Module 2F: Controlling

Group 2 - Mdm Saldivia

Objectives:
1. Define the terms
● Nursing Rounds
● Quality Assurance
● Quality Improvement
● Burnout
2. Define controlling functions
● Definition
● Principles
● Characteristics
● Types
● Steps
● Elements
○ Performance Appraisal
○ Total Quality Management
○ Development of Standards
____________________________________________________________________________________
1. Define the terms
● Nursing Rounds
- technique in monitoring or measuring performance where the nurse pays particular attention to issues of
patient care
- Procedure in which one or more visits to a hospital are scheduled by charge nurse together with all nursing
personnel; attends to the patient's needs.
● Quality Assurance
- Process of evaluation that is applied to the H.C system and provision of H.C services by health workers.
● Quality Improvement
- Process of target degree of excellence of nursing intervention, then taking steps to ensure that each
patient received the agreed upon level of performance
- Aim: quality of the nursing care
● Burnout
- 3 factors composed of emotional exhaustion, diminished sense of personal accomplishment, depersonalization
- Characteristic: apathetic, alienation, depersonalization of patient, job dissatisfaction
- Personal hardiness = buffers burn out
○ Committed → control → excellence → job satisfaction
○ Increase hardiness = increase job satisfaction

2. Define controlling functions

● Controlling
○ Continuously compare your performance against standards and goals
○ Is the evaluating and feedback function of management

Characteristics:
■ Cyclical- continuous, never finished
■ Lead to behavior change
■ Anticipatory and retrospective
● anticipate problems
● preventive actions
■ Views control as responsibility- because you care for employees
■ Employees think its negative, but there will be changes

○ Principles
- There must be only a few people
● this shows best results because when there is less people, there is better
control
- There must be a defined point of control
● There should be 1 authorized leader

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 - Self Control / Discipline
● Personal acceptance of responsibility and accountability

○ Types
● Pre Action
- Focuses on the prevention of deviation through personal supervision
- Rules and regulations, policies, training
● Post Action/ Concurrent
- This is when materials are prepared
- There is monitoring and adjustments of activities to make sure everything is
correctly done
● Feedback
- End result
- Reports are done

● Purpose
- Improves quality of nursing care
- It decreases the cost of nursing care
- Provides a basis for determining nursing negligence
- Control Process:
1. Establishes performance objectives and standards
2. Measure actual performance
3. Compare actual performance with the objectives and standards
4. The necessary action
○ Steps:
1. Setting performance standard
2. Measuring performance
3. Making comparison
4. Corrective action

○ Elements

1. Performance Appraisal
➢ How well employees carry out the duties of their assigned job
➢ Who evaluates:
■ Co worker
■ Patient
■ Supervisor

➢ Tools:

● Trait rating scales

● Job dimension scale
- Increase quality of work performance
● Check list
● Essays
● Self appraisal
● Management by objective
● Behaviorally anchored rating scale
- Desired behavior, checklist
● Peer review
- Recognizes positive and negative
- Performance Appraisal

➢ Common Errors:
● Error of central tendency: all employees are rated average
● Leniency/strictures error: unusually high/low rating (over/underrating)

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 ● Recency error: based largely on employees most recent behavior; performance should be good
● Contrast error: comparison with another employee just previously evaluated
● Halo effect: overrated based on good first impressions (traits)
● Stereotyping: generalizing employee; performance based on group
● Focusing on first impression: logical error
● Horn’s effect: very low rating d/t error committed
● Ambiguous rating: opposite of how rater perceives
● Proximity error
● SRating by position: rating supervisor (high grade)
● Grapevine: based on “chikka”/what people tell you, not performance
● Hawthorne effect: people do good when being watched so rating goes up

2. Total Quality Management

a. Definition:
○ Manage the whole to achieve excellence
○ Customer focus org
○ Comprehensive, improved
b. Principles
○ Customer focused
○ Total employee involvement
○ Process centered
○ Integrated system
○ Continual improvement
○ Communication
○ Strategic and systematic
○ fact based decision making
c. Paradigm
○ Edward Deming
■ Father of quality management movement
■ Quality should be checked each step
○ Joseph Juran
■ Quality as “fitness for use”
■ Characteristics
a. Quality of design
b. Quality of conformance
c. Availability
d. Full service
○ Philip Crosby
■ Quality represents “conformance to requirements”
■ “Zero defects” - do things right the first time
■ Absolutes of quality
a. Definition
b. System
c. Performance standard
d. Quality measurement

