HEALTH CARE DELIVERY SYSTEM IN INDIA

INTRODUCTION: Health is the birth right of every individual. Today health is considered more than a basic human
right; it has become a matter of public concern, national priority and political action. Our health system has
traditionally been a disease-oriented system but the current trend is to emphasize health and its promotion.

DEFINITION:
1)Health: According to WHO, health is defined as ―a dynamic state of complete physical, mental and social well-
being not merely an absence of disease or infirmity.
2)Health care services: It is defined as ―multitude of services rendered to individuals, families or communities by
the agents of the health services or professions for the purpose of promoting, maintaining, monitoring or restoring
health.
3) Health care system: A health system, also sometimes referred to as health care system or as healthcare system,
is the organization of people, institutions, and resources that deliver health care services to meet the health needs of
target populations.
 A health system consists of all organizations, people and actions whose primary intent is to promote, restore or
maintain health. This includes efforts to influence determinants of health as well as more direct health-improving
activities. A health system is therefore more than the pyramid of publicly owned facilities that deliver personal
health services. It includes, for example, a mother caring for a sick child at home; private providers; behaviour
change programmes; vector-control campaigns; health insurance organizations; occupational health and safety
legislation. It includes inter-sectoral action by health staff, for example, encouraging the ministry of education to
promote female education, a well-known determinant of better health. – WHO

HEALTH CARE DELIVERY SYSTEM IN INDIA

In India it is represented by five major sectors or agencies which differ from each other by
health technology applied and by the source of fund available. These are:
I. PUBLIC HEALTH SECTOR
A. Primary Health Care : (1) Primary health centers (2) Sub- canters.
B. Hospital/Health Centers : (1) Community health centers (2) District hospitals/health center
(3) Specialist hospitals (4)Teaching hospitals.
C. Health Insurance Schemes: (1) Employees State Insurance (2) Central Govt. Health Scheme.
D. Other Agencies: (1) Defense services (2) Railways.
II. PRIVATE SECTOR: Private hospitals, polyclinics, nursing homes and dispensaries
General practitioners and clinics.
III. INDIGENOUS SYSTEMS OF MEDICINE
 Ayurveda  Unani  Naturopathy
 Siddha  Homeopathy  Yoga
IV. VOLUNTARY HEALTH AGENCIES
V. NATIONAL HEALTH PROGRAMMES

ORGANIZATION AND ADMINISTRATION OF HEALTH SERVICES IN INDIA AT

DIFFERENT LEVELS.
India is a union of 28 states and 7 Union territories. Under the constitution states are largely independent in
matters relating to the delivery of health care to the people. Each State, therefore, as developed its own system of health
care delivery, independent of the Central Government. Health system in India has 3 links
1. Central level. 2. State level 3. District level
 AT THE CENTRAL LEVEL
The official organs of the health system at the national level consist of 3 units:
1. Union Ministry of Health and Family Welfare.
2. The Directorate General of Health Services.
3. The Central Council of Health and Family Welfare.

I. Union Ministry of Health and Family Welfare

Functions
Union list
1. International health relations and administration of port-quarantine
2. Administration of central health institutes such as All India Institute of Hygiene and Public
Health, Kolkata; National Institute for Control of Communicable Diseases, Delhi, etc.
3. Promotion of research through research centers and other bodies.
4. Regulation and development of medical, nursing and other allied health professions.
5. Establishment and maintenance of drug standards.
6. Census, and collection and publication of other statistical data.
7. Immigration and emigration.
8. Regulation of labor in the working of mines and oil fields

Concurrent list :The functions listed under the concurrent list are the responsibility of both the union and
state governments. The center and states have simultaneous powers of legislation. They are as follows:
1. Prevention of extension of 4. Vital statistics.
communicable diseases from one unit 5. Labor welfare.
to another. 6. Ports other than major.
2. Prevention of adulteration of food 7. Economic and social health planning
stuffs. 8. Population control and family
3. Control of drugs and poisons. planning.

II. Directorate General of Health Services Organizations

Functions
1. General functions: The general functions are surveys, planning, coordination,
programming and appraisal of all health matters in the country.
2. Specific functions
a. International health relations and d. Postgraduate training
quarantine e. Medical education
b. Control of drug standards f. Medical research
c. Medical store depots g. Central Government Health Scheme.
Family welfare services
h. National Health Programmes. j. Health intelligence.
i. Central Health Education Bureau k. National Medical Library

III. Central Council of Health

functions
1. To consider and recommend broad outlines of policy in regard to matters concerning health in
all its aspects such as the provision of remedial and preventive care, environmental hygiene,
nutrition, health education and the promotion of facilities for training and research.
2. To make proposals for legislation in fields of activity related to medical and public health
matters
3. To make recommendations to the Central Government regarding distribution of available
grants-in-aid

AT THE STATE LEVEL

Function
 1. Studies health problems and needs in depth in the state and plan to scheme to solve them
2. Providing curative and preventive services
3. Provision of control of milk and food sanitation
4. Prevention of any outbreak of communicable disease
5. Promotion of health education
6. Promotion of health programmes
7. Supervision of PHC
8. Establishing training courses for health personnel
9. Co-ordination of health services with other minister of state

AT THE DISTRICT LEVEL

There are 593 (year 20001) districts in India. Within each district there are 6 types of administrative areas.
1. Subdivisions 4. Municipalities and corporations
2. Tehsils (talukas) 5. Villages
3. Community development blocks 6. Panchayaths
 Most of the districts in India are divided into two or more subdivisions, each in charge of an assistant collector
or sub-collector.
 Each division is again divided into tehsils in charge of a Tehsildar. A tehsil usually comprises between 200 and
600 villages.
 Finally, there are the village panchayaths, which are institutions of rural local self- government.
 The urban areas of the district are organized into the following local self-government:
 Town area committee – 5,000 – 10,000
 Municipal boards – 10,000 – 2,00,000
 Corporations – population above 2,00,000.
 The towns‟ area committees are like panchayaths. They provide sanitary service.

PANCHAYAT RAJ
 3 tire structure of rural local self-government in India linking the village to the district. It includes:

(1) Panchayat (at the village level):

The Gram Sabha: it the assembly of adults of the village, meets twice in a year. It considers proposal for taxation and
elect members for the gram panchayat.

The Gram Panchayat: population covered 5000 to 15000 or more. It covers the civic administration including
sanitation and public health work for the social and economic department of the village.

(2) Panchayath samiti – at the block level.

The block consists 100 villages and a population of about 80,000 to 1,20,000. The panchayat samiti consist of
Sarpanch, MLAs, MPs residing in block area, representatives of women, SC, ST and cooperative societies.
Function: community development program.
(3) Zilla parishad – at the district level.
Members: all heads of panchayat samiti in the district, MLAs, MPs residing in block area, representatives of
women, SC, ST and cooperative societies.

The National Health Policy

The National Health Policy of 1983 and the National Health Policy of 2002 have served well in
guiding the approach for the health sector in the Five-Year Plans. The current context has however changed in four
major ways.
 First, the health priorities are changing. Although maternal and child mortality have rapidly declined,
there is growing burden on account of non-communicable diseases and some infectious diseases.
 The second important change is the emergence of a robust health care industry estimated to be growing at double
digit.
 The third change is the growing incidences of catastrophic expenditure due to health care costs, which are presently
estimated to be one of the major contributors to poverty.
 Fourth, a rising economic growth enables enhanced fiscal capacity. Therefore, a new health policy responsive to these
contextual changes is required.
The National Health Policy, 2017 (NHP, 2017) seeks to reach everyone in a comprehensive integrated way
to move towards wellness. It aims at achieving universal health coverage and delivering quality health care services
to all at affordable cost.

Goal
 The attainment of the highest possible level of health and well-being for all at all ages, through a preventive and
promotive health care orientation in all developmental policies, and universal access to good quality health care
services without anyone having to face financial hardship as a consequence.
 This would be achieved through increasing access, improving quality and lowering the cost of healthcare delivery.

Objectives

 Improve health status through concerted policy action in all sectors and expand preventive, promotive, curative,
palliative and rehabilitative services provided through the public health sector with focus on quality.

Specific Quantitative Goals and Objectives

Health Status and Programmes Impact

1. Life Expectancy and healthy life
 Increase Life Expectancy at birth from 67.5 to 70 by 2025.
 Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of burden of disease and its
trends by major categories by 2022.
 Reduction of TFR to 2.1 at national and sub-national level by 2025.
2. Mortality by Age and/ or cause
 Reduce Under Five Mortality to 23 by 2025 and MMR from current levels to 100 by 2020.
 Reduce infant mortality rate to 28 by 2019.
 Reduce neo-natal mortality to 16 and still birth rate to “single digit” by 2025.
3. Reduction of disease prevalence/ incidence
 Achieve global target of 2020 which is also termed as target of 90:90:90, for HIV/AIDS i.e, - 90% of all people living
with HIV know their HIV status, - 90% of all people diagnosed with HIV infection receive sustained antiretroviral
therapy and 90% of all people receiving antiretroviral therapy will have viral suppression.
 Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar by 2017 and Lymphatic Filariasis in endemic
pockets by 2017.
 To achieve and maintain a cure rate of >85% in new sputum positive patients for TB and reduce incidence of new
cases, to reach elimination status by 2025.
 To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease burden by one third from current levels.
 To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by 25%
by 2025.

Health Systems Performance

1. Coverage of Health Services
 Increase utilization of public health facilities by 50% from current levels by 2025.
 Antenatal care coverage to be sustained above 90% and skilled attendance at birth above 90% by 2025.
 More than 90% of the newborn are fully immunized by one year of age by 2025.
 Meet need of family planning above 90% at national and sub national level by 2025.
 80% of known hypertensive and diabetic individuals at household level maintain "controlled disease status" by 2025.
2. Cross Sectoral goals related to health
 Relative reduction in prevalence of current tobacco use by 15% by 2020 and 30% by 2025.
 Reduction of 40% in prevalence of stunting of under-five children by 2025.
 Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission).
 Reduction of occupational injury by half from current levels of 334 per lakh agricultural workers by 2020.
 National/ State level tracking of selected health behaviour.

Health Systems strengthening

1. Health finance
 Increase health expenditure by Government as a percentage of GDP from the existing 1.1 5 % to 2.5 % by 2025.
 Increase State sector health spending to > 8% of their budget by 2020.
 Decrease in proportion of households facing catastrophic health expenditure from the current levels by 25%, by 2025.
2. Health Infrastructure and Human Resource
 Ensure availability of paramedics and doctors as per Indian Public Health Standard (IPHS) norm in high priority
districts by 2020.
 Increase community health volunteers to population ratio as per IPHS norm, in high priority districts by 2025.
 Establish primary and secondary care facility as per norm s in high priority districts (population as well as time to
reach norms) by 2025.
3. Health Management Information
 Ensure district - level electronic database of information on health system components by 2020.
 Strengthen the health surveillance system and establish registries for diseases of public health importance by 2020.
 Establish federated integrated health information architecture, Health Information Exchanges and National Health
Information Network by 2025.

