Debre Brehan University School of Health Science Program of Nursing Nursing Service Administration and Leadership Lecture Note

Prepared b y Tesfa D. (B.Sc.)

Unit-one
Introduction to nursing service administration

Management
Definitions: Is a cumulative body of information that furnishes insight for managers on how to manage the organization to reach organizational goal. Is the art of getting things done through people and other organizational resource. Is the process of planning, organizing, leading, controlling, directing, coordinating, and influencing the operation or work of organization and organization members to obtain the desired result and enhance the total performance. More of executive function rather than determinative function. Universal practice, and as old as human kind existence.

Administration
Is an over all determination of policies and major objectives. More of determinative function rather than executive function. Functionally; o Is the laying down of the general purpose of the organization. o The framing of its major policies. o The formulation of general plan of procedure. o Inauguration of broad program. o The approval of specific major project.

Remember
Manager can be an administrator and vice versa. As we go down the hierarchical ladder of the organization, the administrative function became less and less and the management function become more and more.

Nursing service administration

Is a coordinated activity, which provides all of the facilities necessary for the rendering of nursing service to clients. Is the marshaling of a resource to accomplish a purpose. Is the process of planning, organizing, leading and controlling that encompasses human, material, financial, time, space, and informational resource in an organizational environment to achieve the predetermined goal or objective. The primary objective of NSA is the provision of continuous individual, group and community service to the optimum level.

There are three levels or types of manager in organization.

Type or level of manager

These are; 1. Top level manager: Have authority over and responsibility for the entire organization. For example; board of director, president, vice president, nsg administrator. 2. Middle level manager: Act as a liaison b/n top and low level manager. For example; director of nsg, supervisory staff 3. Low level manager: Known as first line or front line or supervisory manager. Over seeing specific work for a particular group of works. For example; dpt leader/head.

Figurative representation
Administra tion

Managem ent

Remember
The primary difference b/n each level of manager is;

Degree of authority Scope of responsibility Organizational activity

Common attribute
Responsible for utilizing resources. Accountable to superiors for results. Formally appointed to position of authority. Charged with directing and enabling others to do their work effectively.

Skill of manager
Manager can also be differentiated by the extent to which they use certain

skills.
There are three managerial skills these are; 1. Conceptual skill 2. Human relation or interpersonal skill 3. Technical skill

Contd
The degree to which each managerial level uses those skills varies based on;

The nature of position Scope responsibility Work activity Number, type, and skills of subordinates.

Contd
There fore ; Senior manager or top managers use more conceptual skills than middle or low level manager. B/c senior manager: Recognize and evaluating multiple complex issues. Engage in planning and problem solving that profoundly affect the HSO. Think globally about the organization and its environment.

First level manager use more technical skills than other skills, b/c this level of manager involve specialized knowledge i.e. directly r/t practice. Interpersonal skill used equivalently by all level of managers.

Contd

Role of manager
Based on Mentize bergs classification there are three major role of mangers. These are; 1. Interpersonal or communication role:
There are three interpersonal communication role of manager. These are;

A. Figure head: All manager especially senior managers are figure head.
The manager is the representative of the whole organization on every situation that concerns the organization. E.g. greeting visitors,

making speech at organization event (forum).

Contd
B.Liaison: The manager is the is channel of communication by telephone, post, letter, eye contact in all of four direction. Involves formal and informal internal and external contact. C. Influencer: Include activities inherent in the directing function, for the purpose of which is to motivate and lead. The manager changes the b/r or mind of the followers by being not

by doing.

Contd
2. Informational roles: There are three informational role of a manager .These are; A. Monitor: The manager check the day to day activity of the members in the organization. B. Disseminator: The manager collects information from the outside environment and gives for the organization and disseminates information with in the organization from one member to another. C. Spokes person: The manager gives information about the organization to any concerned body. E.g. to government agencies, media or press, customer.

Contd
3. Decisional roles: A. Entrepreneurs: Inventing work literally. By seeing the environment or the situation, by working long term research the manager recognize problems and opportunities and initiate new action to move the organization to the desired direction. B. Disturbance handler: The manager control conflict or unexpected event outside the company that may affect based on the organization point of view or ground rule.

Contd
C. Resource allocation: The manager allocates resource by dividing the resource and personal time for various demands in the organization. E.g. assigning work to members, scheduling meeting, approving budget e.t.c D. Negotiator: represents the managerial role on the firm in financial matter. E.g. the manager is a negotiator when a company tries to buy material for the organization.

The benefit of good management in HSO

High lights priority areas. Adopts the service to the needs of a changing situation. Makes use of the most limited resources. Improves the standard and quality of services. Maintain high staff moral.

Management function of a nurse manager in health care setting I. Planning: Determining the long and the short
term objectives (ends) of the institution or unit and the actions (means) that must be taken to achieve these objectives. II. Staffing: Selecting the personnel to carryout these actions and placing them in positions appropriate to their knowledge and skills. III. Organizing: Mobilizing human and material resources that institutional objectives can be achieved.

Contd
IV. Directing: Motivating and leading personnel to carryout the actions needed to achieve the institutional objective. V. Controlling: Comparing results with predetermined standards of performance and taking corrective action when performance deviates from these standards. VI. Decision making: Identifying the problem and searching for solution and selecting the alternatives that best achieves the decision makers objective.

Leaderships
Is the ability to inspire and influence others to follow toward destiny. Is b/r not by doing but by being. Is a trusted privilege offered by followers. Is the ability to elicit a vision from people and empower these people to do what it takes to bring the vision in to reality.

Leader
Is an individual who works with others to develop a clear vision of the preferred future and to make the vision happen .This is called enlightened leadership. Bring the best in people by empowering people.

Contd
There are two types of leader. These are: I. Proactive: The leader that anticipates solution for a problem before the problem occurred. II. Reactive: The leader that anticipate solution when the problems are occurred. N.B.
Leaders often are not even the organization. Informal leaders are not always managers performing managerial function.

Followership
Characters or b/rs exhibited by followers being lead by leader in order to reach the desired destiny.

Comparison b/n leader and manager

Leader
Innovator Original person Develop system Focus on the mind of people Have long range perspective Ask what and why question Do analytic research Originate things Challenge statuesque Do right things Owns person

Manager
Administrator Copy person Maintain system Focus on system and structure of person Have short range perspective Ask how and when question Do descriptive research Imitates things Accept statuesque Do things right Come from headship Focus on results, analysis of failure

Principle of nursing leadership

There are a number of leadership principles based on the perspectives of d/t theories. Early leadership theories 1) Trait theory;
Believed that leaders are born, not grow or made. Assumes a person having innate abilities, personality trait or other xtics and naturally better than others. Focus on who the leader is.

Contd
2) Behavioral theory; Sometimes called functional theory of leadership. Believed that a person who can do better or who influence more are better to be a leader. Focus on what a leader does. More of action oriented and consider the co-actors.

Contd
3) Great man theory ;
Believed that there is a special nature or xtics of a person that made great men. E.g. Caesar, Hitler, Alexander the great.

4) Individual xtics theory;

Believed that to be a leader, a person must have /be physically huge, pervasive, muscular, energetic, tall e.t.c. personal xtics.

5) Charismatic theory;
Believed that a leader with a special supper natural/human ability to influence and lead others with miracles. Leader called they are sent from God. E.g. H.seillasie, Mosses, Mohammed.

Contd
Situational leadership theories A. Contingency theory
Formulated by Fredler. According to this theory there are three situational variable affecting leadership effectiveness to predict the favorability of a situation for a leader. These are; i. Leader-member relations. ii. Degree of task structure iii. The leader legitimate power or position power

Contd
Generally according to the contingency theory a nurse manager should modify situation based on the above variable to improve staff productivity and use this theory by understanding these variable.

Contd
B. Path-goal theory Formulated by Robert house. Introduced in 1971. Concerned with motivation and productivity. For work accomplishment employees should be rewarded and motivation.

Contd
Contemporary leadership theory 1. Theory X Formulated by Douglas McGregor. More of conventional approach. It is based on the common view of human nature Believes that an ordinary person is ; Lazy Un motivated Irresponsible

Contd
Not too intelligent Prefer to be directed rather than acting independently They do not work and care for organizational goals but they work as hard as they must keep their works. They avoid taking additional responsibility. With out specific rules and punishment most workers would come in late and produce careless work.

Contd
There fore according to theory x; Leaders must direct and control people in order to ensure that work is done properly. Detailed rules and regulation need to be developed and strictly enforced. People need to be told exactly what to do and how to do it. Close observation is necessary

Contd
2. Theory Y More of humanistic approach. Believes that b/r described in theory X is not inherent in human nature but a result of mgt emphasis on control, direction, reward, and punishment and these behaviors are the symptoms of poor leaderships.

Contd
There fore according to theory Y; o Work itself can be motivating, rewarding people. o People can be enthusiastic. o They can be trusted. o Under right condition the ordinary person can be imaginative, creative, and productive.

