Controlling or evaluating is an

on-going function of
management which occurs
during planning,organizing and
directive activities.
Opens opportunities for
improvement and compares
performance against set standards.


Controlling
Reasons for Conducting
Evaluation
1. Evaluation ensures that quality nursing care
provided.
2. It allows for the setting of sensible objectives and
with men
3. It provides standars for establishing comparisons.
4. It promotes visibility and a means for the
employees to monitor their own performance.
5. It highlight problems related to quality care and
determines the areas that require priority
attention.
6. It provides an indication of the costs of poor
quality.
7. It justifies the use of resources.
8. It provides feedback for improvement.


Evaluation Principle
1. Must be based on the behavioral standars of performance
which the position requires.
2. There should be enough time to observe employees behavior.
3. The employee should be given a copy of the job description,
performance standars and evaluation.
4. The employees performance appraisal should include both
satisfactory and unsatisfactory results with specific behavior
instnces to exemplify there evaluative comment.
5. Areas needing improment must be prioritized to help the
worker upgrade his/her performance.
6. Should be scheduled and conducted at a covineint time for
the rater and the employee under evaluation in a pleasant
surrounding and with ample time for discussion.
7. Perceived and accepted positively as a mean of improving
job performance.
The evaluation tool should be OBJECTIVE, RELIABLE
and SENSITIVE.
Objectivity means free from bias.

Reliability- accuracy or precision of the tool such
that it will produce the same results if administered
twice.

Validity-relevance of the measurement to the
performance of the employee while sensitivity means
the instrument can measure the fine lines of
differences among the criteria being measured.
Characteristics of an
Evaluation tool
Basic Components of the
control process

1. Establishment of standards, objectives and methods
for measuring performance
2. Measurement of actual performance
3. Comparison of results of performance using
standards and objectives and identifying strengths
and areas for correction and/or improvement
4. Action to reinforce strengths or successes
5. Implementation of corrective action as necessary
Establishments of Standards
for measuring Performance
Standards on
structure
-focus on the
structure or
management
system used by
the agency to
deliver care.
Process standards
-decisions and
actions of the
nurse relative to
the nursing
process which are
necessary to
provide good
nursing care.
Outcome
Standards
-measures the
results of care
provided in terms
of changes in the
health status of
clients served.
Establishment of Objectives
and Methods
Measurable criteria or objectives must be
developed to evaluate process and outcome.
The most commonly method used are task
analysis and quality control.

Quality control refers to the activities and
techniques employed to achieve and maintain the
quality of a product, service or process.
Tasks analysis uses tools such as time studies and
checklist.
Measuring Actual
Performance
Measurement of performance is an on-
going, repetitive process with the actual
frequency dependent on the type of
activity being measured.
It may be scheduled advance, may be done
periodically but unannounced intervals or
may occur at random.

Comparing Results of
performance with Standards and
Objectives
If the performance matches the
standards and objectives, managers are
assured that the needs of patients are
met.
If performance is contrary to standards
and objectives, necessary action are
applied to improve performance.
Reinforcing Strengths or Successes
and Taking Corrective Action as
Necessary

Positive feedback stimulates
motivation, consistently high
performance and growth of the
employee. Corrective actions
are applied to improve
performance.



Responsibility of the
Head/Senior Nurse
Being at the first level of supervision, the Head / Senior Nurses
are in the best position to know whether their staff nurses
perform satisfactorily at work. Their influence has an impact on
promoting quality care to patients.
They have the responsibility to instruct subordinates regarding
the appropriate methods and procedures in providing nursing
care.
They should inform the staff of the likely causes of errors or
defects and preventive measure necessary.
They should initiate and / or facilitate any steps necessary to
improve methods, equipment, materials and conditions in the
work area for which they are responsible.
The feeling of responsibility to render quality performance
must be instilled in all employees for them to follow agreed
upon written procedures and use materials and equipment
correctly as instructed



PERFORMANCE
APPRAISAL

It is a control process in which a
employees performance is evaluated
against standards.
is the most valuable tool in
controlling human resources and
productivity.


Purposes


Determine salary standards and merit increases.
Select qualified individuals for promotion or
transfer.
Identify unsatisfactory employees for demotion
or termination.
Make inventories of talents within the
institution.
Determine training and developmental needs of
employees.
Improve the performance of work groups by
examining, improving, correcting
interrelationships between members.