NATIONAL POPULATION POLICY OF INDIA – 2000

INTRODUCTION
India being a highly populated country, the government has continuously paid attention to the problem of
population growth. Just a few months before the attainment of independence in 1946, the Bhore Committee submitted
its Report, which became the basis for developing a national population policy. This was followed by the launch of
the Family Planning Programme in 1952, coinciding with the launch of the nationwide Community Development
Programme.
 After careful review of the demographic trends and of the Family Planning Programme, in 1976, the government
issued its first statement regarding the National Population Policy, which was followed by the 1977 Policy Statement
on the Family Welfare Programme.
 Subsequently, an Expert Group headed by M.S. Swaminathan was appointed to prepare the draft of a national
population policy. The National Population Policy (NPP) finally came into force in 2000.
 The Policy states that the (1) “Immediate objective of the NPP 2000 is to address the unmet needs for contraception,
healthcare infrastructure, and health personnel, and to provide integrated service delivery for basic reproductive and
child healthcare.
(2) The medium-term objective is to bring the Total Fertility Rate (TFR) to replacement levels by the year 2010,
through vigorous implementation of inter-sectoral operational strategies.
(3) The long-term objective of the Policy is to achieve a stable population by 2045, at a level consistent with the
requirements of sustainable economic growth, social development, and environmental protection.”
The NPP has listed the following goals for 2010:

(1) Address the unmet needs for basic reproductive and child health services, supplies, and infrastructure;
(2) Make school education up to age 14 free and compulsory, and reduce dropouts at the primary and secondary school
levels to below 20 per cent for both boys and girls;
(3) Reduce the infant mortality rate to below 30 per 1,000 live births;
(4) Reduce the maternal mortality ratio to below 100 per 100,000 live births;
(5) Achieve universal immunization of children against all vaccine preventable diseases;
(6) Promote delayed marriage for girls, not earlier than age 18 and preferably after 20 years of age;
(7) Achieve 80 per cent institutional deliveries and 100 per cent deliveries by trained persons;
(8) Achieve universal access to information/counseling, and services for fertility regulation and contraception with a
wide basket of choices;
(9) Achieve 100 per cent registration of births, deaths, marriages, and pregnancy;
(10) Contain the spread of the Acquired Immuno-deficiency Syndrome (AIDS) and promote greater integration
between the management of reproductive tract infections (RTIs) and sexually transmitted infections (STIs) and the
National AIDS Control Organization;
(11) Prevent and control communicable diseases;
(12) Integrate Indian Systems of Medicine (ISM) in the provision of reproductive and child health services, and in
reaching out to households; and
(13) Promote vigorously the small family norm to achieve replacement levels of TFR. Bring about convergence in
implementation of related social-sector programmes so that family welfare becomes a people-centered programme.

The NPP 2000 anticipates that proper implementation of this policy will help limit the population to 1,107
million (110 crores) in 2010, instead of 1,162 million (116 crores) as projected by the Technical Group on Population
Projections. It is hoped that the TFR will reach the replacement level of 2.1 by 2010.

National AYUSH Policy- 2002

INTRODUCTION:
In order to augment the traditional systems of medicine, the Government of India put in place a National
Policy on Indian Systems of Medicine & Homoeopathy (ISM&H) in the year 2002. Ayurveda, Siddha, Unani &
Homeopathy systems of medicine and drugless therapies like Yoga and Naturopathy are officially recognized in
India. Department of INDIAN SYSTEM OF MEDICINE AND HOMEOPATHY – MARCH 1995 • Renamed in
NOVEMBER 2003 as AYUSH

AIMS :
• Upgradation of AYUSH educational standards • Research and development
• Quality control and standardization of drugs • Awareness development of efficacy of systems
• Improving the availability of medicinal plant
material

OBJECTIVES
• Promote good health and expand the outreach of health care
• Ensure affordable AYUSH services
• Facilitate availability of drugs
• Integrate AYUSH in health care delivery system and national programmes
• Provide opportunity in the growth and development of all systems

PLANS FOR AYUSH

• Medical colleges, registered medical practitioners, • Admission capacity per annum in UG colleges 23280
hospitals and dispensaries, drug manufacturing unit • Number of drug manufacturing units 9832
• Institutionally trained practitioners 488714 • Number of hospitals 3841
• Non-Institutionally qualified practitioners 200088 • Number of beds in hospitals 65753
• Number of colleges 437
STATUTORY REGULATORY BODIES
a) Central Council of Indian Medicine (CCIM)
b) Central Council of Homeopathy (CCH)
Functions of Regulatory Councils
• To lay down standards of education
• To ensure adherence to laid down standards
• To maintain a Central Register of practitioner
• To recommend to the Central Government for recognition and withdrawal of medical qualifications awarded by
Universities

POLICY
Policy Statement-1 Efforts would be made to integrate and mainstream ISM&H in health care delivery systems
including National Programmes
Action Taken • Drugs in RCH programme • Pilot project relating to RCH • pilot project on National Diabetes
Control Programme

Policy Statement 2 • A range of options for utilization of ISM&H manpower in the health care delivery system
would be developed by assigning specific goal oriented role and responsibility to the ISM workforce. • An ISM&H
wing would be encouraged and supported at the primary health care level.
Action Taken • Government Ayurvedic dispensaries • Ayurvedic doctors • Siddha doctors • integrating ISM&H
systems in various Health Programmes.

Policy Statement- 3 States would be encouraged to re-enact or modify laws governing the practice of modern
medicine by ISM practitioners so that there is clarity of the subject
Action Taken • use of allopathic medicines by ISM practitioners through gazette notifications/state government
orders

Policy Statement-4 • Referral ISM hospitals in the motherland would be renovated, modernized and upgraded to
provide the full range of ISM treatment • Identification of the hospitals would be made according to current
availability of motivated staff, OPO & IPO attendance and locational advantages.
Action Taken • a scheme to provide RS.20 lakhs to renovate each Ayurvedic hospital

Policy Statement:5 • At the PHC and district hospital level, Central Government would encourage the setting up of
specialty centres and ISM clinics & funds would be provided centrally for drugs listed in the Essential Drugs Lists
Action Taken • To set up Panchakarma/Kamasutra clinics/centers in the existing allopathic hospitals • To fill up the
gaps of scarcity of essential ISM&H drugs

Policy Statement-6 • Central government would assist specialty hospitals of allopathy who wish to establish
Panchakarma and Kamasutra facilities
ACTION TAKEN • Financial assistance • five hospitals have been supported for establishment of specialty clinics of
ISM&H with grant of first installment of Rs.42.55 lakhs

Policy Statement 7 • Private allopathic hospitals would be encouraged to set up specialist treatment centres of
ISM&H and the hiring charges of • Vaidya s/Hakims/Homoeopathy this reimbursed to such hospitals entering into
research collaboration protocols
ACTION TAKEN • This issue is under consideration of the Central Government

Policy Statement-8 • States would be encouraged to consolidate the ISM infrastructure and raise the salary and
social/professional status of ISM practitioners to encourage inflow of talent and an enhanced work-culture.
ACTION TAKEN • equal pay scales and promotion avenues for Ayurvedic doctors on the pattern of allopathic
counterparts. • stipend for M.D.(Ayurveda) students Le., Rs.7000, Rs.7,500 and Rs.8,OOO for three year degree
course
• stipend to the Ayurvedic Post Graduate students equal to M.D. Allopathy students.
 UNIT 2 (MANAGEMENT)
FUNCTION OF ADMINISTRATION
The functions of Management are common to all alike; weather a business firm or a non-business firm. Management‘s
primary function is the satisfaction of the stakeholders. This typically involves making a profit (for the shareholders),
creating valued products at a reasonable cost (for customers), and providing rewarding employment opportunities (for
employees). This can be achieved only when management accomplishes its functions

(1) PLANNING
INTRODUCTION
 Planning means looking ahead and chalking out future courses
of action to be followed taking into consideration available &
prospective human and physical resources. It is a systematic
activity which determines when, how and who is going to
perform a specific job. It is rightly said ―Well plan is half
done‖.
DEFINITION
 According to Koontz & O‘Donnell, ―Planning is deciding in
advance what to do, how to do and who is to do it. Planning
bridges the gap between where we are to, where we want to go.
It makes possible things to occur which would not otherwise
occur.

STEPS IN PLANNING FUNCTION:

i) Establishment of objectives: a. Setting of goals and objectives to be
achieved.
b. Stated in a clear, precise and unambiguous language.
c. Stated in quantitative terms.
d. Should be practical, acceptable, workable and achievable.
ii) Establishment of Planning Premises:
a. Planning premises may be internal or external. Internal includes
capital investment policy, management labour relations, philosophy
of management, etc. Whereas external includes socio- economic,
political and economical changes.
b. Internal premises are controllable whereas external are non
controllable.
iii) Choice of alternative course of action:
a. A number of alternative course of actions have to be considered.
b. Evaluated each alternative in the light of resources available
c. Chose the best alternative.
iv) Securing Co-operation: After the plans have been determined, it is
necessary rather advisable to take subordinates or those who have to
implement these plans into confidence. This motivates them,
valuable suggestions can come and employees will be more
interested in the execution of these plans.
v) Follow up/Appraisal of plans: After the selected plan is implemented, it is important to appraise its effectiveness
and correct deviations or modify the plan as required. Planning is basically a decision making function which
involves creative thinking and imagination that ultimately leads to innovation of methods and operations for growth
and prosperity of the enterprise

(2) CONTROLLING
Controlling can be defined as the regulation of activities in accordance with the requirements of plans.
 Steps of control:
o The control function, whether it is applied to cash, medical care, employee morale or anything else, involves four
steps.
1. Establishments of standards. 3. Comparing the actual results with the standards.
2. Measuring performance 4. Correcting deviations from standards.

(3) CO-ORDINATION
INTRODUCTION
 Co-ordination tries to achieve harmony between individual‘s efforts towards achievement of group goals and is a key
to success of management. Management seeks to achieve co-ordination through its basic functions of planning,
organizing, staffing, directing and controlling.
 Co-ordination is achieved through planning, organizing, staffing, directing and controlling. Co-ordination is life-line
of management. It is required in each and every function and at each and every stage and therefore it cannot be
separated.
DEFINITION
1) Co-ordination is the integrating process in an orderly pattern of group
efforts in an organization toward the accomplishment of a common objective.
2)Co-ordination is the orderly arrangement of group efforts to provide unity
of an action in pursuit of common purpose.