Contd
3. Theory Z Formulated by Ochi (1981). Expanded and enlarged on theory Y. Participative approach or democratic approach to leader ship. It has a humanistic view point and focuses on developing better ways to motivate people, assuming that this will lead to increase satisfaction and productivity.

Contd
There are five elements of Ztheory. These are; 1. Collective decision making. 2. Long term employment. 3. Slow promotion. 4. Indirect supervision. 5. Holistic concern.

Contd
Transformational leadership theory Believes that a transformational leader is one who commits people to action, who convert followers in top leaders and who may convert leaders into change agent. Leadership is thus not so much the exercise of power itself as it is the empowerment of others.

Leadership style
There are three leadership styles. These are; 1. Authoritarian. A. Benevolent (paternalistic)lovely punishment. B. Dictatorship 2. Democratic. 3. Laissez-Faire.

Comparisons b/n Characteristicsleadership style Leadership style

Authoritarian Democratic
Degree of freedom Degree of control Little High Moderate moderate Both Moderate Shared

Laissez faire
Much No control Member Minimal Relinquish(resig n or bow out ) Variable may be poor quality In efficient

Decision making Leader Leader activity level Assumption of Responsibility Out put of the group Efficiency High Leader

High quantity, good quality Very efficient and

Creative, high quality Less efficient than

Becoming a manger who lead

If you look to lead, invest at least 40 percent of your time managing your ethics, character, principles, purpose, motivation, and conduct. Dee hock To get a better picture of what leadership is, think of a leader you respect and know personally, someone who inspires you. The person may be a parent, teacher, political figure, religious leader, supervisor, or friend.

Contd
Then answer those question about the leader who inspires you. Some of the question are; What kind of person is s/he? How does s/he see the world? What does s/he value? How does s/he treat other people?

Contd
People are drawn to leaders because of who they are and the way they relate to others. They help people to think bigger than they may have before. They encourage individuals to take on challenges that they may not have previously thought they could. They support people in their eff orts to forge ahead.

Shift your mindset

To become a manager who leads, you need to gradually shift your mindset toward seeing yourself as someone who mobilizes and empowers others to create the future. To shift your mindset, it is critical to know your values, because they will influence the kind of future you can create and will guide and sustain you on your journey.

Mindset
It is a habitual way of interpreting and responding to situations. Peoples assumptions and beliefs about the world affect their actions. To take a stand and face a challenge, you may need to change how you see a situation, what you focus on and value, and then what you do.

Leader shifts

Remember
To improve your abilities to lead, as well as manage for results, you need to: Empower yourself and others to face challenges. Link leading and managing to positive outcomes. Strengthen your leading and managing practices. Become skilled in using the leading and managing practices.

Building leadership competencies

Leadership competencies are the specific mindset, skills, and knowledge that help managers lead more effectively. There are eight leadership competencies. These are;

1. Master yourself
Reflect on yourself. Be aware of your impact on others, Manage your emotions effectively, use your strengths, and Work on your shortcomings

2. See the big picture

Look beyond a narrow focus to take into account conditions outside your immediate area of work.

3. Create a shared vision

Work with others to envision a better future and use this vision to focus all your efforts

4. Clarify purpose and priorities

Know your own values and what is most important to accomplish.

5. Negotiate conflict
Reach agreements from which both sides can benefit.

6. Communicate effectively
Hold conversations focused on outcomes. Balance advocacy with inquiry. Clarify assumptions, beliefs, and feelings within yourself and others.

7. Motivate committed teams

Create the clarity, trust, and recognition necessary to lead teams to high performance that can be sustained over time

8. Lead change
Enable your work group to own challenges, enlist stakeholders, and navigate through unstable conditions.

Nurse s function or role as a leader

1. Know your objective and have a plan for reaching them. 2. Build a team committed to achieving those objectives. 3. Help each team member to give his or her best effort. 4. Achieving goals depends on teamwork. 5. Explain the why as well as the what .

Contd
6. Set a clear standard. 7. Encourage involvement. 8. Build a positive working r/ship. 9. Keep your team informed. 10. Strive to be fair all employees at all times. 11. Be understood. Keep in mind that every one makes mistake occasionally. When you must criticize, be constructive and tactful.

Contd
12. Build an atmosphere of respect among team members. 13. Put the team first. Make it clear that you are more interested in the groups achievements than in the personal gain. 14. Use d/t leadership style

Contd
15. Develops skills or qualities of leader. i.e. is; Positive-They believe in themselves and others,
and the contributions they can make. that others may dismiss as possible.

Enthusiastic-They are willing to tackle tasks Committed to excellence-They are always

looking for new and better ways to do things.

Contd
Self-confident-They are willing to
make decisions even when these are unpopular.

Sincere-When they make a

promise; they do all they can to keep it.

Open to new ideas-They realize

they do not have all the answers.

Unit-two
Human resource management

Definition of terms
Human resource management:- is the process of acquiring and retaining the organization human resource. Nursing personnel management:- is the process of acquiring and retaining nurse personnel in the health care organization or health educational institution.

1. Acquisition activity
Human resource planning Recruitment Selection Orientation

Human resource planning

Refers to planning for future personnel needs of an organization (includes expansion and development of an organization). Takes into account both internal activities, and factors in the external environment. Human resource planning precedes the other acquiring activities.

Contd
Planning procedures includes ; Planning for future needs Planning for future balance (number needed versus present) Planning for recruiting Planning for the development of employees

Contd
The driving force of staff need in HSO 1. Organizational growth. Due to; Increased demand for service by the organization Addition of new service Higher occupancy Facility expansion

Contd
2. Staffs turn over. Due to; Resignation Discharge Retirement

Contd
Human resources planning have five steps. These are; 1. Profiling:-To profile or show the personnel need of the organization at some future point. 2. Estimating:-Projecting or transferring or designing the type and the number of personnel needed. 3. Inventorying:-HR audit of present employees.

Contd
4. Forecasting:-Anticipating change in the present work force in terms of entries and exits. 5. Planning:-Based on the above assumptions determine the number and type of employee with the required knowledge, skill and practice.

Contd
Human resource Sources 1. Internal Sources:-filling vacancies by transferring or promoting from within the organization. Advantage
It is cost effective, reduces recruiting and relocation costs Usually quicker, and Enhances employee morale

Disadvantage
Seniority rules policy rather than best qualification

Contd
2. External sources New employees from outside. Through;
Advertising vacancies, Visits to colleges and universities, Contacts with public and private employment agencies, and Participation in professional organizations.

Contd
Advantage
Best qualified individual will be recruited It avoids seniority rules and policy

Disadvantage
It is costy Not quicker/late Decrease employee morale

Recruitment
Is the process of attracting qualified people to apply for a job. Or Is the process of making applicants available for selection. Activities in recruitment; 1. Writing job description:-a written description of a non-management job, covering/job title, duties, and responsibilities, and including its location on the organization chart.

Contd
2. Writing position description:- a written description of a management position, covering the title, duties and responsibilities, and including its location on the organizational chart. 3. Writing hiring specification:-a written description of the education, experience, and skills needed to perform a job or fill a position effectively

Contd
Sources for recruitment depend on:
Type skill required (or nature of position) Environmental factors (demand) Local labor pool (availability)

Contd
Affirmative action: giving priority for females and minorities (this is in practice in Ethiopia) Give examples of implementation of affirmative action in Ethiopia. Equal payment : like pay for like jobs (Equal Pay Act USA). Comparable worth: the principle that different jobs that require compare skills and knowledge deserves comparable pay

Contd
Methods of recruitment;
Peer recruiter (advantage: well informed, person is identified). Within the organization (advantage: familiar, inspiring, less expensive). Outside the organization (e.g. colleges, graduate schools, other organizations). Formal announcement (mass media).

Contd
Legal considerations during recruitment
The Laws: it is good to know what the law says in a country or a nation. For instance the laws;

Prohibiting discrimination by: Race, Sex, Age, Color, National origin. E.g. Civil Rights Act of 1964(USA). Discuss how this law or principle is practiced in Ethiopia. Equal employment opportunity: citizens have equal right to be employed as long as they fulfill requirement for a job. E.g. in USA it applies to both public and private sectors. Discuss how this principle is applied in Ethiopia especially in the regions

Selection
It is the process of choosing for employment. It is to choose among the applicants using job qualification as a guide. The essence of selection is to determine whether an applicant is suited for the job in terms of training, experience and abilities. The organization decides whether or not to make job offer and the candidate decides whether or not to accept it.

Contd

Contd
The source of information for selection are; Application forms Pre-employment interview Testing

Contd
selection process The process depends on:1. The level of placement of employee in the organization hierarchy
Lower level: routine (for example recruitments of guards, cleaners, or, low level employees) Middle or upper level: extensive and carefully planned - in-depth interview (for example professionals, administrators).

Contd
2. Information exchange (organization to candidate)
The organization may exaggerate its strength (exaggeration of organizational values and achievements) The candidate may overestimate his or her quality (exaggeration of personal achievements and abilities). It good if the candidate provides realistic job review (strength and weaknesses)

Contd
The candidate may pass through the following process; 1. Complete job application (applicable in many organizations). 2. Initial screening interview (to filter the type of candidate required). 3. Testing (some big organizations follow this method). 4. Background investigation (contacting previous employers or schools, etc).

