Nursing Service Administration and Leadership.

8/6/2019 Nursing Service Administration and Leadership.

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Debre Brehan University

School of Health ScienceProgram of Nursing

Nursing ServiceAdministration and Leadership

Lecture NotePrepared b y Tesfa D. (B.Sc.)



Unit-oneIntroduction to

nursing serviceadministration



Management Definitions:-

Is a cumulative body of information that furnishesinsight for managers on how to manage the organizationto reach organizational goal.

Is the art of getting things done through people and otherorganizational resource.

Is the process of planning, organizing, leading,controlling, directing, coordinating, and influencing theoperation or work of organization and organization members toobtain 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 purposeof 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, theadministrative function becameless and less and the management

function become more and more.



Nursing serviceadministration

Is a coordinated activity, which provides all of thefacilities necessary for the rendering of nursingservice to clients.

Is the marshaling of a resource to accomplish apurpose.

Is the process of planning, organizing, leading and controlling that encompasses human, material,financial, time, space, and informational resource in an organizational environment to achievethe predetermined goal or objective.

The primary objective of NSA is the provision of continuous individual, group and community service to the optimum level.



Type or level of

managerThere are three levels or types of manager in organization. These are;

1. Top level manager : Have authority over andresponsibility 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 lowlevel 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 aparticular group of works.

• For example; dpt leader/head.



Figurativerepresentation

A d

m i n i s t r

a

t i o n

M a n

a g e

m

e n t



Remember

• The primary difference b/n each levelof manager is;

–

Degree of authority –Scope of responsibility –Organizational activity



Common attribute

–Responsible for utilizingresources.

– 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 certainskills.

• There are three managerial skills theseare;

1. Conceptual skill

2. Human relation or interpersonal skill

3. Technical skill



Cont…d

• The degree to which each manageriallevel uses those skills varies based on;

–The nature of position –Scope responsibility –Work activity

–Number, type, and skills of subordinates.



Cont…d

There fore ;

• Senior manager or top managers use moreconceptual 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 thanother 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.



Cont…d



Role of manager

• Based on Mentize bergs classification there arethree 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 seniormanagers 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).



Cont…d

B.Liaison: The manager is the is channel of communication by telephone, post, letter, eyecontact in all of four direction. Involves formal and informal internal and external contact.

C. Influencer: Include activities inherent in thedirecting function, for the purpose of which isto motivate and lead. The manager changesthe b/r or mind of the followers by being not

by doing.



Cont…d

2. Informational roles: There are three informational roleof 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 theorganization and disseminates information with inthe organization from one member to another.

C. Spokes person: The manager gives informationabout the organization to any concerned body. E.g.to government agencies, media or press, customer.



Cont…d

3. Decisional roles: A. Entrepreneurs: Inventing work literally. By seeing

the environment or the situation, by working longterm research the manager recognize problems and

opportunities and initiate new action to movethe organization to the desired direction.B. Disturbance handler: The manager control

conflict or unexpected event outside thecompany that may affect based on the organization

point of view or ground rule.



Cont…d

C. Resource allocation: The manager allocates resourceby dividing the resource and personal time for various demands in the organization. E.g. assigning workto 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 goodmanagement 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.

anagement unct on o



anagement unct on oa nurse manager in

health care settingI. Planning: Determining the long and the shortterm objectives (ends) of the institution or unitand the actions (means) that must be taken toachieve these objectives.

II. Staffing: Selecting the personnel to carryoutthese actions and placing them in positionsappropriate to their knowledge and skills.

III. Organizing: Mobilizing human and material

resources that institutional objectives can beachieved.



Cont…d

IV. Directing: Motivating and leading personnelto carryout the actions needed to achieve theinstitutional objective.

V. Controlling: Comparing results with

predetermined standards of performance andtaking corrective action when performancedeviates from these standards.

VI. Decision making: Identifying the problem

and searching for solution and selecting thealternatives that best achieves the decisionmakers objective.



Leaderships

Is the ability to inspire and influenceothers to follow toward destiny.

Is b/r not by doing but by being.

Is a trusted privilege offered byfollowers.

Is the ability to elicit a vision from

people and empower these people todo what it takes to bring the vision in toreality.



Leader

Is an individual who works withothers to develop a clear visionof the preferred future and to

make the vision happen . This iscalled enlightened leadership.

Bring the best in people by

empowering people.



Cont…d

There are two types of leader. These are:

I. Proactive: The leader that anticipates solutionfor 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 inorder to reach the desired

destiny.



Comparison b/n leaderand 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 nursingleadership

There are a number of leadership principlesbased 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”.



Cont…d

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 aleader.

• Focus on “what a leader does”.

• More of action oriented and consider theco-actors.



Cont…d

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.



Cont…d

Situational leadership theories

A. Contingency theory

• Formulated by Fredler.

• According to this theory there are three situational

variable affecting leadership effectiveness to predictthe 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



Cont…d

• Generally according to thecontingency theory a nursemanager should modify situation

based on the above variable toimprove staff productivity and usethis theory by understanding these

variable.



Cont…d

B. Path-goal theory

–Formulated by Robert house. –

Introduced in 1971. –Concerned with motivation and productivity.

–

For work accomplishmentemployees should be rewarded and motivation.



Cont…d

Contemporary leadership theory1. 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



Cont…d

• Not too intelligent • Prefer to be directed rather than actingindependently

• They do not work and care for organizational goals but they work ashard 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.



Cont…d

There fore according to theory “x”;

Leaders must direct and control peoplein 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



Cont…d

2. Theory “Y”

More of humanistic approach. Believes that b/r described in theory

“X” is not inherent in humannature but a result of mgt emphasis on control, direction,

reward, and punishment and these behaviors are the symptomsof poor leaderships.



Cont…d

There fore according to theory “Y”;oWork itself can be motivating,

rewarding people.

o People can be enthusiastic.o They can be trusted.oUnder right condition the ordinary person can be imaginative, creative,and productive.



Cont…d

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 andfocuses on developing better waysto motivate people, assuming that this will lead to increasesatisfaction and productivity.



Cont…d

There are five elements of “Z”theory . These are;

1. Collective decision making.

2. Long term employment.

3. Slow promotion.

4. Indirect supervision.5. Holistic concern.



Cont…d

Transformational leadership theory

• Believes that a transformational leader is one who commits people to action,

who convert followers in top leadersand who may convert leaders intochange agent.

• Leadership is thus not so much the

exercise of power itself as it is theempowerment 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.



leadership styleCharacteristics Leadership style

Authoritarian Democratic Laissez faire

Degree of freedom

Little Moderate Much

Degree of control

High moderate No control

Decision making Leader Both Member

Leader activity level

High Moderate Minimal

Assumption of Responsibility

Leader Shared Relinquish(resignor bow out )

Out put of thegroup

High quantity,good quality

Creative, highquality

Variable may bepoor quality

Efficiency Very efficient

and

Less efficient

than

In efficient



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 yourespect and know personally, someonewho inspires you. The person may be a

parent, teacher, political figure,religious leader, supervisor, or friend.



Cont…d

• Then answer those question aboutthe 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?



Cont…d

• People are drawn to leaders because of who they are and the way they relateto 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 ortsto forge ahead.



Shift your mindset

• To become a manager who leads, you need togradually shift your mindset toward seeingyourself as someone who mobilizes and empowers others to create the future.

• To shift your mindset, it is critical to knowyour values, because they will influence the kindof future you can create and will guide and sustainyou on your journey.



Mindset

• It is a habitual way of interpreting and responding to situations.

• People’s 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 asituation, what you focus on and

value, and then what you do.



Leader shifts



Remember

• To improve your abilities to lead, aswell 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.

B ildi l d hi



Building leadershipcompetencies

• Leadership competencies arethe specific mindset,

skills, and knowledge that help managers lead moreeffectively.

• There are eight leadershipcompetencies. 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 takeinto account conditions outsideyour immediate area of work.

3. Create a shared vision• Work with others to envision a

better future and use this vision tofocus all your efforts

4 Clarify purpose and



4. Clarify purpose andpriorities

• Know your own values and whatis mostimportant to accomplish.

5. Negotiate conflict• Reach agreements from which

both sides can benefit.

6 Communicate



6. Communicateeffectively

• Hold conversations focused onoutcomes.

• Balance advocacy withinquiry.

• Clarify assumptions, beliefs,and feelings within yourself and others.

7 Motivate committed



7. Motivate committedteams

• Create the clarity, trust, and recognitionnecessary to lead teams to high performancethat can be sustained over time

8. Lead change• Enable your work group to own challenges,

enlist stakeholders, and navigate throughunstable conditions.

Nurse s function or role



Nurse s function or roleas a leader

1. Know your objective and have a planfor 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 .



Cont…d

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 youmust criticize, be constructive and tactful.



Cont…d

12. Build an atmosphere of respect among team members.

13. Put the team first. Make it clear

that you are more interested in thegroups achievements than in the

personal gain.