IMPORTANCE
 It resolves conflicts between line and staff inter-department, intra-
departmental conflicts and restores harmony in operations.
 It results in the accomplishment of organizational goals .
 It helps to increase the effectiveness of management

TECHNIQUES
1. Co-ordination by targets or goals
Most of the managers assign specific goals/ targets to their subordinates facilitate co-ordination.
2. Co-ordination through hierarchy
Rules, regulations and procedures as well as the goals apart, managers also use the chain of command to
achieve co-ordination. When situations arise the specified rules or targets do not cover that, subordinates
are trained to bring the problem to their concerned manager. Co- ordination through the hierarchy works
well as long as the number of problems that must be brought to the boss is not great.
3. Co-ordination through departmentalization
Departmentalization also serves as a technique to bring about effective co-ordination. Some forms of
departmentalization also facilitate co-ordination better than do others. a matrix approach means each
project has the continuous and undivided attention of its own project manager and the project team.
4. Using a staff assistant for co-ordination
To make his job of coordinating easier, a manager may hire an assistant. When subordinate brings a
problem to him, the assistant can comic the information on the problem, research the problem, provide
alternative solutions available. This increases, undoubtedly, the manager‘s ability to handle the problems
and coordinate the work of his subordinates.
5. Using a liaison for coordination
In some big organizations where the volume of contacts between two departments grows, many
managers appoint a special liaison person to facilitate coordination.
6. Using committee for coordination
Another sound technique of coordination is to from committee for understanding various functions and
problems. Committees are increasingly useful for coordinating, planning and executing programs and
controlling the various activities.

7. Using independent integrators for coordination

In some special circumstances, independent integrator may be recruited by organizations. An independent
 integrators job is to coordinate the activities of several interdependent departments.
8. Conferences
Conferences at regular intervals also ensure better coordination. Conferences provide adequate platform
for discussion of various problems being encountered by different departments.
9. The techniques of communication
To promote coordination, communication system must be perfect. It must be well designed.
Communication is an artery through which the decisions flow top to bottom and reports flow from bottom
to top.
10. Miscellaneous
Other coordinating techniques include :grouping the similar activities, reorganization of departments to
ensure coordination, cross functioning of the departments, project management organization hierarchy,
planning techniques, creation of certain staff positions, periodical staff meetings ect.

TYPES OF CO-ORDINATION
Coordination can be classified into two broad categories, one on the basis of its shape in the organization and other on
the basis of its scope and coverage. On the former basis, it can be classified into vertical and horizontal coordination and
on, the latter basis, into internal and external coordination.

(4) DELIGATION
DEFINITION
Delegation is defined as transferring of responsibility to subordinates on behalf of the manager. It is an act through
which a manager gives authority to others to attain certain assignments.

Salient Features
1) Not to delegate total authority
2) Not to delegate authority which he himself does not possess
3) Should be only for organizational purpose and not personal purpose
4) It does not imply reduction in power
Characteristics
1) Delegation of authority can be exercised only by 3) Delegation does not mean transfer of final authority
higher authority 4) Does not involve surrender of power
2) Delegation can be of any kind
Kinds of delegation
1. Full delegation 4. Formal delegation
2. Partial delegation 5. Informal delegation
3. Conditional delegation
Principles of delegation
1. Should be written and specific 6. Should have certain objectives to get certain results
2. Authority and responsibility should be equal 7. Superiors should be ready to give support and
3. Should be properly planned and exercised guidance
4. Right person should be chosen 8.Overall responsibility lies with the superior
5. Good reporting system should be established

Symptoms of poor delegation

1. Dissatisfied subordinates 5. Boss carrying big suitcase
2. Disorganized effort 6. Work never completed in time
3. Long queue in front of boss office 7. Constant time pressure
4. Boss always busy
8. Hold up of activities due to pending orders
from boss

(5) DECISION MAKING- DECENTRALIZATION BASIC GOALS OF

 DECENTRALIZATION.

DEFINITION
 Decision making is a systematic process of choosing among alternatives and putting the choice in to action
- -Lancaster and Lancaster
 Decision making is a necessary component of leadership, power, influence, authority and delegations.
-John 1993
 Decision making process is a conscious, intellectual activity involving judgment, evaluation and selection from
among several alternatives. -According to Claude

TYPES OF DECISION MAKING

There are 4 managerial decisions
a. Mechanistic decision b. Analytical decision
c. Judgmental decision d. Adoptive decision
Mechanistic decision
 Routine and repetitive in nature
 It usually occurs in a situation involving a limited number of decision variables where the outcome of
each alternative is known.
 Tools used for these kinds of decisions are charts, list, decision tree etc.
Analytical decision
 This decision helps to solve the complex problems.
 It involves a problem with a large number of decision variables where the outcome of each decision
alternatives can be computed.
 Computational techniques involve linear programming and statistical analysis.
Judgmental decision
 Decision involves a problem with a limited number of decision variables but the out of the decision
alternatives are unknown.
 These types of decision are useful in marketing investment and to solve the personal problems.
Adaptive decision
 Decisions involving a problem with a large number of decision variables where outcomes are not
predictable.
 Such ill structured problems require contribution of many people with diverse technical background.
Eg. Research finding.

FACTOR AFFECTING DECISION MAKING

Internal factors
 Decision makers physical and
External factors
emotional status
 Personal characteristics and values
 Cultural environment
 Past experience and interest
 Philosophical environment
 Knowledge and Attitude
 Social back ground
 Self-awareness and courage
 Time
 Energy and creativity
 Poor communication
 Resistance to change
 Cooperation
 Sensitivity and flexibility
 Coordination

STEPS IN DECISION MAKING

1. Making the diagnosis 4. Selecting best possible solution
2. Analyzing the problem 5. Putting the decision into effect
3. Searching alternative solutions 6. Following up the decision
 DECENTRALIZATION refers to the assignment of authority along with the responsibility at each level of
the organization. Distribution of the power of decision making along with the related responsibilities among the
different managerial levels is necessary for better management.

FACTORS

 Management’s Philosophy: In the organizations where the top management wants its employees to take some
of the decisions, a decentralized system is formed. However, if the mindset of the administration is such that
they solely prefer to make all the business-related decisions, they won’t go for decentralization.
 Employees’ Efficiency and Competence: If the organization has efficient and skilled resources which it can
rely on, it opts for decentralization. Whereas in the absence of capable managers the top management prefers to
retain the power of decision making.
 Organization’s Nature and Size: If the organization is a sole proprietorship or partnership business running on
a very small scale with the limited number of employees, there is no need for decentralization. However, for the
corporates running on a vast scale, a decentralized system is necessary for smooth functioning of the business.
 Diversification: For an organization which is engaged in the production of a whole range different products,
centralization becomes difficult. Thus, the delegation of authority and division of work is essential for the
organizations involved in a diversified product line.
 Geographical Dispersion: The organizations which expand over a vast geographic area, having branches in
different locations need decentralization. Since the management cannot function and take all operational
decisions solely in such cases.
 Technical Complexity: While introducing new technology into the organization, the top management has to
shift some authority and responsibility to the experts in the area, i.e. the managers. They know all the in and
outs of the business operations and the new technology.
 Cost and Importance of the Decisions: The top management analyzes the impact and importance of the
decisions before delegating the authority of such decision making to the managers. Mostly, the decisions related
to business operations are entrusted to the managers.
 Willingness of the Subordinates: Decentralization is also influenced by the desire and initiative of the
subordinates to take responsibility for their decisions along with its authority.

DECENTRALIZATION VERSUS CENTRALIZATION

 The term centralized and decentralized refer to the degree to which an organization has spread its lines of
authority, power, and communication.
 The centralization tends to concentrate decision making at the top level of the organization, whereas
decentralization disperses decision making and authority throughout decision making and authority throughout
and further down the organizational hierarchy. The centralization and decentralization can be thought of as two
theoretical extremes of one continuum. In other words the decentralization is the extent of authority is passed
down to lower levels in the organization. The centralization is the extent to which authority is retained at the top
of the organization.
Complete centralization complete decentralization

Authority decentralization

Authority not delegated

OBJECTIVE
 Development of Managerial Personnel: Decentralization provides for self-learning of the managers by facing
the problem, finding the solutions themselves and taking the correct decisions. It adds on to the skills,
experience and expertise of the managers in their respective departments.
  Effective Control and Supervision: The managers exercise better control over the operations of the
subordinates by taking disciplinary actions. They can make decisions related to production schedules,
promotions and leaves taken by the subordinates.
 Flexibility: Decentralization leads to flexibility in business operations. It also provides authority to the
managers to handle unexpected situations
independently. It allows them to manage
their respective departments in the way
they want to.
 Motivates and Boosts Morale: It creates
self-dependent managers and drives them
to enhance their performance, take the
initiative and develop a problem-solving
attitude. Decision making also boosts
their morale and confidence.
 Prompt Decision Making: There are
times when the managers have to take
immediate and unplanned decisions at
operational levels, it is only possible in
decentralized organizations. On the
contrary, in a centralized organization, the
decision-making process is quite lengthy
and complex which is ineffective for handling unforeseen operational problems and issues.
 Reduces the Burden of Top Management: The management has to take certain crucial strategical decisions
which require a lot of analysis and planning. Decentralization releases the management from operational
decision making facilitating them to engage themselves in the future strategic planning.

Limitations of Decentralization

 Increases Administrative Expenses:

To practice decentralization, the top
management has to appoint well
qualified and experienced managers.
These managers need to be paid
reasonably thus increasing the
administrative expenses of the
organization.

 High Operational Cost: When

different department are formed during
decentralization, the organization
incurs excessive cost on the day to day
operations, resources, employees, etc.
 Managerial Inefficiency: At times the managers are not efficient and skilled enough to take decisions on their
own. The decisions taken by such managers may sometimes prove to be disastrous for the organization.
 Not Suitable for Small Firms: The organizations which are small in size does not require decentralization or
departmentation. They can be efficiently managed by the owner or the management itself.
 Lacks Uniformity: Every manager in a decentralized organization will possess a different opinion, individual
set of actions and a unique management style which brings in non-uniformity in the organization.
 Co-ordination Problem: Decentralization allows decision making at all levels. These decisions need to be
taken in collaboration with other departments. Sometimes there is a coordination problem among the managers
of the different departments creating loopholes in the business operations.

ADVANTAGES AND LIMITATIONS OF DECENTRALIZATION

Advantages
 1. Relieves top manager from burden of managing.
2. Encourages subordinates to undertake responsibility.
3. More freedom to managers.
4. Increases motivation of subordinates.
5. Enhances competition among various departments/units.
6. Helps setting up of profit centres.
7. Promotes development of general managers.
8. Prepares mangers for rapid change in the organization.
Limitations
1. Maintenance of uniform policy throughout organization becomes difficult.
2. Increases complexity of coordination.
3. May lead to loss of control by superior level managers.
4. May be limited by inadequate control techniques.
5. May be constrained by inadequate planning.
6. Limited by inadequate training.
7. Limited by inadequate number of qualified personnel at lower level.
8. It may be limited by external factors like; government regulations, taxation policy of
government, etc.

CONCEPT OF MANAGEMENT
The term ‘management’ has been used in different senses. Sometimes it refers to the process of planning, organizing,
staffing, directing, coordinating and controlling, at other times it is used to describe it as a function of managing
people. It is also referred to as a body of knowledge, a practice and discipline. There are some who describe
management as a technique of leadership and decision-making while some others have analyzed management as an
economic resource, a factor of production or a system of authority.

A) Art of Getting Things Done:

Mary Parker Follett:
“Management is the art of getting things done through others.” Follett describes management as an art of directing the
activities of other persons for reaching enterprise goals. It also suggests that a manager carries only a directing
function.
Harold Koontz: “Management is the art of getting things done through and with people in formally organized
groups.” Koontz has emphasized that management is getting the work done with the co-operation of people working
in the organization.