Contd
5. In-depth selection interview (competition among the possible candidates) 6. Physical examination (this is usually a requirement when the job is about to be offered) 7. Job offer(the candidate wins a position and the official offer comes from the organization)

Orientation/socialization
It is a program designed to help employees to fit into the organization smoothly. Types of information provided General information:-routine activities (universal precautions). About the organization:-history, purpose, operation, values, structure, philosophy, services /products,, expected contribution of the employee to the organization Detailed presentation:-policies, rules and regulations, issuing an identification badge, benefits plans, brochure.

Contd
Employee concerns
Anxious because of new environment. Perception of the tasks and performance. Experience in relation to job and organization. How to go along with other employee. Personal and family problems.
Solutions :-Socialization programs:

Provide information, introduce, encourage questions.

Contd
Advantage;
Builds employees sense of identification in the HSO. Helps to get acceptance by fellow workers. Give them a clear understanding of many things they need to know. Enables the new employee to become familiar with the entire organization as well as their own work area and dpt.

2. Retention activity
Personnel training and development Performance appraisal Placement Discipline and corrective counseling Staff development

Contd
Compensation and benefit administration Health Motivation Promotion Personnel policy

Personnel training and development

Personnel training is the formal procedure which an organization utilizes to facilitate learning. Training is a management tool designed to enhance organization's efficiency and attain the goals of both the organization and the individual. For managers: conceptual and human skills (future). Non-managers: technical skills (current job).

Contd
Management development program To improve knowledge and skills of managers (for effectiveness and promotion). Now a days frequently used because experience takes time. Costly . Some prefer to providing practical job experience.

Contd
Assessing training needs Procedures to determine training needs of individuals; 1.Performance appraisal: measure work against the standards 2.Analysis of job requirements: job requirements/available skill. 3.Organizational analysis: effectiveness of organization
Train those with low performance and high turnover

1.Employee survey: about problems faced and actions needed.

Contd
Approaches to training: A.On-the-job training : While employees are in job or duty.
Job rotation: variety working unit. Internship: combined classroom teaching. Apprenticeship: training under guidance of skilled co-worker.

Discuss about its advantage and disadvantage .

Contd
B. Off-the-job training: While workers are outside the work area or in cut of work until the training finished.
Vestibule training: training on realistic job setting or equipment. Behaviorally experienced training: simulation, exercises, cases, games, roleplaying (done outside the organization).

Discuss about its advantage and disadvantage .

Performance appraisal
It is a systemic review of an individual employee's performance on the job, which is used to evaluate the effectiveness of his/her work. Can be; Informal appraisal:-Feedback on day-to-day performance (strength/weaknesses). Formal systematic appraisal:-A systematic feedback about performance (semi-annually or annually).

Contd
Purpose of PA; Provide information for decision regarding salary praises, promotions, transfers or discharges. Helps to assist employees in their personal development.

Contd
Helps to assess the effectiveness of hiring and recruiting practices. Helps to identify training and development needs of the employees. Helps in the establishment of standards of job performances.

Contd
Common problem in PA;
Difficult to perform if the span of control is high. Standard and rates vary widely with some raters being tough and others are lenient. Leniency error - some raters are hard (below the true level i.e. is negative leniency) or easy graders (above the true level i.e. is positive leniency).

Contd
An appraiser may replace organizational standard with personal values and bias. Halo error is evaluations based on the raters general feeling about the employee. B/c of lack of information, standards by which employees think they are being judged are some times d/t from those superiors actually use. The validity of ratings may be reduced by the supervisors resistance to making the ratings.

Contd
Tools of performance appraisal; Rating scale-Consisting of b/r or xtics to be rated and scale that indicate fulfillment. Methods; Managers rating (commonest) Group of managers rating (second most commonest) Group of peers rating Employees rating of bosses combination of methods.

Contd
Check list-Consisting of a number of questions that measure the employees performance. Mgt by objective-Observation of predetermined goals that have been jointly agreed up on by the employee and the evaluator. Characteristics of an effective PA; Relate PA to the job description. Understand the criteria for evaluation.

Contd
Appraisal methods designed to avoid raters bias; The field review method- Comparison of several evaluators for the same employee. The forced choice rating method-The evaluator choose from among a group statements those that best describes the individual being evaluated and those that least describe this person. The critical incident technique-The supervisor observes, collect, and record instances of the employee carrying out responsibilities critical to the job.

Promotion
Moving to a higher position and responsibility To recognize outstanding performance Should be fair (merit-based) Problems:
Some maybe bypassed: morale and resentfulness Discrimination may occur: sex, race, age, and minority

Motivation
Is the force either with in or external to a person that arouses enthusiasm and persistence to peruse a certain course of action. A process of stimulating people to action to accomplish desired goal. Motivating: the management process of influencing peoples behavior based on the knowledge what makes people thick.

Contd
Basic assumptions about motivation Motivation is commonly assumed to be a good thing e.g. family, teachers. Motivation is one of several factors that goes into a persons performance e.g. ability, resources, conditions. Motivation is short supply and in need of periodic replenishment. Motivation is a tool with which managers can arrange job relationship in organizations.

Contd
Motivation issues for managers of health service organizations Entering the organization. : attractiveness Remaining in the org.: attachment and attractiveness Attendance: motivation of employee to work regularly, punctually and predictably Performance: quality of work and output Citizenship behaviors: cooperation, making positive statements, avoiding wastage, protecting fellow employees and org. property.

Contd
Administrators should; Understand why persons are willing to contribute their efforts. Have skill in obtaining cooperation from members of the org.

Contd
Characteristics of motivation May be financial or non-financial: wages, allowances, recognition, and praise, giving more responsibility and inducing to participate in the decision -making process. Unending process: Human needs are infinite/endless.

Contd
Determined by human needs: knowing the need of an individual. Can not be applied to a frustrated person. A psychological process: psychology of workers. Total , not partial: is related to the needs and psychological states of people.

Contd
Importance of motivation Peoples develop willingness to work Absenteeism would be decreased Labor turn over would be decreased Efficient or qualified personnel would be attracted to the ogs

Contd
Good labor relations KAP of employee is improved People develop sense of belongingness Finally the ogs can utilize the factors of production to the maximum

Contd
Guidelines for effective motivation Manager must actively and intentionally motivate their sub-ordinate. Manager should understand their own strength and limitation before attempting to modify those of others. Manager must recognize that employees have d/t motives and abilities.

Contd
Reward should be r/t performance, not seniority or other non-merit based considerations. Jobs should be designed to offer challenge and variety. Sub-ordinate must clearly understand what is expected of them. Mgt should foster an orgnal culture oriented to performance.

Contd
The six motivator in work place 1. The work itself 2. Self improvement 3. Recognition 4. Advancement 5. Achievement 6. Responsibility

Theories of motivation
1. Need hierarchy (Maslow) theory Maslow stated that a lower level need is prerequisite, or controls b/r until satisfied, and then the next higher need energize and directs b/r. The hierarchy of Maslow include the following components;

Contd
A. Physiological need (e.g. hunger, thirst,) B. Safety and security need (e.g. bodily safety) C. Love and belongingness (e.g. affection, friendship,) D. Self-esteem (e.g. recognition, selfrespect, appreciation,) E. Self-actualization (e.g. developing ones whole potential,)

Contd
2. Two factor (Hertzberg) theory or theory of job satisfaction
Hertzberg enlarged on theory Y approach by dividing the needs that affect a persons motivation to work into two sets of factors. These are;

A. Hygiene/ maintainance factor-those factors that meet a persons need to avoid pain, insecurity, and discomfort that affect dissatisfaction. If not meet employees dissatisfied.

Contd
This include; Adequate salary Appropriate supervision Good interpersonal r/ships Safe and tolerable working conditions(including reasonable policies and procedure)

Contd
B. Motivation factor-those that meet needs to grow psychologically, when meet, the employee feels satisfied. This include; Adequate recognition Appropriate responsibility Satisfying, meaningful work Opportunities for advancement and achievement

Contd
3. Achievement need (McClelland) theory McClelland claimed that human needs are socially acquired and that humans feel basic needs for achievement, affiliation, and power. Needs for achievement is the drive to exceed ones former accomplishments, to perform an activity more skillfully and effectively than before.

Contd
A person with high achievement needs to spend much time thinking about how to improve personal performance, how to overcome obstacles to improvement, and what feelings will result from success and failure. McClelland claims that people with high achievement need to set moderate, realistic goals, enjoy problem solving activities, and desires concrete feedback on performance.

Contd
4. Equity (Adams) theory Suggests that an employee continuously compare his or her work input (skill, effort, time) and outcomes (status, pay, privileges) with those of other employees. The employee perceives inequity when ever her or his rewards are disproportionate to those received by other employees for the same amount of input. Feeling of inequity motivate an employee to resolve the inequity by reducing input attempting to increase out comes, selecting a d/t comparison worker, or resigning.