Improve communication between
supervisors and employees and reach an
understanding on the objectives of the job.

Establish standards of supervisory
performance.

Discover the aspirations of the
employees and reconcile these with the
goals of the institution.

Provide employee recognition for
accomplishments.

Inform employees where they stand.









FACTORS CONTRIBUTING TO AN EFFECTIVE
PERFORMANCE APPRAISAL SYSTEM
1. Compatibility between criteria for individual
evaluation and organization goals.
2. Direct application of the rated performance to
performance standards and objectives
expected of the worker
3. Deployment of behavioral expectations which
have been mutually agreed upon by both the
rater and the worker.
4. Understanding the process and effective
utilization of procedure by the rater


5. Rating of each individual by the immediate
supervisor
6. Concentration on the strengths and weakness to
improve individual performance
7. Encouragement of feedback from the rated
employees about their performance needs and
interests.
8. Provision for initiating preventive and corrective
action and making adjustments to improve
performance.
Methods of Measuring
Performance
INFORMAL
may consist of
incidental
observation of
performance while
the worker is
engaged in
performing nursing
care or by
responses made by
worker during
conferences
interaction of
worker with clients,
their families ,
visitors and co-
workers should also
be noted.

FORMAL
is accomplished
regularly and
methodically by
collecting objective
facts that can
demonstrate the
difference between
what is expected
and what was done.
this methods
include essay,
checklist, ranking,
rating scale, forced-
choice comparison,
and anecdotal
records.

Essay
The appraiser writes a paragraph or more about the
workers strengths, weakness and potentials.
Essays appraisals carry significant weight on the
presumption that an honest statement from someone
who knows the person well is valid.

Checklists
A checklist is a compilation of all nursing performances
expected of a worker. The appraisers task is to mark
the appropriate column whether the worker does or
does not show the desired behavior.



Ranking
In simple ranking, the evaluator ranks the
employees according to how he or she fared with
co-worker with respect to certain aspects of
performance or qualifications.

Rating Scales
A rating scale includes a series of item
representing the different task or activities in the
nurses job description or the absence or presence
of desired behaviors and the extent to which
these are possessed.



Forced-choice Comparison
In this method, the evaluator is asked to choose the
statement that best describes the nurse being
evaluated. The items are so grouped that evaluator is
force to choose from favorable as well as unfavorable
statements and to counter the tendency towards
leniency by some evaluator.
Anecdotal Recording
It describes the nurses experience with a group or a
person, or in validating technical skill and
interpersonal relationship.
The anecdotal records should include
1. A description of the particular occasion
2. A delineation of the behavior noted including
answers to the question who, what, when, and
how
3. The evaluators opinion or assessment of the
incident or behavior



WHAT IS QUALITY
ASSURANCE?
It is a process of evaluation that is applied to the
health care system and the provision of health care
services by health workers.

TOTAL QUALITY
IMPROVEMENT
-Is a way to ensure customer
satisfaction by involving all employees
in the improvement of the quality of
every product or service.
Is a process of
continuously improving a
system by gathering data
or performance and using
multidisciplinary team to
analyze the system,
collect measurements,
and propose changes.
Continuous Quality
Improvement
PRINCIPLES UNDERLYING QUALITY
ASSURANCE EFFORTS



1. All health professionals should collaborate in the effort
to measure and improve care.
2. Coordination is essential in planning a comprehensive
quality assurance program
3. Resource expenditure for quality assurance activities is
appropriate.
4. There should be focus on critical factors such as
functions and activities that promise to yield the greatest
health and financial benefit to reveal significant findings.
5. Quality patient care is accurately evaluated through
adequate documentation.
6. The ability to achieve nursing objectives depends upon
the optimal functioning of the entire nursing process and
its effective monitoring.
7. Feedback to practitioners is essentials to improve
practice. It perpetuates good performance and replaces
unsatisfactory interventions with more effective
methods.




8. Peer pressure provides the impetus to effect
prescribed changes based on the results of
assessments and needed improvements on the
quality of care
9. Reorganizations in the formal organizational
structure may be required if assessment reveal the
need for a different pattern of health care.
10. Collection and analysis of data should be utilized
to motivate remedial action.