14. Use d/t leadership style



Cont…d

15. Develops skills or qualities of leader. i.e.is;

–Positive-They believe in themselves and others,

and the contributions they can make.

–Enthusiastic-They are willing to tackle tasksthat others may dismiss as possible.

–Committed to excellence-They are always

looking for new and better ways to do things.



Cont…d

–Self-confident-They are willing to

make decisions even when theseare unpopular.

–Sincere-When they make apromise; they do all they can tokeep it.

–

Open to new ideas-They realizethey do not have all the answers.

U it t



Unit-twoHuman

resource

management



Definition of terms

Human resource management:- is theprocess of acquiring and retaining theorganization human resource.

Nursing personnel management:- is theprocess of acquiring and retaining nurse personnel in the health care organizationor health educational institution.



1. Acquisition activity

® Human resource planning

® Recruitment

® Selection

® Orientation

Human resource



Human resourceplanning

Refers to planning for future personnel needs of an organization (includesexpansion and development of an

organization). Takes into account both internal

activities, and factors in the external environment.

Human resource planning precedes theother acquiring activities.



Cont…d

Planning procedures includes ;Planning for future needs

Planning for future balance(number needed versus present)

Planning for recruiting

Planning for the development of employees



Cont…d

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



Cont…d

2. Staffs turn over. Due to; –Resignation

–Discharge

–Retirement



Cont…d

Human resources planning have five steps. These are;

1. Profiling:-To profile or show the personnelneed of the organization at some future point.

2. Estimating:-Projecting or transferring ordesigning the type and the number of personnelneeded.

3. Inventorying:-HR audit of present employees.



Cont…d

4. Forecasting:-Anticipating change inthe present work force in terms of entries and exits.

5. Planning:-Based on the aboveassumptions determine the numberand type of employee with the

required knowledge, skill and practice.



Cont…d

Human resource Sources1. Internal Sources:-filling vacancies by

transferring or promoting from within theorganization.

Advantage – It is cost effective, reduces recruiting and

relocation costs – Usually quicker, and –

Enhances employee moraleDisadvantage – Seniority rules policy rather than best

qualification



Cont…d

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.



Cont…d

Advantage

– Best qualified individual will berecruited

– It avoids seniority rules and policy Disadvantage

– It is costy –

Not quicker/late – Decrease employee morale



Recruitment

Is the process of attracting qualifiedpeople to apply for a job. Or

Is the process of making applicants

available for selection.Activities in recruitment;

1. Writing job description:-a writtendescription of a non-management

job, covering/job title, duties, and responsibilities, and including itslocation on the organization chart.



Cont…d

2. Writing position description:- a writtendescription 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



Cont…d

Sources for recruitment depend on:

– Type skill required (or nature of position)

– Environmental factors (demand) – Local labor pool (availability)



Cont…d

Affirmative action: giving priority for femalesand minorities (this is in practice in Ethiopia)

Give examples of implementation of affirmative action in Ethiopia.

Equal payment : like pay for like jobs (EqualPay Act –USA).

Comparable worth: the principle that different jobs that require compare skills and knowledgedeserves comparable pay

d



Cont…d

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, otherorganizations).

– Formal announcement (mass media).

C d



Cont…d

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 toboth public and private sectors.Discuss how this principle is applied in

Ethiopia especially in the regions

S l i



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 interms of training, experience and abilities.

– The organization decides whether or not tomake job offer and the candidate decides

whether or not to accept it.

C t d



Cont…d

C t d



Cont…d

The source of information for selectionare;

–Application forms

–Pre-employment interview

–Testing

C t d



Cont…d

selection processThe process depends on:-

1. The level of placement of employee inthe organization hierarchy – Lower level : routine (for example recruitments

of guards, cleaners, or, low level employees)

– Middle or upper level : extensive and carefullyplanned - in-depth interview (for example

professionals, administrators).

C t d



Cont…d

2. Information exchange (organizationto candidate) – The organization may exaggerate its strength

(exaggeration of organizational values and

achievements)

– The candidate may overestimate his or herquality (exaggeration of personal achievementsand abilities). It good if the candidate provides

realistic job review (strength and weaknesses)

C t d



Cont…d

The candidate may pass through thefollowing process;1. Complete job application

(applicable in many organizations).

2. Initial screening interview (to filterthe type of candidate required).

3. Testing (some big organizationsfollow this method).

4. Background investigation(contacting previous employers orschools, etc).

C t d



Cont…d

5. In-depth selection interview(competition among the possible candidates)

6. Physical examination (this is usually arequirement when the job is about to beoffered)

7. Job offer (the candidate wins a position andthe official offer comes from the

organization)

O i t ti / i li ti



Orientation/socialization

• It is a program designed to help employees to fitinto 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 theemployee to the organization

• Detailed presentation:-policies, rules andregulations, issuing an identification badge,benefits plans, brochure.

C t d



Cont…d

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, encouragequestions.

C t d



Cont…d

Advantage; – Builds employees sense of identification

in the HSO.

– Helps to get acceptance by fellowworkers.

– Give them a clear understanding of many things they need to know.

– Enables the new employee to becomefamiliar with the entire organization aswell as their own work area and dpt.

2 Retention acti it



2. Retention activity

® Personnel training anddevelopment

® Performance appraisal

® Placement

® Discipline and correctivecounseling

® Staff development

Cont d



Cont…d

® Compensation and benefitadministration

® Health

® Motivation

® Promotion

® Personnel policy

Personnel training and



gdevelopment

• Personnel training is the formal procedurewhich an organization utilizes to facilitatelearning.

• Training is a management tool designed to

enhance organization's efficiency and attain the goals of both the organizationand the individual.

• For managers: conceptual and human skills

(future).

• Non-managers: technical skills (current job).

Cont d



Cont…d

Management development program• To improve knowledge and skills of

managers (for effectiveness and promotion).

• Now a days frequently used becauseexperience takes time.

• Costly .

• Some prefer to providing practical jobexperience.

Cont d



Cont…d

Assessing training needs• Procedures to determine training needs of

individuals;1.Performance appraisal : measure work against

the standards

2.Analysis of job requirements: jobrequirements/available skill.

3.Organizational analysis: effectiveness of organization

–

Train those with low performance and highturnover

1.Employee survey : about problems faced andactions needed.

Cont d



Cont…d

Approaches to training:

A.On-the-job training : Whileemployees 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 .

Cont d



Cont…d

B. Off-the-job training: While workersare outside the work area or in cutof work until the training finished.

–

Vestibule training: training on realistic jobsetting or equipment.

– Behaviorally experienced training:simulation, exercises, cases, games, role-

playing (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 isused to evaluate the effectiveness of his/her work.

• Can be;

– Informal appraisal :-Feedback on day-to-dayperformance (strength/weaknesses).

– Formal systematic appraisal:-A systematicfeedback about performance (semi-annually orannually).

Cont d



Cont…d

Purpose of PA;

–Provide information for decision regarding salary

praises, promotions, transfersor discharges.

–Helps to assist employees in

their personal development.

Cont d



Cont…d

–Helps to assess theeffectiveness of hiring and recruiting practices.

–Helps to identify training and development needs of theemployees.

–Helps in the establishment of standards of job performances.

Cont d



Cont…d

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 othersare lenient. Leniency error - some raters are hard (below the true leveli.e. is negative leniency ) or easy

graders (above the true level i.e. ispositive leniency).

Cont d



Cont…d

– An appraiser may replace organizational standardwith personal values and bias. Halo error isevaluations based on the rater’s general feelingabout the employee.

– B/c of lack of information, standards by which

employees think they are being judged are sometimes d/t from those superiors actually use.

– The validity of ratings may be reduced by thesupervisor’s resistance to making the ratings.

Cont d



Cont…d

Tools of performance appraisal; – Rating scale-Consisting of b/r or xtics to

be rated and scale that indicate fulfillment.

• Methods;

–Manager’s rating (commonest) –Group of managers rating (second most commonest)

–Group of peers rating –Employees’ rating of bossescombination of methods.

Cont d



Cont…d

– Check list -Consisting of a number of questions that measure the employee’sperformance.

– Mgt by objective-Observation of

predetermined goals that have been jointlyagreed up on by the employee and theevaluator.

Characteristics of an effective PA;

– Relate PA to the job description. – Understand the criteria for evaluation.

Cont d



Cont…d

Appraisal methods designed to avoid raters bias;• The field review method - Comparison of

several evaluators for the same employee.

•

The forced choice rating method -Theevaluator choose from among a groupstatements those that best describes theindividual being evaluated and those thatleast describe this person.

•

The critical incident technique-Thesupervisor observes, collect, and recordinstances of the employee carrying outresponsibilities critical to the job.

Promotion



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, andminority

Motivation



Motivation

Is the force either with in or external to aperson that arouses enthusiasm and persistenceto peruse a certain course of action.

