Controlling
Definition of Controlling
Controlling
The use of formal authority to ensure the achievement of goals and objectives.
During the controlling phase, performance is measured against predetermined standards,
and action is taken to correct discrepancies between these standards and actual
performance.
Managers who engage in the controlling activity watch, evaluate, and when needed, suggest
corrective action.
Definition of Controlling
Controlling
controlling is a complex activity that is performed at many organizational levels.
Upper-level managers, monitor their organization’s overall strategic plans, which can be
implemented only if middle-level managers control the organization’s divisional and
departmental plans, which, in turn, rely on lower-level managers’ control of groups and
individual employees
Control Process
Establish standards
Standards are criteria of performance.
This means setting up of the target which needs to be achieved to meet organisational goals
eventually.
Control Process
Establish standards
Standard is a predetermined level of excellence that serves as a guide for practice.
Characteristics of standards: they are predetermined, established by an authority, and
communicated to and accepted by the people affected by them.
Standards are used as measurement tools, they must be objective, measurable, and
achievable.
Control Process
Establish standards
Standards are criteria of performance.
This means setting up of the target which needs to be achieved to meet organisational goals
eventually.
Employees must know the standard expected of them at their organization.
Control Process
Establish standards
Employees must be aware that their performance will be measured in terms of their ability
to meet the established standard.
Ex. hospital nurses should provide postoperative patient care that meets standards specific
to their institution. A nurse’s performance can be measured only when it can be compared
with a preexisting standard
Control Process
Monitor ongoing organizational behavior and results.
make an assessment of what has actually taken place and determine whom, when and how
to measure organizational behavior.
measurement of actual performance of employees in terms of fixed standards as per his job.
the 3 key aspects of measurement: completeness, objectivity and responsiveness
Control Process
Completeness
the manager to concentrate on all aspects of the job instead of neglecting unmeasured tasks
in favour of measured ones.
Objectivity
Objective measures avoid bias that is essentially found in subjective assessment of task and
people.
Responsiveness
Responsive measures support the belief that effort and performance lead to improvement
in the systems of control
Control Process
Compare actual behavior/performance and results against standards.
It involves comparing the differences between the actual performance and set of standard.
deviations may be due to errors in planning, defective implementation or careless
performance of the employees.
only major or exceptional deviations should be communicated to top management in the
form of reports. This is known as “management by exception‟
Control Process
Evaluate and take corrective actions.
knowing the degree of differences, managers have to decide to maintain the status quo,
change the standard, or take corrective actions.
Corrective steps are initiated by managers with a view to rectify the defects in actual
performance.
Corrective action includes the change in strategy, structure, compensation practices,
training programmes, redesign of jobs, replacement of personnel, re-establishment of
budgets or standards, etc.
Quality of Improvement
Quality Improvement (QI) is a management philosophy to improve the organizational
structure and the level of performance of key processes in the organization to achieve high
quality outcomes.
This philosophy states that quality is an organizational issue, that is, that variation in quality
is as much due to the way in which care is organized and coordinated as it is to the
competence of the individual caregivers.
QI logic suggests that high quality could lead to a higher volume of use of the organization
by patients and providers who have the flexibility to make choices about where they seek
health care.
Higher volume generally leads to higher profits which, in turn, may be directed toward
improving programs and services, thus achieving higher quality, can result in the
organization’s thriving/success.
Quality of Improvement
Increased quality Increased volume Increased profit Enahanced
programs/services Increased quality
or reverse is more likely when quality is poor or inferior,
Decreased quality Decreased volume Decreased profit Cutting corners
Decreased quality
Concepts of Quality of Improvement
Productive work involves work processes.
The customer/client is central to every processes.
Look at improvement of all work processes to meet the customer’s needs reliably and
efficiently.
To improve quality: eliminate defects in the work process and devise ways that better meet
customers’ needs or preferences efficiently.
The problems in the work process is the main sources of quality defects.
Workers basically want to succeed in carrying out the work process correctly.
Concepts of Quality of Improvement
Quality defects are costly in terms of internal losses from lowered productivity and
efficiency, increased requirements for inspection and monitoring, and dissatisfied
customers.
