHANNEL OF

COMMUNICATION

COMMUNICATION

COMMUNICATION• EXCHANGE OF INFORMATION OR OPINIONS• FOUNDATION ON WHICH NURSING

MANAGEMENT ACHIEVES INTERPERSONAL AND ORGANIZATIONAL OBJECTIVES

• INTERPERSONAL COMMUNICATION▫ PROCESS OF EXCHANGING INFORMATION AND

MEANING BETWEEN TWO PEOPLE OR IN A SMALL GROUPS OF PEOPLE

• ORGANIZATIONAL COMMUNICATION▫ PROCESS WHEREBY MANAGERS USE THE

ESTABLISHED COMMUNICATION SYSTEM TO RECEIVE AND RELAY INFORMATION TO PEOPLE WITHIN THE ORGANIZATION AND TO RELEVANT INDIVIDUALS AND GROUP OUTSIDE THE ORGANIZATION

COMMUNICATION PROCESS• ELEMENTS

• SENDER

• MESSAGE

• RECEIVER

• FEEDBACK

• PRINCIPLES OF EFFECTIVE COMMUNICATION▫ GIVING INFORMATION IS NOT THE

SAME AS COMMUNICATION REQUIRES INTERACTION, UNDERSTANDING AND RESPONSE

▫ SENDER IS RESPONSIBLE FOR CLARITY

▫ USE SIMPLE EXACT LANGUAGE▫ ENCOURAGES FEEDBACK▫ SENDER MUST HAVE CREDEBILITY▫ USE DIRECT COMMUNICATION

CHANNELS WHEN POSSIBLE

INTERFERENCE AND INTERACTION• INTERFERENCE

▫ ANYTHING THAT IMPEDES THE COMMUNICATION OF A MESSAGE

▫ TYPES: EXTERNAL –

ORIGINATES OUTSIDE A PERSON

INTERNAL – FROM WITHIN THE RECEIVER A. PHYSICAL PSYCHOLOGICAL

• INTERACTION▫ ELEMENTS – SENDER,

RECEIVER, MESSAGE & FEEDBACK INTERACTS WITH OTHER COMPONENTS EX: NURSE TELLS A

PATIENT ABOUT A PROCEDURE, THE PATIENT PROVIDE FEEDBACKS THAT HE DOES NOT UNDERSTAND THE PREPARATION FOR THE PROCEDURE THE NURSE ASK ANOTHER FEEDBACK THAT THE PATIENT DOES NOT UNDERSTAND SOME WORDS.

THE NURSE SIMPLIFY THE VOCABULARY AND THEN REPEATS THE MESSAGE

COMMUNICATION MODELSA. STRATEGIC CHOICE MODEL• 4 STRATEGIC STEPS FOR HELPING LEADERS CHOOSE

HOW THEY COMMUNICATE▫ IDENTIFY COMMUNICATION GOALS▫ IDENTIFY OPTIONS

POSSIBILITIES AVAILABLE CONCERNING STYLE, PRESENTATION & CHANNEL TO BE USE TO CONVEY THE MESSAGE

▫ ASSESS PROBABLE RESPONSE LEADERS ANALYZE RECEIVER’S KNOWLEDGE, PERSONALITY,

NEEDS, ATTITUDES & CULTURAL BACKGROUND THAT COULD AFFECT HOW MESSAGE IS RECEIVED

▫ ASSESS RELATIVE FORCE LEADER ANALYZE

MESSAGE EFFECTIVENESS IN MEETING ORGANIZATIONAL GOALS TIME REQUIRED TO DELIVER THE MESSAGE WHETHER MESSAGE QUALITY IS CONSISTENT WITH ITS