This view point suffers from the following deficiencies:

(i) This concept does not specify what type of functions is required to be performed for getting things done from
others.
(ii) Management is treated as an art. These days management has also acquired the status of science.
(iii) The workers are treated as means of getting results. The needs and aspirations of workers are not taken into
account.
Management is much more than just getting the things done through others. Management may be a
technique for getting things done through others by satisfying their needs and helping them grow. Harold Koontz
emphasized the attainment of business goals with the co-operation of people working in the organization.
B) Management as a Process:Henry Fayol:“To manage is to forecast and plan, to organize, to command, to co-
ordinate, and to control.” Fayol
described management as a
process of five functions such as
planning, organizing,
commanding, coordinating and
controlling. Modern authors,
however, do not view co-
ordination as a separate function
of management.

George R. Terry:
“Management is a distinct
process consisting of activities of
planning, organizing, actuating
and controlling, performed to
determine and accomplish stated
objectives with the use of human beings and other resources.” Though Terry has described four functions to be a part
of management process but managerial functions are classified into five categories.

C) Management as a Discipline:
Sometimes the term ‘management’ is used to connote neither the activity nor the personnel who performs it,
but as a body of knowledge, a practice and a discipline. In this sense, management refers to the principles and
practices of management as a subject of study. Management is taught as a specialized branch of knowledge in
educational institutions. It has drawn heavily from Psychology, Sociology, and Anthropology etc. A person acquiring
degree or diploma in management can try for a managerial job.

D) Management As Art And Science

Management is treated both as an art as well as science. An art is often regarded as the systematic application
of skill or knowledge in effecting accomplishment of results. In management one has to use personal skill and
knowledge in solving many complicated problems to achieve enterprise objectives. Management is regarded as a
science because it has developed certain principles, generalizations and techniques which have more or less universal
application. So management is a study of a specific discipline. When one says that a particular person is in
management stream then it is assumed that he is studying a particular field of learning.

E) Art and Science of Decision-Making and Leadership:

Decision-making and guiding others is considered an important element of management. A manager has to take
various decisions every day for properly running an enterprise.
Donald J. Clough:
“Management is the art and science of decision-making and leadership.” The author views management as an art and
science of decision-making. The quality of decisions determines the performance of a manager. He has also to provide
leadership to subordinates for motivating them to undertake their work.
Rose Moore:
“Management means decision-making.” Decision-making cannot be the only function of management even though it
is very important.

F) An Art of Increasing Productivity:

John F. Mee:
“Management may be defined as the art of securing maximum prosperity with a minimum of effort so as to secure
maximum prosperity and happiness for both employees and employer and give public the best possible service.”

F.W. Taylor:
“Management is the art of knowing what you want to do in the best and cheapest way.”
G) Integration of Efforts:
Management makes use of human and physical resources for the benefit of the enterprise.
Keith and Gubellini:
“Management is the force that factors integrate men and physical plant into an effective operating unit.” Management
integrates physical and human resources for operating the manufacturing process in a better way.
Barry M. Richman:
“Management entails the coordination of human and material resources towards the achievement of organizational
objectives as well as the organization of the productive functions essential for achieving stated or accepted economic
goals.” Management alms to co-ordinate and integrate various resources in the organization for achieving enterprise
objectives. The thrust of above-mentioned definitions is that integration and co-ordination of various factors of
production is essential for running a business properly and this function is undertaken by management.

H) Management as a Group of Managers:

The term management is frequently used to denote a Refers to managerial group of managerial personnel. When one
says that personnel management of such and such company is efficient, he refers to the group of persons who are
looking after the working of the enterprise. These persons individually are called managers. “Management is the body
or group of people which performs certain managerial functions for the accomplishment of pre-determined goals.”

All managers perform managerial functions of planning, organizing, staffing, directing and controlling. These persons
collectively arc called ‘body of managerial personnel.’ In actual practice the term ‘management’ is used to denote top
management of the organization. Top management is mainly concerned with determination of objectives, strategic
planning, policy formulation and overall control of the organization.

Concept of Management:

NURSING MANAGEMENT
INTRODUCTION
Nursing management consists of the performance of the leadership functions of governance and decision-making
within organizations employing nurses. It includes processes common to all management like planning, organizing,
staffing, directing and controlling. (Wikipedia)
It is common for registered nurses to seek additional education to earn a Master of Science in Nursing or Doctor of
Nursing Practice to prepare for leadership roles within nursing. Management positions increasingly require candidates
to hold an advanced degree in nursing.
DEFINITION:
 (1) The art of securing maximum result with minimum effort so as to secure maximum prosperity and happiness
for both nurse managers and nurses to render the best possible patient care.
(2) The process of working through nursing staff members to provide care, cure, and comfort to patient. - Gillies
DA

CONCEPT OF NURSING MANAGMENT

Human Resources Management
Nurse managers use their training in human resources management to ensure their units are functioning efficiently.
With a shortage of nurses, they look for ways to improve the performance of available nurses. For instance, a nurse
manager can conduct performance appraisals or enroll nurses in training and development workshops. Improved
compensation and benefits and better technical skills can motivate nurses to do more work, temporarily easing a
crisis.

Decision Making
Nurse managers make decisions to solve specific problems that arise on a day-to-day basis. For instance, if a
pharmaceutical supplier delays delivering ordered drugs, the nurse makes a quick decision to address the issue. She
can, for instance, ask the procurement officer to purchase drugs for use until the supplier delivers the products. In
general, individuals in nursing management positions should be quick thinkers and problem solvers. A good manager
is sensitive to factors that can affect her decision-making, such as the nature of the situation and the resources spent in
implementation.

Quality Assessment
All nursing services offered by a health facility need evaluation for quality from time to time. This helps ensure health
care services meet required standards. Nurse managers use the quality assessment concept to evaluate the
performance of the hospital staff in accordance with institutional policies and federal and state laws. They often
establish objectives that nurses should pursue in order to maintain high-quality care for patients. For instance, a nurse
manager can ask nurses in her staff to enlist with one or more professional nursing associations, where they can
interact with other nurses and share views on how to improve health care services.

Effective Communications
Effective communication that include monitoring responses from the staff, understanding and utilizing non-verbal
communication and reducing stress on the job by creating a lighter atmosphere with humor and humility.

Resource Management
Managers have a finite set of resources within which to work. As such, nurses must become adept at working with
limited human resources and equipment budgets. Effective nurse managers receive training on how to order supplies
so that all the needs of the unit are filled and know who to call within the facility when supplies or technical
assistance is needed. At the same time, nurse managers must be able to create schedules and work with a staff that
often fluctuates. Nurses who can work within a team and show that they can step in when needed earn the respect of
their staff who, in turn, become more loyal. Loyal staff members show up when needed and fill in when necessary.

Conflict Resolution
Staff and patients experience less stress when the nurse manager knows how to effectively resolve conflicts when
they arise. Collaboration and communication, vital to provide safe patient care, break down when conflicts go
unresolved. Nurses on the job experience conflict from a range of sources, including patients, family members,
doctors and peers. Effective managers take each new instance and deal with the conflict based on the participants and
their immediate needs. For example, when a family member demands to see a patient’s file against the patient’s
wishes, the nurse manger steps in and brings the family to a quiet place to explain the rules. When conflicts arise
between staff members, nurse managers are fair and listen closely to everyone involved before making decisions.

Team Building
Nurses work in interdisciplinary teams and must cooperate with each other to provide the most effective, safe and
efficient care for patients. Formal roles are defined by the organization, but nurse managers play a significant role in
how the staff undertakes various team responsibilities. Effective team builders lead by example and understand the
 needs of the unit at any given time. They realize the patient flow and available resources and can place staff members
in the most appropriate positions so the teams flow effortlessly. Leaders take time to listen to the needs of their team
members through regular team meetings and sessions designed to build the best patient outcomes, allowing everyone
on the team to participate.

Nursing management parallels nursing process

TYPES OF NURSING MANAGEMENT

PRINCIPLES OF MANAGEMNT IN NURSING

1. Divison of work (principle of specialization)

2. Authority and responsibility

3. Discipline
4. Unity of command

5. Unity of direction

6. Subordination of indivisual interest to general interest

7. Remuneration

8. Centralization

9. Scalar chain of command or hierarchy

10. Order

11. Equity

12. Stability of tenure

13. Initiative
14. Espirit de crops( Union is strength )

VISION AND MISSION

STATEMENT
A vision statement focuses on
tomorrow and what an organization
wants to ultimately become. A
mission statement focuses on today
and what an organization does to
achieve it. Both are vital in directing
goals.
 Unit 3: Planning
DEFINITION:
1)Planning is the selection and relating of facts and making and using of assumptions regarding the future in the
visualization and formalization of proposed activities believed necessary to achieve the desired result.
-- George Terry
2) Planning is the function of manager, which involves the selection from among alternatives for the enterprise as
a whole and each department within it. – Koontz and O’Donnell
3)Management planning involves the development of forecasts, objectives, policies, programmes, procedure,
schedules and budgets. – Louis A Allen
4) “The plan of action is, at one and the same time, the result envisaged, the line of action to be followed, the
stages to go through, and methods to use.”-- Henry Fayol
5) According to Koontz and O’Donnell, planning is “an intellectual process, the conscious determination of
courses of action, the basing of decisions on purpose, facts and considered estimates.”

CONCEPT OF PLANING:
 Concept Planning is deciding in advance what to do and how to do. It is one of the basic managerial functions.
Before doing something, the manager must formulate an idea of how to work on a particular task.
 Thus, planning is closely connected with creativity and innovation. But the manager would first have to set
objectives, only then will a manager know where he has to go.
 Planning seeks to bridge the gap between where we are and where we want to go. Planning is what managers
at all levels do.
 It requires taking decisions since it involves making a choice from alternative courses of action.
 Planning, thus, involves setting objectives and developing appropriate courses of action to achieve these
objectives. Objectives provide direction for all managerial decisions and actions. Planning provides a rational
approach for achieving predetermined objectives.
 All members, therefore, need to work towards achieving organizational goals. These goals set the targets
which need to be achieved and against which actual performance is measured. Therefore, planning means
setting objectives and targets and formulating an action plan to achieve them.
 It is concerned with both ends and means i.e., what is to be done and how it is to be done. The plan that is
developed has to have a given time frame but time is a limited resource. It needs to be utilized judiciously.
 If time factor is not taken into consideration, conditions in the environment may change and all business plans
may go waste.
 Planning will be a futile exercise if it is not acted upon or implemented.

PRINCIPLES OF PLANING

1. Principle of Commitment:
This means that certain resources must be committed or pledged for the purpose of planning. Planning is not an
easy task. So, necessary help is to be taken from experts. The enterprise must be ready to exhaust the available
resources for the achievement of a plan.
2. Principle of the Limiting Factor:
A plan involves varied factors of different importance. This principle implies that more emphasis has to be put on
that factor which is scarce or limited in supply or extremely costly. This will help in selecting the most favorable
alternative.
3. Principle of Reflective Thinking:
Planning, being an intellectual activity is based on rational considerations. These involve reflective thinking which
signifies problem-solving thought process—a process by which past experiences are superimposed on the facts of
the present situation and possible future trends. None can be a planner whose mind is not active, who does not
possess any deliberate power and whose sense of judgement is not strong.
 4. Principle of Flexibility:
Though a plan is prepared after reflective thinking, this does not mean that no departure can be made in the course
of its operation. The plan should be so prepared that there is sufficient scope for changing it from time to time.
Changes must necessarily be affected in the plan for taking into account new developments that may take place in
the course of the operation of the plan.