3. Development of Standards
■ Predetermined level of excellence as guide for practice
■ Purpose
● Improve quality
● Decrease cost of nursing care
○ Minimizes supplies, materials
● Basis for determining negligence (no problem if you follow standard)
● Provides potential solutions to issues
■ Significance
● Guides nurses to professional responsibilities
■ Types:

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 ● Structure
● Process (nurse-oriented)
● Outcome (end result, patient-oriented)

Techniques to measure/improve performance:

1. Nursing Audit
○ Evaluation of quality of care
○ Assessment of the quality of clinical nursing
○ Types:
■ Concurrent
● Open chart; includes interview significant other and patient
● Patient is still admitted (assess past and present care)
■ Retrospective
● Closed chart
● Patient is discharged
● Inspect chart after discharge
2. Nursing Rounds
are given separate names according to purpose

● information giving rounds

- used to acquaint staff with all patient on ward or division
● instructional rounds
- nurse is expected to read the charts and comes to rounds with the basic information in mind
● problem solving rounds
- to help the nursing staff learn to conduct initial interviews, make assessment of patient needs and identify nursing
care problem

3. Variance Report
- document comparing planned financial outcomes with actual outcomes

4. Discipline
- ensure employee compliance
- form of self control
- individual acts in code of behavior

Principles:
● manager should improve as a correction, not punishment
● progressive oral counseling, written warning

Saldivia’s Notes: DAY 1

CONTROLLING
● 4th/ Last step in the management process
● Can sound dominating and mean - use coordinating instead
● Coordinating is also controlling
Definitions :
According to Brooten:
● Continuous process of comparing your own and groups performance against standards and goals

According to Hersey
● Regulating, curbing and restraining organization’s activities

According to Swansburg:
● Seeing that everything is being carried out in accordance with the plan
● Significance
○ assures consistent and continuous performance and quality of an organizational service or product
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 ○ Controlling assesses achievement of objectives
○ Controlling involves sets of standards
○ Recycling process

Functions of Control
● Serves both as a means and an end - Cyclical process, overlapping, continuous
● Promotes effective use of resources - all resources are evaluated and maintained
● Provides professional reinforcements - given discipline and different reinforcements
● Maintains activity and expectations

Principles of Controlling
1. A critical few - fewer people involved in control
2. defined point of control- centralized or decentralized
3. Self Control nor Discipline - personal acceptance, responsibility, and accountability

Characteristics of Control Process

● is cyclical - never finished because its a cycle
● Often leads to management expecting employee behavior to change
○ employees view controlling as negative, regardless of how positive the control is
● is both anticipatory and retrospective
○ anticipate problems and take preventive action with collective action
● views control as responsibility
○ the employer cares

Kinds of Formal Control

● Pre-Action Control or Feed Forward
○ Controlling by means of personal supervision and utilizing control checks consisting of procedures for any
given tasks or functions
○ Focuses on problems of preventing deviations → policies instituted
○ Ex. Policies, safety system, budget
● Post –Action Control or Concurrent
○ Being performed, or has been performed
○ Applies processes while it is ha
○ Ex: preparing materials like a dressing set, preparing computers
○ Tools: supervisory activity, job description (i missed one)
● Feedback Control
○ Focus on end result
○ Quality control that enhances safety
○ Standard cost analysis
○ Timely reports

STEPS OF CONTROL
A. Establish and Specify Criteria and Performance Standards
● Setting Standards and Determining Criteria
○ Standards: is a descriptive statement of desired level of performance
■ Basis for measuring
■ Statements of desired level of performance
■ Must be updated and reflect a higher level of desired performance
■ Are temporary
● Can be altered or abandoned, working model
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 ○ Nursing Care Standard: is a descriptive statement of desired quality of performance
○ Standards are created during the steps of planning
○ Policies and procedures are set
○ Job descriptions are set when standards of nursing are set

