Unit 3 PLANNINGDEFINITION AND NATURE

Planning can be defined as the process to determining is advance the objectives to be accomplished and the means by which these objectives are to be attained

Planning is the first function of management all other management functions-organizing, staffing, directing, and controlling — are dependent on planning. Planning is largely conceptual, but the results of planning are clearly visible

The nurse managers needs to be familiar with the decision — making process and tools so that they can identify the purpose of the institution state the philosophy, define goals and objectives, outline policies and procedures, prepare budgets to implement the plans, and effectively manage the time and that of the organization.

PLANNING PROCESS

1) The Purpose or mission statement:

The purpose is a brief statement identifying the reason that an organization exists as well as its future aim or function.

So, clarification of the purpose the first priority for planning, because it influences the development of an organization’s philosophy, goals, objectives, policies, procedures, and rules.

Most nursing services exist to provide quality nursing care to clients. Some also encourage teaching and research. Each specialty area, with its own specific purposes, contributes to the overall purpose of the institution.

The following is an example of mission statement for hospital X:

Mission statement

Hospital X is a tertiary care facility and provides comprehensive, holistic care to all state residents who seek treatment, the purpose of Hospital X is to combine high quality, holistic health car with the provision of learning opportunities for students in medicine, nursing, and allied health sciences. Research will b encouraged as a means of identifying new treatment regime. and for the promotion of high quality health care for generations to come

The purpose o the in-service education department is to orient staff to the job and to provide educational programs to improve the quality o the staff work

The burn unit exists to provide quality nursing service to its with burns The relationship among the purpose, philosophy, goals objectives, policies and

procedures should be examined periodically for Consistency.

2) Philosophy: 15

The philosophy flows from the purpose, and it is a statement of beliefs and values that direct one’s practice.

It should be written, placed in appropriate documents, and reviewed periodically. If the philosophy is stated in vague, abstract terms that are not easily understood, it

is useless. Workers are most likely to interpret the philosophy from the pronouncement and

actions of the leaders in the institution. Therefore, conformity of action to belief is important.

A philosophy that might be generated from hospital X's mission statement follows:

Organizational philosophy

The board of directors, medical and nursing staff, and administrators of Hospital X believe that human beings are unique, due to differing genetic endowments, personal experiences in social, and physical environments, and the ability to adapt to biophysical, psychosocial, and spiritual. Thus, each client is considered to be a unique individual, with unique needs. Identifying outcomes and goals, setting priorities, prescribing strategy, options, and selection an optimal strategy will be negotiated by the client, physician, and health care team.

As unique individuals, clients provides medical, nursing, and allied health students invaluable diverse learning opportunities. Because the board of directors, medical and nursing staff, and administrators believe that the quality of health care provided directly reflects the quality of the education of its future health care providers, students are welcome, and encouraged to seek out as many learning opportunities as possible. Because high – quality.

The organization philosophy provides the basis for developing nursing philosophies at the unit level and for nursing service as a whole. The nursing service philosophy in conjunction with the organizational philosophy, need to examine fundamental beliefs about nursing and nursing care, and should draw upon the concepts of holistic care, education, and research. Hospital X's nursing service philosophy might look something like the following.

Nursing service philosophy

The philosophy of nursing at hospital X is based upon respect for the individual's dignity and worth. We believe all patients have the right to receive effective nursing care. This care is a personal service that is based on patients needs and their clinical disease or condition. Recognizing the obligation of the nursing to help restore patients to the best possible state of physical, mental, and emotional health, and to maintain patients sense of spiritual and social well being, we pledge intelligent cooperation in coordinating nursing service with the medical and allied professional practitioners. Understanding the

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importance of research and teaching for improving Pt care, the nursing department will support, promote, and participate in these activities. Using knowledge of human behavior, we shall strive for mutual trust and understanding between nursing service and nursing employees to provide an atmosphere foe developing, the fullest possible potential of each individual member of the nursing team. We believe that nursing personnel are individually accountable to patients and their families for the quality and compassion of the Pt care rendered and for upholding the standards of care as delineated by the nursing staff.