Contd
5. Expectancy (Vector Vroom) Indicates that a persons attitudes and b/r are shaped by the degree to which they facilitate the attainment of valued out comes. The amount of an employees job effort depends on her or his perception of the r/ship b/n good performance and specific outcomes.

Unit-three Organizing care

Delivery system
System is a set of elements standing in inter relation and work together for common goal. There are two type of system. These are; A. Open system:-A system interact with the out side envt to exchange matter. It is very important for the given orgn. B. Closed system:-Self contained with no interaction with the external envt. Only found in physical science and not relevant for a given orgns.

Contd
System theory States that the whole is more than the sum of elements. The it self is can be explained only as a totality. Holism is the opposite of elementarism.

Contd
Xtics of system 1. Input or importation of energy. 2. Through put or process 3. Out put 4. Cyclic event with in the system boundaries 5. Negative entropy

Contd
6. Information input/feedback 7. Homeostasis or steady state 8. Differentiation 9. Integration or coordination 10.Equi-finality

Nursing service delivery system

With in these different nsg service delivery system there are advantage and disadvantage for: Quality care Uses of resources Staff growth These different nsg service delivery system as follows;

Contd
A. Case method
Is the new method. Began in the early days of nsg profession during F.nightnigale. The convenient and appropriate to manage care. According to F.nightingale the care is given based on case. The nurse is responsible to give the totality of care to the pt. The nurse report to the head nurse (immediate superior).

Contd
Advantage Holistic Job satisfaction Continuity of care Allow independent decision making Good therapeutic r/ship (nurse-client r/ship), b/c increase personal contact Easy to identify the responsible nurse when problem raises and success is occurred

Contd
Disadvantage Much loss of energy in the staff or burdening of the staff No specialty of care Gap may be occur due to shortage of skill and knowledge from the nurse Over extend span of control for the head nurse

Contd
B. Functional method Assignment of pt care made by the level of task. Each person performs one task function in keeping with the employees educational experience. Advantage
Reduce personnel cost Specialty of care Experienced or qualified staff care Timely care is given for the pt Support cost control

Contd
Disadvantage It may cause burden on the head nurse It is difficult to implement in ogn with few staff members It is difficult to identify the responsible person when positive or negative event happened No continuity of care Decrease personal contact with pt Fragments of nsg care Decreased job satisfaction

Contd
C. Team nursing This is accomplished by arranging the workers in team. The head nurse doesnt directly communicate with staff rather through team head nurse. Introduced after 1945. There is delegation of authority and activity or decentralization.

Contd
The team consists of; Senior professional nurse (team leader), Registered nurses (RNs), Licensed practical nurses (LPNs) or vocational nurses, and Nurses aides.

Contd
Advantage Span of ctrl decreased Comprehensive care is provided Increase cost-effectiveness Increase job satisfaction Team sprit is developed Decreased mgt burden for the head nurse Experience sharing b/n the team members Qualified care is given

Contd
Disadvantage It may endanger nsg service if there is conflict or disagreement Reduce personnel responsibility Continuity of care is reduced Mgt is affected b/c there is a gap b/n manager and the employee

Contd
D. Primary nursing Is a philosophy and structure that places responsibility and accountability for planning, giving, communicating and evaluation of care for a group of pt in the hands of the primary nurse. Was intended to return the nurse to bedside, thus improving the quality of care and increasing the job satisfaction of the nurse staff.

Contd
The primary nurse is expected to establish therapeutic r/ship. The best aspect of primary nsg is the improved communication provided by the one-to-one r/ship b/n nurse and pt.

Contd
Advantage o Increase job satisfaction o Improves the quality of care, if the individual is well qualified o Continuity of care o Allows independent decision making o Support nurse-client communication o Encourage discharge planning

Contd
Disadvantage Increases personnels cost initially Exhaustive Need high level qualified and experienced profession or requires properly trained nurses to carryout system principles Restrict opportunity for evening and night shift nurses to participate 24 hrs work

Contd
E. Case management Most recent. Evolved from other system. It is system of health asst, planning, service procurement and delivery, coordination and monitoring the multiple needs of clients. This is an all-inclusive, comprehensive model and is not restricted to hospital setting.

Contd
When pts deviate from the usual expected course of recovery or health, consultation ensures to quickly correct the problem. This requires a great deal of systemic knowledge about a pts problems and putting that knowledge in the nsg care (Case management plan). In addition to the nursing and medical services that are required for pt, other services are included. Such as physical therapy, respiratory therapy.

Contd
Advantage Totality of care Continuity of care Job satisfaction Improves nurse responsiveness to clients changing needs Independent decision making

Contd
Disadvantage Exhaustive Increase personnel cost It requires highly qualified and experienced individual

Organizational characteristics
Span of control-The number of employees a manager can effectively oversee. Mostly top manager can not manage as many employees as managers at lower level. For example, the ratio for manager to employees is1:3 in top level, 1:6 in middle level, and 1:20 in low level.

Contd
The effective span of ctrl for each manager depends on; Work pace Pattern of worker skill and knowledge The amount of work interdependence

Contd
When span of ctrl is broad; The manager has insufficient time to observe Can not evaluate performance Can not give feedback When span of ctrl is too narrow; Manager supervises employees closely. To close supervision discourage subordinates problem solving, independent decision making, creative thinking. Research show that worker productivity is higher when close supervision is impossible.

Contd
Organizational principle Unity of command :-the employee should be responsible to only one supervisor. Requisite authority :-an authority over both on the position and resource during delegation. Continuing responsibility :-managers function not diminished during delegation for subordinate. Organizational centrality (communication) :-greater interaction in work place and have high information in the orgn.

Contd
Organizational concept Responsibility :-is the obligation to do. Authority :-the right of decision and commands. Delegation :-assigning duties. Accountability :-answering for what has been done.

Organization structure
Organization- is a group of people under formal or informal rules working together for common goal. Organization is has two concepts, both structure and process. A.Organization process-refers to the method used to achieve ognal goal. B.Organization structure-refers to the lines of authority, communication and delegation. Can be formal or informal.

Contd
1. Informal ognal structure Every ogn also has an informal structure, xterized by unspoken, often covert, lines of communication and authority r/ships not depicted in the orgnal chart. The informal structure develops to meet individuals needs for friendship, a sense of belongingness, and power.

Contd
The lines of communication in the informal structure commonly called the grapevine and concerned mainly with social issue. Persons with access to vital information can become powerful in the informal structure. Some administrator try to hinder the effect of informal orgn, b/c they facilitate the passing of information.

Contd
The information may be a rumor, but the best way to combat rumor is by free flow of trustful information. The informal orgn can help to serve the goal of formal orgn if it is made by the servant of administration. It should not be controlled. A major shortcoming in its use is that not all employees are part of the informal orgn.

Contd
The principal purpose for defining orgn diagram is to clarify chain of command, span of ctrl, official communication, and linkage for on dpt personnel. It is customary to show formal orgn structure in a diagrammatic form with a three dimensional model having depth, height, and width.

Contd
Boxes containing various position titles are positioned vertically to highlight difference in status and responsibility. Position boxes are connected with lines to demonstrate the flow of communication and authority through out the entire network.

Contd
D/t types of interconnecting lines signify d/t types of r/ships. For example; a solid line b/n two positions indicates direct authority or command giving r/ship, a dashed line or a broken or a dotted line indicate a consulting r/ship with no prescribed frequency of the structure to collaborate for planning or ctrl purpose and commands dont flow.

Contd
The orgn chart does not show the degree of authority, i.e. a manager has over subordinates. For example, a manager with authority of head nurse may lack authority hire or fire the worker.

Contd
2. Formal ognal structure An ogns formal structure is depicted in its ognal chart i.e. provides a blue print, representing formal relations, functions and activities. The primary significance of formal orgnal structure is the frequency of communication b/n particular staff members. Particular workers are expected to relate directly with certain individuals and not others.

Contd
Types of formal orgnal structures 1. Line pattern/relationship The oldest and the simplest. It is a straight forward, direct chain of command with superior-subordinates r/ship. More efficient than other formal orgnal structure b/c it provides clear authority responsibility r/ship b/n workers and requires less information transmission b/n workers and manager.

Contd
The typical line pattern is divided laterally into segments representing d/t nsg specialties. The perspective of workers differs from the bottom to the top of structure. Workers at the base of pyramid nsg assistant, at the middle head nurse and at the top vice president or director or assistant director.

Contd
Advantage Easy to orient new employee Easy to manage workers Well established division of labor There is a clear cut work specialization and role separation

Contd
Disadvantage Makes employee task narrow, repetitive performance and communication difficulties among specialists due to specialization. Workers tend to resist innovative change and resist recommendation from outsiders b/c of rigidity. Causes passivity and dependency in staff members and autocratic b/r in manager.

Contd
The strong chain of command and concentration of authority at the top of hierarchy causes lower level employees to refer difficult problems to their immediate superior. Manager talks more than to listen. Weak integration of d/t divisions or dpts.