1. Standards
1.1 Purposes of Standards
● improve quality of nursing care
○ By publication of these standards, everyone should know it bc this motivates to work harder
● Decrease the cost of nursing care
○ It can eliminate non essentials that serve no use for goals
○ Lessens the mistakes by following standards
● provide a basis for determining nursing negligence
○ Not reaching standards may cause harm to patients

1.2 Types of Nursing Care Standards

● Structural - Standards on the basis of the physical set up , management system to deliver care.
○ Group or institution oriented
○ Examples:
■ Number of personnel
■ Categories of nursing personnel (auxiliaries, staff, etc)
■ Ratio of the staff (ex 1 nurse : 15 patients)
● Process Standards- Criteria that specify method for Nursing Care delivery
○ Nurse oriented
○ Refers to actual nursing care, procedures or activities engaged by nurses
○ To determine care
● Outcome Standards- Descriptive statements of desired patient care results.
○ Patient oriented
○ Measuring results of nursing care
○ How is the outcome? Whether outcome has improved or not
○ Ex. budgeting, discipline, conflict management

1.3 Significance of Nursing standards

● Guide to their professional responsibilities to clients
● Guides the nurses in professional responsibilities

2. Resource Controls
● Time Control
○ Deadlines and time constraints
● Material Control
○ Inventory of supplies and materials
● Equipment Control
○ ?
● Cost Control
○ ?
● Employee Performance
○ Ex: absences, tardiness, accidents
● Financial Control
○ Facilitates achievement of organizational profits

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 ● Operations Control
○ How efficient and effective the organizational task formation process is
○ TQM (Total Quality Management)
● Statistical Process Control
○ Physics, mathematical methods to determine where production operations are performed
● Just-in-Time System
○ Timely application of medication for patients and purchasing of patients
○ Communication of supervisors and staff

B. Monitor and measure Performance of Nursing Services against Standards

● Techniques for monitoring and measuring performance
1. Nursing Rounds
■ Pay attention to issues of patient services
■ Monitor the performance
■ Do nursing rounds, ask questions from patients and workers
● “How was the care given to you by your nurse?”
■ A conference or meeting where problems are talked about
2. Quality Assurance
■ Monitors clients and establishes standards
■ Includes assessment of patient care and correction of problems identified
■ Interview patients, families and nursing staff
■ Make plans for change and follow up for feedback
3. Patient care Audit (Nursing Audit)
■ Evaluated quality of client care according to predetermined standards and criteria

Quality Assurance Process

● Setting standards
● Determining criteria
● Evaluating performance
● Making plans for change
● Follow-up evaluation

Rationale of Quality Assurance

● Increasing rising cost of care
○ We will only focus on the significant problems
● Need to improve quality of care
● Need for proof of the quality of care actually delivered

Components/ Approaches of Quality Assurance (Focus of Evaluation)

● Structure - relates to the environment in which healthcare is given (policies, procedures, personnel, supplies)
● Process
○ Use of ADPIE
● Outcome
○ deals with patients condition at the conclusion of the episode of treatment or point of conclusion
○ Criteria for outcomes:Death rates, rates of permanent impairment, nosocomial infections, patient’s clinical
manifestations (improved or not?), patients knowledge, satisfaction of patient
*there are other quality assurance methods, like in fast food places: peer reviews, evaluation of person by others of the same
status, evaluation of equipments/resources, survey/reviews

TYPES OF PATIENT CARE AUDIT OR NURSING AUDIT

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 - Evaluates the quality of client care according to predetermined standards
1. Concurrent
○ Open chart
○ Evaluation or a recording of a patient or client who is still receiving the care
○ While the patient is still admitted
○ Assess the past and present care given to a client
○ More costly, more time needed as they are still admitted
2. Retrospective
○ Closed chart
○ Inspection of the pt chart after they have been discharged
○ Less time required
○ Interpret and analyze results
○ Revision of tools and procedures as needed

Purposes of Nursing Audit:

1. Prioritizes nursing care
- By promoting optimum nursing care, bc you already have the data and basis
2. Identify deficiencies
- To correct deficiencies
3. Increase performance
- To assure improvements have been maintained
- Giving corrections and improvements