3) Goals and objectives:

Goals and objectives state actions for achieving the purpose and philosophy. All philosophies must be translated into specific goals and objectives if they are to

result in action. Thus goals and objectives " Operationalize " the philosophy. A GOAL: may be defined as the desired result toward which effort is directed,

it is the aim of the philosophy Goals, although somewhat global in nature, should be specific enough to clearly

delineate the desired end-product and should be. measurable and realistic. Goals may be change over time, therefore they require periodic reevaluation and

prioritization.

The following are sample goal statements

All nursing staff will develop recognition of patient's need for independence and, right for privacy and will assess patient’s level of readiness to learn in relationship to their illness.

The nursing staff will provide effective patient care relative to patient needs in so far as the hospital and community facilities permit through the use of card plans, individual patient care and discharge planning, including follow-up contact

An ongoing effort will be made to create an atmosphere conducive to favorable patient and employee morale and which fosters personal growth .

The performance of all employees in nursing department will be evaluated, in a manner that produces growth in the employee and upgrades nursing standards.

All nursing units within Hospital X will work cooperatively with other departments within the hospital to further the mission, philosophy and goals of the institution.

OBJECTIV: are more specific and measurable than goals because they identity “how” and “when” the goal is to be accomplished.

So, they motivate individuals to a specific end, and are explicit, measurable, observable, and obtainable.

Goals usually have multiple objectives that are each accompanied by a targeted completion data. 17

Writing good objective requires time and practice.

The following format is suggested in writhing clear objectives.

1. Who- will do the work.2. Write the word "to" followed by an action verb. 3. Write a single key result to be achieved. 4. Write the word "by" and state the target date for accomplishment. 5. Write the maximum cost in terms of money time.

Example

If one of hospital Z's goals was " All registered nurses will be proficient in the administration of intravenous fluid ". Then objectives for hospital Z might include the following:

All registered nurses will complete hospital Z's course " IV therapy certification " within one month of beginning employment. The hospital will bear the cost of this program.

Registered nurses scoring less than 70 percent on a comprehensive examination in " IV therapy certification " must attend the remedial four – hours course " review of basic IV principles " not more than two week after the completion of " IV therapy certification ".

Registered nurses unable to achieve a score of 70 percent or bettered on the comprehensive examination for " IV therapy certification " after completing " review of basic IV principles " will not be allowed to perform IV therapy on patients. An individualized plan with be established by the unit manager and the employee who failed the examination.

4) Policies and procedures:

Policies and procedures are means for accomplishing goals and objectives. When policies are written, the purpose, philosophy, goals, and objectives should

serve as guides. It can be defined as ‘broad general statements of expected actions that serve as

guides to managerial decision making or to supervising the actions of subordinates”. Thus, policies direct individual behavior toward the organization’s mission and

define broad limits and desired outcomes of commonly recurring situations. Policies serve as a basis for future decisions and actions, help coordinate plans,

control performance, and increase consistency of action by increasing the probability that different managers will make similar decisions when independently facing similar situations.

Morale is increased when personnel perceive that they are being treated equally. Fairness is n important ch.ch. that is attributed to the application of the policy. POLICIES: are of no use if no one knows of their existence. 18

Oral communication is appropriate to introduce and explain new policies. It is appropriate to send a letter of purpose and a copy of policies to personnel

affected by them. Policy formation is a continuous process so the policy is continually reappraised and

restated as necessary. Examples: annual leave, sick leave, leave without pay.

PROCEDURES

Are plans that have been reduced to a sequence of steps of required action Procedures are intradepartmental or interdepartmental and do not affect the entire

organization to the extent that policy statements do Procedure manuals provide a basis for orientation and staff development and are a

ready reference for all personnel. They standardize procedures and equipment and can provide a basis for evaluation,

Good procedures—increases the quality of the end-product and will be implemented as desired,

Save staff time, facilitate delegation, reduce cost, increase productivity and provide a means of control.

5) Rules or regulation:

Generally included as part of policy and procedure statements.

Unit 4 FISCAL PLANNING " BUDGETS " Of all the forms of planning, fiscal planning is often perceived as the most difficult

one, Fiscal planning like all planning, is a learned skill that improves with practice. This type of planning also requires vision, creativity, and a thorough knowledge of

the political, social, and economic forces that shape health care. Fiscal planning is a written statement of what resources, money, time, and people —

will be needed to provide specific services or products over a specified amount of time.

THE ROLE OF THE NURSE MANAGER IN FISCAL PLANNING

It is essential that unit managers develop expertise in managing and understanding costs.