WHAT IS QUALITY
ASSURANCE AND
PERFORMANCE EVALUATION?
Performance Evaluation
-focuses on the worker. It asks questions about
how well the worker satisfies the requirements of his or her job
within the organization.

Quality Assurance
-focuses on the care and service the patient
receives than on how well the professional performs the duties
the duties that the position requires.



Several methods:
Concurrent and retrospective
patient care audits
Patient care profile analysis
Peer review
Quality circles

Quality Assurance Methods
-purpose is to measure and
improve the quality of nursing delivered in the
agency.
Developing Quality
Assurance Criteria
Structure Approach

includes physical
setting,
instrumentalities
and conditions
through which
nursing care is
given such as the
philosophy and
objectives, the
building,
organizational
structure, financial
resources, and
equipment
Process Approach

includes the steps
in the nursing
process in
compliance with
established
standards of
nursing practice.

Outcome Approach

identifies
desirable
changes in the
patients health
status such as
modification of
symptoms, signs,
knowledge,
attitudes,
satisfaction, skill
level, and
compliance with
the treatment
regimen.

Nursing Audit Committee
A nursing audit is composed of a
representative from all levels of the
nursing staff:
A member of the training staff
Supervising Nurse
Head/Senior Nurse
Staff Nurse

Patient Care Audits

Concurrent Audit
1. Is one in which patient
care is observed and
evaluated. It is given
through:
2. A review of the patients
charts while the patients
are still confined in the
hospital.
3. Observation of the staff
as patient care is given.
4. Inspection of patients
and/or observation of
the affects of patient
care where the focus is
on the patient.
Retrospective Audit
-Is one which patient
care is evaluated
through
A review of discharged
patients charts;
Questionnaires sent to or
interviews conducted on
discharged patients.


Peer
Review

-Patient care audits may be
done by peers (employees of
the sane profession, rank,
and setting) evaluating
anothers job performance
against accepted standards.

Quality
Circles
-One of the most publicized
approaches to quality control
introduced by the Japanese.

-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
solutions to management.
Utilization
of Results

- The Nursing Staff in the
unit is given a feedback on
the results of the quality
assurance study.

-Positive Feedback reinforces
desirable performance.
Consistent positive findings
deserve a commendation
from the nursing service.

-Negative Feedbacks should
tactfully be conveyed in a
face-to-face situation so that
assessment results may
easily be clarified.
Control of Resources

-Part of the control process is the periodic review
of the utilization of materials and supplies in the
various nursing units.

-Requisitions of and/ or stocking a large number
of supplies and materials should be avoided to
prevent pilferage, misuse, or spoilage.



DISCIPLINE

-Discipline meant rigid obedience to rules and
regulations, the violation of which resulted in
punitive actions in the past.

-Discipline is regarded as constructive and
effective means employees take personal
responsibility for their own performance and
behavior.




Factors that influence self discipline

1.A strong commitment to the vision, philosophy,
goals and objectives of the institution

2.Laws that govern the practice of all professionals
and their respective codes of conduct.

3.Understanding the rules and regulation of the
agency.

4.An atmosphere of mutual trust and confidence

5.Pressure from peers and organization.


Disciplinary Approaches
This should include a set of
disciplinary policies and procedures, a uniform
application of discipline rules, a disciplinary
committee, and an orientation program for all
new employees were expectations of
appropriate performance and behavior are
emphasized. There must be continuous
communication to all employees regarding
changes in personnel and discipline policies.



Disciplinary Action
Any employee charged for breach of
the rules and regulations, policies, norms of conduct
shall be given due process.
-Should be progressive in nature such as
counseling and oral warning, suspension and
dismissal



Counseling and Oral warning
-The employee is given a fair chance to air
his/her side
-the relevant facts are analyzed and evaluated
against his/her past performance.
Written warning
-it is preceded by an interview similar to the oral.
-the employee must be told after the interview
that he/she will be given a written warning.
-includes statement of the problem, identification
of the rule which was violated, consequences of
continued deviant behavior, the employees
commitment to take corrective action, and any
follow up action to be taken.
Suspension

-given after an evidence of oral and written
warnings.
-this is applied when the management feels
that the employee can still be rehabilitated.

Dismissal
-the Disciplinary Committee should be very sure
that the cause for dismissal conforms with the
criteria of a major discipline violation as
contained in the policy manual.
-invoked only when all other disciplinary
efforts have failed.