A process of stimulating people to action to

accomplish desired goal.Motivating: the management process of

influencing people’s behavior based on theknowledge “what makes people thick”.

Cont d



Cont…d

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 person’s performance e.g.ability, resources, conditions.

• Motivation is short supply and in needof periodic replenishment.

• Motivation is a tool with whichmanagers can arrange job relationshipin organizations.

Cont d



Cont…d

Motivation issues for managers of healthservice 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, makingpositive statements, avoiding wastage,protecting fellow employees and org. property.

Cont d



Cont…d

Administrators should;• Understand why persons are

willing to contribute their

efforts.• Have skill in obtaining

cooperation from members of

the org.

Cont d



Cont…d

Characteristics of motivationMay be financial or non-financial:

wages, allowances, recognition, andpraise, giving more responsibility andinducing to participate in the decision-making process.

Unending process: Human needs are

infinite/endless.

Cont d



Cont…d

Determined by human needs: knowing the need of an individual.

Can not be applied to a frustrated person.

A psychological process: psychologyof workers.

Total , not partial: is related to the

needs and psychological states of people.

Cont d



Cont…d

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 og’s

Cont d



Cont…d

–Good labor relations –KAP of employee is improved

–People develop sense of

belongingness

–Finally the og’s can utilize thefactors of production to the

maximum

Cont…d



Cont…d

Guidelines for effective motivationManager must actively and intentionally

motivate their sub-ordinate.

Manager should understand their ownstrength and limitation before attempting tomodify those of others.

Manager must recognize that employees

have d/t motives and abilities.

Cont…d



Cont…d

Reward should be r/t performance, notseniority or other non-merit basedconsiderations.

Jobs should be designed to offerchallenge and variety.

Sub-ordinate must clearly understandwhat is expected of them.

Mg’t should foster an org’nal cultureoriented to performance.

Cont…d



Cont…d

The six motivator in work place1. The work itself

2. Self improvement

3. Recognition

4. Advancement

5. Achievement 6. Responsibility

Theories of motivation



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 nexthigher need energize and directsb/r.

– The hierarchy of Maslow includethe following components;

Cont…d



Cont…d

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, self-respect, appreciation,)

E. Self-actualization (e.g. developing one’swhole potential,)

Cont…d



Cont…d

2. Two factor (Hertzberg) theory or theory of job satisfaction

Hertzberg enlarged on theory “Y” approach by dividingthe needs that affect a person’s motivation to workinto two sets of factors. These are;

A. Hygiene/ maintainance factor-those factorsthat meet a person’s need to avoid pain,insecurity, and discomfort that affect dissatisfaction. If not meet employeesdissatisfied.

Cont…d



Cont…d

This include; – Adequate salary

– Appropriate supervision

– Good interpersonal r/ships

– Safe and tolerable workingconditions(includingreasonable policies andprocedure)

Cont…d



Cont…d

B. Motivation factor-those that meetneeds to grow psychologically, whenmeet, the employee feels satisfied.

This include;

Adequate recognition

Appropriate responsibility

Satisfying, meaningful work Opportunities for advancement

and achievement

Cont…d



Cont…d

3. Achievement need (McClelland) theory McClelland claimed that human needs are

socially acquired and that humans feel basicneeds for achievement, affiliation, and power.

Needs for achievement is the drive toexceed one’s former accomplishments, to perform an activity more skillfully and effectively than before.

Cont…d



Cont…d

A person with high achievement needs to spendmuch time thinking about how to improve personal performance, how to overcomeobstacles to improvement, and what feelings will result from success and failure.

McClelland claims that people with highachievement need to set moderate, realisticgoals, enjoy problem solving activities, and desires concrete feedback on performance.

Cont…d



Cont…d

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 byother employees for the same amount of input.

• Feeling of inequity motivate an employee toresolve the inequity by reducing input attempting to increase out comes, selecting a d/t

comparison worker, or resigning.

Cont…d



Cont…d

5. Expectancy (Vector Vroom)• Indicates that a person’s attitudes and

b/r are shaped by the degree to which

they facilitate the attainment of valuedout comes.

• The amount of an employee’s job

effort depends on her or his perceptionof the r/ship b/n good performance andspecific outcomes.



Unit-three

Organizing

care

Delivery system



y y

System is a set of elements standing in interrelation and work together for common goal.

There are two type of system. These are;

A. Open system:-A system interact with the out

side env’t to exchange matter. It is veryimportant for the given org’n.

B. Closed system:-Self contained with nointeraction with the external env’t. Only found in

physical science and not relevant for a givenorg’ns.

Cont…d



System theoryStates that the whole is more than

the sum of elements.

The it self is can be explained only asa totality.

Holism is the opposite of

elementarism.

Cont…d



Xtics of system1. Input or importation of energy.

2. Through put or process3. Out put

4. Cyclic event with in thesystem boundaries5. Negative entropy

Cont…d



6. Information input/feedback 7. Homeostasis or steady state

8. Differentiation

9. Integration or coordination10.Equi-finality

Nursing service deliverysystem



system• With in these different nsg service

delivery system there are advantageand disadvantage for:-

® Quality care® Uses of resources

® Staff growth

These different nsg service deliverysystem as follows;

Cont…d



A. Case method• Is the new method.• Began in the early days of nsg profession during F.nightnigale.

•

The convenient and appropriate to managecare.• 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).

Cont…d



AdvantageHolistic Job satisfactionContinuity of care

Allow independent decision makingGood therapeutic r/ship (nurse-client

r/ship), b/c increase personal contact Easy to identify the responsible nurse

when problem raises and success isoccurred

Cont…d



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 thenurse

• Over extend span of control for thehead nurse

Cont…d



B. Functional method• Assignment of pt care made by the level of

task.

• Each person performs one task function in keepingwith the employee’s educational experience.

Advantage® Reduce personnel cost ® Specialty of care® Experienced or qualified staff care

® Timely care is given for the pt ® Support cost control

Cont…d



DisadvantageIt may cause burden on the head nurseIt is difficult to implement in og’n with few

staff membersIt is difficult to identify the responsible person when positive or negative event happened No continuity of careDecrease personal contact with pt

Fragments of ns’g careDecreased job satisfaction

Cont…d



C. Team nursing• This is accomplished by arranging the

workers in team.

• The head nurse doesn’t directly communicate with staff rather throughteam head nurse.

• Introduced after 1945.

•

There is delegation of authority and activity or decentralization.

Cont…d



• The team consists of; –Senior professional nurse

(team leader), –Registered nurses (RNs), –Licensed practical nurses

(LPNs) or vocational nurses,

and –Nurses’ aides.

Cont…d



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 teammembers Qualified care is given

Cont…d



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

Cont…d



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 thehands of the primary nurse.• Was intended to return the nurse to bedside,

thus improving the quality of care andincreasing the job satisfaction of the nurse

staff.

Cont…d



• The primary nurse is expected toestablish therapeutic r/ship.

• The best aspect of primary nsg is the

improved communication provided by the one-to-oner/ship b/n nurse and pt.

Cont…d



Advantageo Increase job satisfactiono Improves the quality of care, if the

individual is well qualified o Continuity of careo Allows independent decision makingo Support nurse-client communication

o Encourage discharge planning

Cont…d



Disadvantage• Increases personnel’s 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

Cont…d



E. Case management• Most recent.

• Evolved from other system.

• It is system of health ass’t, planning,

service procurement and delivery,coordination and monitoring the multipleneeds of clients.

• This is an all-inclusive, comprehensive model

and is not restricted to hospital setting.

Cont…d



• When pts deviate from the usual expected courseof recovery or health, consultation ensures toquickly correct the problem. This requires a greatdeal of systemic knowledge about a pts problemsand putting that knowledge in the nsg care (Case

management plan).

• In addition to the nursing and medical services thatare required for pt, other services are included.Such as physical therapy, respiratory therapy.

Cont…d



Advantage® Totality of care

® Continuity of care

® Job satisfaction® Improves nurseresponsiveness to clients

changing needs® Independent decision making

Cont…d



Disadvantage• Exhaustive• Increase personnel cost • It requires highly qualified and

experienced individual

Organizationalcharacteristics



characteristics• Span of control -The number of

employees a manager can effectivelyoversee.

• Mostly top manager can not manage asmany employees as managers at lowerlevel.

• For example, the ratio for manager to

employee’s is1:3 in top level, 1:6 inmiddle level, and 1:20 in low level.

Cont…d



• The effective span of ctrl for eachmanager depends on;

Ö Work pace

Ö Pattern of worker skill and knowledge

Ö The amount of work

interdependence

Cont…d



•

When span of ctrl is broad ;© The manager has insufficient time toobserve© Can not evaluate performance

© Can not give feedback • When span of ctrl is too narrow;

© Manager supervises employees closely. To close supervision discourage subordinatesproblem solving, independent decision making,creative thinking. Research show that workerproductivity is higher when close supervision isimpossible.