Focus first on the most important work processes to improve. Identify desired performance
levels, measure current performance, interpret it, and take action when necessary.
Involve every worker in QI and empower them to take action.
Set high standards for performance; go for being the best. Emphasize this until it becomes a
work habit and part of the organization’s daily operations.
Total Quality Management
Total Quality Management (TQM) is a management philosophy that emphasizes a
commitment to excellence throughout the organization.
Core Characteristics of Total Quality Management
Customer/client focus
Total organizational involvement
Use of quality tools and statistics for measurement
Key processes for improvement identified
Total Quality Management
Customer/client focus
To address the needs of both internal and external customers.
Internal customers include employees and departments within the organization, such as the
laboratory, admitting office, and environmental services.
External customers of a health care organization include patients, visitors, physicians,
managed care organizations, insurance companies, and regulatory agencies
Total Quality Management
Customer/client focus
Under the principles of TQM, nurses must know who the customers are and endeavor to
meet their needs.
Ex. Providing flexible schedules for employees, adjusting routines for a.m. care to meet the
needs of patients, extending clinic hours beyond 5 p.m., and putting infant changing tables
in restrooms and lactating room for nursing mothers. Provide a neutral restroom.
Total Quality Management
Principles of Total Quality Management
Delivery high-quality work for the first time
putting the client first
approaching a project strategically,
developing a plan for continuous improvement,
and fostering a culture of cooperation and mutual respect
Total Quality Management
Total Organizational Involvement.
The goal of total quality management is to involve all employees and empower them with
the responsibility to make a difference in the quality of service they provide.
All employees must have knowledge of the TQM philosophy as it relates to their job and the
overall goals and mission of the organization.
Knowledge of the TQM process breaks down barriers between departments.
“That’s not my job” phrase should be eliminated and departments should work together as a
team and it can lead to teamwork, productivity and patient positive outcomes.
Total Quality Management
Use of Quality Tools and Statistics for Measurement.
A common management adage is, “You can’t manage what you can’t (or don’t) measure.”
Tools for data analysis and display can be used to identify areas for process and quality
improvement, and then to benchmark the progress of improvements.
Deming develop a model he called the PDCA cycle (Plan, Do, Check, Act)
Total Quality Management
Identification of Key Processes for Improvement.
All activities performed in an organization can be described in terms of processes.
Processes within a health care setting can be:
Systems related (e.g., admitting, discharging, and transferring patients)
Clinical (e.g., administering medications, managing pain)
Managerial (e.g., risk management and performance evaluations).
Processes can be very complex and involve multidisciplinary or interdepartmental actions.
Total Quality Management
TQM is based on the premise that the individual is the focal element on which production
and service depend (i.e., it must be a customer-responsive environment) and that the quest
for quality is an ongoing process.
It is a philosophy developed by Edward Deming
Production and service focus on the individual and that quality can always be better.
Identifying and doing the right things, the right way, the first time, and problem-prevention
planning—not inspection and reactive problem solving—lead to quality outcomes.
Continuous Quality Improvement
Continuous Quality Improvement (CQI)
It is used to improve quality and performance and is a never-ending endeavors.
CQI means more than just meeting standards and solving problems. It involves evaluation,
actions, and a mind-set to strive constantly for excellence.
This concept is sometimes difficult to grasp because patient care involves the
synchronization of activities in multiple departments.
The importance of developing and implementing a well-thought-out process is key to a
successful CQI implementation.
There are four major players in the CQI process
Continuous Quality Improvement
Continuous Quality Improvement (CQI)
There are four major players in the CQI process:
Resource person
Coordinator
Team Leader
Team
Continuous Quality Improvement
The resource group is made up of senior management (e.g., CEO, vice presidents).
It establishes overall CQI policy, vision, and values for the organization and actively involves
the board of directors in this process, thereby ensuring that the CQI program has sufficient
emphasis and is provided with the resources needed.
The CQI coordinator is often appointed by the CEO to provide day-to-day management of
the CQI process and related activities (e.g., training programs).
CQI teams are designated to evaluate and improve select processes.