5. Principle of Contribution to Enterprise Objectives:

A major plan is prepared and it is supported by many derivative plans. But all plans must contribute in a positive
way towards the achievement of the enterprise objectives.
6. Principle of Efficiency:
A plan should be made efficient to attain the objectives of the enterprise at the minimum cost and least effort. It
must also achieve better results with the minimum of unexpected happenings. Therefore, it is to be seen that what
is expected is likely to be achieved.
7. Principle of Selection of Alternatives:
Planning is basically a problem of choosing. The essence of planning is the choice among alternative courses of
action. There is no need for planning if there is only one way for doing something. In choosing from alternatives,
the best alternative will be that which contributes most efficiently and effectively to the accomplishment of a
desired goal.
8. Principle of Planning Premises:
A plan is prepared against some foundations or backgrounds known as ‘Planning Premises’. There must be
complete agreement among the managers in respect of planning premises over which the structure of plan is to be
framed.
9. Principle of Timing and Sequence of Operations:
Timing and sequence of operations determine the starting and finishing time for each piece of work according to
some definite schedule and give practical and concrete shape and form to work performance.
10. Principle of Securing Participation:
To secure participation of the employees with whole-hearted co-operation in execution of the plan, it is necessary
that the plan must be communicated and explained to them for their full understanding. This understanding
provides the basis for additional knowledge about new facts and matters to the employees. This is needed for
improvement in the quality of planning. It also ensures an obligation of the personnel of the enterprise to execute
the plan by individual and joint participation.
11. Principle of Pervasiveness:
Though major planning function is entrusted to the top management, it is not restricted to the top level only. It is a
function of every manager at every level in the organization.
12. Principle of Strategic Planning:
Strategic planning is essential where there is competition. It is prepared in the light of what the competitors are
intending to do. Planners must take into account the strategies of the rival organizations, otherwise the planning
projection may land them in trouble.
13. Principle of Innovation:
A good system of planning should be responsive to the opportunities for innovation. Innovation consists in
creating something new for increasing satisfaction of the consumers. This may also be stated as an important
strategy of business. Innovation is a necessity for its sustaining growth in this dynamic world. Innovation is
achieved through research and development and planning is required to provide such scope.
14. Principle of Follow-up:
In the course of execution of a plan, certain obstacles may crop up in midway and planning may require revision,
alteration or correction. This is why there must be a follow-up system in the planning process itself. This allows
timely changes in the planning and makes it more effective.

INSTITUTIONAL POLICY
 Policies are general statements that guide thinking or channelize energies towards a particular direction.
Policies provide a basis for interpreting strategy which is usually stated in general terms.
 They are guides to managerial action and decisions in the implementation of strategy.
 For example, the company may have a recruitment policy, pricing policy within which objectives
are set and decisions are made.
 If there is an established policy, it becomes easier to resolve problems or issues. As such, a policy is the
general response to a particular problem or situation.
 There are policies for all levels and departments in the organization ranging from major company policies to
minor policies. Major company policies are for all to know i.e., customers, clients, competitors etc., whereas
minor polices are applicable to insiders and contain minute details of information vital to the employees of an
organization.
 But there has to be some basis for divulging information to others.
 Policies define the broad parameters within which a manager may function. The manager may use his/her
discretion to interpret and apply a policy.
For example, the decisions taken under a Purchase Policy would be in the nature of manufacturing
or buying decisions. Should a company make or buy its requirements of packages, transport services, printing
of stationery, water and power supply and other items? How should vendors be selected for procuring
supplies? How many suppliers should a company make purchases from? What is the criteria for choosing
suppliers? All these queries would be addressed by the Purchase Policy.

IMPORTANCE OF PLANING
1. Providing Basis of Decision: 10. Planning reduces the risks of uncertainty
2. Focusing Attention on Objectives:
3. Minimizing Uncertainty and Risk: 11. Planning reduces overlapping and wasteful
4. Adapting with Changes: activities
5. Securing Economy: 12.Planning promotes innovative ideas
6. Helping in Co-ordination:
7. Making Control Effective: 13. Planning facilitates decision making
8. Increasing Organizational Effectiveness:
9. Planning provides directions 14.Planning establishes standards for controlling

OBJECTIVE OF PLANING
1) To set the objectives 5) To reduce risk and uncertainty
2) To focus on meaningful activities 6) To ensure proper control
3) To economize the Time and effort and other 7) To achieve organizational effectiveness
resources 8) Planning promotes creativity
4) To maintain coordination 9) To improve efficiency

STRATEGIC PLANING
INTRODUCTION:
 It is a part of the strategic management process, which ensures that every aspect of the organization is working
towards the achievement of the organization’s goals, i.e. in the right and intended direction.
 Strategic Planning ascertains what an organization is, to whom it serves, where is it going and what are the paths,
which are to be followed to follow its vision. It includes strategic decision making, strategic intent, strategic
management model and strategy formulation.

DEFINITION: Strategic Planning can be understood as a systematic long-range planning activity, that an organization
uses to fix priorities, strengthen operations, ascertain objectives and focus on the resources required and are to be
allocated in order to pursue the strategy and attain the objectives.

CHARACTERISTICS OF STRATEGIC PLANNING

 Strategic Planning is an analytical process which formulates strategic and operational plans for the organization.
The implementation of strategic plans is possible through projects, whereas various units or divisions of the firm
implement operational plans.
 It performs SWOT Analysis, i.e. during the planning process, the firm’s Strengths, Weaknesses, Opportunities
And Threats are taken into consideration.
 It is a forward-looking activity wherein the future opportunities and threats are ascertained while considering its
profitability, market share, product and competition.
 It presupposes that a firm
should always be ready to
adapt itself according to the
dynamic business environment.
For this purpose, alternative
strategies are developed for
different circumstances, i.e.
from best to worst, for the
future
 It can be done for the entire
organization or to a specific
business unit.
 It is helpful in selecting the
best strategy, among the
various strategies taking into
account the firm’s interest,
personal values and corporate
social responsibility.
 It acts as a guide to the
executive to reduce the risk
involved in the business and
also to take the best possible advantage of the opportunities. So, in this way, it contributes to the success of the
enterprise.
Key components of strategic planning
The key components of 'strategic planning' include an understanding of the firm's vision, mission, values and strategies.
The vision and mission are often captured in a Vision Statement and Mission Statement.

 Vision: outlines what the organization wants to be, or how it wants the world in which it operates to be (an
"idealized" view of the world). It is a long-term view and concentrates on the future. It can be emotive and is a
source of inspiration
 Mission: Defines the fundamental purpose of an organization or an enterprise, succinctly describing why it exists
and what it does to achieve its vision. For example, the charity above might have a mission statement as "providing
jobs for the homeless and unemployed".
 Values: Beliefs that are shared among the stakeholders of an organization. Values drive an organization's culture
and priorities and provide a framework in which decisions are made. For example, "Knowledge and skills are the
keys to success" or "give a man bread and feed him for a day, but teach him to farm and feed him for life". These
example values may set the priorities of self-sufficiency over shelter.
 Strategy: Strategy, narrowly defined, means "the art of the general." A combination of the ends (goals) for which
the firm is striving and the means (policies) by which it is seeking to get there. A strategy is sometimes called a
roadmap which is the path chosen to plow towards the end vision. The most important part of implementing the
strategy is ensuring the company is going in the right direction which is towards the end vision
 The Strategic Planning Process
Mission :A company's mission is its reason for being. The mission often is expressed in the form of a mission
statement, which conveys a sense of purpose to employees and projects a company image to customers. In the
strategy formulation process, the mission statement sets the mood of where the company should go.
Objectives: Objectives are concrete goals that the organization seeks to reach, for example, an earnings growth
target. The objectives should be challenging but achievable. They also should be measurable so that the company
can monitor its progress and make corrections as needed.
 Situation Analysis: Once the firm has specified its
objectives, it begins with its current situation to devise
a strategic plan to reach those objectives. Changes in
the external environment often present new
opportunities and new ways to reach the objectives. An
environmental scan is performed to identify the
available opportunities. The firm also must know its
own capabilities and limitations in order to select the
opportunities that it can pursue with a higher
probability of success. The situation analysis therefore
involves an analysis of both the external and internal
environment.
 The external environment has two aspects: the macro-
environment that affects all firms and a micro-
environment that affects only the firms in a particular
industry. The macro-environmental analysis includes
political, economic, social, and technological factors
and sometimes is referred to as a PEST analysis.
 An important aspect of the micro-environmental
analysis is the industry in which the firm operates or is considering operating. Michael Porter devised a five forces
framework that is useful for industry analysis. Porter's 5 forces include barriers to entry, customers, suppliers,
substitute products, and rivalry among competing firms.
 The internal analysis considers the situation within the firm itself, such as:
 Organization culture  Operational efficiency
 Organization image  Operational capacity
 Organizational structure  Market share
 Key staff  Financial resources
 Access to natural resources  Exclusive contracts
 Position on the experience curve  Patents and trade secrets

Strategy Formulation: Once a clear picture of the firm and its environment is in hand, specific strategic alternatives
can be developed. While different firms have different alternatives depending on their situation, there also exist generic
strategies that can be applied across a wide range of firms. Michael Porter identified cost leadership, differentiation,
and focus as three generic strategies that may be considered when defining strategic alternatives. Porter advised against
implementing a combination of these strategies for a given product; rather, he argued that only one of the generic
strategy alternatives should be pursued.
Implementation: The strategy likely will be expressed in high-level conceptual terms and priorities. For effective
implementation, it needs to be translated into more detailed policies that can be understood at the functional level of the
organization. The expression of the strategy in terms of functional policies also serves to highlight any practical issues
that might not have been visible at a higher level. The strategy should be translated into specific policies for functional
areas such as:
 Marketing  Production
 Research and development  Human resources
 Procurement  Information system

In addition to developing functional policies, the implementation phase involves identifying the required resources and
putting into place the necessary organizational changes.

Control: Once implemented, the results of the strategy need to be measured and evaluated, with changes made as
required to keep the plan on track. Control systems should be developed and implemented to facilitate this monitoring.
Standards of performance are set, the actual performance measured, and appropriate action taken to ensure success.
 Dynamic and Continuous Process: The strategic management process is dynamic and continuous. A change in one
component can necessitate a change in the entire strategy. As such, the process must be repeated frequently in order to
adapt the strategy to environmental changes. Throughout the process the firm may need to cycle back to a previous
stage and make adjustments.