Cont…d



Organizational principle• Unity of command :-the employee should be

responsible to only one supervisor.

• Requisite authority :-an authority over both onthe position and resource during delegation.

• Continuing responsibility :-managers functionnot diminished during delegation for subordinate.

• Organizational centrality (communication) :-greater interaction in work place and have highinformation in the org’n.

Cont…d



Organizational concept• Responsibility :-is the obligation

to do.

• Authority :-the right of decisionand commands.

• Delegation :-assigning duties.

• Accountability :-answering forwhat has been done.

Organization structure



• Organization- is a group of peopleunder formal or informal rules workingtogether for common goal.

• Organization is has two concepts, both

structure and process.

A.Organization process-refers to themethod used to achieve og’nal goal.

B.Organization structure-refers to the linesof authority, communication and delegation.Can be formal or informal.

Cont…d



1. Informal og’nal structureEvery og’n also has an informal structure,

xterized by unspoken, often covert, lines of communication and authority r/ships not

depicted in the org’nal chart. The informal structure develops to meet

individual’s needs for friendship, a senseof belongingness, and power.

Cont…d



• The lines of communication in the informal structurecommonly called the “grapevine” and concernedmainly with social issue.

• Persons with access to vital information canbecome powerful in the informal structure.

• Some administrator try to hinder the effect of informalorg’n, b/c they facilitate the passing of information.

Cont…d



The information may be a rumor, but thebest way to combat rumor is by free flowof trustful information.

The informal org’n can help to serve the goal of

formal org’n 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 org’n.

Cont…d



• The principal purpose for defining org’ndiagram is to clarify chain of command,span of ctrl, official communication,and linkage for on dpt personnel.

• It is customary to show formal org’nstructure in a diagrammatic form with a

three dimensional model havingdepth, height, and width.

Cont…d



• Boxes containing various positiontitles are positioned vertically tohighlight difference in status and

responsibility.• Position boxes are connected with

lines to demonstrate the flow of

communication and authoritythrough out the entire network.

Cont…d



•

D/t types of interconnecting lines signify d/t typesof r/ships.

– For example;

• a solid line b/n two positions indicatesdirect authority or command giving r/ship,

• a dashed line or a broken or a dotted lineindicate a consulting r/ship with no prescribed frequency of the structure tocollaborate for planning or ctrl purposeand commands don’t flow.

Cont…d



• The org’n chart does not showthe degree of authority , i.e. amanager has over subordinates.

•For example, a manager withauthority of head nurse may lackauthority hire or fire the worker.

Cont…d



2. Formal og’nal structure• An og’ns formal structure is depicted in its og’nal

chart i.e. provides a “blue print”, representingformal relations, functions and activities.

• The primary significance of formal org’nal structureis the frequency of communication b/n

particular staff members.

• Particular workers are expected to relatedirectly with certain individuals and not

others.

Cont…d



Types of formal org’nal structures1. 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 org’nal

structure b/c it provides clear authority responsibility r/ship b/n workers and requires less information transmission b/n

workers and manager.

Cont…d



• The typical line pattern is divided laterally intosegments representing d/t nsg specialties.

• The perspective of workers differs from the bottomto 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.

Cont…d



AdvantageEasy to orient new employeeEasy to manage workers

Well established division of labor There is a clear cut work

specialization and role

separation

Cont…d



Disadvantage• Makes employee task narrow, repetitive performance and communication difficultiesamong specialists due to specialization.

• Workers tend to resist innovative change and

resist recommendation from outsider’s b/c of rigidity.

• Causes passivity and dependency in staff members and autocratic b/r in manager.

Cont…d



•

The strong chain of command and concentration of authority at the topof 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.

Cont…d



2. Line and staff pattern/relationship• Line functions are those i.e. direct responsibility for

accomplishing the objective of nsg dpt. For the mostpart they are filled with RN, licensed assistant nurse or other type of nurse.

•

Staff functions are those that assist the line inaccomplishing the primary objective of nsg. They include clerical, personnel, budgeting and financing, staff development and research.

Cont…d



•

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 ensuresthat line and staff authority r/ships areclearly defined. Personnel of both shouldwork to make their r/ship effective.

• They attempt to minimize friction by

increasing trust and respect.

Cont…d



Advantage• Key mgt function that the chief

executive has neither skill nor time to

execute well are delegated tofunctional experts who can devote fulltime to the assigned function with out being distracted by responsibilities of day today mgt of material and

personnel.

Cont…d



Disadvantage• Staff officer have less power than line officer b/c

the later directs the basic operations

• Staff officer must stand quietly in thebackground while, line managers receiverecognition for improvements.

• Staff positions are located at the periphery of the org’nal structure, which casts incumbents in the role of social isolates.

Cont…d



3. Matrix org’nal structure• Is a complex constructed in which and employee

may be responsible to two or more bossesfor d/t aspect of work.

• Potential problem with a matrix type of org’nalstructure can easily be observed or perceived.

• If for example, the head nurse and the casemanager give conflicting orders to the staff nurse the job may be indefensible, or amanipulative nurse may play his or her twobosses off against each other.

Cont…d



•When a matrix org’n is used, theremust be a clear decision rules and it is hoped, good interpersonal r/ships.

• The employees must know whichbosses have the final word when theyreceive conflicting orders or demands

concerning work priorities.

Cont…d



4. Functional line and staff pattern

• Staff officers are no longer purely advisory but have somecommand authority aver line employees.

• The director of in-service may have the authority to decidehow much indoctrination training and what type of orientation each new nurses must receive and whenorientation class will be held.

• The director of quality improvement may have the authorityto assign selected staff nurses to gather data on criticalindicators of care quality, regularly submit qualitymonitoring reports, and remedy identified problems.

Cont…d



Advantage• The expert responsible for a specified mgt function,

such as staffing, policies, quality improvement, or staff development has authority to command linemanagers to implement needed action that relateto the expert specified function.

As a nsg org’n increases in size, it may evolvefrom a pure line to a line and staff, and finally to functional line and staff structure.

Cont…d



Standards for evaluating the effectiveness of lineand staff r/ship in heirarchial org’n standards

1. Line authority r/ships are clearly delineated and defined by the org’nal and/or functional chartsand policies.

2. Staff authority r/ship are clearly delineated and

defined by the org’nal and/or functional chartsand policies.3. Functional authority relations are clearly

delineated and defined by the org’nal and/or functional charts and policies.

Cont…d



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 org’nal 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. Message3. Receiver 4. Channel 5. Feedback/response

Cont…d



A. Sender :- is source of information.B. Message:- is any form of signal that canbe understood by one or more sense of the receiver, e.g. hearing, touching,smelling, tasting.

C. Channel :- is the method that is used tocommunicate. E.g. written material,media (radio, TV, …).

D.Receiver :- is the person who receive the

sender message.E. Feedback :- is the response of receiver.

Cont…d



•

All of these components areinfluenced by an environment andcapable of enhancing or inhibitingthe understanding of themessage.

• To be a leader/manager the nursemust have understanding the

communication process .

Cont…d



In technical terms ,the communication processconsist of six steps .These are;

1. Ideation: the message, the idea, or thought tobe conveyed to an individual or group.

2. Encoding :the manner in which the message in

conveyed and may be other than verbal, such as awritten message or visual or audible cue(sign orindication ) ,and non - verbal behaviors such asgesture or an expression .

Cont…d



3. Transmission: the actual expression of themessage.

4. Receiving: the receiver accepting of themessage.

5. Decoding: the receiver understanding orinterpreting of the message.

6. Response or feed beck : the response shouldconvey to the leader or the degree of

understanding held by the individual or thegroup.

Cont…d



Cont…d



Ten basics points for good communication

1. Clarify your ideas before communicatingothers .Before speaking to an individual or group, plan and organize what it is you are going tosay . Analyze your thought carefully, and keep in

mind the objective you wish to meet as well as theuniqueness of the individual or the group .Providean opportunities for questions and answers toenhance the clarity of the message.

Cont…d



2. Consider the setting, both physical and psychological or mental setting. The physicalsetting can be conducive or can be serious block tocommunication. The psychological environment isreferred to as the communication or social climate.

The psychological and emotional relationship betweenand among the work group and the manager and maybe supportive or defensive.

Cont…d



Characteristics of supportivecommunication 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 .

Cont…d



Characteristics of defensivecommunication 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 isusually non-productive and un pleasant .

Cont…d



3. Consult with others when necessary to beexact and objective . The worst mistake aleader can make is to communicate incorrectinformation to the members of the group. If missinformation is given to an individual or to the

group, the leader should acknowledge the errorand correct the situation. This demonstrates tothe staff and to superior that leader deal withmistakes in a direct, honest and forthrightmanner.