SIGNIFICANCE

COMMUNICATION MODELS

B. COGNITIVE MANAGEMENT APPARATUS OR TARGOWSKI-BOWMAN MODEL

▫USE TO HELP UNDERSTAND THE COMPLEXITIES OF COMMUNICATION WITHIN LEADERSHIP OR MANAGEMENT SETTINGS

▫DESCRIBES DIFFERENT “LINKS” THE MESSAGE MOVES THROUGH

DIFFERENT LINKS THE MESSAGE MOVES THROUGH

• PHYSICAL LINK ▫ ACTUAL PHYSICAL CONNECTION BETWEEN THE RECEIVER

AND SENDER TELEPHONE FACE TO FACE PRINTED WORDS

• SYSTEMS LINK▫ MEDIA

PRINT WEB

• AUDIENCE LINK▫ CONSIDERS AUDIENCE’S:

KNOWLEDGE PERCEPTION SIZE

DIFFERENT LINKS THE MESSAGE MOVES THROUGH•SESSION LINK

▫COMMUNICATION TIME & SPACE•ENVIRONMENTAL LINK

▫EFFECT OF SORROUNDINGS ON THE COMMUNICATION

•FUNCTION/ROLE LINK▫EFFECT ON MESSAGE OF TE

ORGANIZATIONAL ROLE AND FUCTION OF BOTH SENDER AND RECEIVER

DIFFERENT LINKS THE MESSAGE MOVES THROUGH• SYMBOLS LINK• BEHAVIOR LINK

▫CONSISTENCY AND INCONSISTENCY BETWEEN VERBAL AND NONVERBAL MESSAGE

• VALUES LINK▫IMPACT OF INDIVIDUAL’S PERSONAL AND

CULTURAL VALUES ON HOW THEY RECEIVE AND PROCESS INFORMATION

• STORAGE/RETRIEVAL LINK▫PREVIOUS EXPERIENCES OF THE SENDER

AND RECEIVER AND HOW THEY IMPACT EVALUATION OF MESSAGE

MODES OF COMMUNICATIONA. VERBAL

COMMUNICATION▫ COMPONENTS

WORD CHOICE VOCABULARY TONE PACE – SPEED OR

TIMING

B. NONVERBAL COMMUNICATION▫ COMPONENTS

BODY LANGUAGE PERSONAL SPACE AMOUNT OF SPACE

THAT PEOPLE NEED TO FEEL COMFORTABLE

BODY POSITIONS, POSTURE OR GESTURES

LINES OF COMMUNICATION

• UPWARD COMMUNICATION▫ REPORTING INFORMATION TO FACILITATE

PROBLEM-SOLVING & DECISION MAKING• DOWNWARD COMMUNICATION

▫ WITH SUBORDINATES▫ STRATEGIES TO SUCCESSFUL DOWNWARD

COMMUNICATION KNOW WHAT NEEDS TO BE DONE, WHO SHOULD DO

IT & STEPS NEEDED TO COMPLETE IN ELIMINATE INTERFERENCE AS POSSIBLE GIVE INFORMATION CLEARLY AND CONCISELY ACTIVELY SOLICIT FEEDBACK FOLLOW UP BY ANSWERING QUESTIONS AND VERIFY