C. Compare Performance Standards or Criteria to Determine Deviation

- Reporting of results
- Ways or techniques or corrections and improvement:
1. Program evaluation and review technique (PERT)
○ A record or diagram of the probable and time estimates for basing from legends
○ Vertical : all the activities
○ Horizontal : Dates/time of accomplishment
○ Just check when you're finished
○ Like the GANTT chart
2. Benchmarking
○ Seeks out the best practices to improve the importance
○ Always a practice
○ Visits institutions and takes the best practices of that institutions so when you go back to yours,
you either follow or improve your institution
3. Delegation

D. Enact Remedial Measures or Steps to Correct Deviations or Errors

1. Correct Deviations or Errors
○ By changing the plans
2. Master Control Plan
○ Showing general objective and specific activities
3. Take Necessary Action
○ Keep continuous process

ELEMENTS OF CONTROLLING
A. Performance Appraisal
- Evaluation of an employee conducted at regular intervals by an employer persons in line positions.
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 - Methods of
- Employees performance are recorded against the standards

Purposes of Performance Appraisal:

- To encourage the development of employees
- Evaluate the productivity of the staff
- Basis for administrative decisions
- To determine manpower requirements
- staffing
- To improve employee relations
- Organizational development
- To assess need for training
- Know who are those that need training in a specific aspect of care

Methods to evaluate performance:

- Peer review
- Evaluation of persons by others of equal status
- Recognize the positive and negative aspects of performance
- Afraid to give negative feedback
- Biased

- Trait rating scale

- Rate accepted standards like job description
- Job dimension scale
- Increases quality work performance
- Checklist
- Composed of behavioral statements that represent desirable behavior
- BARS - Behaviorally Anchored Rating Scale
- Focus on desired behavior to improve the performance
- Self-appraisal
- Allows employee to evaluate their own performance
- Ex. return demonstration
*anybody can evaluate (ex. committee, peers, patients, you hehe)

Common Errors in Appraisal

- Halo Effect
- Tendency to overrate based on the first impression
- Logical Error
- Based on the 1st impression on the later using logic
- Central tendency
- You rate staff average based on feedback
- Feedback tools are inadequate
- Inadequate data so you get the average
- Ex: 1-5 so you choose 3
- Leniency Error
- Overlook the weaknesses and mistakes of the person being evaluated leading to inaccurate
performance evaluation
- Hawthorne Effect
- This is the behavior just because you know that you are being observed by an evaluator
- Ex: very participative because there’s a visitor in the back
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 - Ex: CHED visiting the school is the only time the school looks nice
- Horn’s Effect
- Rating is very low due to an error committed
- Proximity Error
- Rating is influenced by the preceding characteristic
- If recent characteristic is good, rating is good
- Recency Error
- Recent performance influence rate
- Forget the old performances
- Rating by position
- Rate is based by the position/rank of the employee
- Give good/high ratings for your superior
- Ambiguous Evaluation Standard
- Rating based on Grapevine
- based on what you hear from others

TQM- Total Quality Management

● The process that involves everyone in the organization focusing on the customer to continually improve product value

4 Primary Principles of TQM

● Focus on delivering customer value.
○ If organization is successful, they make sure customers are satisfied
● Continually improve the system on its processes
○ Quality and value continue to change
○ If company is satisfied with old standard, they will stay with that but they will lost customers with better
standards
● Focus on managing Processes rather than people
○ Employees work based on their skills and resources which the management provides to help them
● Work in teams
○ To execute processes efficiently and effectively
○ “2 heads are better than 1”

DISCIPLINE
● Manager’s standpoint : the process of ensuring employees compliance with institutional rules and regulations
○ Basis: institutions rules and regulations
○ Official employees standards of conduct
● Employees standpoint : a form of self-control through which the individual acts in accord with the institutions code of
behavior
*disciplining is not a punishment

Principles of Discipline
● Manager should improve disciplinary action for the purpose of correcting rather than punishing a wayward employee
○ It is not for punishing but more on correction
○ Sanctions may be given and is usually thought of as punishments
● Discipline should be administered from promptly, privately, and consistently
○ You don’t give different sanctions to same offense, only have the gravity of offense
● Discipline should be progressive in nature and preceded by counselling
○ Starts with a friendly or informal talk advice
○ Oral reprimand → firm
○ If committed again → Written
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 ○ No improvement → suspension
○ Commits again → staff will be discharged from office
○ Should be preceded by counselling
● Uses cautions in instituting disciplinary procedures
○ Since problems can be very severe
● The same reprimand is given to all offenders
○ Same mistakes, base it on gravity of offense
○ Hoarding grievances → promote a blow up
○ Sweetened forms of criticism → employee will not recognize mistake
○ Instituting discipline unfairly

