CONTROLLING

- Coordinating or evaluating Customer satisfaction

- A process of monitoring performance and taking action to ensure desired
results
- It sees to it that the right things happen, in the right ways, and at the right
time. process opens opportunities for improvement and comparing  The primary purpose of QA programs in nursing is to measure and
performance against set standard. improve the quality of nursing delivery in the agency.
 The patient is the best and sometimes the only judge of the interpersonal
Why is there a need to conduct Evaluation? aspects of care, like empathy, communication, room & food services.
 Patient satisfaction is an essential goal of care.
- It ensures that the quality of care is provided  Patients attitude influence the degree of compliance to the medical
- To provide standards for establishing comparisons regimen
- It promotes visibility for employees to monitor their own performance
- Provides feedback for improvement Quality Assurance

Kinds of Control - focuses on the care and service the patient receives than on how well the
professional performs the duties the that the position requires.
 Pre-action Control – personal supervision and utilizing standards or
procedure Performance Evaluation
 Post-action Control – correcting deviations from standards and plans
- focuses on the worker. It asks questions about how well the worker
Tools for controlling organizational performance satisfies the requirements of his or her job within the organization.

 Feed-forward Control – A control that prevents anticipated problems 4 Main Principles of CQI
before actual occurrence of the problem.
 Concurrent Control – A control that takes place while the monitored 1. Customer focus
activity is in process. 2. Identification of key processes to improve quality
3. The use of quality tools and statistics
 Feedback Control – A control that takes place after an activity is being
4. Involvement of all people in problem solving
done.
Nursing Audit Committee
The Control Process
- A nursing audit is composed of a representative from all levels of the
1. Establish objectives and standards.
nursing staff:
2. Measure actual performance.
3. Compare results with objectives and standards.  A member of the training staff
4. Take necessary action.  Supervising Nurse
 Head/Senior Nurse
Model of Control Process  Staff Nurse

Patient Care Audits

- Patient care audits may be concurrent or retrospective.

 Concurrent Audit
- Is one in which patient care is observed and evaluated. It is given
through:
- A review of the patient’s charts while the patients are still confined in
the hospital.
- Observation of the staff as patient care is given.
- Inspection of patients and/or observation of the effects of patient care
where the focus is on the patient.
 Retrospective Audit
- Is one which patient care is evaluated through
1. Establish objectives and specify Criteria/standards and - A review of discharged patient’s charts;
Performance - Questionnaires sent to or interviews conducted on discharged patients.
 Standards -guidelines
 Time – deadlines
 Financial – budgeting
 Operation – good services & quality, inventory
2. Measure, Monitor & Actual Performance of Nursing Care Services
Peer Review
 Nursing Rounds
 Quality Assurance - Patient care audits may be done by peers (employees of the same
 Nursing Audit profession, rank, and setting) evaluating another’s job performance
against accepted standards.

Quality Circles

- One of the most publicized approaches to quality control introduced by

Quality Assurance is a process of evaluation that is applied to the health care the Japanese.
system and the provision of health care services by health workers - A group of workers doing similar work who meet regularly, voluntarily,
on normal working time, under the leadership of their supervisor, to
identify, analyze and solve work related problems and to recommend
TQM & CQI (continuous quality improvement) solutions to management.
Utilization of Results Counseling and Oral Warning

- The Nursing Staff in the unit is given feedback on the results of the - The employee is given a fair chance to air his/her side
quality assurance study.
- Positive Feedback reinforces desirable performance. Consistent positive Suspension
findings deserve a commendation from the nursing service.
- Negative Feedbacks should tactfully be conveyed in a face-to-face - is given after evidence of oral and written warnings. Suspension is
situation so that assessment results may easily be clarified. applied when management feels that the employee can still be
rehabilitated.
Compare performance with standards, criteria to determine deviations
Dismissal

- is invoked only when all the other disciplinary efforts have failed.
Enact Remedial measures or steps to correct deviations
Steps in Progressing Discipline
- Maybe done by changing the number of personnel, training
subordinates, minimizing resources or increasing quality care. 1. Counselling
2. Official reprimand
Performance Appraisal 3. 2nd reprimand
4. Suspension
- A control process in which an employee’s performance is evaluated 5. Termination
against standards. It is the most valuable tool in controlling human
resources and productivity. Providing Feedback

Different Tools in Measuring Performance

 Essay – strength & weaknesses

 Checklist – compilation of all nursing performances
 Ranking – educational level, clinical efficiency, ska
 Anecdotal Recording
 Rating scale – 1-5
 Trait scale – job description, personal trait Principles of Disciplinary Action
 Peer review
 Self-appraisal  Have a positive attitude – expect the best from your staff; very
important in correcting undesirable behavior
Forced Choice Comparison  Investigate Carefully – collect facts
 Be prompt – do not delay
- Ex: Select the statement that best describes the nurse being evaluated
 Protect privacy – save face
and the statement that least describes him/her.
 Focus on the act
1 – respects ideas for other  Enforce rules consistently – it reduces the possibility of favoritism
 Be flexible – consider length of service, intent
2 – limited communication ability  Advise the employee – that their conduct is not acceptable/anecdotal
notes can be useful here
3 – even tempered  Take corrective action
4 – capable of enduring long hours  Follow up

5 – tends to be a loner Potential Errors in Performance

- Falling to investigate
- Criticizing the employee rather than the performance
- Blaming
- Conducting one-way conversation

Modification of Employee Behavior

Common Errors in Appraisal
 Reinforcement – Acknowledgement, praise, pay, special assignments,
 Halo Effect or Logical Error – impressions merit with pay
 Central Tendency Error – used when feedback tools are inadequate,  Shaping – I see you were in 30 minutes today, 15 mins….
staff is rated average  Extinction – Never praise everyone all the time, not worth
 Leniency Error – overlooking the weaknesses of the subordinate  Punishment
 Hawthorne Effect
 Horn’s Effect – low rating because of an error committed

Discipline

- Discipline means rigid obedience to rules and regulations, the violation

of which resulted in punitive actions in the past.
- Today, discipline is regarded as constructive and effective means
employees take personal responsibility for their own performance and
behavior.

Disciplinary Action

- Any employee charged for breach of the rules and regulations, policies,
norms of conduct shall be given due process.