THAT TASK ARE BEING PERFORMED ACCORDING TO INSTRUCTION GIVEN

LINES OF COMMUNICATION

•LATERAL OR HORIZONTAL▫PEERS/CO-WORKERS▫SAME HIERARCHIAL LEVEL

•DIAGONAL PEOPLE AT DIFFERENT HIERARCHIAL

LEVELS WITHIN THE ORGANIZATION BUT NO DIRECT SUPERVISOR/SUBORDINATE RELATIONSHIP

EX: NURSE-TO-PHYSICIAN COMMUNICATION

TYPES OF COMMUNICATION

•FORMAL COMMUNICATION▫OFFICIAL▫CLEARLY DOCUMENTED▫EX: MEMOS, REPORTS

•INFORMAL COMMUNICATION▫GRAPEVINE INFORMATIONS

•PUBLIC COMMUNICATION

TOOLS THAT ASSSIST COMMUNICATION 1. WRITTEN COMMUNICATION

▫MEMO One page communication targeted within an

organization Communication medium use to distribute

information through out the organization▫LETTERS▫BROCHURES

2. ELECTRONIC COMMUNICATION▫WEB-BASED INFORMATION▫E-MAIL▫VOICE MAIL

3. COMPUTERIZED INFORMATION SYSTEM• NURSING INFORMATION

SYSTEM▫ PATIENT CLASSIFICATION▫ CARE PLANNING AND

DOCUMENTATION▫ QUALITY IMPROVEMENT▫ INVENTORY▫ DISCHARGE PLANNING▫ PERFORMANCE

MEASUREMENT▫ POINT OF CARE SYSTEM

• HOSPITAL INFORMATION SYSTEM▫ MANAGE INFORMATION

FROM CLINICAL AND ADMINISTRATIVE SERVICES

• DECISION SUPPORT SYSTEM▫ HELP LEADERS MAKE

INFORMED OPERATING DECISIONS BASED ON PREDECTIVE DATA

• INCLUDES:▫ COST ACCOUNTING▫ CASE MIX INFORMATION AND

ACUITY MEASUREMENT TO GUIDE STAFFING REQUIRMENT

▫ DEPARTMENT AND ORGANIZATION WIDE BUDGET AND FORECASTING

▫ MARKETING

COMPUTERIZED INFORMATION

•EXECUTIVE INFORMATION SYSTEM▫ALLOWS LEADERS TO EXPLORE KEY

INDICATORS SUCH AS PERFORMANCE CASH FLOW CAPITAL EXPEDITURES PAYIENT ACUITY STAFFING LEVELS PATIENT AND STAFF SATISFACTION

COMMUNICATION SKILLS NEEDED BY NURSING LEADERS • A. ACTIVE LISTENING OR ATTENDING

▫REQUIRES: PAYING CLOSE ATTENTION TO THE SPEAKER NOTING BOTH VERBAL AND NON-VERBAL

MESSAGES MAINTAINING EYE CONTACT AVOIDING BEHAVIORS THAT DISTRACT THE

LISTENERS AND THE SPEAKER• B. RESPONDING

▫INCLUDE ACTION SUCH AS: NONVERBAL AFFIRMATION VERBAL AFFIRMATION QUESTIONING REPHRASING

COMMUNICATION SKILLS NEEDED BY NURSING LEADERS •C. CLARIFYING

▫ALLOWS LISTENERS TO ACCURATELY PROCESS INFORMATION THAT MAY BE DISORGANIZED OR NOT CLEAR

▫USES: RE-STATING QUESTIONING

PRINCIPLES OF EFFECTIVE ACTIVE LISTENING• 1. MINIMIZE DISTRACTIONS• 2. LOOK DIRECTLY AT THE OTHER PERSON• 3. PAY ATTENTION TO BOTH VERBAL AND

NONVERBAL MESSAGES• 4. ASK QUESTIONS TO CLARIFY IF NEEDED• 5. USE EMPATHY• 6. GET FEEDBACK ABOUT WHAT YOU HEAR• 7. ACKNOWLEDGE THE OTHER PERSON’S

MESSAGE AND FEELINGS• 8. BE PATIENT, AVOID FINDING INSTANT

SOLUTION

ADVANCED COMMUNICATION SKILL• ASSERTIVE BEHAVIOR + CONSISTENT

ACTIVE LISTENING ALLOWS THE NURSE LEADER TO PRACTICE ADVANCED COMMUNICATION SKILL▫1. FOCUSING▫2. PROVIDING INFORMATION TO PEOPLE