Drawbacks of this Process: The strategic planning process outlined above is only one approach to strategic
management. It is best suited for stable environments. A drawback of this top-down approach is that it may not be
responsive enough for rapidly changing competitive environments. In times of change, some of the more successful
strategies emerge informally from lower levels of the organization, where staff Nurses are closer to customers on a day-
to-day basis.

MANAGEMENT BY OBJECTIVE
DEFINITION:
(1) Management by Objectives (MBO) or otherwise called as Management by Results (MBR) is management
philosophy which was first propounded by Peter F. Drucker in the year 1954, in his book “Practice of
Management”.
(2) MBO or management by objectives is defined as a comprehensive managerial system that integrates many
key managerial activities in a systematic process and that is consciously directed toward the effective and
efficient achievement of organizational and individual objectives
 Management by objectives is a planning and controlling system, in which the superior and subordinates work
together in order to define business objectives and establish targets that are to be achieved by the subordinates,
and also determine each individual’s key area of responsibility as regards the results expected. Further, these
measures are considered as yardstick to run the unit and also assess the contribution of each individual.
Assumption of Management by Objectives
MBO relies on the premise that people tend to perform better when they are known about what is expected from
them and when they can associate their personal goals with that of the objectives of the organization. In
addition to this, it also proposes that people have interest in establishing goals and comparing the performance against
the set target.

Process of Management by Objectives

The 6 steps of the MBO process are;
1. Define organizational goals
2. Define employees’ objectives
3. Continuous monitoring performance and progress
a. Identifying ineffective programs by comparing
performance with pre-established objectives,
b. Using zero-based budgeting,
c. Applying MBO concepts for measuring individual and
plans,
d. Preparing long and short-range objectives and plans,
e. Installing effective controls, and
f. Designing a sound organizational structure with clear,
responsibilities and decision-making authority at the
appropriate level.
4. Performance evaluation
5. Providing feedback: This continuous feedback is
supplemented by periodic formal appraisal meetings
which superiors and subordinates can review progress
toward goals, which lead to further feedback.
6. Performance appraisal: Performance appraisals are a regular review of employee performance within organizations. It
is done at the last stage of the MBO process.
 Benefits of Management by Objectives
1. It facilitates the employees to understand their tasks and duties in a better way.
2. It is helpful in designing Key Result Area (KRA) for each employee, according to their interest, specialization,
experience and competency.
3. It eliminates overlapping and confusions in the tasks and duties.
4. Every employee contributes towards the achievement of the objectives by successfully completing the tasks and
duties assigned to them by the superior.
5. It creates an open communication enviornment in the organization
In a nutshell, Management by objectives is nothing but a process wherein the goals, plans and control
system of the organization are defined by the management and employees jointly.

Difference Between Strategic Planning and Operational Planning

Planning is an important activity, performed by the management, keeping in view, the vision, mission, goals and
objectives of the enterprise. It implies thinking in advance, what we need to do in future and creates a rough draft, so
as to fulfill the business objectives.
 Planning occurring at the corporate level is termed as strategic planning, while the planning process taking place
at the functional level is called operational planning.
BASIS FOR
STRATEGIC PLANNING OPERATIONAL PLANNING
COMPARISON

Meaning The planning for achieving the Operational Planning is a process of

vision of the organization is deciding in advance of what is to be done
Strategic Planning. to achieve the tactical objectives of
business

Time Horizon Long term planning Short term planning

Approach Extroverted Introverted

Modifications Generally, the plan lasts longer. The plan changes every year.

Performed by Top level management Middle level management

Scope Wide Narrow

Emphasis on Planning of vision, mission and Planning the routine activities of the
objectives. company.

PLANNING FOR CHANGE

 EXAMPLE OF MISSION, VISION, PHILOSOPHY STATEMENT

Mission
The mission of Michigan State University's College of Nursing is to enhance the health of the community by
providing excellence in nursing education, nursing research and nursing practice. We will advance the profession of
nursing and serve as an advocate for optimal healthcare for all people.
The mission will be accomplished through our strategic priorities:
Education: Provide a balanced array of educational programs to prepare nurse leaders for practice, research, and
education.
Research: Increase research activity in focused areas of excellence and expand team science.
Practice: Lead nursing practice partnerships that translate nursing science into practice to improve health outcomes.

Vision
The Michigan State University College of Nursing is a leader in creating positive change in healthcare outcomes
locally, nationally, and globally through excellence in nursing education, research, and practice.
 Establish the highest standards of Neuro Psychiatric nursing care and rehabilitation at primary, secondary and tertiary
levels.
 Advance manpower development by providing nursing education of the highest standard in the field of mental health
and neuro sciences, reflecting the philosophy and core values of the nursing profession.
 Promote research-oriented nursing practice to fortify the science of nursing, and use research as an integral part of
nursing care in improving patient outcomes.
 Provide consultancy services in areas relevant to the current and future direction of nursing practice, education, and
research
Philosophy
The College of Nursing, as an integral part of Michigan State University, subscribes to the land-grant philosophy and its
tripartite mission including outreach that bridges the areas of teaching, research, and service. The College provides leadership for
the education of nurses at the undergraduate, master’s, and doctoral levels who practice within an integrated, dynamic, and
diverse health care system. All faculty members are committed to scholarship in teaching, research, service, and practice.

The goal of professional nursing education is to promote competence and leadership in evidence-based nursing practice,
scholarship, and research spanning from the community to the international level. Nursing education is a lifelong process that
applies the concepts and theories from nursing, the humanities, and the natural and behavioral sciences. Learning is most
effective when individual learner needs are considered, and active learner participation is facilitated. This objective is best
accomplished in an atmosphere that promotes educational access and respect for diversity.

The beginning practitioner of nursing, a caring professional, skilled clinician, effective communicator, and clinical scholar who
promotes the well-being of individuals, families, and populations in health and illness, is awarded the Bachelor of Science in
Nursing (BSN). The beginning advanced practice nurse, a specialist prepared in theory application, role development, evidence-
based practice, application ethics, shaping policy/organizations, health promotion, and illness prevention/management to meet
the diverse needs of specific populations, is awarded the Master of Science in Nursing (MSN); or with an expanded area of
expertise in leadership involving these areas and quality improvement, the advanced practice nurse is awarded the Doctor of
Nursing Practice (DNP). The nurse scientist who is awarded the Doctor of Philosophy (PhD) in Nursing is prepared to conduct
an independent program of research with rigorous scientific inquiry that extends knowledge to advance nursing practice, steward
the profession, shape health policy, and impact the health and well-being of populations.

Objectives
 To provide quality nursing care to patients and families in the hospital, as well as in the community, through
multidisciplinary approach
 To maintain quality in educational programs for students (Ph.D., M.Sc. Psychiatric Nursing, Diploma in
Psychiatric/Mental Health Nursing, Diploma in Neuro Science Nursing, other short-term training programs)
 To provide clinical learning experience to students of various categories placed in the Department from India and
abroad
 To build up research potential in the Department
 To provide leadership in the field of mental health and neuro science nursing in the country
 To provide advisory and consultation services in the field of nursing service, education, and research.
 UNIT: 4 ORGANIZATION
DEFINITION
(1) An organization may be defined as a formally constituted group of people who have identified tasks and who
work together to achieve a specific purpose defined by the organization.
(2) Organization is a form of every human association for the attainment of common purpose and the process of
relating specific duties or function in a whole - J D Mooney
(3) Organization consists of the relationship of individual to individuals and groups to groups which are related as
to bring about an orderly division of labor. - Pfiffiner.
(4) Organization is a formal structure of authority through which work subdivisions are arranged, defined and
coordinated for the defined objective. - Luther Gullick

CONCEPT OF ORGANIZATION
The working relationships — vertical and horizontal associations between individuals and groups — that exist within
an organization affect how its activities are accomplished and coordinated. Effective organizing depends on the
mastery of several important concepts: work specialization, chain of command, authority, delegation, span of control,
and centralization versus decentralization. Many of these concepts are based on the principles developed by Henri
Fayol.
1]WORK SPECIALIZATION : One popular organizational concept is based on the fundamental principle that
employees can work more efficiently if they're allowed to specialize. Work specialization, sometimes called division
of labor, is the degree to which organizational tasks are divided into separate jobs. Employees within each department
perform only the tasks related to their specialized function

2]CHAIN OF COMMAND :The chain of command is an unbroken line of authority that links all persons in an
organization and defines who reports to whom. This chain has two underlying principles: unity of command and
scalar principle.
 Unity of command: This principle states that an employee should have one and only one supervisor to whom he
or she is directly responsible. No employee should report to two or more people. Otherwise, the employee may
receive conflicting demands or priorities from several supervisors at once, placing this employee in a no‐win
situation.
 Scalar principle: The scalar principle refers to a clearly defined line of authority that includes all employees in
the organization.

3]AUTHORITY is the formal and legitimate right of a manager to make decisions, issue orders, and allocate resources
to achieve organizationally desired outcomes. A manager's authority is defined in his or her job description.
Organizational authority has three important underlying principles:
 Authority is based on the organizational position, and anyone in the same position has the same authority.
 Authority is accepted by subordinates. Subordinates comply because they believe that managers have a
legitimate right to issue orders.
 Authority flows down the vertical hierarchy. Positions at the top of the hierarchy are vested with more formal
authority than are positions at the bottom.

4]DELEGATION: A concept related to authority is delegation. Delegation is the downward transfer of authority from
a manager to a subordinate. Most organizations today encourage managers to delegate authority in order to provide
maximum flexibility in meeting customer needs. In addition, delegation leads to empowerment, in that people have
the freedom to contribute ideas and do their jobs in the best possible ways.

5]SPAN OF CONTROL: refers to the number of workers who report to one manager. For hundreds of years, theorists
have searched for an ideal span of control. When no perfect number of subordinates for a manager to supervise
became apparent, they turned their attention to the more general issue of whether the span should be wide or narrow.
 A wide span of management exists when a manager has a large number of subordinates. Generally, the span of
control may be wide when
 The manager and the subordinates are very competent.
  The organization has a well‐established set of standard operating procedures.
 Few new problems are anticipated.
 A narrow span of management exists when the manager has only a few subordinates. The span should be narrow
when
 Workers are located far from one another physically.
 The manager has a lot of work to do in addition to supervising workers.
 A great deal of interaction is required between supervisor and workers.
 New problems arise frequently.
 Keep in mind that the span of management may change from one department to another within the same
organization.

6] A centralized organization systematically works to concentrate authority at the upper levels. In a decentralized
organization, management consciously attempts to spread authority to the lower organization levels.