Cont…d



4. Be mindful of the overtones as well as the message it self .Non-verbal cuesmay be saying something opposite fromthe word nature .It may give mixed

message ,making it very difficult for thelisteners to know what you are trying tocovey .Non-verbal behavior shouldsupport your message ,not detract from it.

Cont…d



5. Take the opportunity to convey something to help ,value or praise to thereceiver. People need to know that theircontribution are useful and respected .This isnot just limited to subordinates ;you also mightwish to acknowledge the helpful contribution of superiors.

6. Follow up your communication . You mustget feed back to make sure that the messageunderstood as you intend it to be understood.Ask question and encourage the receiver toexpress his or her reaction by follow upcontacts.

Cont…d



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 beconfusion, and people will tend to deny what has beensaid.

8. Give credit for the contributions of others whengenuinely deserved .It is amazing how powerfulpraise can be in establishing positive feeling in otherpeople. Every one need to know when he or she havedone something especially well.

Cont…d

i li i h h



9. Be an active listener .Practice what you preach.Listen to what the person has said as well as the inwhich it was said. Probably one of the leastdeveloped skills in the communication process. Atrue leader must develop the self mastery to besilent when someone else is speaking. To do thatyou must consider the other person s ideas to bemore 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 tointerrupt the conversation. It does mean that youmust learn the others point of view by hearing and

trying to understand the message .It only throughunderstands what the differences are that thepotential for positive solution exist.

Cont…d



10. Be an assertive when expressingyour view .Communication patternsexist on continuum from passive toaggressive .Assertive communication and

behavior maintain a balance betweenaggressive and passive style .Theassertive style considers the right of allpersons involved in the communicationprocess.

Cont…d



Communication barriers• Refers to obstacles that some how prevent the message from beingdelivered or understood.

• There are four main communicationbarriers. These are;

1. Poor listening skill.2. Psychological blocks.

3. Environmental distractions.4. Semantic barriers.

Cont…d

C i ti t k



Communication network

– Communication networks, allow information to becirculated among the group.

– These networks affect the way groups solve problem.

– The actual pattern of the communication networks maybe as varied as the number of groups in existence.

– The real issue is not whether every participant shares atwo way communication channel with every othermember but whether the communication is adequate asmeasured through the appropriate performance of thegroup.

Cont…d



The common communicationnetworks or patterns are:

1. Downward

2. Upward 3. Downward and upward

4. Circular

5. Multi channel

Cont…d





FourProblem solving,

Critical thinking,Creativity, and

Decision making

Problem Solving

bl l i i b i i ll l h



Problem Solving is basic intellectual process that has been refined and systemized for the variouschallenges people face.

Problem solving which involves a decision makingsteps 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”

Cont’d…



There is a dissatisfaction that the problemcreates for individual, group, and organization. In attempting to address theseissue the participant gather and examinesinformation in an effort to define the problem and

identifying possible solutions.

Effective problem solving and decisionmaking are predicted on an individuals ability tothink critically.

Critical thinking

I i f



It isintellectually disciplined

process of conceptualizing, applying, analyzing,synthesizing, and evaluating informationgathered 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?”.

Cont’d…



o

It is important for manager to assesstheir staff members to think criticallyand enhance their knowledge andskill through;

oStaff development programs.oCoaching.

oRole modeling

Cont’d…



Critical thinking is important for;Problem solving.Creativity.

Decision making.Clinical judgment Critical thinking is the

concept that link all theabove mentioned concepts.

Cont’d…



Creativity



It is the ability to generate options or alternative solution ideas.

It is the capacity to have newthoughts and to create expressionsunlike any other.

It is a basic element in many humanendeavors, such as art, music,

literature, and performance.

Cont’d…



Encouragingcreativity

Convergent thinking:-the

problem is dividedinto smaller andsmaller pieces to finda more manageableperspective.

Problem

Decision

Cont’d…



•

Divergent thinking:-One'sview of theproblem is

expanded. Theproblem isconsidered indifferent ways.

Figure

Decisi

on

Problem

Cont’d…



• Brain storming: under favorablecircumstances a group workingtogether can identify more ideasthan an individual or the groupof individuals workingseparately. It is a techniquemanagers can use to create a free

flow of ideas.

Decision Making

It is a purposeful and goal directed effort that



• It is a purposeful and goal directed effort thatuses a systematic process to choose among twoor 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.

Cont’d…



Phases of decision making1.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.

Cont’d…

Poor quality decision is likely if the objectives are



• Poor quality decision is likely if the objectives arenot clearly identified or if they are inconsistent withthe 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 yougoing?” Hana replied “I don’t know” finally the man replied “it doesn’t matter you can

follow any one”.

Cont’d…



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.

Cont’d…

Based on the above assumption there are four



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.

Cont’d…



II. Descriptive/ Behavioral DM model Used when the situation is

complex, unpredictable, and uncertain.

You don’t know the outcome.

Information is subjective and everyperson define or interprets into

different direction.

Cont’d…

III Satisfying/ Conservative DM model



III. Satisfying/ Conservative DM model

Used when information is gathered to meetthe minimum requirement for the objectiveof decision.

This model is appropriate when critical,urgent, immediate answer were needed within a short period of time.

Cont’d…

IV Optimal DM model



IV. Optimal DM model

The solutions/decisions are selected based onoptimal requirement for objectivedecision.

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.

Cont’d…



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 decisionrules.

Cont’d…

1. The importance of the decision quality



1. The importance of the decision quality to the institutional success.

2. The degree to which the manager process the information and skills todecision.

3. The degree to which the followers havethe necessary information to generate aquality decision.

4. The degree to which the problem is

structured.

Cont’d…



5. The importance of followerscommitment.

6. The likelihood that an autocraticwould be accepted.

7. The strength of followerscommitment to institutional goals.

8. The likelihood of followers conflict

over the final decision.

Cont’d…



Based on the above mentioned rulesthere are three Dm styles. These are;

1.Autocratic DM style.

2.Democratic DM style.3.Anarchic DM style.

Based the stated rules characterize

them.

Cont’d…

Types of decisions



Types of decisions

• Decisions made in the nursing service can becategorized depending upon the followingcriteria

How much time the manager spends in

making decision?What proportion of the organizationmust be involved in making decision?The organization function/ the nursing

functions on which they focus.

Cont’d…



On the basis of these there arethree classifications:

1. Ends -Means

2. Administrative-Operational 3. Programmed-Non- programmed

Cont’d…

1. Ends-Means



Ends: deals with the determination of desired individual or organizational results to beachieved.Means: decisions deal with strategic or

operational programmes, activities that willaccomplish desired results. These usually occurduring managerial planning processes,strategy and objective formulation processes.

Cont’d…

2. Administrative-Operational



2. Administrative Operational

• Administrative: made by senior management ,which have significant impact throughout theorganization. Usually this type of decision isconcerned with policy, resource allocation

and utilization.• Operational: are generally made by mid level

and first line managers and address day today operational activities of a particular

organizational.

Cont’d…



3. Programmed-Non -programmedProgrammed :-these are repetitive

and routine in nature. Since they canbe programmed, procedures, rulesand often manuals are formulated tocover those situations.

• None programmed :- unique and

non- routine. This can be used inemergency/urgent situation.

Cont’d…



Conditions that initiate decisionmaking are;

1.Opportunity

2.Threat 2. Crisis

3. Deviation

4. Improvement

Cont’d…

Ways of Decision Making



1. Relying on tradition: taking the samedecisions that had been undertaken whensimilar problem arouse in the past.

2. May appeal to authority :- make decisionsbased on suggestions from an expert/a

higher level management.3. Prior reasoning: based on assumption4. Logical decision making: is a rational,

intelligent and systematic approach todecision making

Cont’d…



Factors Influencing DecisionMaking

1. Decision makers attribute

• Knowledge, experience, and judgment

• Perception and personality

• Values and philosophy

Cont’d…

2. The Situation



• Urgency of solution and time pressures• Magnitude and importance

• Structure and uncertainty and risk • Cost benefit

3. Environmental Constraints

• External • Internal

Cont’d…

Decision Making Tools



g

There are many tools. The most common are:

1. Probability theory : is the likelihood that anevent or outcome will actually occur and allow

decision makers to calculate an expected valuefor each alternative. Expected Value (EV) =Income it would produce (I) x its probability of making that income (P).

Cont’d…

2. Decision tree:-are graphic decision



g pmaking tools used to evaluate decisionscontaining a series of steps

Deciding to decide1. Is the problem easy to deal with?

– Tip: avoid being bogged down in trivialdetails. Effective managers reservedecision making techniques forproblems that require them.

2. Might the problem resolve itself. – Tip: prioritize and rank problems inorder of importance.

Cont’d…

3. Is it my decision?



y

Tip: the closer to the origin of the problem thedecision is the better. Before deciding askthe following questions:

• Does the issue affect other departments?

• Will it have a major impact on thesuperior's area of responsibility?

• Does it need further information from

higher blevel?