Contd
2. Line and staff pattern/relationship Line functions are those i.e. direct responsibility for accomplishing the objective of nsg dpt. For the most part they are filled with RN, licensed assistant nurse or other type of nurse. Staff functions are those that assist the line in accomplishing the primary objective of nsg. They include clerical, personnel, budgeting and financing, staff development and research.

Contd
The r/ship b/n line and staff are a matter of authority. Line has authority for direct supervision of employees while staff provides advice and counsel. To make staff effective, top mgt ensures that line and staff authority r/ships are clearly defined. Personnel of both should work to make their r/ship effective. They attempt to minimize friction by increasing trust and respect.

Contd
Advantage Key mgt function that the chief executive has neither skill nor time to execute well are delegated to functional experts who can devote full time to the assigned function with out being distracted by responsibilities of day today mgt of material and personnel.

Contd
Disadvantage Staff officer have less power than line officer b/c the later directs the basic operations Staff officer must stand quietly in the background while, line managers receive recognition for improvements. Staff positions are located at the periphery of the orgnal structure, which casts incumbents in the role of social isolates.

Contd
3. Matrix orgnal structure Is a complex constructed in which and employee may be responsible to two or more bosses for d/t aspect of work. Potential problem with a matrix type of orgnal structure can easily be observed or perceived. If for example, the head nurse and the case manager give conflicting orders to the staff nurse the job may be indefensible, or a manipulative nurse may play his or her two bosses off against each other.

Contd
When a matrix orgn is used, there must be a clear decision rules and it is hoped, good interpersonal r/ships. The employees must know which bosses have the final word when they receive conflicting orders or demands concerning work priorities.

Contd
4. Functional line and staff pattern Staff officers are no longer purely advisory but have some command authority aver line employees. The director of in-service may have the authority to decide how much indoctrination training and what type of orientation each new nurses must receive and when orientation class will be held. The director of quality improvement may have the authority to assign selected staff nurses to gather data on critical indicators of care quality, regularly submit quality monitoring reports, and remedy identified problems.

Contd
Advantage The expert responsible for a specified mgt function, such as staffing, policies, quality improvement, or staff development has authority to command line managers to implement needed action that relate to the expert specified function. As a nsg orgn increases in size, it may evolve from a pure line to a line and staff, and finally to functional line and staff structure.

Contd
Standards for evaluating the effectiveness of line and staff r/ship in heirarchial orgn standards 1. Line authority r/ships are clearly delineated and defined by the orgnal and/or functional charts and policies. 2. Staff authority r/ship are clearly delineated and defined by the orgnal and/or functional charts and policies. 3. Functional authority relations are clearly delineated and defined by the orgnal and/or functional charts and policies.

Contd
4. Staff personnel consult with, advice and provide counsel to line personnel. 5. Service personnel functions are clearly understood by line and staff personnel. 6. Line personnel seek and effectively use staff services. 7. Appropriate staff service are being provided by line nsg personnel and other orgnal dpt or services. 8. Service is not being duplicated b/c of line and staff authority r/ships.

Unit-Four Communica tion

Communication process
Comn :-is the transfer of information and understanding from one person to another person. Communication process has five components. These are; 1. Sender 2. Message 3. Receiver 4. Channel 5. Feedback/response

Contd
A. Sender:- is source of information. B. Message:- is any form of signal that can be understood by one or more sense of the receiver, e.g. hearing, touching, smelling, tasting. C. Channel:- is the method that is used to communicate. E.g. written material, media (radio, TV, ). D. Receiver:- is the person who receive the sender message. E. Feedback:- is the response of receiver.

Contd
All of these components are influenced by an environment and capable of enhancing or inhibiting the understanding of the message. To be a leader/manager the nurse must have understanding the communication process .

Contd
In technical terms ,the communication process consist of six steps .These are; 1. Ideation: the message, the idea, or thought to be conveyed to an individual or group. 2. Encoding :the manner in which the message in conveyed and may be other than verbal, such as a written message or visual or audible cue(sign or indication ) ,and non - verbal behaviors such as gesture or an expression .

Contd
3. Transmission: the actual expression of the message. 4. Receiving: the receiver accepting of the message. 5. Decoding: the receiver understanding or interpreting of the message. 6. Response or feed beck: the response should convey to the leader or the degree of understanding held by the individual or the group.

Contd

Contd
Ten basics points for good communication 1. Clarify your ideas before communicating others .Before speaking to an individual or group ,plan and organize what it is you are going to say .Analyze your thought carefully, and keep in mind the objective you wish to meet as well as the uniqueness of the individual or the group .Provide an opportunities for questions and answers to enhance the clarity of the message.

Contd
2. Consider the setting, both physical and psychological or mental setting. The physical setting can be conducive or can be serious block to communication. The psychological environment is referred to as the communication or social climate. The psychological and emotional relationship between and among the work group and the manager and may be supportive or defensive.

Contd
Characteristics of supportive communication climate:
A leader who listens. A leader is empathetic. A leader offers acceptance of individuals. A leader exhibits a shared problem solving attitude. A leader is open and value equality in the work place. The member of the group exhibits the same attitude and behavior.

Contd
Characteristics of defensive communication climate: A leader is controlling, punishing, evaluating and advice giving. A leader says, I am superior and always right. The followers are submissive or aggressive and communication is usually non-productive and un pleasant.

Contd
3. Consult with others when necessary to be exact and objective .The worst mistake a leader can make is to communicate incorrect information to the members of the group. If miss information is given to an individual or to the group, the leader should acknowledge the error and correct the situation. This demonstrates to the staff and to superior that leader deal with mistakes in a direct, honest and forthright manner.

Contd
4. Be mindful of the overtones as well as the message it self .Non-verbal cues may be saying something opposite from the word nature .It may give mixed message ,making it very difficult for the listeners to know what you are trying to covey .Non-verbal behavior should support your message ,not detract from it.

Contd
5. Take the opportunity to convey something to help ,value or praise to the receiver. People need to know that their contribution are useful and respected .This is not just limited to subordinates ;you also might wish to acknowledge the helpful contribution of superiors. 6. Follow up your communication .You must get feed back to make sure that the message understood as you intend it to be understood .Ask question and encourage the receiver to express his or her reaction by follow up contacts.

Contd
7. Be sure your actions support your communication .In other words, what I say I do. If actions and attitudes are in conflict, there will be confusion, and people will tend to deny what has been said. 8. Give credit for the contributions of others when genuinely deserved .It is amazing how powerful praise can be in establishing positive feeling in other people. Every one need to know when he or she have done something especially well.

Contd
9. Be an active listener .Practice what you preach. Listen to what the person has said as well as the in which it was said. Probably one of the least developed skills in the communication process. A true leader must develop the self mastery to be silent when someone else is speaking. To do that you must consider the other person s ideas to be more important than your own. Active listening is, however, does not imply agreement on your part, nor does it imply that you do not have the right to interrupt the conversation. It does mean that you must learn the others point of view by hearing and trying to understand the message .It only through understands what the differences are that the potential for positive solution exist.

Contd
10. Be an assertive when expressing your view .Communication patterns exist on continuum from passive to aggressive .Assertive communication and behavior maintain a balance between aggressive and passive style .The assertive style considers the right of all persons involved in the communication process.

Contd
Communication barriers Refers to obstacles that some how prevent the message from being delivered or understood. There are four main communication barriers. These are; 1. Poor listening skill. 2. Psychological blocks. 3. Environmental distractions. 4. Semantic barriers.

Contd
Communication network Communication networks, allow information to be circulated among the group. These networks affect the way groups solve problem. The actual pattern of the communication networks may be as varied as the number of groups in existence. The real issue is not whether every participant shares a two way communication channel with every other member but whether the communication is adequate as measured through the appropriate performance of the group.

Contd
The common communication networks or patterns are: 1. Downward 2. Upward 3. Downward and upward 4. Circular 5. Multi channel

Contd

Unit Four Problem solving, Critical thinking,

Decision making

Creativity, and

Problem Solving
Problem Solving is basic intellectual process that has been refined and systemized for the various challenges people face. Problem solving which involves a decision making steps focused on trying to an immediate problems which can be viewed as a gap between what is? and what should be? Problem makes leader better, not bitter

Contd
There is a dissatisfaction that the problem creates for individual, group, and organization. In attempting to address these issue the participant gather and examines information in an effort to define the problem and identifying possible solutions. Effective problem solving and decision making are predicted on an individuals ability to think critically.

Critical thinking
It is intellectually disciplined process of conceptualizing, applying, analyzing, synthesizing, and evaluating information gathered from or generated by observation, experience, reflection, reasoning, and communication as guide to belief and action. It is manifested when ever a nurse ask why?, what?, and how?.

Contd
o It is important for manager to assess their staff members to think critically and enhance their knowledge and skill through; oStaff development programs. oCoaching. oRole modeling

Contd
Critical thinking is important for; Problem solving. Creativity. Decision making. Clinical judgment Critical thinking is the concept that link all the above mentioned concepts.

