Controlling

An ongoing function of management which occurs during planning,

organizing and directing activities Process wherein the performance is measured and corrective action is taken to ensure the accomplishment of organizational goal
Is the use of formal authority to assure achievement of goals and

objective Action is taken to correct discrepancies between this standards and actual performance Reasons for Conducting Evaluation 1. Evaluation ensures that quality nursing care provided. 2. It allows for the setting of sensible objectives and with men 3. It provides standars for establishng comparisons. 4. It promotes visbility and a means for the employes to mnitor thier own perpormance. 5. It highlight problems related to quality care and determines the areas that require priority attention. 6. It provides an indicaion of the costs of poor quality. 7. It justifies the use of resources. 8. It provides feedback for improvement. Evaluation Principle 1. Must be based on the behavioral standars of performance which the position requires. 2. There should be enough time to observe employees behavior. 3. The employee should be given a copy of the job description, performance standars and evaluation.

4. The employees performance appraisal should include both satisfactory and unsatisfactory results with specific behavior instnces to exemplify there evaluative comment. 5. Areas needing improment must be prioritized to help the worker upgrade his/her performance. 6. Should be scheduled and conducted at a covineint time for the rater and the employee under evatustion in sush a way that it is perceiveding and with ample time for discussion. 7. Should be structured in sush a way that it is perceived and accepted positively as a mean of improving job performance. Steps in Control Process Establish standards and criteria Measure performance Compare results with standards Match with standards? YES NO - do nothing to improve - take corrective action

Establishment of the Standards Performance for Measuring

Standards are desirable sets of condition and performance necessary to ensure the quality of nursing care services which are acceptable to those instrumental to or responsible for setting and maintaining them.

THREE TYPES OF PERFORMANCE STANDARDS:

A. STANDARDS ON STRUCTURE
Are those that focus on the structure or management system used

by the agency to deliver care. Includes: Number and categories of nursing personnel

 Education Personal and professional qualities Function Physical facilities Equipments B. PROCESS STANDARDS Refers to the decision and actions of the nurse relative to the nursing process which are necessary to provide good nursing care. INCLUDES : Assessment Plan of care Nursing intervention C. OUTCOME STANDARDS
Are design to measure the results of care provided in terms of

changes of health status of clients served, changes in the level of their knowledge, skills and attitudes and satisfaction of those served including the members of the nursing and health team.

Establishment of Objectives and Methods for Measuring Performance

Measurable criteria or objectives specific to giving nursing care must be developed to evaluate process and outcome. The establishment of objectives provides clear direction and communication of expected levels of achievement, The greater the participation of the employee, the greater the motivation to achieve. Objectives should be challenging but attainable. The most commonly used methods for measuring nursing care are task analysis and quality control. In task analysis task and procedures such are written guides, schedules, rules, records, budgets are expected.

Quality control refers to the activities and techniques employed to achieved and maintain the quality of a product, service or process, the level of nursing care provided and its effect to the client are assessed

Measuring Actual Performance A measurement of performance is an on-going, repetitive process with the actual frequency dependent on the type of activity being measured. For example, nursing care to patients is continuously monitored, whereas, a formal performance appraisal maybe done only twice a year. Measurements maybe scheduled in advance, maybe done at periodic but unannounced intervals or may occur at random. The purpose of measurement should be clarified and the staff should be informed about the tasks and levels of care that need attention. Reinforcing Strengths or Successes and Taking Corrective Action as Necessary Positive feedback stimulates motivation, consistently high performance and growth of the employee. Corrective actions are applied to improve performance. Comparing Objectives results of Performance with Standards and

Comparing the results of performance with standards and objectives is one of the easiest steps in the control process. If performance matches standards and objectives, managers are assured that the needs of patients are met. However, if performance is contrary to standards and objectives set, then necessary action should be taken.

Performance Appraisal
It is a control process in which employees performance is evaluated against standards. It is the most valuable tool in controlling human resources and productivity. Purpose of Performance Appraisal
Determine salary standards and merit increases.

Select qualified individuals for promotion or transfer. Identify unsatisfactory employees for demotion or termination. Make inventories of talents within the institution. Determine training and developmental needs of employees. Improve the performance of work groups by examining, improving, correcting interrelationships between members. reach an understanding on the objectives of the job.

Improve communication between supervisors and employees and

Establish standards of supervisory performance. Discover the aspirations of the employees and reconcile these

with the goals of the institution.

Provide employee recognition for accomplishments. Inform employees where they stand.

Factors Contributing to an effective Performance

Appraisal System Compatibility between the criteria for individual evaluation and

organization goals.
Direct application of rated performance to performance standards

and objectives expected of the worker.