Historically, nursing management play a limited role in determining resource allocation in health care institutions.

Nursing was classified as a “non-income producing” service. Therefore nursing input was shorthand in the budget process.

Over the last 20 years, health care organizations have grown to recognize the importance of nursing input in fiscal planning. 19

Currently, nursing budgets can account for more than half of the total expenses in health care institutions, therefore, participation in fiscal planning is viewed as a fundamental and powerful tool for nursing.

Nurses must be involved in fiscal planning to see that adequate resources are available to provide nursing services.

It is also unit manager who can best monitor and evaluate all aspect of a unit’s budget control.

The economic climate for the future of health care is uncertain. Since the nursing department budget can account for as much as half of an

institutions total expenses, there continues to be significant. pressure on this department to increase efficiency and effectiveness. For nursing to respond to the pressures and the uncertainty, nurse managers at all

levels must become proficient in the budgeting process, It is the nurse manager on the unit level who is in the best position to predict trends

in census and acuity, as well as supply and equipment needs, A budget helps management plan and control the distribution of resources within the

organization. A budget is a plan that uses numerical data, to predict the activities of an

organization over a period of time.

Note that the "when" is just as important as the (how much). The money has to be available at the right time.

It is used as control mechanism, and as a tool to evaluate the organization’s performance over the past year.

In the budget, expenses are classified as either fixed, or variable, and either controllable or non-controllable.

Fixed expenses do not vary with volume, while variable expenses do. Controllable expenses can be controlled or varied by the manager, while non-

controllable expenses cannot.

STEPS IN THE BUDGETARY PROCESS

1) Determine the requirements of the budgets.

- A composite of unit needs in terms of personnel, equipment, and operating expenses can then be compiled to determine the organizational budget.

2) Develop a plan (Planning involves reviewing the established goals and objectives of the nursing unit, department, and the organization.

- The budget plan may be developed in many ways: Planning is done for a specific time period.

- A budgeting cycle that is set for 12 months is called a fiscal year budget.

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- But may be subdivided into monthly, quarterly, or semiannual periods.

3) Analyze and control the operation:

- To avoid inadequate or excess funds at the end of the fiscal year.

- Each unit manager is accountable for budget deviation from that budget. Large deviations must be examined for possible causes and remedial action must be taken if necessary.

- Variance: the difference between budget and actual performance. Ex. Anything under 4% or 500$ is acceptable thus only variances over that percentage would be examined.

4) Review the plan:

- The budget is reviewed periodically and modified as needed throughout the fiscal year.

TYPES OF BUDGETS:

There are three major types of expenditures that concern unit manager:

1) The personnel Budget:

The largest of budget expenditures is the workforce or personnel budget because health care is labor intensive.

It includes the salaries of all nursing staff, as well as compensation for vacation time, sick leave, holidays, overtime, and orientation and education time.

Manager must monitor the personnel budget closely to prevent understaffing or overstaffing. As pt. days or volume decrease, managers must decrease personnel costs, by consider consolidating pts from partially filled units, closing units.

The manager must also be aware of the institution’s pt acuity so that the most economical level of nursing care- that will cover pt needs can provided.

Because the pt census, number of visits, or cases per day never remain constants, the nurse manager must be ready to alter staffing when volume increase or decrease,

2) The operating budget or revenue-and-expense budgets.

Included in this budget are such daily expenses as the cost of electricity, repairs and maintenance, and medical, surgical supplies, office supplies1 laundry service drugs, in service education.

Next to personnel costs, supplies are the 2nd most significant component in the hospital budget.

Because nurses use many supplies, a cost conscious unit manager can be invaluable to the organization.

Formulation of the operating budget should begin several months before the beginning of the next fiscal year to provide sufficient data and time for planning.

3) Capital Budget:

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Capital expenditure budget plan for buildings and or major. equipment which includes equipment that has a long life (usually greater than five years).

Managers are usually required to complete specific capital equipment request forms either annually or semiannually and to justify their request.

The desired result of careful fiscal planning is cost effectiveness. (as a unit manager’s goal).

Cost effective does not mean cheap It means getting the most for your money or than the product is worth the price.

Cost effectiveness takes into account factors such as

1- anticipated length of service2- need for such a service3- availability of other alternatives.

PREREQUISITES TO BUDGETING:

Some conditions are necessary for the development and implementation of a budgetary program.