They are formally established and supported by the resource group. CQI teams range in
size from 5 to 10 people, representing all major functions of the process being evaluated.
Each CQI team is headed by a team leader who is familiar with the process being evaluated.
The leader organizes team meetings, sets the agenda, and guides the group through the
discussion, evaluation, and implementation process.
Benchmarking
Benchmarking
The process of measuring products, practices, and services against best performing
organizations as a tool for identifying desired standards of organizational performance.
Organizations can determine how and why their performance differs from exemplar
organizations and use the exemplar organizations as role models for standard development
and performance improvement
Benchmarking
Benchmarking
The process of measuring products, practices, and services against best performing
organizations as a tool for identifying desired standards of organizational performance.
Organizations can determine how and why their performance differs from exemplar
organizations and use the exemplar organizations as role models for standard development
and performance improvement
Performance Appraisal
Performance appraisals.
Employees are evaluated on their performance.
The primary purpose of performance evaluations is to give constructive feedback and is
esstential for employees to be professionally accountable.
It is a systematic, standardized evaluation of an employee by the supervisor, aimed at
judging the perceived value of the employee’s work contribution, quality of work, and
potential for advancement or promotion.
The employee’s work is measured against standards, and in that sense it is very much like
the quality improvement process.
Performance Appraisal
Performance appraisals.
Peer review in nursing is defined as the examination and evaluation of practice by a nurse’s
associates.
Self-evaluation is the aspect of performance appraisal whereby employees do self-
assessments of their own perceptions about their performance as compared with stated
objectives and expectations.
Component of a comprehensive performance appraisal system: determine the abilities
required for the position (job description); match the individual’s capabilities or abilities
with the job requirements (personnel selection); improve the abilities of the employee (staff
development); and using a motivational reward system to enhance employee performance
(reward system)
Performance Appraisal
Performance appraisals.
Job analysis should identify competencies required for job performance.
Job description should identify work standards and the knowledge, skills, and abilities
necessary for the job.
The performance appraisal specifies employee behaviors and compares job performance
with criteria.
Performance appraisal is a cyclical process that begins when the employee is hired and ends
when the employee leaves.
Performance Appraisal
Purposes of Performance appraisals.
For the employee, these include job productivity, compensation, job performance
recognition, and planning for professional development.
For the organization, they include worker requirements, job analysis, compensation
administration, training needs analysis, and employee promotion or discipline evaluation.
Performance management is focused on the job, involves continual evaluation, and is
participative.
If employees believe that the appraisal is based on their job description rather than on
whether the manager approves of them personally, they are more likely to view the
appraisal as relevant.
Goals of Performance Appraisal
Improve performance
Improve communication
Reinforce positive behavior
Communicate about and ultimately correct negative or less-than-optimal behaviors
Provide a basis for rewards, which also is a basis for motivation
Provide a basis for termination if necessary
Identify learning needs and develop personnel
Common Errors in Performance Appraisal
Recent behavior bias
Occurs when the rater remembers primarily the employee’s most recent behavior rather
than the entire rating period.
Horn effect
The employee’s rating is very low because of the error committed.
Halo effect
Occurs when a manager perceives one positive aspect of an employee’s characteristics or
her performance and generalizes it into an overall high rating
Similar-to-me effect
Occurs when a manager rates the employee performance higher when a person is
accurately or inaccurately perceived to have the same characteristics as the manager
Common Errors in Performance Appraisal
Logical Error
It refers to the first impressions of the rater to the ratee.
Central Tendency Error
This rates the staff as average because tools are inadequate and not sufficient time for the
rater to observe the ratee.
Hawthorne’s Effect
The behavior of the ratee changes simply because rater observes him.
Nursing Audit
An audit is a systematic and official examination of a record, process, structure,
environment, or account to evaluate performance
Auditing in healthcare organizations allows managers to apply the control process to
determine service quality.
Auditing can occur retrospectively, concurrently, or prospectively.
Retrospective audits refer to examining patient’s records after discharge.
Concurrent audits are performed while the patient is receiving the service.
Prospective audits attempt to identify how current interventions will affect future
performance.