Cont’d…



• Does it involve serious breach of my department’s budget?

• Is this problem outside my area of

responsibility or authority? If theanswer to any of these questions is'YES' pass it to your superior.

Cont’d…

Barriers to Effect Decision-Making



1. Easy recall : the more easily can recall the event, themore frequently they believe it occur.

2. Easy search: not to put effort to seek informationfrom the appropriate sources.

3. Misconception of chance: Most people do not

understand the nature of random events.4. Confirmation gap/bias: bending evidence to fitone’s beliefs.

5. Relaxed avoidance: the manager decides not todecide or act after noting that the consequences of inaction will not be serious.

Cont’d…

6. Defensive avoidance: Faced with a



problem and unable to find a good solutionbased on past experience, this manager seeksa way out. He/she may let someone else makedecisions. This resigned posture may preventconsideration of more viable alternatives.

7. Panic: the manager feels pressurized notonly by the problem but also time.

Cont’d…



Overcoming barriers to individualproblem solving

1. Setting priority.

2. Acquiring relevant information.3. Proceeding methodically and

carefully.

Unit Five



Health

ManagementInformation

System (HMIS)

Why healthinformation system?

•Good management is a prerequisite for



increasing the efficiency of health services.

•Improved health information system is clearlylinked to good management.

•Information is crucial at all management

levels of the health services from periphery tothe centre.

Cont’d…

•It is required by policymakers,



managers, health care providers,community health workers.

•“Changing the way information is

gathered, processed, and used fordecision-making implies changing theway an organization operates.”

What is HMIS?

Definition of MIS;



• A formal method of making availableaccurate and timely information tomanagement that is necessary to

facilitate the decision- making process and enable the organizations planning, control and operationalfunctions to be carried out

effectively.

Cont’d…

•It is the practice of maintenance and care of

http://en.wikipedia.org/wiki/Medical_record



health records by traditional (paper-based) andelectronic means in hospitals, physician's officeclinics, health departments, health insurancecompanies, and other facilities that providehealth care or maintenance of health records.

Cont’d…

•With the widespread computerization of health


http://en.wikipedia.org/wiki/Hospital

http://en.wikipedia.org/wiki/Physician

http://en.wikipedia.org/wiki/Health_department

http://en.wikipedia.org/wiki/Health_insurance

http://en.wikipedia.org/wiki/Health_care

http://en.wikipedia.org/wiki/Health_care

http://en.wikipedia.org/wiki/Health_insurance

http://en.wikipedia.org/wiki/Health_department

http://en.wikipedia.org/wiki/Physician

http://en.wikipedia.org/wiki/Hospital




records and other information sources, includinghospital administration functions andhealth human resources information,health informatics andhealth information technology are beingincreasingly utilized in information managementpractices in the health care sector.

Cont’d…

•HMIS is application of the principles of

http://en.wikipedia.org/wiki/Hospital_information_system

http://en.wikipedia.org/wiki/HRHIS

http://en.wikipedia.org/wiki/Health_informatics

http://en.wikipedia.org/wiki/Health_information_technology

http://en.wikipedia.org/wiki/Information_management

http://en.wikipedia.org/wiki/Health_care_system

http://en.wikipedia.org/wiki/Health_care_system

http://en.wikipedia.org/wiki/Information_management

http://en.wikipedia.org/wiki/Health_information_technology

http://en.wikipedia.org/wiki/Health_informatics

http://en.wikipedia.org/wiki/HRHIS

http://en.wikipedia.org/wiki/Hospital_information_system



management information system in healthcare systems.

The system provides information on past, present and projected future & relevant

events inside and outside the organization.

Cont’d…

fi i i f



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

Health System - All the activities whose primarypurpose is to promote, restore or maintain health.

Information - Meaningful collection of facts or data.

Information System - Systems that provide specificinformation support to the decision-making processat each level of an organization.

Cont’d…

Health Information System - A set of d d i d



components and procedures organizedwith the objective of generatinginformation which will improve health caremanagement decisions at all levels of the

health system.

The ultimate objective of health informationsystem is not “to gain information” but

“to improve action”

Cont’d…

Health management information system;

I f i



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.

Cont’d…

•Health information management professionals;

l i f ti t d l h lth li d id tif

http://en.wikipedia.org/wiki/Information_system

http://en.wikipedia.org/wiki/Health_policy





– plan information systems, develop health policy, and identifycurrent and future information needs.

–apply the science of informatics to the collection, storage,use, and transmission of information to meet the legal,professional, ethical and administrative records-keepingrequirements of health care delivery.

–work with clinical, epidemiological, demographic, financial,reference, and coded healthcare data.

Cont’d…

E l ti



http://en.wikipedia.org/wiki/Informatics_(academic_field)

http://en.wikipedia.org/wiki/Informatics_(academic_field)





EvolutionIn the past, mostly informal.

Present, electronic data

processing (EDP) – use of computers in informationmanagement (computer based

information system).Now called MIS.

Cont’d…

What is wrong with current health MIS?I l f th i f ti th d



• Irrelevance of the information gathered

• Poor quality of data

• Duplication and waste among parallel healthinformation system

•Lack of timely reporting and feedback

• Poor use of information

• The difference in culture between data peopleand decision makers: Planning and managementstaff rely primarily on “gut feeling” to formulate

ad hoc decisions rather seek pertinent data.

Cont’d…

What’s the HMIS objective?



Ensuring the quality of all health data.

Strengthening the ability to analyze anduse the data.

Making informed and cohesive decisionscan and will positively affect the healthand lives of the people.

Planning, organizing, leading, controlling

and decision-making.

Cont’d…

•

El t f H lth



Elements of Healthinformation systemmanagement

–Organization rules

–Data collection standards

–Case definitions–Data transmission

Cont’d…

C fid ti lit



–Confidentiality–Training standards

–Software design

–Procurement/ Distribution

–Quality assurance

–Private sector

Cont’d…

Factors to evaluate informationi d



received

1. Information quality – accuracy andreliability.

2. Information timeliness – beforedeviations occur.

3. Information quantity – just sufficient.

4. Information relevance – related tasks

and responsibilities.

Cont’d…

D i f HMIS



Design of HMIS• Desired characteristics of

information in health services

RelevanceAccuracy

Completeness

TimelinessConciseness

Cont’d…

Sources of Information SystemH lth i tit ti (i ti t/ t ti t



oHealth institutions (inpatient/outpatientand other activities)

• Vital registration systems (births,deaths, and migratory movements)

oLaboratories and pharmaceuticals

oCommunity

Cont’d…

oCensus



oSpecial programmes reportingsystems (tuberculosis and leprosycontrol, MCH, school health)

oAdministrative systems (healthcare financing systems, healthpersonnel systems, logisticsystems)

Cont’d…

o

In esti ation of o tbreaks



Investigation of outbreaks –Surveys and surveillances

–Diseases notifications

–

Routine reportsWhich of the above sourcesare computerized?

Each source has its ownadvantages and limitations.

Cont’d…

A framework for defining information

needs and indicators



needs and indicators

• Perform a functional analysis at eachmanagement level of the health servicesystem.

• Identify information needs and selectfeasible indicators

•Patient / Client management

•Health Unit management •Health System management

Cont’d…

•Indicators are variables that help tomeasure changes directly or



measure changes, directly orindirectly.

- WHO

• Indicators are variables that indicateor show a given situation, and thuscan be used to measure change.

Cont’d…

Indicators are important to:



–To analyze present situation

–To make comparisons

–To measure trends

Most health indicators arequantitative (numbers)

Cont’d…

Helpful questions in selecting good

indicators



indicators• What is the indicator supposed tomeasure (validity)?

• What will be the cost of measuringthe data to arrive at the numeratorand denominator of the indicator?

• Is the change shown by theindicator a true change in the

situation under study.

Cont’d…

•What is the relative importance of the

subject matter to be addressed and the



subject matter to be addressed and thedecision to be made based on theindicator (relevance)?

•Does the indicator actually capture thechanges that occur in the situation understudy (specificity)?

Cont’d…

Types of Indicators:Health policy



–Health policy

– Social and Economic DevelopmentIndicators

–

Population changes –Provision of health care

–Health Status (nutritional, morbidity,mortality)

Information is collected, analyzed,presented and communicated.

Cont’d…

Steps in development of effective HMIS

1 Identify users: for whom?



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

Cont’d…

Steps involved int t i f H lth MIS



Steps involved inrestructuring of Health MIS

Step 1: Identifying information

Step 2: Defining data sources aStep 3: Developing a data trans

Step 4: Ensuring use of t



Step 4: Ensuring use of tStep 5: Planning for heal

Step 6: Developing a set

Cont’d…

K i



Key issuesa) Movement of datathrough out the system

b) Accessibility andanalyzability of data

c) Transmission of findingto potential users

Cont’d…

T k



Tasks –Filing and storing

–Compiling

–

Analyzing

Cont’d…

Types of reports (three)O ti l d t il d



–Operational: detailed

–Technical: mentoring and evaluation

–Strategic: to justify priorities and

decisions

Cont’d…

Managing the flow of dataImpose strict timetable at each le el



–Impose strict timetable at each level.