1- There is need for sound or organization structure with clear lines of authority and responsibility.

Each employee knows his/her responsibilities and to whom she/he is responsible. Each person has the authority to do what she is responsible for and is held

accountable for his/her actions. Organization charts and job descriptions are available, Goals and objectives are set

for areas of responsibilities, Then budgets are developed to conform to the pattern of authority and responsibility.

2- Statically data such as number of admissions, average length of stay, percentage of occupancy, and number of pt days are used for planning and control of the budgetary process.

Someone must be responsible for collecting and reporting statistical data,

3- Revenues and expenses are reported for planning and providing budgetary control for evaluation as performance can be compared to plans.

4- Managerial support is essential for a budgetary program.

Although budgeting is done at the departmental level, it must be valued by top administration.

5- Formal budgeting’ policies and procedures should be available in a budget manual.

Objectives of the budgetary program are defined.

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Instructions for budget development are discussed in detail. Procedures for reviews1 revision, and approval budgets are discussed in detail.

Unit 5 DECISION – MAKING IN NURSING Because managers spend much time making decisions and solving problems,

developing skills in these areas is essential to increasing effectiveness. Nursing manager is confronted by a variety of situations. Hospital or agency policies

provide guidelines for dealing with routine situations. But exceptional instances can make decisions more difficult and require a mature sense of judgment.

Decision making is the scientific problem — solving process. Problem solving is a skill that can be learned.

Decision making can be defined s the process of selecting one course of action from alternatives, is e continuing responsibility of the nurse manger (choosing from alternatives)

DECISION MAKING PROCESS

1) Identify the problem:

The first step is defining the problem. What is wrong? Where is improvement needed?

The decision—making process begins when the nurse manager perceives a gap between what is actually happening and what should be happening and it ends with action that will narrow this gap or close it.

The nurse manager can identify the problem by analyzing situation. The supervisor should have a questioning attitude. What is the desirable situation? What are the presenting symptoms? What are the

discrepancies? Who is involved? When? Where ? How? So, with answers to these questions the supervisor can develop tentative hypotheses

and test them against what she/he knows. Progressive elimination of hypotheses that fail to conform to the facts reduces the

number of causes to be considered. Feasible hypotheses should be further tested for causal validity. When the manager believes she/he has identified the cause or causes of the problem

by analyzing available information, she/he should begin exploring possible solutions

2) Explore alternatives:

When solving a problem, the manager should determine first if the situation is covered by policy. If it is not, he must draw on his education and experience.

Drawing on one’s experience is probably the most common apporoach to solving problems, but it may be inadequate.

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The more experience the manager has had, the more alternatives may be suggested that can help solve a variety of problems.

However, health care is changing rapidly, and solutions to yesterday’s problems may not work today, so, the manager should look beyond his own experiences and learn how others are solving similar problems.

This can be done through continuing education, professional meetings, review of the literature, and brainstorming with staff.

3) Choose most desirable alternative:

One alternative is not always clearly superior to all others, The supervisor must try to balance multiple factors such as pt safety, staff acceptance, morale, public acceptance, cost, and risk of failure.

Criteria for calculating the value of decisions are useful. The following question may be asked,

Will this decision accomplish the stated objectives? If it does not, it should not be enforced and another option should be used,

Dose it maximize effectiveness and efficiency? One should use available resources before seeking outside assistance,

Can the decision be implemented? If. not, it will not solve the problem

4) Implement decision:

After the decision has been made, it needs to be implemented. The manager will need to communicate the decision to appropriate staff in a manner

that does not arouse antagonism. The decision and procedures for its implementation can be explained in an effort to

win the cooperation of those responsible for its implementation

5) Evaluate results:

Evaluate the results of the implementation of the chosen alternative, Because solutions to old problems sometimes create new problems, additional

decisions may need to be made and evaluated.

CREATIVITY IN DECISION MAKING

Decision making stresses choice of a solution, while the creative process emphasizes the uniqueness of the solution,

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Creativity, simply defined, is the ability to develop and implement new and better solution

The creativity has four stages.

1) Preparation:

- After the decision maker is ‘felt need” he start work stage of acquiring information to understand the situation. through observation and extensive use of libraries for data collection, make notes on readings

2) Incubation stage:

- Is a period for pondering the situation. Repetition of the same thoughts, with no new ideas or interpretations, reexamine the situation and review the data collected.