Contd

Creativity
It is the ability to generate options or alternative solution ideas. It is the capacity to have new thoughts and to create expressions unlike any other. It is a basic element in many human endeavors, such as art, music, literature, and performance.

Contd
Encouraging creativity Convergent thinking:-the problem is divided into smaller and smaller pieces to find a more manageable perspective.

Pro ble m

De cis ion

Contd
Divergent thinking:-One's view of the problem is expanded. The problem is considered in different ways. Figure
Pro ble m

De cisi on

Contd
Brain storming: under favorable circumstances a group working together can identify more ideas than an individual or the group of individuals working separately. It is a technique managers can use to create a free flow of ideas.

Decision Making
It is a purposeful and goal directed effort that uses a systematic process to choose among two or more options to solve specific problem. It is choosing the best alternative to reach the predetermined objective. Not all decision making begins with a problem situation, instead the hallmark of decision making is the identification and selection of alternatives.

Contd
Phases of decision making
1.Defining objectives. 2.Generating options. 3.Identifying advantage and disadvantage of each options. 4.Ranking the options. 5.Select the option most likely to achieve the predetermined objective. 6.Implementing the option. 7.Evaluating the result.

Contd
Poor quality decision is likely if the objectives are not clearly identified or if they are inconsistent with the value of an individual or organization. Example ; Hana comes across a fork of road and found some body on the scen and asked which way shall I take?, a man replied where are you going? Hana replied I dont know finally the man replied it doesnt matter you can follow any one.

Contd
Decision making models/theory
The decision method you used depends on the following circumstances. Is the situation routine, predictable, complex, and uncertain? Is the goal of the decision to make a decision conservatively (just good enough) or optimally? E.t.c.

Contd
Based on the above assumption there are four decision making model. I. Normative or Prescriptive DM model Used when the outcome is predictable, the problem/situation is well structured. Information is objective. The decision is already prescribed. Example: if one student get F, the student should take the course again by adding.

Contd
II. Descriptive/ Behavioral DM model Used when the situation is complex, unpredictable, and uncertain. You dont know the outcome. Information is subjective and every person define or interprets into different direction.

Contd
III. Satisfying/ Conservative DM model Used when information is gathered to meet the minimum requirement for the objective of decision. This model is appropriate when critical, urgent, immediate answer were needed within a short period of time.

Contd
IV. Optimal DM model The solutions/decisions are selected based on optimal requirement for objective decision. Appropriate in the situation that needs time. This model is appropriate when non-critical, urgent, immediate answer were needed within a short period of time.

Contd
Decision making style The situation and circumstances should dictate which decision making style is most appropriate. To select an appropriate decision making style, the nurse manager should look at the following decision rules.

Contd
1. The importance of the decision quality to the institutional success. 2. The degree to which the manager process the information and skills to decision. 3. The degree to which the followers have the necessary information to generate a quality decision. 4. The degree to which the problem is structured.

Contd
5. The importance of followers commitment. 6. The likelihood that an autocratic would be accepted. 7. The strength of followers commitment to institutional goals. 8. The likelihood of followers conflict over the final decision.

Contd
Based on the above mentioned rules there are three Dm styles. These are; 1.Autocratic DM style. 2.Democratic DM style. 3.Anarchic DM style. Based the stated rules characterize them.

Contd
Types of decisions Decisions made in the nursing service can be categorized depending upon the following criteria How much time the manager spends in making decision? What proportion of the organization must be involved in making decision? The organization function/ the nursing functions on which they focus.

Contd
On the basis of these there are three classifications: 1. Ends -Means 2. Administrative-Operational 3. Programmed-Nonprogrammed

Contd
1. Ends-Means Ends: deals with the determination of desired individual or organizational results to be achieved. Means: decisions deal with strategic or operational programmes, activities that will accomplish desired results. These usually occur during managerial planning processes, strategy and objective formulation processes.

Contd
2. Administrative-Operational Administrative: made by senior management, which have significant impact throughout the organization. Usually this type of decision is concerned with policy, resource allocation and utilization. Operational: are generally made by mid level and first line managers and address day to day operational activities of a particular organizational.

Contd
3. Programmed-Non -programmed Programmed:-these are repetitive and routine in nature. Since they can be programmed, procedures, rules and often manuals are formulated to cover those situations. None programmed:- unique and non- routine. This can be used in emergency/urgent situation.

Contd
Conditions that initiate decision making are; 1. Opportunity 2. Threat 2. Crisis 3. Deviation 4. Improvement

Contd
Ways of Decision Making 1. Relying on tradition: taking the same decisions that had been undertaken when similar problem arouse in the past. 2. May appeal to authority :- make decisions based on suggestions from an expert/a higher level management. 3. Prior reasoning: based on assumption 4. Logical decision making: is a rational, intelligent and systematic approach to decision making

Contd
Factors Influencing Decision Making 1. Decision makers attribute Knowledge, experience, and judgment Perception and personality Values and philosophy

Contd
2. The Situation Urgency of solution and time pressures Magnitude and importance Structure and uncertainty and risk Cost benefit 3. Environmental Constraints External Internal

Contd
Decision Making Tools There are many tools. The most common are: 1. Probability theory: is the likelihood that an event or outcome will actually occur and allow decision makers to calculate an expected value for each alternative. Expected Value (EV) = Income it would produce (I) x its probability of making that income (P).

Contd
2. Decision tree:-are graphic decision making tools used to evaluate decisions containing a series of steps Deciding to decide 1. Is the problem easy to deal with?
Tip: avoid being bogged down in trivial details. Effective managers reserve decision making techniques for problems that require them.

2. Might the problem resolve itself.

Tip: prioritize and rank problems in order of importance.

Contd
3. Is it my decision? Tip: the closer to the origin of the problem the decision is the better. Before deciding ask the following questions: Does the issue affect other departments? Will it have a major impact on the superior's area of responsibility? Does it need further information from higher blevel?

Contd
Does it involve serious breach of my departments budget? Is this problem outside my area of responsibility or authority? If the answer to any of these questions is 'YES' pass it to your superior.

Contd
Barriers to Effect Decision-Making 1. Easy recall: the more easily can recall the event, the more frequently they believe it occur. 2. Easy search: not to put effort to seek information from the appropriate sources. 3. Misconception of chance: Most people do not understand the nature of random events. 4. Confirmation gap/bias:bending evidence to fit ones beliefs. 5. Relaxed avoidance: the manager decides not to decide or act after noting that the consequences of inaction will not be serious.

Contd
6. Defensive avoidance: Faced with a problem and unable to find a good solution based on past experience, this manager seeks a way out. He/she may let someone else make decisions. This resigned posture may prevent consideration of more viable alternatives. 7. Panic: the manager feels pressurized not only by the problem but also time.

Contd
Overcoming barriers to individual problem solving 1. Setting priority. 2. Acquiring relevant information. 3. Proceeding methodically and carefully.

Unit Five Health Management Information System (HMIS)

Why health information system?

Good management is a prerequisite for increasing the efficiency of health services. Improved health information system is clearly linked to good management. Information is crucial at all management levels of the health services from periphery to the centre.

Contd
It is required by policymakers, managers, health care providers, community health workers. Changing the way information is gathered, processed, and used for decision-making implies changing the way an organization operates.

What is HMIS?
Definition of MIS; A formal method of making available accurate and timely information to management that is necessary to facilitate the decision- making process and enable the organizations planning, control and operational functions to be carried out effectively.

Contd
It is the practice of maintenance and care of health recordsby traditional (paper-based) and electronic means inhospitals,physician'soffice clinics,health departments,health insurance companies, and other facilities that provide health careor maintenance of health records.

Contd
With the widespread computerization of health records and other information sources, including hospital administration functionsand health human resources information, health informaticsand health information technologyare being increasingly utilized ininformation management practices in thehealth care sector.

Contd
HMIS is application of the principles of management information system in health care systems. The system provides information on past, present and projected future & relevant events inside and outside the organization.

Contd
Definitions of terms
System - Any collection of components that work
together to achieve a common objective.

Health System - All the activities whose primary

purpose is to promote, restore or maintain health.

Information - Meaningful collection of facts or data. Information System - Systems that provide specific
information support to the decision-making process at each level of an organization.

Contd
Health Information System - A set of components and procedures organized with the objective of generating information which will improve health care management decisions at all levels of the health system. The ultimate objective of health information system is not to gain information but to improve action

Contd
Health management information system; Information
Organized, analyzed, usable from. Key factor in an organization (managers). An asset.

Data : (unanalyzed numbers, facts, raw,). System: Purpose, organized nature, unity & integrity. Management: Management oriented, computerization. Health: Application of MIS in Health.

Contd
Health information management professionals;
planinformation systems, develophealth policy, and identify current and future information needs. apply the science of informaticsto the collection, storage, use, and transmission of information to meet the legal, professional, ethical and administrative records-keeping requirements of health care delivery. work with clinical, epidemiological, demographic, financial, reference, and coded healthcare data.