–Ensure two-way flow.

–Establish regular cycle of analysis and

feedback .

Cont’d…

Data collection instruments

D ll i i f



Data collection instruments forpatient/ client management

Curative

•Medical records

•Laboratory forms

•Referral forms

Cont’d…

Preventive



Preventive•Growth cards

•MCH cards•School health card

•Family registrationrecords

•Other issues



•Other issues–Content (comprehensive)

–Record filing (patient-retainedvs.. health unit-retained)

–Layout (self-explanatory)

–Production form

–Electronic patient record

Cont’d…

•

Data collection instruments forhealth unit management



Data collection instruments forhealth unit management

• Service delivery records.

– Registers– Tally sheets (Abstract register

– Population charts

•Resource Management records

Cont’d…

Strategies for MIS Development Plan carefully for modification of



Plan carefully for modification of existing system establishing new.

Change attitudes to information

gathering processing andutilization.

Participate staff in HMIS.

Provide training for utilizing HIS

Cont’d…

Computer applications in health service

delivery



delivery1. Clinical information systems

2. Administrative information systems

Issues in the application of Microcomputers to HMIS;

• Generally: find out what is necessary todo, then choose the appropriate tools.

Cont’d…

How to decide on need for



How to decide on need fora computer?

o Technical feasibility

o Operational feasibility

o Economic feasibility

Cont’d…

•

How to introduce microcomputers



How to introduce microcomputers

–Choose software

–Choose computer –Assess the physical environment

–Assess the organizational

environment

Cont’d…

–o Train personnel to use computers

o Social behaviour



–o Social behaviour

–o Training for managers

–o Training for problem solving

–o Define role of computer in work environment

Cont’d…

HMIS in Ethiopia

Discuss on the following points:



g p1. 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 theorganization.

Cont’d…

Hospital InformationH it l d t h ld b



Hospital Information• Hospital data should becollected timely and regularly.

They should be used for sounddecision making. Performanceshould be evaluated using

performance indicators –Out patient attendance

Cont’d…

–

Admissions by age sexlocation and so on



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



Turn over interval•No. of major operations

•Delivery admissions

•Laboratory tests

Cont’d…

•No of referrals



No. of referrals•Budget allocation

•Expenditures

•No. and type of manpower

Unit Six

Delegation Stress



Delegation, Stressand Time

Management

memanagement



Cont’d…

•Is not often thought as a resource.

•It is non-renewable resource;



•No event can take place unless there is timefor it.

•Using time effectively is a management skilland can be seen from two angles:

Cont’d…

1. Finding out how staff uses time:

Time spent on different activities by individual staff canbe answered by keeping a daily dairy for a few days



be answered by keeping a daily - dairy for a few days.

It useful to know what proportions of time is spent oncertain activities. This will help to make the best use of time.

Events are written in daily, weekly , monthly or yearlytime periods, depending on their frequency orregularity.

Cont’d…

Time plans are written in various common

forms ;Ti t bl F d il / kl l i



Timetable: For daily/weekly regular recurringevents.

Schedule: For intermittent, irregular orvariable events, including details of wherethe 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.

Cont’d…

2. Time plans in a health service

A well-managed rural health unit may need thefollowing time- plans:



g p

A weekly time table: showing the time of the week whencertain regular events always occur, e.g. staff meetings.

Several schedules: showing the detailed dates on whichintermittent 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.

Cont’d…

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



1. To distribute work fairly and evenly out side normalworking hours. E.g. night, weekends etc…

2. To distribute uninteresting or difficult work, andinteresting or varied work, equally among the various

members of the units, e.g. Maternity work.3. To divide extra duties among the whole staff,

Cont’d…

•Unless they are arranged very carefully they can

cause a great deal of trouble and quarrelling.Therefore, rosters have to be changed frequently.



Therefore, rosters have to be changed frequently.

•Two rules for duty rosters:

A. The length of time of each duty period must bethe same as for all other types of duty period.

B. The number of people /Groups working in turnmust divide evenly in to the number of dutystation/ duty periods.

Cont’d…

• A Program: is a plan that out lines a series of

events or activities that will take place in thefuture A Program usually includes:



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 programchart. A Convenient way is to list the activities,in the order in which they must occur.

•

Benefits of timet



Benefits of timemanagement

–Efficient

–Successful

–Healthy

Cont’d…

Obstacles to effective timemanagementUnclear



managementUnclearobjectives

Disorganization

Inability to say“no”

Cont’d…

Interrupti



Interruptions

Moreinterruptions

Periods of inactivity

Cont’d…

Too many things at



Too many things atonce

Stress andfatigue

All work and noplay

Cont’d…

•

What can we do?



What can we do? –Recognize that obstaclesexist

–Identify them

–

Employ strategies toovercome

Cont’d…

–Set goals

•Specific



•Specific

•Measurable

•Achievable

•Realistic

•Time-based

Cont’d…

•

PrioritizeD



PrioritizeDo

Delegate

DelayDelete

Cont’d…

1.Address the urgent2 Accomplish what you



g2.Accomplish what you

can early

3.Attach deadlines tothings you delay

Cont’d…

•

Organize



Organize

Cont’d…

•

Learn when to say



Learn when to say“NO”o You can’t do

everythingoDon’t

undertakethings you’

Cont’d…

•

Use your waiting time• On public



Use your waiting timeOn publictransportatio

n• At thedoctor’soffice

• Waiting for

Cont’d…

Corresponde



pnce

Letters ormemos

Books ortapes

Cont’d…

•

Concentrate on the taskat hand



Concentrate on the task at hand•Focus on

your goal•Tune out

interruptions

Cont’d…Consider your

personal prime time



personal prime time•Morni

ng?•Evenin

g?•Late

Cont’d…

Celebrate yoursuccess



success

Cont’d…

The Ethiopian Context

The daily attendance of staff is takenby using different formats and each



by using different formats and eachstaff 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 allcheck up.

Stressmanagement

• John M. Ivancevich and Michael T. Matterson have

defined stress as “adoptive response, mediatedby individual characteristics and/ or psychologicalprocesses that is a consequence of any external



processes, that is a consequence of any externalaction, situation or event that places specialphysical and/or psychological demands upon aperson”.

Cont’d…

Stress is the “wear and tear”our minds and bodies



experience as we attempt tocope with our continually

changing environment

TYPES OF STRESS

1. External

2. Internal

Cont’d…1. EXTERNAL STRESSORS

• Physical Environment



y

• Social Interaction

• Organisational

• Major Life Events

• Daily Hassles

Cont’d…PHYSICAL ENVIRONMENT

•Noise



•Noise

•

Bright Lights•Heat

•Confined Spaces

Cont’d…

•Aggressiveness



Aggressivenessby others

•Rudeness

•

Bossiness•Bullying

Cont’d…ORGANISATIONAL

• Rules



• Regulations

• “Red - Tape”

• Deadlines

Cont’d…MAJOR LIFE EVENTS

• Birth



• Death

• Lost job

• Promotion

• Marital statuschange

Cont’d…DAILY HASSLES

• Commuting



g• Misplaced keys

• Mechanical breakdowns

Cont’d…2. INTERNAL STRESSORS

• Lifestyle choices



y

• Negative self - talk

• Mind traps

• Personality traits

Cont’d…LIFESTYLE CHOICES

•Caffeine



Caffeine

•

Lack of sleep•Overloaded

schedule

Cont’d…NEGATIVE SELF - TALK

•Pessimistic



Pessimistic

thinking•Self criticism

•Over analysing

Cont’d…MIND TRAPS

• Unrealistic expectations



• Taking things personally

• All or nothing thinking• Exaggeration

•

Rigid thinking

Cont’d…PERSONALITY TRAITS

• Perfectionists



• Workaholics

Cont’d…

FACTORS INFLUENCING WORK

STRESS• The drive • Uncertaint



e d efor success

• Changingwork patterns

• Workingconditions

•

y

• Conflict• Responsibi

lity• Relationships at work

Cont’d…

SOURCES OF JOB STRESS



Cont’d…

1.Environment Stressors:-societal, economic,financial, cultural, familial and technological

factors which have tremendous influence onmental health of the employees.

2 O i i l S i i



2.Organizational Stressors:-mission statement,strategies, policies, organizational structureand design, reporting channels, communication,

various processes, systems and last but not theleast the working conditions.

Cont’d…

3. Group Stressors:- group cohesiveness, groupnorms and importance of group objective for

attainment of organizational goals.4. Individual Stressors:-Personal life and events of

ffi i l lif t b t d E t f



official life cannot be separated. Events of marriage, divorce, death in the family has aremarkable impact on work situation. Personal

life difficulties are highly stressful. It includes;

Cont’d…

(a) Job Security :- A person must have a jobcommensurate with his qualification.