3) Incubation stage or illumination:

- Is the discovery of solution. It may come to mind in the middle of the night or during the performance of another task.

- The manager realizes a connection between the old and new problems.

4) Verification:

- Is the period of experimentation.

- Some decisions have failed at implementation because potential problems were not anticipated.

ETHICAL DECISION MAKING

Ethics is the systematic study of what our conduct and actions ought to he with regard to ourselves, other human beings, and the environment, the justification of what is right or good, and the study of what our lives and relationships ought to be-not necessarily what they are.

Ethics is a moral philosophy, a science of judging the relationship of means to ends, and the art of controlling means so they will serve human ends. It involves conflict, choice, and conscience.

The following forces ensure that ethics will become a greater dimension in management decision making in 2005.

A. Increasing technology, and regulatory pressures.B. Competitiveness among health care providers.

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C. National nursing shortages, and reduced fiscal resources, spiraling costs of supplies and salaries.

D. The public’s increasing distrust of the health care delivery system and its institution.

ETHICAL DILEMMAS

Individual values, beliefs, and personal philosophy play a major role in the ethical decision making what is part of the daily routine of all managers

How do managers decide that is right and what is wrong V What dose the manager do if no right or wrong answer exists? What if both answers are right or wrong? Ethical dilemmas can be defined as having to choose between two equally desirable

ore undesirable alternative.

In order for a problem to be an ethical dilemma, it must have three characteristics:

1) The problem cannot be solved using only empirical data.2) The problem must be so perplexing that deciding what facts and data need to be used

in making the decision is difficult.3) The result of the problem must affect more than the immediate situation there should

be far - reaching effects.

ETHICAL PROBLEM SOLVING AND DECISION MAKING.

Learning systematic approaches to ethical decision making and problem solving reduces personal bias , facilitates better decision - making ,and lets managers feel more comfortable about decisions they have made , even the most ethical courses of action can have undesirable and unavoidable consequences. The quality of ethical problem solving should be evaluated in terms of the process used to make the decision.

If problem solving approach is used, data gathering is adequate, and multiple alternatives are analyzed, then regardless of the outcome the manager should feel comfortable that the best possible decision was made at that time with the information and resources available

THE MORAL DECISION - MAKING MODEL

Crisham (1985) developed a model for ethical decision making incorporating the nursing process and principles of biomedical ethics.

This model is especially useful in clarifying ethical problems that result from conflicting obligations.

This model is represented by the mnemonic "MORAL" representing:

M.— Massage the dilemma. Collect data about the ethical problem and who should he involved in the decision-making process.

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O.— Outline options. identify alternatives and analyze the causes and consequences of each.

R.— Review criteria and resolve. Weigh the options against the values of those involved in the decision.

A. — Affirm position and act. Develop the implementation strategy.

L.— Look back. Evaluate the decision making.

ETHICAL FRAMEWORKS FOR DECISION MAKING

These frameworks do not solve the ethical problem, but assist the manager in clarif ing personal values and beliefs.

four of the most commonly used ethical frameworks include:

1) Utilitarianism:

Using this ethical framework encourages the manager to make decisions bused upon what provides the greatest good for the greatest number of people.

In doing so1 the needs and wants of the individual are diminished.

For example: a manger might decide o use travel budget money to send many staff to local workshops rather than to fund one or two individuals to attend a national conference.

2) Duty -based reasoning:

Is an ethical framework which says that some decisions must be made because there is a duty to do what is right.

3) Rights based reasoning:

Is based on the belief that some things or a person’s just due. Rights are deferent from needs, wants, or desires.

4) The intuitionist framework:

Allows the decision maker to review each ethical problem or issue on a case-by case basis comparing the relative weights of goals duties, and rights. This weighting is determined primarily by intuition. What the decision maker feels is right for the particular- situation.

- But the. disadvantages are subjectivity and bias,

THERE ARE MODELS FOR ETHICAL RELATIONSHIPS:

1- The priestly model. The manager is paternalistic and make decisions without considering other’s values or seeking others’ input. ‘Autocratic leadership may use the priestly model”

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2- The engineering model. Suggests that one person presents facts to another and sets aside his/her own code of ethics to do what the ether wants “Staff working for line authority may be an example of this model”,

3- The contractual model. Provides a contract that identifies general obligations and benefits for two or more people. It deals with the morals of both parties and is appropriate for superior-subordinate relationships.