THAT THEY DID NOT PREVIOUSLY HAVE▫3. REASSURING – RESTORE CONFIDENCE OR

DECREASING FEAR▫4. USING APPROPRIATE HUMOR▫5. EXPRESSING ACCEPTANCE OR

APPRECIATION▫6. ASKING QUESTIONS TO EXPAND THE

LISTENER’S UNDERSTANDING

ASSERTIVENESS IN COMMUNICATION•THE ABILITY TO STAND UP FOR ONE’S

RIGHTS AND NEEDS WITHOUT VIOLATING THE RIGHTS OF OTHERS

•BEHAVIORS APPROPRIATE TO PROFESSIONALLY ASSERTIVE COMMUNICATION:▫1. DO NOT APOLOGIZE UNLESS YOU

ARE CLEARLY AT FAULT OR YOU KNOW WHO IS AT FAULT AND YOU ARE TAKING RESPONSIBILTY FOR WHAT HAPPENED

ASSERTIVENESS IN COMMUNICATION

▫2. AVOID REACTIONS SUCH AS : TANTRUMS REVENGE SARCASM THREATS

▫3. MAKE SURE THAT NONVERBAL AND VERBAL MESSAGES ARE CONSISTENT

▫4. AVOID KNEE-JERK REACTION TO NEGATIVE RESPONSE OR CRITICISM

▫5. USE “I” STATEMENTS TO CONVEY FEELINGS AND BE HONEST ABOUT FEELINGS, NEEDS OR IDEAS

▫6. ACKNOWLEDGE FAULTS BUT DO NOT OVERLY APOLOGIZE FOR THEM

COMMUNICATION BARRIERS

•A. CULTURE•B. EMOTIONS•C. GENDER•D. CONFLICT•E. OTHERS SUCH AS:

▫1. STRESS▫2. STEREOTYPING▫3. INTERRUPTING▫4. INATTENTION

DECISION MAKING

DECISION MAKING

•THE PROCESS OF ESTABLISHING CRITERIA BY WHICH A LEADER CAN DEVELOP AND SELECT COURSE OF ACTION FROM A GROUP OF ALTERNATIVES

•THE PROCESS OF DEVELOPING A COMMITMENT TO A PARTICULAR COURSE OF ACTION

DECISION MAKING PROCESS• RELIES ON THE SCIENTIFIC PROBLEM-

SOLVING• STEPS:

▫1. IDENTIFY THE PROBLEM▫2. ANALYZE THE SITUATION▫3. EXPLORE ALTERNATIVES AND CONSIDER

CONSEQUENCES▫4. CHOOSING THE MOST DESIRABLE

ALTERNATIVE▫5. IMPLEMENTING THE DECISION▫6. EVALUATING RESULTS

CREATIVE DECISION MAKING• DECISION MAKING STRESSES CHOICE OF

A SOLUTION, WHEREAS CREATIVE PROCESS EMPHASIZE THE UINQUENESS OF THE SOLUTION

• PHASES OF CREATIVE PROCESS;▫I. A FELT NEED▫II. PREPARATION – THE WORK STAGE

CREATIVE IDEAS EMERGES▫III. INCUBATION – PERIOD OF PONDERING

THE SITUATION▫IV. ILLUMINATION – THE DISCOVERY OF A

SOLUTION

TECHNIQEUE USE FOR CREATIVE DECISION MAKING•1. BRAINSTORMING

▫TECHNIQUE USE TO CREATE FREE FLOW OF IDEA

▫ENCOURAGE THE MEMBER TO CONTRIBUTE IDEAS WITH OUT FEAR OF CRITICISM

•2. REVERSE BRAINSTORMING▫ENCOURAGES CONVERGENT THINKING

TO BREAK DOWN IDEAS INTO SMALLER PARTS; ANALYZE AND FOCUS ON A PARTICULAR PROBLEM

▫DONE VERBALLY

TECHNIQUE USE FOR CREATIVE DECISION MAKING• 3. BRAINWRITING

▫ENCOURAGES FREE ASSOCIATION AND RECORDING OF IDEAS WITHOUT VERBAL INTERACTION PROBLEM IS IDENTIFIED PARTICIPANTS ARE GIVEN BLANK PIECE OF