Absenteeism
- Any time away from work
● Contributory Factors
○ Staff has double jobs
● Distance between home and workplace
○ Online issues (slow internet)
○ Early shift
○ Gender
■ more absences in females due to menstruation
■ Mondays absent for males cuz they have a nightlife (hungover)
○ Accidents
● Emotional Causes
○ Mental and emotional disorders
○ Low self-esteem
○ Job dissatisfaction because of long shift - so kapoy
○ Monotonous tasks
● Effects
○ Increase cost → call other people to do the work
○ Inefficiencies and errors → work is left behind and mistakes are committed
○ Demoralization of other workers → bc others always present others always absent
○ Poor quality of care d/t exhaustion of nurse or understaffing
● Types
○ Voluntary
■ employees control
○ Involuntary
■ Unavoidable situations
● Measures to reduce:
○ Keep records of attendance
○ “Call in” policy
■ Fill in absent slip at the station, get a medical certificate from the ER and send them to
the nursing office
● Needs to be completed before you go back on work
○ Home visits - they visit the students in their homes
○ Improve work environment
○ Incentive plans
■ For complete attendance
○ Negative sanctions - deduction from pay
2 Factors that affect absenteeism:
1. Ability to attend
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 2. Motivation to attend

Burn out us rn sadt

● Composite Factors
○ Emotional exhaustion - feeling of overworked
○ Depersonalization - lack of affect
○ Diminished sense of personal accomplishment?
● Characteristics
○ Apathy
○ Alienation
○ Job Dissatisfaction
○ Depersonalization
● Personal Hardiness
○ The higher the personal hardiness, the more the job satisfaction
○ The weaker the personal hardiness, the weaker the incidence of burn out

Characteristics to Determine Personal Hardiness

1. Commitment - sense of dedication to self and others
2. Challenge - challenging careers and opportunities

Turn Over
- Separation of employees from their jobs
- Hospitals have fast turnovers bc many are going out of the country
● Types
- Voluntary - individual leaves on own accord
- Involuntary - individual is asked to leave
● Causes
- Lack of conduit between institutions needs and manpower
● Consequences
- Negative effect on hospital
- Increased costs
- Undesirable effect on patients (from mistakes)
- newbies still learning how to perform procedure with big responsibility
● Measures to improve
- Job description, recruitment, and selection should be evaluated
- Methods of assignment
- Increase salary

Extra discussion:
● Directions must come across as requests, not commands - TRUE
○ As nurse managers, you should give your directions nicely
● Any conflict causes dysfunction - TRUE
● A win-lose strategy in a conflict resolution, represses rather than resolves a conflict - TRUE
● Anything that can be planned can be controlled - TRUE
● A standard control system must be applied only to nursing units - FALSE
○ Not only in nursing units but in all units of hospital
● The control process is a continuous flow between measuring and actual performance and compare with standards -
FALSE
● Collegial evaluation - PEER REVIEW
● No such thing as performance assessment or performance audit
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● Providing feedback
○ When you give a feedback report, you use surveys, progress notes ?? did she give an answer for this
● Measuring nursing performances: nursing rounds, quality assurance and nursing audit
● 1 characteristic of effective control is any of the:
○ Stops once the problem is resolved - NO
○ Anticipate organizational problems - YES
○ Compare performance with standards - NO
○ Assess appropriateness and effectiveness of services - YES
● If performance is found to have deviation from standards, the nurse may take action to minimize the costs, or attend
trainings or seminars - YES
○ Take corrective action is the first step, needs to have due process
● When giving disciplinary measures, you are into this area of nursing management - HUMAN RESOURCES
● This is an error in appraisal where the rater rates the staff to average: ERROR OF CENTRAL TENDENCY
● The tendency to rate a person due to an error committed: HORN’S EFFECT
● Discipline is given only to offenders: NO

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