4- The collegial model. Individual's share mutual goals and reach decisions through discussion and consensus. When there are shared values, this model h&ps build teams and minimize conflict.

To make an ethical decision, one must first consider what is intended to be a means and an end.

If a major evil is intended either as a means or an end, it is an unethical decision

SUMMARYCreativity in decision making:

Creativity, simply defined, is the ability to develop and implement new and better solutions.

The creativity has four stages:

1) Preparation:2) Incubation stage.3) Insight stage or illumination: is the discovery of solution.4) Verification: Is the period of experimentation.

Ethical decision making:

ETHICS is the systematic study of what cur conduct and actions ought to be with regard to ourselves, other human beings, and the environment, the justification of what is right or good, and the study of what our lives and relationships ought to be-not necessarily what they are.

ETHICS is a moral philosophy, a science of judging the relationship of means to ends, and the art of controlling means so they will serve human ends. It involves conflict, choice, and conscience.

The following forces ensure that ethics will become a greater dimension in management decision making in 2000s.

1. Increasing technology.2. Regulatory pressures.3. Competitiveness among health care providers.

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4. National nursing shortages, and reduced fiscal resources, spiraling costs of supplies and salaries.

5. The public’s increasing distrust of the health care delivery system and its institution.

Ethical Dilemmas:

Ethical dilemmas can be defined as having to choose between two equally desirable ore undesirable alternative.

In order for problem to be an ethical dilemma, it must have three characterizes:

1. The problem cannot be solved using only empirical data2. The problem must be so perplexing that deciding what f:acts and data need to be

used in making the decision is difficult.3. The result of the problem must affect more than the immediate situation there should

be far -reaching effects.

The moral decision-Making Model:

Crisham (1985) developed a model for ethical decision making incorporating the nursing process and principles of biomedical ethics.

This model is represented by the mnemonic "MORAL" representing:

M.— Massage the dilemma. O.— Outline options.

R.— Review criteria and resolve. A. — Affirm position and act.

L.— Look back.

Ethical frameworks for decision making:

1) Utilitarianism

Using this ethical framework encourages the manager to make decisions bused upon what provides the greatest good for the greatest number of people.

In doing so, the needs and wants of the individual are diminished.

2) Duty- based reasoning

Is an ethical framework which says that some decisions must be made because there is a duty to do what is right.

3) Rights based reasoning

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Is based on the belief that some things or a person’s just due. Rights are different from needs, wants, or desires.

4) The intuitionist framework

Models for Ethical Relationship:

1) The priestly model: The manager is paternalistic "Autocratic"2) The engineering model3) The contractual model4) The collegial model: Through discussion and consensus.

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SELEC1ING DCISION MAKING STYLES

1- Continuum of participation:

- Participation in decision making is based on the principle that all members of a group or organization should be encouraged to contribute to decision. The extent of participation allowed is dependent on such factors as organizational philosophy, managerial style, and organizational climate, Agencies that discourage participation have an authoritarian climate, Agencies that allow greater participation at lower echelons are democratic in nature.

A- Tannenbaun and Schmidt: developed the continuum of leadership behavior and participation related to the degree of authority used by the leader and the amount of freedom granted subordinates are reaching decisions.

- The actions on the extreme left characterize the manager who maintains a high degree of control, whereas the actions on the right characterize the leader who releases a high degree of control. Neither extreme is with out limitations.

B- Manager makes the decision and announces it: In this situation the manager identifies the problem, explores alternative solutions, chooses one of them, and then reports her decision. She provides no opportunity for others to participate, may or may not give consideration to others thoughts and feelings, and may or may not imply coercion.

C- Manager "sells" decision: Here the manager identifies the problem and makes a decision. However, instead of merely announcing the decision, she tries to persuade subordinates to accept it. This procedure recognizes the possibility of some resistance and seeks to reduce it by such acts as explaining to employees what they gain from the decision.

D- Manager presents ideas and invites questions: Now the manager, who has made a decision and has tried to persuade subordinates to accept it, provides an opportunity for

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others to ask questions to get a fuller explanation of her thinking and intentions. This discussion allows exploration of the implications of the decision.

