Nursing Management

Functions

CONTROLLING
Intended Learning Outcomes:
• Explain the value of controlling and its functions in the nursing
service.
• Differentiate the kinds of control as it is applied in the nursing
service.
• Discuss the control process and its implication to leadership and
management.
• Explain the elements of controlling in various areas of leadership
and management.
• Utilize the principles of total quality management in any nursing
care activity.
• Explain the meaning of standards of care as it affects performance
of nurses.
Controlling
- is the use of formal authority to assure the
achievement of goals and objectives.
- performance is measured and corrective action is
taken to ensure the accomplishment of
organizational goals.
- it involves assisting, regulating, monitoring, and
evaluating individual and group performance.
Principles of Controlling
1. A Critical Few, meaning that fewer people involved in
control brings about the best results.

2. A defined Point of Control or a centralization or

decentralization of authority.

3. Self-control or Discipline, which translates to personal

acceptance of responsibility and accountability.
KINDS OF FORMAL CONTROL
1. Pre-action Control. this is controlling by means of
personal supervision and utilizing control checks
consisting of policies and procedures for any given task or
function.
2. Post-action Control. this is controlling as the task or
function is being performed or may have been performed
and correcting deviations from standards or plans.
Types of Control
1. Feedforward Controls. focus on operations before they
begin. Their goal is to prevent anticipated problems.

2. Concurrent Controls. apply to processes as they are

happening, enacted while work is being performed.

3. Feedback controls. focus on the results of operations.

They guide future planning, inputs, and process designs.
Characteristics of Effective Controls
1. Control systems must be designed appropriately to be
effective.

2. When control standards are not flexible or unrealistic,

employees cannot focus on the organization's goals.

3. Control systems must prevent, not cause, the problems

they were designed to detect.
Designing Effective Control Systems
1. Control at all levels in the health care delivery system. All
nursing units must have a standard control system.

2. Acceptability of those who will enforce the decisions. The

nurse manager's manner of influence on her staff to
comply with the policies or procedures.

3. Flexibility of the enforcers and the implementors to

enforce decisions based on practical situations.
4. Accuracy. Steps or mechanisms of control must be clear
and vivid with significant implications.

5. Timeliness. Activities are planned with time target set.

6. Cost effectiveness. Resources used are well maintained and

enough or adequate to meet the needs of the unit.

7. Understandability. Policies and procedures are simple, easy

to understand and can be implemented with less difficulty.
8. Balance between Theory of Objectivity and Subjectivity,
and practice-based system.

9. Coordinated with planning, organizing and leading.

THE CONTROL PROCESS
Steps in the control process
1. Establish and Specify Criteria and Performance Standards
2. Monitor and Measure Performance of Nursing Care Services
and Evaluate it against the Standards through Records, Report
and Observation
3. Compare Performance with Standards, Models or Criteria to
Determine Deviations or Differences in Performance
4. Enact Remedial Measures or Steps to Correct Deviations or
Errors
1. Establish and Specify Criteria and Performance Standards

a. Standards. created when objectives are set during the

planning process.
• is any guideline established as basis for measurement.
b. Time Controls. relate to deadlines and time constraints.
c. Financial Controls. facilitate achieving the organization's
profit motive. One method of financial control is budgeting.
d. Operations control. methods assess how efficiently and
effectively an organization's transformation processes create
goods and services.
e. Statistical process control is the use of statistical or
mathematical methods and procedures to determine whether
production operations are being performed correctly, to detect any
deviations, and to find and eliminate their causes
f. The Just-in-Time System is the timely application of
materials for use in case nurses need it for patient care such as
giving of medication for the illness of a patient.
2. Monitor and Measure Performance of Nursing Care Services
and Evaluate it against the Standards through Records,
Report and Observation
Techniques for monitoring and measuring service.
a. Nursing Rounds Nurses pay particular attention to issues of
patient care and nursing practice. This will also find out if the
needs and problems of patients are met or unmet.
b. Quality Assurance monitors compliance of nursing
personnel with established standards in terms of nursing care
given to patients.
c. Nursing Audit consists of documentation of the quality of
nursing care in relation to the standards established by the
nursing department.
• It prioritizes nursing care by promoting optimum nursing
care.
• It can identify deficiencies in the organization and
administration of nursing care
• It may also be used to increase performance to assure that
improvements have been maintained.
How data was collected to measure actual performance

• Written data might include time cards, production tallies,

inspection reports and sales tickets.

• Personal observation, statistical reports, oral reports and written

reports can be used to measure performance.