Contd
Evolution
In the past, mostly informal. Present, electronic data processing (EDP) use of computers in information management (computer based information system). Now called MIS.

Contd
What is wrong with current health MIS?
Irrelevance of the information gathered Poor quality of data Duplication and waste among parallel health information system Lack of timely reporting and feedback Poor use of information The difference in culture between data people and decision makers: Planning and management staff rely primarily on gut feeling to formulate ad hoc decisions rather seek pertinent data.

Contd
Whats the HMIS objective? Ensuring the quality of all health data. Strengthening the ability to analyze and use the data. Making informed and cohesive decisions can and will positively affect the health and lives of the people. Planning, organizing, leading, controlling and decision-making.

Contd
Elements of Health information system management
Organization rules Data collection standards Case definitions Data transmission

Contd
Confidentiality Training standards Software design Procurement/ Distribution Quality assurance Private sector

Contd
Factors to evaluate information received
1. Information quality accuracy and reliability. 2. Information timeliness before deviations occur. 3. Information quantity just sufficient. 4. Information relevance related tasks and responsibilities.

Contd
Design of HMIS Desired characteristics of information in health services Relevance Accuracy Completeness Timeliness Conciseness

Contd
Sources of Information System o Health institutions (inpatient/outpatient and other activities) Vital registration systems (births, deaths, and migratory movements) o Laboratories and pharmaceuticals o Community

Contd
o Census o Special programmes reporting systems (tuberculosis and leprosy control, MCH, school health) o Administrative systems (health care financing systems, health personnel systems, logistic systems)

Contd
o Investigation of outbreaks
Surveys and surveillances Diseases notifications Routine reports

Which of the above sources are computerized? Each source has its own advantages and limitations.

Contd
A framework for defining information needs and indicators Perform a functional analysis at each management level of the health service system. Identify information needs and select feasible indicators Patient / Client management Health Unit management Health System management

Contd
Indicators are variables that help to measure changes, directly or indirectly. - WHO Indicators are variables that indicate or show a given situation, and thus can be used to measure change.

Contd
Indicators are important to:
To analyze present situation To make comparisons To measure trends

Most health indicators are quantitative (numbers)

Contd
Helpful questions in selecting good indicators What is the indicator supposed to measure (validity)? What will be the cost of measuring the data to arrive at the numerator and denominator of the indicator? Is the change shown by the indicator a true change in the situation under study.

Contd
What is the relative importance of the subject matter to be addressed and the decision to be made based on the indicator (relevance)? Does the indicator actually capture the changes that occur in the situation under study (specificity)?

Contd
Types of Indicators:
Health policy Social and Economic Development Indicators Population changes Provision of health care Health Status (nutritional, morbidity, mortality)

Information is collected, analyzed, presented and communicated.

Contd
Steps in development of effective HMIS 1. Identify users: for whom? 2. Identify needs: planning, organizing, directing, controlling, decision-making 3. Select indicators 4. Select data collection instrument 5. Process data into useful information 6. Provide feedback to users

Contd

Steps involved in restructuring of Health MIS Step 1: Identifying information n Step 2: Defining data sources an Step 3: Developing a data transm

Step 4: Ensuring use of th Step 5: Planning for healt Step 6: Developing a set

Contd
Key issues
a) Movement of data through out the system b) Accessibility and analyzability of data c) Transmission of finding to potential users

Contd

Tasks
Filing and storing Compiling Analyzing

Contd
Types of reports (three)
Operational: detailed Technical: mentoring and evaluation Strategic: to justify priorities and decisions

Contd
Managing the flow of data
Impose strict timetable at each level. Ensure two-way flow. Establish regular cycle of analysis and feedback.

Contd
Data collection instruments Data collection instruments for patient/ client management Curative Medical records Laboratory forms Referral forms

Contd Preventive
Growth cards MCH cards School health card Family registration records

 Other issues
Content (comprehensive) Record filing (patient-retained vs.. health unit-retained) Layout (self-explanatory) Production form Electronic patient record

Contd
Data collection instruments for health unit management Service delivery records.
Registers Tally sheets (Abstract register Population charts

Resource Management records

Contd
Strategies for MIS Development Plan carefully for modification of existing system establishing new. Change attitudes to information gathering processing and utilization. Participate staff in HMIS. Provide training for utilizing HIS

Contd
Computer applications in health service delivery 1. Clinical information systems 2. Administrative information systems Issues in the application of Microcomputers to HMIS; Generally: find out what is necessary to do, then choose the appropriate tools.

Contd
How to decide on need for a computer?
o Technical feasibility o Operational feasibility o Economic feasibility

Contd
How to introduce micro computers
Choose software Choose computer Assess the physical environment Assess the organizational environment

Contd
o Train personnel to use computers o Social behaviour o Training for managers o Training for problem solving o Define role of computer in work environment

Contd
HMIS in Ethiopia Discuss on the following points: 1. What are the major sources? 2. Explain the limitations of these sources. 3. How is the status of HMIS in Ethiopia? 4. What should be done? Use various committees at different levels to knit together the different parts of the organization.

Contd
Hospital Information Hospital data should be collected timely and regularly. They should be used for sound decision making. Performance should be evaluated using performance indicators
Out patient attendance

Contd
Admissions by age, sex, location and so on Discharges by cause and severity of illness. Deaths Bed days occupied Average length of stay

 Turn over interval No. of major operations Delivery admissions Laboratory tests

Contd

No. of referrals Budget allocation Expenditures No. and type of manpower

Unit Six Delegation, Stress and Time Management

Time management

Contd
Is not often thought as a resource. It is non-renewable resource; No event can take place unless there is time for it. Using time effectively is a management skill and can be seen from two angles:

Contd
1. Finding out how staff uses time:
Time spent on different activities by individual staff can be answered by keeping a daily - dairy for a few days. It useful to know what proportions of time is spent on certain activities. This will help to make the best use of time. Events are written in daily, weekly , monthly or yearly time periods, depending on their frequency or regularity.

Contd
Time plans are written in various common forms ;
Timetable: For daily/weekly regular recurring events. Schedule: For intermittent, irregular or variable events, including details of where the events take place. Roaster: For duties planned for different staff members, for different times in turn. Program: For long term arrangements of several different events or activities.

Contd
2. Time plans in a health service
A well-managed rural health unit may need the following time- plans:
A weekly time table: showing the time of the week when certain regular events always occur, e.g. staff meetings. Several schedules: showing the detailed dates on which intermittent events occur and where they occur ,e.g. Visits to peripheral health centers. Several duty rosters: for different sections of the work, e.g. night call, out patent duties.

Contd
Duty rosters are Common in all types of health work.
They are needed for three purposes:

1. To distribute work fairly and evenly out side normal working hours. E.g. night, weekends etc 2. To distribute uninteresting or difficult work, and interesting or varied work, equally among the various members of the units, e.g. Maternity work. 3. To divide extra duties among the whole staff,

Contd
Unless they are arranged very carefully they can cause a great deal of trouble and quarrelling. Therefore, rosters have to be changed frequently. Two rules for duty rosters: A. The length of time of each duty period must be the same as for all other types of duty period. B. The number of people /Groups working in turn must divide evenly in to the number of duty station/ duty periods.

Contd
A Program: is a plan that out lines a series of events or activities that will take place in the future. A Program usually includes:
What will be done? Where it will take place Who will do it & When it will occur.

There are several ways to make a program chart. A Convenient way is to list the activities, in the order in which they must occur.

 Benefits of time management

Efficient Successful Healthy

Contd
Obstacles to effective time management Unclear objectives Disorganizat ion Inability to say no

Contd
Interrupti ons More interruptions Periods of inactivity

Contd
Too many things at once Stress and fatigue All work and no play

Contd
What can we do?
Recognize that obstacles exist Identify them Employ strategies to overcome

Contd
Set goals

Specific Measurable Achievable Realistic Time-based

Contd

Prioritize Do Delega te Delay Delete

Contd
1.Address the urgent 2.Accomplish what you can early 3.Attach deadlines to things you delay

Contd

Organize

Contd

Learn when to say oYou NOcant do

everything oDont undertake things you

Contd

Use your waiting time

On public transportatio n At the doctors office Waiting for

Contd
Corresponde nce Letters or memos Books or tapes

Contd Concentrate on the task at hand

Focus on your goal Tune out interruptio ns

Contd Consider your

personal prime time Morni ng? Evenin g? Late

Celebrate your success

Contd

Contd
The Ethiopian Context The daily attendance of staff is taken by using different formats and each staff has to sign over the format Usually it is done twice per day during the morning and afternoon sessions. The Personnel office does the over all check up.

John M. Ivancevich and Michael T. Matterson have defined stress as adoptive response, mediated by individual characteristics and/ or psychological processes, that is a consequence of any external action, situation or event that places special physical and/or psychological demands upon a person.