The audits most frequently used in quality control include the outcome, process, and
structure audits.
Nursing Audit
Nursing Audit is the examination of records and verification of nursing care activities to
measure quality care which is determined through systematic critical analysis of nursing
records.
Nursing audit is an exercise to find out whether good nursing practices are followed (Walfer
Gostler n.d)
The audit is a means by which nurses can define standards from their point of view and
describe the actual practice of nursing.
Joseph, Elizabeth. n.d. Basics for Nursing Audit. Wockhardt Hospitals. Retrieved from
[Link]
Purposes of Nursing Audit
Joseph, Elizabeth. n.d. Basics for Nursing Audit. Wockhardt Hospitals. Retrieved from
[Link]
Purposes of Nursing Audit
Joseph, Elizabeth. n.d. Basics for Nursing Audit. Wockhardt Hospitals. Retrieved from
[Link]
Budgeting
Budgeting is a process of planning and controlling future operations by comparing actual
results with planned expectations.
The main purpose of a nursing budget is to determine how to allocate the fiscal resources
necessary to accomplish the objectives, programs, and activities of nursing services
Definition of Terms in Budgeting
Budget is defined as a written financial plan to control resource allocation.
A budget is used to manage programs, plan for goal accomplishment, and control costs.
A budget is based on what is known about how much was spent in the past and how that
will inevitably change in the coming year.
Definition of Terms in Budgeting
Expenses are defined as the costs or prices of activities undertaken in the organization’s
operations.
Revenues are income or amounts owed for purchased services or goods.
Total operating expenses result from summing the costs of all resources used to provide
services.
Total operating revenues are the result of multiplying the volume of services provided by
the charges (rate) for the services.
Income is the excess of revenues over expenses, or revenues minus expenses, for a given
time (Johnson & Carpenter, 1990)
A variance is the difference between the budgeted and the actual amounts.
A budget becomes a financial timetable and plan for the organization that is translated into
monetary terms.
Types of Budget
1. Operating Budget
is the overall plan for a nursing department and accounts for expenses and revenues related
to the day-to-day operation of the nursing unit for a fiscal year, which is a 12-month period
that either typically coincides with the calendar year or runs from July 1 to June 30.
The operating budget includes all unit expenses (e.g., costs related to providing care to
patients) and revenues (e.g., income from providing such services).
Types of Budget
2. Personnel Budget
allocates expenses related to nursing personnel, Include personnel salaries, which include
normal wages, overtime, paid holidays, benefits, shift differentials, and other paid time.
To develop the personnel budget, nurse leaders and managers must consider some core
staffing concepts.
Types of Budget
2. Personnel Budget
First, they must determine the full-time equivalents (FTEs) needed to staff their unit to
maintain safe,patient care for 24 hours per day, 7 days per week, 52 weeks per year (Finkler
& McHugh, 2008).
An FTE position equals 40 work hours per week for 52 weeks a year, or 2,080 hours per
year.
3. Capital Budget
It includes equipment, furniture, technology hardware and software, and building
renovations, and it is separate from the operating and personnel budget processes
Expenses
include the total cost of running the nursing unit such as office supplies, surgical supplies,
and medications.
Fixed expenses include administrative salaries, rental or mortgage payments, insurance
premiums, utilities, and taxes.
Variable expenses include patient care supplies, medications, linen, and food.
Expenses
If the number or acuity level of patients increases, more supplies, medications, linens, and
food will be needed, resulting in higher variable expenses
The personnel budget is also an example of a variable expense because staffing can vary
depending on the patient census and level of acuity.
Expenses
Direct expenses directly affect patient care and include the costs of providing patient care.
Ex. personnel salaries, medical and surgical supplies, and medications
Indirect expenses are necessary for daily operations of the organization but do not affect
patient care.
Expenses
Examples of indirect expenses include utilities, building maintenance, and salaries of
ancillary staff members such as security guards or parking attendants.
Revenues is income from services provided and varies depending on the type of unit and
organization
Ex. patient visits or procedures (Anderson & Danna, 2013 grants, donations, gifts,
Medicaid, Medicare, and income from gift shops, parking fees, and vending machines.