E- Manager presents tentative decision subject to change: In this situation the manager presents her tentative decision for reaction by the people who will be affected by it. She reserves the power to make the final decision but takes others thoughts and feelings into account when making the decision.

F- Manager presents problem gets suggestions, make decision: Now the manager identifies the problem but gets suggestions, from subordinated before making a decision. This approach uses the knowledge and experiences of others. The manager selects what she considers the best solution from the expanded list of alternatives developed by herself and others.

G- The manager defines the limits and requests the group to make a decision: The manager identifies the problem, sets the boundaries within which the decision must be made, and gives the group, including herself, the power to make the decision.

H- The manager permits the group the to make decisions within prescribed limits: This represents the extreme degree of group freedom where the group identifies the problem explores alternatives, and makes the decision. The only limits imposed on the group’s decision are from top-level administration. The manger commits herself in advance of the decision making to help implement the decision of the group. She may or may not be a. part of the group decision making. If so, she acts with no more authority than any other member of the group.

I– A manager can be autocratic in making decision and have little or no input from others: or a manager can be very democratic and involve others in the process. Whether the manager chooses a more autocratic or democratic approach depends on several factors (The following questions should be asked):

1. How important is the quality of the decision?2. Does the manager have sufficient information to make a good decision? If not,

others should be involved in the decision.3. Is acceptance of the decision critical for its implementation? If so, the implementers

should be involved with the decision making. Subordinates should be included in decision making if they share organizational goals and are not in conflict with preferred solutions.

2- Vroom and yetton normative mode:

They address decision making as a social process and emphasize how managers do rather than should behave in their normative model.

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This model is a useful approach in selecting an appropriate decision making style. They identify the following alternative decision processes:

A = autocratic C = Consultative G = Group

I = First variant II = Second variant

They have identified five decision – making methods or style:

AI- You solve the problem or make the decision yourself, using information available to you at that time.

AII- You obtain the necessary information from your subordinate(s), then decide on the solution to the problem yourself. You may or may not tell your subordinates what the problem is in getting the information from them, The role played by your subordinates in making the decision is clearly one of providing the necessary information to you, rather than generating or evaluating alternative solutions.

CI- You share the problem with relevant subordinated individually, getting their ideas and suggestions without bringing them together as a group. Then you make the decision that may or may not reflect your subordinates’ influence.

CII- You share the problem with your subordinates as a group, collectively obtaining their ideas and suggestions. Then you make the decision that may or may not reflect your subordinates’ influence.

GII- You share a problem with your subordinates as a group. Together you generate and evaluate alternatives and attempt to reach agreement (consensus) on a solution. Your role is much like that of chairman, You do not try to influence the group to adopt ‘your” solution and you are willing to accept and implement any solution has the support of the entire group.

There are also seven situation variables identified by veroom (1973). These situation variables (or rules) determine which of the five decision – making style is appropriate in a given situation.

( Three rule protect decision quality and four protect acceptance )

1) THE INFORMATION RULE. If the quality of the decision is important and the leader does not possess enough information or expertise to solve the problem by himself, AI is eliminated from the feasible set. (Its use risks a low-quality decision).

2)THE GOAL CONGRUENCE RULE. If the quality of the decision is important and if the subordinates do not share the organizational goals to be obtained in solving the problem, GII is eliminated from the feasible set (Alternatives that eliminate the leader’s final control over the decision reached may jeopardize the quality of the decision.)

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3)THE UNSTRUCTURED PROBLEM RULE. In decisions in which the quality of the decision is important, if the leader lacks the necessary information or expertise to solve the problem by himself, and if the problem is unstructured, i.e. he does not know exactly what information is needed and where it is located the method used must provide not only for him to collect the information but to do so in an efficient and effective manner. Methods that involve interaction among all subordinate with full knowledge of the problem are likely to be both more efficient and more likely to generate a high-quality solution to the problem. Under these conditions, AI, AII, and CI are eliminated from the feasible set. (Al does not provide for him to collect the necessary information, and AII and CI represent more cumbersome, less effective, and fess efficient means o bringing the necessary information to bear on the solution of the problem than methods that do permit those with the necessary information to interact.)

4) THE ACCEPTANCE RULE. If the acceptance of the decision by subordinated is critical to effective implementation, and if it is not certain that an autocratic decision made by the leader would receive that acceptance, AI and AII are eliminated from the feasible set. (Neither provides an opportunity for subordinated to participate in the decision, and both risk the necessary acceptance.)