PRINCIPLES OF ORGANIZATION
1. Principle of unity of objectives: Organizational goals, departmental goals, and individual goals must be clearly
defined. All goals and objectives must have uniformity. When there is contradiction among different level of goals
desired goals can’t be achieved. Therefore, unity of objectives is necessary
2. Principle of specialization: Sound and effective organization believes on organization. The term specialization is
related to work and employees. When an employee takes special type of knowledge and skill in any area, it is known
as specialization. Modern business organization needs the specialization, skill and knowledge by this desired sector of
economy and thus, efficiency would be established.
3. Principle of coordination: In an organization many equipment, tools are used. Coordination can be obtained by
group effort that emphasize on unity of action. Therefore, coordination facilitates in several management concepts
4. Principle of authority: Authority is the kind of right and power through which it guides and directs the actions of
others so that the organizational goals can be achieved. It is also related with decision making. It is vested in
particular position, not to the person because authority is given by an institution and therefore it is legal. It generally
flows from higher level to lowest level of management. There should be unbroken line of authority.
5. Principle of responsibility: Authentic body of an organization is top level management, top level management
direct the subordinates. Departmental managers and other personnel take the direction from top level management to
perform the task. Authority is necessary to perform the work .only authority is not provided to the people but
obligation is also provided. So the obligation to perform the duties and task is known as responsibility. Responsibility
can’t be delegated. It can’t be avoided.
6. Principle of delegation: Process of transferring authority and creation of responsibility between superior and
subordinates to accomplish a certain task is called delegation of authority. Authority is only delegated, not
responsibilities in all levels of management. The authority delegated should be equal to responsibility
7. Principle of efficiency: In enterprise different resources are used. Therese resources must be used in effective
manner. When the organization fulfill the objectives with minimum cost, it is effective. Organization must always
concentrate on efficiency.
8. Principle of unity of command: subordinates should receive orders from single superior at a time and all
subordinates should be accountable to that superior. More superior leads to confusion, delay and so on.
9. Principle of span of control: unlimited subordinates can’t be supervised by manager, this principle thus helps to
determine numerical limit if subordinates to be supervised by a manager. This improves efficiency.
10. Principle of balance: the functional activities their establishment and other performances should be balanced
properly. Authority, centralization, decentralization must be balance equally. This is very challenging job but efficient
management must keep it.
11. Principle of communication: Communication is the process of transformation of information from one person to
another of different levels. It involves the systematic and continuous process of telling, listening and understanding
opinions ideas, feelings, information, views etc, in flow of information. Effective communication is important
12. Principle of personal ability: for sound organization, human resources is important. Employees must be capable.
Able employees can perform higher. Mainly training and development programs must be encouraged to develop the
skill in the employees
13. Principle of flexibility: organizational structure must be flexible considering the environmental dynamism.
Sometimes, dramatically change may occur in the organization and in that condition, organization should be ready to
accept the change
14. Principle of simplicity: this principles emphasizes the simplicity of organizational structure, the structure if
organization should be simple with minimum number of levels do that its member an understand duties and
authorities

OBJECTIVES OF ORGANIZATION
DEFINITION: It is a future target or end result that an organization wishes to achieve.” Planning is meaningless if
objectives are not framed. Objectives serve as guide to planning i.e., planning is directed towards specific objectives.
FEATURES OF OBJECTIVES:
1. Challenging 4. Time limit 7. Priority
2. Attainable 5. Supportive 8. Flexible
3. Specific and measurable 6. Hierarchy

IMPORTANCE OF OBJECTIVES:
1. Basis for managerial functions:
Objectives provide basis for all managerial functions. Planning, organizing, staffing, directing and controlling are
directed towards organizational objectives. Unless organizational objectives are clearly identified, managerial
functions will not be effectively carried out.
2. Basis for organizational existence:
Objectives provide foundation or legitimacy to business organization. An Organization will not come into existence if
it has no objective to achieve. Objectives enable the Organization to make its profile (identify its strengths and
weaknesses) and relate it with environmental profile (opportunities and threats). Organization can, thus, relate itself
with the environment.
3. Basis for various types of plans:
Different types of plans like policies, programmes, procedures etc. are directed towards Organizational objectives. If
objectives are clear, managers will be able to make the plans. Clearly defined objectives encourage unified planning.
They promote vision of the future so that instructions can be given to move in the right direction.
4. Standards of performance:
Objectives provide standards of performance against which actual performance is measured. Organizational
performance is directed towards objectives. Objectives, thus, provide the basis for control. Deviations in actual
performance are rectified and performance of sub-units, units and departments is synchronized in a common direction.
5. Unity of action:
Objectives provide unity of action. All Organizational activities related to all departments (production, marketing etc.)
are targeted towards Organizational objectives.
6. Motivation:
Objectives at one level are a source of inspiration and motivation to achieve goals at higher levels. Workers strive
hard to achieve innovative and challenging goals. Rational and attainable objectives motivate employees to work
hard. Organizational goals should also satisfy personal goals. If goals fulfill personal needs of employees, they feel
motivated to contribute to Organizational goals also.
7. Basis for coordination:
Objectives coordinate the efforts of people in different departments. Individual, sectional and departmental goals are
coordinated towards corporate goals. They also integrate the efforts of individuals with those of the groups and the
Organization. People as individuals (internal and external to the Organization) cannot think differently from groups
and the Organization. Creditors, suppliers, customers, employees — all depends upon how well the objectives of the
Organization are defined.
8. Basis for decision-making:
Decision-making is goal-oriented. Objectives frame the areas for discretion within which Organizational decisions
can be made.
9. Basis for Organization structure:
Organization structure is designed keeping in view concepts like departmentation, span of control, delegation,
decentralisation etc. All these activities have to move towards a common direction. Framing realistic and attainable
objectives play important role in this regard.
 In a hierarchy, goals/objectives are generally framed at three levels:
1. Top level: Strategic goals,
2. Middle level: Tactical goals, and
3. Lower level: Operational goals.

TYPES AND THEORY OF ORGANIZATION

Organizational theory attempts to explain the workings of organizations to produce understanding and
appreciation of organizations. Organizational theory draws from various bodies of knowledge and disciplines.
Some types of organizational theories include classical, neoclassical, contingency systems and organizational
structure. These variations on organizational theory draw from multiple perspectives, incl uding modern and
postmodern views.
2) Neoclassical theory 4) Individual processes:
1) Classical organization theory 3) Modern theories a) Motivational theory
a) Taylor‘s scientific management a) The systems approach b) Role theory
approach b) Socio-technical approach c) Personality theory
b) Weber‘s bureaucratic approach c) The contingency or situational
c) Administrative theory approach

1) Classical Organizational Theory

The classical perspective of management originated during the Industrial Revolution. It focuses primarily on
efficiency and productivity and does not take into account behavioral attributes of employees. Classical
organizational theory combines aspects of scientific management, bureaucratic theory and administrative theory.
Scientific management involves obtaining optimal equipment and personnel and then carefully scrutinizing each
component of the production process, states StatPac Inc, an international software development and research
company. Bureaucratic theory places importance on establishing a hierarchical structure of power. Administrative
theory strives to establish universal management principles relevant to all organizations.

A) Scientific management
 The scientific management theory was introduced by Frederick Winslow Taylor to encourage production efficiency
and productivity. Taylor argues that inefficiencies could be controlled through managing production as a science.
Taylor defines scientific management as "concerned with knowing exactly what you want men to do and then see in
that they do it in the best and cheapest way." According to Taylor, scientific management affects both workers and
employers, and stresses the control of the labor force by management.
 The Principles of Scientific Management
1. The creation of a scientific method of measurement that replaces the "rule-of-thumb" method
2. Emphasis placed on the training of workers by management
3. Co-operation between manager and workers to ensure the principles are being met
4. Equal division of labor between managers and workers

B) Weber's bureaucratic approach

Weber (1947) based the concept of the formal organization on the following principles:
1. Structure: In the organization, positions should be arranged in a hierarchy, each with a particular,
established amount of responsibility and authority.
2. Specialization: Tasks should be distinguished on a functional basis, and then separated according to
specialization, each having a separate chain of command.
3. Predictability and stability The organization should operate according to a system of procedures
consisting of formal rules and regulations.
4. Rationality: Recruitment and selection of personnel should be impartial.
5. Democracy: Responsibility and authority should be recognized by designations and not by persons.
 C) Administrative theory
 The elements of administrative theory (Henri Fayol, 1949) relate to accomplishment of tasks, and include
 Principles of management,  Committees and
 The concept of line and staff,  Functions of management.

2) Neoclassical Organizational Theory

The Hawthorne study suggested that employees have social and psychological needs along with
economic needs in order to be motivated to complete their assigned tasks. This theory of management was a product
of the strong opposition against "the Scientific and universal management process theory of Taylor and Fayol." This
theory was a response to the way employees were treated in companies and how they were deprived of their needs
and ambitions.
1. 'Illumination Experiments (1924–27) to find out the effect of illumination on worker's productivity.'
2. 'Relay Assembly Test Room experiment (1927–28) to find out the effect of changes in number of work hour and
related working condition on worker productivity.'
3. 'Experiment in interviewing Working: In 1928, a number of researchers went directly to workers, kept the
variables of previous experiment aside, and talked about what was, in their opinion, important to them. Around
20,000 workers were interviewed over a period of two years. The interviews enabled the researchers to discover a
rich and intriguing world that previously remained undiscovered and unexamined within the Hawthorne studies
undertaken so far. The discovery of the informal organization and its relationship to the formal organization was the
landmark of experiments in interviewing workers. These experiments led to a richer understanding of the social,
interpersonal dynamics of people at work.'
4. 'Bank wiring Room Experiments (1931–32) to find out social system of an organization.

3) Modern theory
a) Contingency Theory
Contingency theory accepts that there is no universally ideal leadership style because each organization faces
unique circumstances internally and externally. In contingency theory, productivity is a function of a manager’s
ability to adapt to environmental changes. Managerial authority is especially important for highly volatile
industries. This allows managers the freedom to make decisions based on current situations. The contingency
theory reveals situations that require more intense focus and takes account of unique circumstances.
Factor
Some examples of such constraints (factors) include:
 The size of the organization
 How the firm adapts itself to its environment
 Differences among resources and operations activities
1. Contingency on the organization
In the contingency theory on the organization, it states that there is no universal or one best way to manage an
organization. Secondly, the organizational design and its subsystems must "fit" with the environment and lastly,
effective organizations must not only have a proper "fit" with the environment, but also between its subsystems.
2. Contingency theory of leadership
In the contingency theory of leadership, the success of the leader is a function of various factors in the form of
subordinate, task, and/ or group variables. The following theories stress using different styles of leadership
appropriate to the needs created by different organizational situations. Some of these theories are:
 The contingency theory: The contingency model theory, developed by Fred Fiedler, explains that group
performance is a result of interaction between the style of the leader and the characteristics of the environment in
which the leader works.
 3. Contingency theory of decision-making
The effectiveness of a decision procedure depends upon a number of aspects of the situation:
 The importance of the decision quality and acceptance.
 The amount of relevant information possessed by the leader and subordinates.
 The amount of disagreement among subordinates with respect to their alternatives.

4) Systems Theory
Systems theorists believe all organizational components are interrelated. Changes in one component may affect all
other components, according to StatPac. Systems theory views organizations as open systems in a state of dynamic
equilibrium, which are continually changing and adapting to environment and circumstance. Nonlinear
relationships between organizational components create a complex understanding of organizations in systems
theory.
5) Organizational Structure
Organizational structure became an important aspect of organizational theory due to the increasing complexities of
multinational organizations and the need to more quickly and efficiently reach the market. Project -focused
structures enable a greater responsiveness to market demands than purely functional or bureaucratic structures.
Projectized organizational structures focus on the project manager or project management office for information
and activities related to business projects. The matrix organizational structure features vertical hierarchies of
functional departments that facilitate projects along a horizontal axis. The continual exchange of information and
energy characterizes the relationship between organizational structure and environment.