Stress management

Contd
Stress is the wear and tear our minds and bodies experience as we attempt to cope with our continually changing environment TYPES OF STRESS 1. External 2. Internal

Contd
1. EXTERNAL STRESSORS

Physical Environment Social Interaction Organisational Major Life Events Daily Hassles

Contd
PHYSICAL ENVIRONMENT

Noise Bright Lights Heat Confined Spaces

Contd

Aggressiveness by others Rudeness Bossiness Bullying

ORGANISATIONAL

Contd

Rules Regulations Red - Tape Deadlines

MAJOR LIFE EVENTS

Contd

Birth Death Lost job Promotion Marital status change

Contd DAILY HASSLES

Commuting Misplaced keys Mechanical breakdowns

Contd
2. INTERNAL STRESSORS

Lifestyle choices Negative self - talk Mind traps Personality traits

Contd
LIFESTYLE CHOICES

Caffeine Lack of sleep Overloaded schedule

Contd
NEGATIVE SELF - TALK

Pessimistic thinking Self criticism Over analysing

Contd
MIND TRAPS

Unrealistic expectations Taking things personally All or nothing thinking Exaggeration Rigid thinking

Contd
PERSONALITY TRAITS

Perfectionists Workaholics

Contd
FACTORS INFLUENCING WORK STRESS Uncertaint

The drive for success Changing work patterns Working conditions

y Conflict Responsibi lity Relationshi ps at work

Contd
SOURCES OF JOB STRESS

Contd
1.Environment Stressors:-societal, economic, financial, cultural, familial and technological factors which have tremendous influence on mental health of the employees. 2.Organizational Stressors:-mission statement, strategies, policies, organizational structure and design, reporting channels, communication, various processes, systems and last but not the least the working conditions.

Contd
3. Group Stressors:- group cohesiveness, group norms and importance of group objective for attainment of organizational goals. 4. Individual Stressors:-Personal life and events of official life cannot be separated. Events of marriage, divorce, death in the family has a remarkable impact on work situation. Personal life difficulties are highly stressful. It includes;

Contd
(a) Job Security :- A person must have a job commensurate with his qualification. (b) Relocation:-Relocation is related to transfer of a person to a different place. (c) Changes in life structure:-Span of life has many facets. Some of these are socio-economic environment, culture, systems, religion, race, education and persons interaction with society in different roles.

Contd (d) Stress and Behavior

Contd
Nature of stress
The nature of the stressor is variable. i.e
an event or change that is stress full for one person may not be stress full for another . an event that produces stress at one time and place may not also at another time and place.

Contd
Stressors
An internal or external event or situation that creates the potential for physiological, emotional, cognitive or behavioural changes in an individual. Stressors exist in many forms and categories

Contd

They may be described as:

Physical:- hot, cold, Psychological losing a job Physiological

Contd
Stressors have also been classified as ;
Day to day frustrations Major complex occurrences involving large groups, even entire nations Stressors that occur less frequently and involve fewer people .

Contd
Stress full events in the nursing function / role / stressors
Work over load Conflict b/n staff members In appropriate salary income Limited resource

Contd
In appropriate infrastructure Limited man power Lack of promotion Job dissatisfaction Loss of job In adequate knowledge

Contd
New working environment New health policy Un programmed work load Failure in achievement of work Upgrade to higher position Lack of educational opportunity

Contd
MANAGEMENT OF STRESS A.Individual Level Strategies 2.Define objective for Self: 3.Plan your life: 4.Social Support: 5.Physical Fitness: 6.Biofeedback:

Contd
6. 7. 8. 9. Yoga; Meditation; Time Management; Live a simple Life;

Contd
B. Organizational Level Strategies (a)Organizational goals must be in realms of achievement. (b)Employees must be empowered. (c)Corporate policies, physical work environment should be suitable for higher productivity. (d)An updated systems and processes increases efficiency. (e)Management must create an healthy working environment.

Contd

STRESS CONTROL ABC STRATEGY A = AWARENESS

What causes you stress? How do you react?

Contd
B = BALANCE There is a fine line between positive / negative stress How much can you cope with before it becomes negative ? C = CONTROL What can you do to help yourself combat the negative effects of stress ?

Delegation
It is the process of assigning part or all of one persons responsibility to another person or persons. Delegating is an effective management competency by which nurse managers get the work done through the employees. The purpose of delegation is efficiency; no one person can do all the work that must be done; therefore, some work must be passed on, or delegated to others.

Contd
Nurse managers need to be able to delegate some of their own duties, tasks, and responsibilities as a solution to overwork, which lead to stress, anger, and aggression. As nurse managers learn to accept the principle of delegation, they become more productive and come to enjoy relationships with the staff.

Contd
The following list suggests ways for nurse managers to successfully delegate.
Train and develop subordinates. It is an investment. Give them reasons for the task, authority, details, opportunity for growth, and written instructions if needed.

Contd
Control and coordinate the work of subordinates, but do not go over their shoulders. To prevent errors, develop ways of measuring the accomplishment of objectives with communication, standards, measurements, feedback and credit.

Contd
Follow up by visiting subordinates frequently. Expect employees to make suggestions to improve work and use the feasible ones. Encourage employees to solve their own problems, and then give them the autonomy and freedom to do.

Contd
Assess results. The nurse manager should accept the fact that employees will perform delegated tasks in their own style. Give appropriate rewards Do not take back delegated tasks.

Contd
Advantages of delegation Delegating some decision-making saves time for other duties. When work is spread over a large area, as in rural health work, the health workers on the spot must be able to make decisions according to circumstances.

Contd
Delegations of responsibility save long delays that occur then awaiting decisions from a central office or other distant authority. Health workers who are allowed to make decisions enjoy their work more and become more knowledgeable and skilful.

Contd
Disadvantages of delegation If wrong decisions are made, the work is not done or it may be done less well. A leader who does not delegate properly may pass all the work on to the team members, leaving very little more to do. A leader may delegate decisions to people with insufficient experience.

Contd
Rules for delegating authority and responsibility
Be clear about exactly what is delegated. Select the person who you are sure can do the work. Explain to others that you have delegated work and to whom. Do not interfere unless asked to, and be prepared for some mistakes. Give support as needed and follow up the progress of work.

Contd
Steps in Delegation I Introduce the task D-Demonstrate clearly what needs to be done E-Ensure understanding A-Allocate authority, information and resources L-Let go S-Support and monitor

Contd Introduce

the

Determin e task to be delegate d Determin

Task

Contd

Determine task to be delegated Determine tasks to retain Select delegate

Those tasks you completed prior to assuming new role Those tasks your delegates have more experience with Routine activities Those things not in your core competency

Contd

Determine task to be delegated Determine tasks to retain Select delegate

Supervision of subordinates Long-term planning Tasks only you can do Assurance of program compliance Dismissal of volunteers/members/p arents, etc.

Contd
Determine task to be delegated Determine tasks to retain Select delegate
Look at individual strengths/w eaknesses Determine interest areas Determine need for

Contd

Use WhatWhy Stateme nts: I want you

 Show examples of previous work Explain objectives Discuss

Demonstrate Clearly

Contd

Contd
Ensuring Understanding
Clear communication Ask for clarification Secure commitment Dont say no for them Collaboratively determine methods for follow-up

Contd
Allocate authority, information, resources Grant authority to determine process, not desired outcomes Provide access to all information sources Refer delegate to contact persons or specific resources that have assisted previously Provide appropriate training to ensure success

 Communicat e delegates authority Step back, let them work Use

Let go

Contd

Contd
Support and Monitor
Schedule follow-up meetings Review progress Assist, when requested Avoid interference Publicly praise progress and completion Encourage problem solving

Contd
Delegation Stressors Loss of control? If you train your subordinates to apply the same criteria as you would yourself, then they will be exercising your control on your behalf.

Contd
Too much time spent on explaining tasks The amount of time spent up front is, in fact, great. But, continued use of delegation may free you up to complete more complex tasks and/or gain you some time for yourself.

Contd
Compromising your own value By successfully utilizing appropriate delegation, your value to the group/organization will grow at a greater rate as you will have more time to do more things.

Contd
Consequences of poor delegating Information and decision-making not shared by the group When leaders leave groups, no one has experience to carry on Group morale becomes low and people become frustrated and feel powerless

Contd
The skills and knowledge of the group/organization are concentrated in a few people New members dont find any ways to contribute to the work of the group. Leaders become tired out

Contd
Barriers to Delegating Barriers in the Delegator Preference for operating by oneself Demand that everyone know all the details I can do it better myself fallacy Lack of experience in the job or in delegating.

Contd
Insecurity Fear of being disliked Refusal to allow mistakes Lack of confidence in subordinates Perfectionism, leading to excessive control

Contd
Lack of organizational skill in balancing workloads Failure to delegate authority commensurate with responsibility Uncertainty over tasks and inability to explain Disinclination to develop subordinates Failure to establish effective controls and to follow up

Contd
Barriers in the Delegatee
Lack of experience Lack of competence Avoidance of responsibility Over dependence on the boss Overload of work Immersion in trivia

Contd
The secret of success is not in doing your own work but in recognizing the right [person] to do it. ~Andrew Carnegie

The End!