5)THIE CONFLICT RULE. If the acceptance of the decision is critical, and an autocratic decision is not certain to be accepted, and subordinates are likely to be in conflict or disagreement over the appropriate solution, AI, AII, and CI are eliminated from the feasible set. (The method used in solving the problem should enable those in disagreement to resolve their differences with full knowledge of problem. Accordingly, under these conditions, AI, AII, and CI, which involve no interaction or only “one-on-one” relationships and therefore provide no opportunity for those in conflict to resolve their differences, are eliminated from the feasible set, Their use runs the risk of leaving some of the subordinates with less than the necessary commitment to the final decision.

6)THE FAIRNESS RULE. If the quality of decision is unimportant and if acceptance is critical and not certain to result from an autocratic decision, AI, AII, CI, and CII are eliminated from the feasible set. (The method used should maximize the probability of acceptance as this is the only relevant consideration in determining the effectiveness of the decision). Under these circumstances, AI, AII, CI. And CII, which create less acceptance or commitment then GII, are eliminated from the feasible set. To use them is to run the risk of getting less than the needed acceptance of the decision.

7) THE ACCEPTANCE PORITY RULE. If acceptance is critical, not assured by an autocratic decision, and if subordinated can be trusted, AI. AII. CI, and CII are eliminated from the feasible set. (Methods that provide equal partnership in the decision-making process can provide greater acceptance without risking decision quality. Use of any method

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other than Gil results in a n unnecessary risk that the decision will not be fully accepted or receive the necessary commitment on the part of: subordinates).

- As one asks the diagnostic questions and applies the rules to specific situations, one may eliminate all but one decision style from the feasibility set. However, it is more likely that several decision styles could be used and still protect both the decision quality and acceptance requirements. Then the time factor is used to determine which of the feasible options will require the least time.

Vroom and Yetton focus on three classes of outcomes that influence the ultimate effectiveness of decisions:

1. The quality of the decision.2. Acceptance of the decision by the subordinates.3. Available time needed to make the decision.

The authors found that managers can diagnosis a situation quickly and accurately by answering following questions:

1) Is there a quality requirement such that one solution is likely to be more rational than another?

2) Do I have sufficient information to make a high - quality decision?3) Is the problem structured?4) Is acceptance of decision by subordinates critical to effective implementation?5) If you were to make the decision by yourself, is It reasonably certain that It would be

accepted by your subordinates?6) Do subordinates share the organizational goals to be obtained in solving this

problem?7) Is conflict among subordinates likely in preferred solutions?

Individuals as decision makers:

The underlying belief of an autocratic manager is that others are not as competent as he/she.

The autocrat fears that decisions made by others may be more costly, less effective, and represent a threat to the manager power.

There are individual variations in decision making. Everyone has different values and life experiences, and because each perceives and

thinks differently, various decisions are made given the me set of circumstances. Values, life experiences, preferences, risks, and the way individuals think all

influence decision making. Thus, people may perceive the same situation differently.

1- Values and decision making:

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Individual decisions are based upon each person’s value system.

Represent what is right, good, or desirable, they help an individual to decide which mode of conduct is preferable to the others.

2- Life experience and decision making.

3- Individual preference and decision making. The manager must be honest, and risk taking.

4- Individual ways of thinking and decision making.

- Evaluating information and alternatives to arrive at a decision is a thinking skill.- Individuals think differently the way one thinks has much to do with individual

problem solving and decision making.

Group factors in decision making:

Within an agency it is unusual for an individual to complete the decision making process by himself.

Commitment to the decision is important to its implementation and may be increased by participation in the decision making process.

The advantages of group participation in decision making:

1- It increase acceptance and understanding of the decision and leads to enhanced cooperation in effective implementation.

2- Broader experiences, wider range of knowledge.3- Time consuming for a group to make a decision than for an individual to gather

information and analyze it.4- Allows the nurse to express her views and attempt to persuade others.5- Sustain friendship.

Disadvantages of group participation in decision making:

1) Subordinate may influenced by his desire for group acceptance or be quite all the time of meeting.

2) Few people may be dominated the group.3) Interested in an argument than in determining the best alternatives.4) Consensus which may is not the optimal alternative.

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