MINIMUM REQUIRENMWNT FOR ORGANIZATION

1) Clarity
• Nurses need to know
-Where they belong,
-Where they stand in relation to the quality and quantity of their performances
-Where to go for assistance.
2) Economy:
• Nurses need as much self-control of their work as they can possibly be given.
• They need to be self-motivating.
• There should be the smallest possible number of overhead personnel necessary to keep the division and
units operating and well maintained.
3) Direction of vision-
• Nurse managers must direct their vision and that of their employees
-toward performance, -toward the future and - toward strength.
4) Decision making-
• Nurses should be organized to make decisions on the right issues and at the right levels.
• They should be organized to convert their decisions into work and accomplishments.
5) Stability and Accountability-
• Nurses should be organized to feel community belongingness.
• They can adapt to show objectives requiring changes in their functions and productivity.
6) Perception and Self renewal-
• Nursing services should be organized to produce future leaders.
• The organizational structure should produce continuous learning for the job each nurse holds and for
promotion.

ORGANIZATIONAL STRUCTURE
Definition
1) The typically hierarchical arrangement of lines of authority, communications, rights and duties of an organization.
Organizational structure determines how the roles, power and responsibilities are assigned, controlled, and
coordinated, and how information flows between the different levels of management
 2) Organizational structure helps a company assign a hierarchy that defines roles, responsibility, and supervision. It’s
the plan that outlines who reports to whom and who is responsible for what. It’s usually recorded and shared as an
organizational chart that includes job titles and the reporting structure.

Basic parts of Organization

by Henry Mintzberg, 1979

ELEMENTS OF ORGANIZATION STRUCTRE

1) Chain of Command: One of the most basic elements of
an organizational structure, chain of command is exactly
what it sounds like: an unbroken line of authority that
extends from the top of the organization (e.g. a CEO) all
the way down to the bottom. Chain of command clarifies
who reports to whom within the organization.

2) Span of Control
Span of control refers to the number of subordinates a
superior can effectively manage. The higher the ratio of
subordinates to superiors, the wider the span of control.

3) Centralization
Who makes the decisions in an organization? If decision-making
power is concentrated at a single point, the organizational
structure is centralized. If decision-making power is spread out,
the structure is decentralized.
While a decentralized structure promotes a more democratic
decision-making process, it can also slow down the decision-
making process, making it harder for organizations to operate
efficiently.
 4) Specialization
Also known as division of labor, specialization is the
degree to which activities or tasks in an organization
are broken down and divided into individual jobs.
High specialization can be beneficial for an
organization, as it allows employees to become
“masters” in specific areas, increasing their productivity
as a result.
However, low specialization allows for more flexibility,
as employees can more easily tackle a broader array of
tasks (as opposed to being specialized for a single task).

5) Formalization
Similar to specialization, formalization deals
with the how jobs are structured within an
organization. The key differentiator here is that
formalization also takes into account the
degree to which an employee’s tasks and
activities are governed by rules, procedures,
and other mechanisms.
A formal organizational structure seeks to
separate the individual from the role or
position, as the role or position stays the same
regardless of who’s holding it. An informal
organization, on the other hand, places more
value on the individual. It allows for the
evolution of a role or position based on an
individual’s preferences, skill set, etc., and
places less importance on what team or department
that individual is part of.

6) Departmentalization
Departmentalization refers to the process of
grouping jobs together in order to coordinate
common activities and tasks.
If an organization has rigid departmentalization,
each department or team is highly autonomous, and
there is little (or no) interaction between different
teams. In contrast, loose departmentalization entails
that teams have more freedom to interact and
collaborate.

ORGANIZATIONAL CLIMATE
 The concept of organizational climate was formally introduced by the human relationists in the late 1940s. Now it
has become a very useful metaphor for thinking about and describing the social system. Organizational climate is
also referred to as the “situational determinants” or “Environmental determinants” which affect the human behaviour.
 Some persons have used organizational culture and organizational climate interchangeably. But there are some basic
differences between these two terms. According to Bowditch and Buono, “Organizational culture is connected with
the nature of beliefs and expectations about organizational life, while climate is an indicator of whether these beliefs
and expectations are being fulfilled.”
 Climate of an organization is somewhat like the
personality of a person. Just as every individual has a
personality that makes him unique and different from
other persons. Each organization has an organizational
climate that clearly distinguishes it from other
organizations.
 Basically, the organizational climate reflects a person’s
perception of the organization to which he belongs. It is
a set of unique characteristics and features that are
perceived by the employees about their organizations
which serves as a major force in influencing their
behaviour. Thus, organizational climate in a broad
sense, can be understood as the social setting of the
organization.
Meaning and Definition:
(1) “Climate in natural sense is referred to as the average course or condition of the weather at a place over a period of
years as exhibited by temperature, wind, velocity and precipitation.”
According to Forehand and Gilmer, “Climate consists of a set of characteristics that describe an organization,
distinguish it from other organizations are relatively enduring over time and influence the behaviour of people in it.”

(2) According to Campbell, “Organizational climate can be defined as a set of attributes specific to a particular
organization that may be induced from the way that organization deals with its members and its environment. For the
individual members within the organization, climate takes the form of a set of attitudes and experiences which
describe the organization in terms of both static characteristics (such as degree of autonomy) and behaviour outcome
and outcome- outcome contingencies.”
Main Feature:
 It is a perception of the work environment.
 It is a “psychological atmosphere.”
 It is a quick picture of the relationship between the organization and its employees.
 It is a set of properties that can be measured by the correct instruments.
 It is related to the quality and suitability of the work environment.
 It has to do with the support that employees feel they receive from the organization.
 The organizational structure strongly influences the organizational climate.
 The organizational climate is a reflection of the degree of employee motivation.
 It has positive and negative effects on people’s behavior in the workplace.
Characteristics of Organizational Climate:
1. General Perception:
Organizational climate is a general expression of what the organization is. It is the summary perception which people
have about the organization. It conveys the impressions people have of the organizational internal environment within
which they work.
2. Abstract and Intangible Concept:
Organizational climate is a qualitative concept. It is very difficult to explain the components of organizational climate
in quantitative or measurable units.
3. Unique and District Identity:
Organizational climate gives a distinct identity to the organization. It explains how one organization is different from
other organizations.
4. Enduring Quality:
Organizational climate built up over a period of time. It represents a relatively enduring quality of the internal
environment that is experienced by the organizational members.
5. Multi-Dimensional Concept:
Organizational climate is a multi- dimensional concept. The various dimensions of the organizational climate are
individual autonomy, authority structure, leadership style, pattern of communication, degree of conflicts and
cooperation etc.
 Factors Influencing Organizational Climate:
Litwin and Stringer have included six factors which affect organizational climate. These factors are:
(i) Organizational Structure: Perceptions of the extent of organizational constraints, rules, regulations, red tape,
(ii) Individual Responsibility: Feeling of autonomy of being one’s own boss,
(iii) Rewards: Feelings related to being confident of adequate and appropriate rewards,
(iv) Risk and Risk Taking: Perceptions of the degree of challenge and risk in the work situation,
(v) Warmth and Support: Feeling of general good fellowship and helpfulness prevailing in the work setting.
(vi) Tolerance and Conflict: Degree of confidence that the climate can tolerate, differing opinions.
Schneider AND Barlett give a broader and systematic study of climate dimensions.

They include the following factors:

(i) Management Support, (iv) Inter-agency conflict,
(ii) Management Structure. (v) Agent dependence and
(iii) Concern for new employees (vi) General Satisfaction

ORGANIZATION OF NURSSING SERVICES AND PATIENT CARE

Nursing Service
Nursing service is the part of the total health organization which aims at satisfying the nursing needs
of the patients/community. In nursing services, the nurse works with the members of allied disciples such as
dietetics, medical social service, pharmacy etc. in supplying a comprehensive program of patient care in the
hospital.
Nursing service administration
Nursing service administration is a complex of elements in interaction and is organized to achieve the
excellence in nursing care services. It results in output of clients whose health is unavoidably deteriorating,
maintained or improved through input of personnel and material resources used in a process of nursing
services.

Definition of nursing service

WHO expert committee on nursing defines the nursing services as the part of the total health
organization which aims to satisfy major objective of the nursing services is to provide prevention of disease
and promotion of health.

OBJECTIVES OF NURSING SERVICE

The first component of nursing service administration is the planning and it should be based on clearly
defined objectives. The objectives of nursing service department are as follows:

Objectives in relation to Patient care

 To give highest possible quality care in terms of total patients need which include physical, psychological,
social, educational and spiritual needs by collaborating with other health tem members.
 To assist the physician in providing medical care to the patients.
 To provide preventive and rehabilitative services.
 To provide round the clock nursing care to all the patients.
 To render timely and appropriate nursing service to emergency patients.
 To provide cost effective quality care as per the needs of patients.
 Confidentiality and privacy of each patient should be maintained.
 Constant monitoring and evaluating is of utmost importance to improve patient care continuously.

Objectives in relation to Education

 Planning of education and training programme for nurses are must for professional growth and development
needs through in-service education and research support.
 To provide regular staff development, in-service education and guidance services for all members of
 nursing staff.
 To conduct regular orientation programme for new entrants and for those have been on the job for a long
time.
 To conduct training for operating procedure of latest gadgets and on handling sophisticated bio-medical
equipment.

Objectives in relation to Administration and Organization

 To make regular supervision through rounds.
 To ensure that the essential equipment is provided in functional status for nursing care services.
 To provide regular flow of essential supplies to render quality nursingcare.
 To have a proper system of rotation of staff, provision for annual leave and days off for the nursing staff
without hampering patient care.
 Establish a communication system for nursing personnel, other health worker, patients, health authorities,
government authorities and public.
 Ensure that each nurse identifies her job responsibilities and accountability.
 Counseling for health personnel, patients and the public.
 The formulation of policies, standards, goals of nursing service, education and practice.
 Maintaining proper documentation of the personnel employed in nursing service.

Objectives in relation to Research

 Establish a system for collection of essential information, research and studies concerning all aspects of
nursing.
 To contribute in research programme conducted by hospitals and by other health personnel.
 To encourage and support the nurse to conduct research projects/ activities.

Objectives in relation to Performance appraisal

 Appraise the performance of nursing service personnel regularly against set standards and performance
indicators objectively with a view to maintain quality-nursing services.

ESSENTIAL CHARACTERISTICS OF GOOD NURSING SERVICES DEPARTMENT

 Written statement of purposes and  Adequate infrastructure facilities,
objectives of nursing services supplies and equipment
 Plan of organization  Written job description & job
 Policy and administrative manuals specifications
 Nursing practice manual  Personnel records Personnel
 Nursing service budget policies Health services
 Master staffing pattern  Inservice education
 Nursing care appraisal plan  Coordination
 Nursing service administrative  Advisory committee
meetings
ORGANIZATIONAL STUCTURE OF NURSING SERVICES