(b) Relocation:-Relocation is related to transfer of a person to a different place



a person to a different place.

(c) Changes in life structure:-Span of life hasmany facets. Some of these are socio-economic

environment, culture, systems, religion, race,education and person’s interaction with societyin different roles.

Cont’d…

(d) Stress and Behavior



( )

Cont’d…

Nature of stress

• The nature of the stressor is variable. i.e –an event or change that is stress full for oneperson may not be stress full for another



person may not be stress full for another .

–an event that produces stress at one timeand place may not also at another time and

place.

Cont’d…

Stressors

• An internal or external event orit ti th t t th t ti l



situation that creates the potentialfor physiological, emotional,

cognitive or behavioural changes inan individual.

• Stressors exist in many forms and

categories

Cont’d…

•They may bedescribed as:



y ydescribed as:

•

Physical:- hot, cold,•Psychological – losing a job

•Physiological

Cont’d…

•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 .

Cont’d…

• Stress full events in the nursing

function / role / stressorsWork over load



–Work over load

–Conflict b/n staff members

–In appropriate salary income

–Limited resource

Cont’d…

–In appropriateinfrastructure



–Limited man power

–Lack of promotion

– Job dissatisfaction

–Loss of job

–In adequate knowledge

Cont’d…

–New working environment

–New health policy

–Un programmed work load



p g

–Failure in achievement of work

–Upgrade to higher position

–Lack of educational opportunity

Cont’d…

MANAGEMENT OF STRESS

A.Individual Level Strategies2 Define objecti e for Self



2.Define objective for Self:3.Plan your life:4.Social Support:5.Physical Fitness:

6.Biofeedback:

Cont’d…

6. Yoga;7. Meditation;



7. Meditation;

8. Time Management;9. Live a simple Life;

Cont’d…

B. Organizational Level Strategies

(a)Organizational goals must be in realmsof achievement.



(b)Employees must be empowered.

(c)Corporate policies, physical work

environment should be suitable forhigher productivity.

(d)An updated systems and processesincreases efficiency.

(e)Management must create an healthyworking environment.

Cont’d…

•

STRESS CONTROLABC STRATEGY



A = AWARENESS

What causes you stress?

How do you react?

Cont’d…

B = BALANCE

There is a fine line betweenpositive / negative stress



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 person’sresponsibility to another person or persons.

•Delegating is an effective management competency bywhich nurse managers get the work done through the

l



employees.

•The purpose of delegation is efficiency; no one person cando all the work that must be done; therefore, some work

must be passed on, or delegated to others.

Cont’d…

•Nurse managers need to be able to delegate

some of their own duties, tasks, andresponsibilities as a solution to overwork, whichlead to stress, anger, and aggression.



, g , gg

•As nurse managers learn to accept the principleof delegation, they become more productive and

come to enjoy relationships with the staff.

Cont’d…

•The following list suggests ways for nurse

managers to successfully delegate. –Train and develop subordinates. It is aninvestment Give them reasons for the task



investment. Give them reasons for the task,authority, details, opportunity for growth,and written instructions if needed.

Cont’d…

–Control and coordinate the work of

subordinates, but do not go over theirshoulders. To prevent errors, develop ways of measuring the accomplishment of objectives



g p jwith communication, standards,measurements, feedback and credit.

Cont’d…

–Follow up by visiting subordinates frequently.Expect employees to make suggestions toimprove work and use the feasible ones.

–Encourage employees to solve their own

bl d th i th th t



problems, and then give them the autonomyand freedom to do.

Cont’d…

Assess results. The nurse manager

should accept the fact thatemployees will perform delegatedtasks in their own style



tasks in their own style.

–Give appropriate rewards

–Do not take back delegated tasks.

Cont’d…

Advantages of delegation

• Delegating some decision-making savestime for other duties.



•When work is spread over a large area, asin rural health work, the health workers on

the spot must be able to make decisionsaccording to circumstances.

Cont’d…

•Delegations of responsibility save long delays

that occur then awaiting decisions from acentral office or other distant authority.

Health workers who are allowed to make



•Health workers who are allowed to makedecisions enjoy their work more and becomemore knowledgeable and skilful.

Cont’d…

Disadvantages of delegation

• If wrong decisions are made, the work isnot done or it may be done less well.

A leader who does not delegate properly



• A leader who does not delegate properlymay pass all the work on to the teammembers, leaving very little more to do.

• A leader may delegate decisions to peoplewith insufficient experience.

Cont’d…

Rules for delegating authority and

responsibility –Be clear about exactly what is delegated.

–Select the person who you are sure can



Se ec e pe so o you a e su e cado 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 theprogress of work.

Cont’d…

Steps in Delegation

I –Introduce the task

D Demonstrate clearly what needs to be done



D-Demonstrate clearly what needs to be done

E-Ensure understanding

A-Allocate authority, information and resources

L-Let go

S-Support and monitor

Cont’d…Introduce the

Task • Determin



e task to

bedelegate

d• Determin

Cont’d…

Determine task to be Determine task to be

delegated delegated Determine tasks toDetermine tasks to

Those tasks youThose tasks you

completed prior tocompleted prior toassuming new roleassuming new role



retainretain

Select delegateSelect delegate

Those tasks your Those tasks your

delegates have moredelegates have more

experience withexperience with

Routine activitiesRoutine activities

Those things not inThose things not in

your core competencyyour core competency

Cont’d…

Determine task to beDetermine task to be

delegateddelegated Determine tasks to Determine tasks to

Supervision of Supervision of

subordinatessubordinates Long-term planningLong-term planning



retainretain

Select delegateSelect delegate

g p gg p g

Tasks only you can doTasks only you can do

Assurance of programAssurance of programcompliancecompliance

Dismissal of Dismissal of

volunteers/members/pvolunteers/members/p

arents, etc.arents, etc.

Cont’d…

• Determinetask to bed l t d

• Look atindividualstrengths/w



delegated

• Determinetasks toretain

• Select delegate

strengths/weaknesses

• Determineinterest

areas• Determine

need for

Cont’d…

Use What-Why



yStatements:

I want you

Cont’d…Demonstrate

Clearly• Show



examples of

previous work • Explain

objectives• Discuss

Cont’d…

Ensuring Understanding

–Clear communication



–Ask for clarification

–Secure commitment –Don’t say no for them

–Collaboratively determinemethods for follow-up

Cont’d…

Allocate authority, information, resources

• Grant authority to determine process, notdesired outcomes

•Provide access to all information sources



•Refer delegate to contact persons or specificresources that have assisted previously

• Provide appropriate training to ensure success

Cont’d…Let go…

•

Communicate delegate’s



authority

• Step back,let them

work • Use

Cont’d…

• Support and Monitor –Schedule follow-up meetings

–Review progress



–Review progress

–Assist, when requested

–Avoid interference

–Publicly praise progress andcompletion

–Encourage problem solving

Cont’d…

Delegation Stressors

Loss of control?If you train your subordinates to

l h i i



apply the same criteria as youwould yourself, then they will beexercising your control on yourbehalf.

Cont’d…

Too much time spent on explaining

tasksThe amount of time spent up frontis in fact great But continued use



is, in fact, great. But, continued useof delegation may free you up to

complete more complex tasks and/orgain you some time for yourself.

Cont’d…

Compromising your own value

By successfully utilizing appropriatedelegation, your value to thegroup/organization will grow at a



group/organization will grow at agreater rate as you will have more

time to do more things…….

Cont’d…

Consequences of poor delegating

• Information and decision-making notshared by the group

•When leaders leave groups, no one has



•g p ,

experience to carry on

•

Group morale becomes low and peoplebecome frustrated and feel powerless

Cont’d…

•The skills and knowledge of the

group/organization areconcentrated in a few people

•New members don’t find any ways



•New members don t find any waysto contribute to the work of the

group.•Leaders become tired out

Cont’d…

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.

Cont’d…

Insecurity

Fear of being dislikedRefusal to allow mistakes



Refusal to allow mistakes

Lack of confidence insubordinates

Perfectionism, leading to

excessive control

Cont’d…

Lack of organizational skill in balancing

workloadsFailure to delegate authority

commensurate with responsibility



commensurate with responsibility

Uncertainty over tasks and inability to

explain

Disinclination to develop subordinates

Failure to establish effective controls

and to follow up

Cont’d…

Barriers in the Delegatee –Lack of experience

–Lack of competence



Lack of competence

–Avoidance of responsibility

–Over dependence on the boss

–Overload of work

–

Immersion in trivia

Cont’d…

“The secret of success is not

in doing your own work but inrecognizing the right [person]



ecog g e g [pe so ]to do it.” ~Andrew Carnegie

The End!



e d

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Nursing Service Administration and Leadership.

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