• Management by walking around or observation of employees

working, provides unfiltered information, extensive coverage
and the ability to read between the lines.
3. Compare Performance with Standards, Models or Criteria to
Determine Deviations or Differences in Performance
Techniques to improve performance based on feedbacks
a. The Program Evaluation and Review Technique (PERT) employs
a matrix that uses network of activities represented in a chart,
including the goals or product desired, time management, budget
and estimation of critical paths.
b. Benchmarking seeks out the best so as to improve its
performance. It provides a standard or point of reference in
measuring or judging such factors as quality, values and cost.
4. Enact Remedial Measures or Steps to Correct Deviations or
Errors

a. Correction of deviations or errors.

b. A Master Control Plan
c. Take necessary action.
Characteristics of the Control Process

1. The control process is cyclical which means it is never finished.

2. Controlling often leads to management expecting employee
behavior to change.
3. Control is both anticipatory and retrospective.
4. Ideally, each person in the health care delivery views control as
his or her responsibility.
5. Controlling builds on planning, organizing and leading.
I. PERFORMANCE APPRAISAL
− appraisal is a method of acquiring and processing information
needed to improve the individual's performance and
accomplishments.
− the purpose of the evaluation is to assess the appropriateness,
adequacy, effectiveness and efficiency of services. The methods
used may be anecdotal records, checklist, rating scale, ranking
among others.
Performance Appraisal Tools
1. Trait Rating Scale This is a method of rating a person against a
set standard which may be the job description, desired behavior
and personal trait.

2. Job Dimension Scale It focuses on job requirements and the

quality work performance

3. Behaviorally Anchored Rating Scale (BARS) This focuses on

desired behaviors to improve performance.
4. Checklist It is composed of behavioral statements that
represent desirable behavior.

5. Peer Review It is a collegial evaluation of the performance

done to promote excellence in practice and offer information,
support, guidance, criticism and direction to one another.

6. Self-Appraisal This tool allows the employee to evaluate his

own performance.
Common Errors in Appraisal
1. Halo Effect. this has a tendency to overrate staff based on
the rater's first impression of the ratee.

2. Logical Error. it is often based on first impressions of the

rater to the ratee.

3. Central Tendency Error . this rates the staff as average. This

is used by the rater when feedback tools are inadequate and
when there's no sufficient time for the rater to observe the
ratee.-
4. Leniency Error. there is the propensity to overlook or observe
the weaknesses and mistakes of the person being evaluated
leading to an inaccurate picture of the job performance.

5. Hawthorne Effect. the behavior of the ratee changes simply

because he is observed by the rater. The ability of the rater to
closely observe the ratee is challenged by the knowledge he/she
has of the ratee.

6. Horn's Effect. this occurs when rating an employee very low

because of an error committed.
II. TOTAL QUALITY MANAGEMENT (TQM)
− is a management approach for an organization, focused on
quality, based on the participation of all its members and aimed
at long-term success through customer satisfaction and benefits
to all members of the organization and to society.

− is aimed at embedding awareness of quality in all organizational

processes.
The three basic principles of TQM are to:
1. Focus on achieving customer satisfaction;
2. Seek continuous and long-term improvement in all the
organization's processes and outputs; and
3. Take steps to ensure the full involvement of the entire work
force in improving quality.
TQM is composed of three paradigms:
1. Total: Involving the entire organization, the entire chain,
and/or product or outcome life cycle.
2. Quality: With its usual characteristics, with all its complexities
to meet total client satisfaction.
3. Management: The system of managing the organization with
steps like Planning, Organizing, Controlling, Leading, Staffing,
Provisioning and the like.
In Japan, TQM comprises four process namely:
1. Kaizen - Focuses on "Continuous Process Improvement", to
make processes visible, repeatable and measurable.
2. Atarimae Hinshitsu – The idea that "things will work as they
are supposed to" for example, a pen will write.
3. Kansei - Examining the way the user applies the product leads
to improvement in the product itself.
4. Miryokuteki Hinshitsu The idea that "things should have an
aesthetic quality " for example, a pen will write in a way that is
pleasing to the writer".
III.DEVELOPMENT OF STANDARDS
− Standard is a pre-determined level of excellence that serves as a
guide to practice.

− Organizational standards outline the level of acceptable practice

within the institution while nursing audit is a measurement tool
used to provide the yard stick for measuring quality care.
TYPES OF STANDARDS
1. Structure Standards
− Standards that focus on the structure or management
system used by an agency to organize and deliver nursing
care, including the number and categories of nursing
personnel who provide that care

2. Process Standards
− Standards that refer to actual nursing care procedures or
those activities engaged in by nurses to administer care.
3. Outcome Standards
− These are standards that are designed for measuring the
results of nursing care. Other means of monitoring and
measuring include Conflict Management, Budgeting and
Discipline.