PAPER& TOLD TO WRITE AT LEAST 4 IDEAS, SUGGESTIONS, & SOLUTIONSPAPER IS PASSED ON TO OTHERS TO STIMULATE MORE IDEAS AND WRITTEN ON THE PAPER AND THE PROCESS CONTINUES UNTIL NO ONE CAN THINK OF ANYTHING TO WRIT

TECHNIQUE USE FOR CREATIVE DECISION MAKING•4. COLLECTIVE NOTEBOOK TECHNIQUE

▫PROBLEM IS IDENTIFIED AND PARTICIPANTS ARE INSTRUCTED TO RECORD THOUGHTS AND IDEAS ABOUT THE PROBLEM FOR A SPECIFIED PERIOD

▫EACH PARTICIPANTS GIVES HIS NOTEBOOK TO ANOTHER PERSON, READ IT , LOOK FOR PATTERNS & SYNTHESIZES THE CONTENT

▫PARTICIPANT THEN MEET, ANALYZE THE RESULTS AND MAKE RECOMMENDATIONS TO SOLVE THE PROBLEM

TECHNIQUE USE FOR CREATIVE DECISION MAKING• THE DELPHI TECHNIQUE

▫ALLOWS MEMBERS WHO ARE DISPERSED OVER GEOGRAPHIC AREA TO PARTICIPATE IN DECION MAKING WITH OUT MEETING FACE TO FACE

▫PROBLEM IS IDENTIFIED, MEMBERS ARE ASK TO MAKE POTENTIAL SOLUTIONS THROUGH THE USE OF QUESTIONAIRES

▫QUESTIONAIRES ARE RETURNED ANONYMOUSLY AND RESULTS ARE CENTRALLY COMPILED

▫EACH MEMBER IS SENT A COPY OF THE RESULT AND ASK FOR THEIR SUGGESTIONS AGAIN

▫THE PROCESS CONTINIOUS UNTIL CONSENSUS IS REACHED

TECHNIQUE USE FOR CREATIVE DECISION MAKING•6. LIST

▫CHECKLIST METHOD ▫SCAMPER TECHNIQUE IS USED – LIST

VERBS THAT ARE IDEA GENERATING▫SUBSTITUTE-COMBINE-ADAPT-MODIFY-

PUT TO OTHER USES-ELIMINATE-REVERSE

•7. DRAWING▫USED TO EVOKE AND RECORD

CREATIVE INSIGHT

TECHNIQUE USE FOR CREATIVE DECISION MAKING• 8. SYNETICS

▫THE JOINING TOGETHER OF APPARENTLY IRRELEVANT ELEMENTS

▫PROBLEM IS IDENTIFIED, BRIEF ANALYSI IS GIVEN

▫PROBLEM IS THEN SIMPLIFIED TO CLARIFY IT AND REINTERPRETED IN ANALOGY OR METAPHOR

▫THE GROUP THEN PLAYS WITH ANALOGY▫A FANTASY FORCE FIT DEMANDS THAT THE

METAPHOR FOR THE ORIGINAL PROBLEM BE CONSIDRED IN DEPTH

TECHNIQUE USE FOR CREATIVE DECISION MAKING• 9. VISUALIZATION

▫FREE ASSOCIATION ARE USED TO CREATE BIG DREAM APPROACH

▫DESIRED OUTCOME ARE VISUALIZED AND VISUALLY RUN BACKWARD TO IDENTIFY NEW APPROACH

▫ONCE YOU HAVE IMAGIND WHAT YOU WANT, YOU CAN BEGIN DREAMING ABOUT HOW TO MAKE YOR DREAM A REALITY

▫THIS TECHNIQUE ALLOWS YOU TO PRETEND THAT YOU ALREADY HAVE WHAT YOU WANT AND FACILITATES CONCENTRATION ON THE OUTCOMES

TECHNIQUE USE FOR CREATIVE DECISION MAKING• 10. FORECASTING ALTERNATIVE FUTURE

SCENARIOS• THE PROCESS INCLUDES:

▫ ASSESSING THE PRESENT SITUATION▫ IDENTIFY ITS STRENGTHS AND WEAKNESSES▫ RECOGNIZE THE DRIVING FORCE IN THE

ENVIRONMENT▫ CONSTRUCTING POSSIBLE ALTERNATIVE

FUTURE SCENARIOS▫ IDENTIFYING THE PREFERRED FUTURE▫ DEVELOPING PLAN OF ACTION▫ IMPLEMENTING THE PLAN▫ EVALUATING IMPLEMENTATION

TECHNIQUE USE FOR CREATIVE DECISION MAKING•11. MODELLING

▫LOOK AT HOW OTHERS AREDOING WHAT YOU WISH TO DO

•12. MEDITATION▫COCENTRATION OR “PLAYING LOOSE”

BLOCKS TO CREATIVITY

•1. NEGATIVE ATTITUDE•2. SELF CENSORSHIP•3. LACK OF CONFIDENCE•4. LACK OF EFFORT•5. HABITS•6. CONFORMITY•7. RELIANCE ON AUTHORITY

ETHICAL POSITIONS OF DECISION MAKING• ULITARIANISM

▫ A COMMUNITY ORIENTED POSITION▫ FOCUSES ON THE CONSENQUENCES AND

PREFERS THE GREATEST AMOUNT OF GOOD AND HAPPINESS FOR THE MOST PEOPLE, OR THE LEAST AMOUNT OF HARM

• EGOISM▫ SEEKS SOLUTION THAT ARE THE BEST FOR

ONESELF WITHOUT REGARD FOR OTHERS• FORMALISM

▫ CONSIDERS THE NATURE OF THE ACT AND THE RELATED PRINCIPLE WITHOUT THOUGHT TO PERSONAL POSITION OR CONSEQUENCES OF THE ACTIONS

▫ REMEMBER THE GOLDEN RULE

ETHICAL POSITIONS OF DECISION MAKING•RULE ETHICS

▫EXPECTS OBIDIENCE TO LAWS, RULES, PROFESSIONAL CODES, AND AUTHORITY

•FAIRNESS▫CONSIDERS DISTRIBUION OF BENEFITS

AND LIABILITIES FROM TH E VIEW POINT OF THE LEAST ADVANTAGED

MODELS FOR ETHICAL RELATIONSHIPS•PRIESTLY MODEL

▫MANAGER IS PATERNALISTIC AND MAKES DECISION WITHOUT CONSIDERING OTHERS VALUES OR SEEKING OTHER’S INPUT

▫USE BY AUTOCRATIC LEADERSHIP•ENGINEERING MODEL

▫SUGGEST THAT ONE PERSON PRESENTS THE FACT TO ANOTHER AND SET ASIDE OWN CODE OF ETHICS TO DO WHAT THE OTHER WANTS

▫STAFF WORKING FOR LINE AUTHORITY MAKE USE OF THIS MODEL

MODELS FOR ETHICAL RELATIONSHIPS•CONTRACTUAL MODEL

▫PROVIDES A CONTRACT THAT IDENTIFIES THE GENERAL OBLIGATIONS AND BENEFITS FOR TWO OR MORE PEOPLE

▫DEALS WITH THE MORALE OF BOTH PARTIES ▫APPROPRIATE FOR SUPERIOR-SUBORDINATE

RELATIONSHIP•COLEGIAL LEVEL

▫INDIVIDUAL SHARES MUTUAL GOALS AND REACH DECISIONS THROUGH DISCUSSIONS AND CONSENSUS

TOOLS USED IN DECISION MAKING

• PROBABILITY THEORY▫APPLIEDWHEN RISK OR UNCERTAINTY IS

PRESENT IN A DECISION▫OPERATES ON THE ASSUMPTION THAT

FACTORS ACCUR IN ACCORDANCE WITH A PREDICTABLE PATTERN

• SIMULATION, MODELS AND GAMES▫USE TO SIMPLIFY PROBLEMS BY

IDENTIFING BASIC COMPONENTS AND USING TRIAL AND ERROR TO DETERMINE A SOLUTION

▫MAY BE USED TO STUDY ORGANIZATIONAL CHANGES, SCHEDULING, ASSEMBLY LINE MANAGEMENT AND TIME SEQUENCES


•GANTT CHART▫ALLOWS ONE TO VISUALIZE MULTIPLE

TASK THAT HAVE TO BE DONE•DECISION TREES

▫A GRAPHIC METHOD THAT CAN HELP THE MANAGER VISUALIZE THE ALTERNATIVES AVAILABLES, OUTCOMES, RISK AND INFORMATION NEEDED FOR SPECIFIC PROBLEM OVER A PEROD OF TIME


• PERT – PROGRAM EVALUATION AND REVIEW TECHNIQUE▫ A NETWORK SYSTEM MODEL FOR PLANNING

AND CONTROL UNDER UNCERTAIN CONDITIONS▫ INVOLVES:

IDENTIFYING THE KEY ACTIVITIES IN THE PROJECT SEQUENCING THE ACTIVITIES IN FLOW DIAGRAM ASSIGNING THE DURATION OF EACH PHASE OF THE

WORK RECOGNIZED THAT CERTAIN TASK MUST BE

COMPLETED BEFORE THE TOTAL PROJECTS CAN BE COMPLETED AND THAT SUBTASK MUST BE COMPLETED BEFORE OTHERS CAN BE STARTED

▫ HELPS DETERMINE PRIORITIES


•CPM- CRITICAL PATH METHOD▫CALCULATES A SINGLE TIME ESTIMATE FOR

EACH ACTIVITY. THE LONGEST POSSIBLE TIME

▫COST ESTIMATE IS FIGURED OUT FOR BOTH NORMAL AND CRASH OPERTAING CONDITIONS NORMAL = THE LEAST COST METHOD CRASH = CONDITION IN LESS NORMAL

▫TIMEUSEFUL WHEN COST IS A SIGNIFICANT FACTOR AND EXPERIENCE PROVIDES A BASIS FOR ESTIMATING THE COST


• QUEING THEORY▫DEALS WITH WAITING, LINES OR INTERMITTENT

SERVICING PROBLEM▫MATHEMATICAL TECHNIQUE FOR DETERMINING

THE MOST EFFICIENT BALANCE OF FACTORS RELATED TO INTERMITTENT SERVICE

▫APPLICABLE WHEN UNITS TO RECEIVE SERVICE ARRIVE IN RANDOM FASHION, BUT THE TIME REQUIRD FOR SERVICE IS PREDICTABLE

▫BALANCE THE COST OF WAITING VS PREVENTING OF WAITING BY INCREASING SERVICES


•LINEAR PROGRAMMING▫USE MATRIX ALGEBRA OR LINEAR

MATHEMATICAL EQUATIONS TO DETERMINE THE BEST WAY TO USE LIMITED RESOURCES TO ACHIEVE MAXIMAL RESULTS

▫BASED ON THE ASSUMPTION THAT A LINEAR RELATIONSHIP EXIST BETWEEN THE VARIABLES AND THE LIMITS OF THE VARIATIONS CAN BE CALCULATED


• THREE CONDITIONS NECESSARY FOR LINEAR PROGRAMMING

• 1. EITHER A MAXIMAL OR MINIMAL VALUE IS SOUGHT TO OPTIMIZE THE OBJECTIVE

• 2. THE VARIABLES AFFECTING THE GOAL MUST HAVE A LINEAR RELATIONSHIP▫ THE RATIO OF CHANGE IN ONE VARIABLE TO

THE CHANGE IN ANOTHER VARIABLE MUST BE CONSTANT IF IT TAKES 3 MINUTES TO DO A TASK, IT SHOULD TAKE 15 MINUTES TO THE TASK 5 TIMES

• 3. CONSTRAINTS OR OBSTACLES TO THE RELATIONSHIP OF VARIABLES EXIST

MERRY CHRISTMAS

organizing - nursing management

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