Development

of behavioral expectations which have mutually agreed upon by both the rater and the worker. by the rater.

been

Understanding the process and effective utilization of procedure

Rating of each individual by the immediate supervisor. Concentration on the strengths and weaknesses to improve

individual performance.

 Encouragement of feedback from the rated employees about their

performance needs and interests. Provision for initiating preventive and corrective actions and making adjustments to improve performance.

Methods of Measuring Performance Informal may consist of incidental observation of performance while the worker is engaged in performing nursing care or by responses made by worker during conferences interaction of woker with clients, their families , visitors and coworkers should also be noted.

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

Essay The appraiser writes a paragraph or more about the workers strengths, weakness and potentials. In most situations, particularly in managerial positions, essays appraisals carry significant weight on the presumption that an honest statement from someone who knows the person well is valid. Checklists

A checklist is a compilation of all nursing performances expected of a worker. The appraisers task is to mark the appropriate column whether the worker does or does not show the desired behavior. Ranking In simple ranking, the evaluator ranks the employees according to how he or she fared with co-worker with respect to certain aspects of performance or qualifications. Rating Scales A rating scale includes a series of item representing the different task or activities in the nurses job description or the absence or presence of desired behaviors and the extent to which these are possessed.

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

Quality Assurance
Assurance

-means achieving a sense of accomplishment and implies a guarantee of excellence.

 Quality -is the degree of excellence -common language for improvement -enables different people to communicate with each other in pursuit of common goal. Quality of Care -degree to which health services for individuals and population increase the likelihood of desired health outcomes and are consistent with the current professional knowledge. -exist to the degree that service is efficient, well-executed, effective and appropriate.*Workers must accept the responsibility that they have to do the right thing/job the first time and every time. Quality Assurance -is a process of evaluation that is applied to the health care system and the provision of health care services by health workers.
Quality Improvement Program

-is the umbrella program that extends the many areas for the purpose of accountability to the consumer and payor. - continuous, on-going measurement and evaluation process that includes structure, process, and outcome.
Sentinel event indicators

-Measures a low volume but serious undesirable and often avoidable process or outcome such as falls and medication errors.
Benchmarking

-is a tool to assists in quality of care decision making. -It is a continuous process of measuring what exists against the best in search for industry best practices.
Best Practice

-is a service, function or process that has been fine tuned, improved and implemented to produce superior outcomes. -lead in establishing benchmarks
Total Quality Management

-Is way to ensure customer satisfaction by involving all employees in the improvement of the quality of every product or service. - all systems are evaluated and improved. -It aims to reduce waste and cost of poor quality -It is a structured system for involving an entire organization in a continuous quality improvement process targeted to meet and exceed customer expectations.
Continuous Quality Improvement

-is a process of continuously improving a system by gathering data or performance and using multi-disciplinary tem to analyze the system, collect measurements , and propose changes.
FOUR MAIN PRINCIPLES

Customer focus Identification of key processes to improve quality The use of quality tools and statistics Involvement of all people in problem solving
PRINCIPLES UNDERLYING QUALITY ASSURANCE EFFORTS

All health professionals should collaborate in the effort to measure and improve care. Coordination is essential in planning a comprehensive quality assurance program Resource expenditure appropriate. for quality assurance activities is

 There should be focus on critical factors such as functions and activities that promise to yield the greatest health and financial benefit to reveal significant findings. Quality patient care is accurately evaluated through adequate documentation. The ability to achieve nursing objectives depends upon the optimal functioning of the entire nursing process and its effective monitoring. Feedback to practitioners is essentials to improve practice. It perpetuates good performance and replaces unsatisfactory interventions with more effective methods. Peer pressure provides the impetus to effect prescribed changes based on the results of assessments and needed improvements on the quality of care Reorganizations in the formal organizational structure may be required if assessment reveal the need for a different patternof health care. Collection and analysis of data should be utilized to motivate remedial action. Quality Assurance and Performance Evaluation
Performance Evaluation

-focuses on the worker. It asks questions about how well the worker satisfies the requirements of his or her job within the organization. Quality Assurance -focuses on the care and service the patient receives than on how well the professional performs the duties the duties that the position requires.
Quality Assurance Methods

-purpose is to measure and improve the quality of nursing delivered in the agency.
Several methods:

 Concurrent and retrospective patient care audits Patient care profile analysis Peer review Quality circles
Developing Quality Assurance Criteria

Structure, process and outcome or any combination of these, are common approaches to evaluation.
Structure Approach includes physical setting, instrumentalities

and conditions through which nursing care is given such as the philosophy and objectives, the building, organizational structure, financial resources, and equipment.
Process Approach- includes the steps in the nursing process in

compliance with established standards of nursing practice.

Outcome Approach- identifies desirable changes in the patients

health status such as modification of symptoms, signs, knowledge, attitudes, satisfaction, skill level, and compliance with the treatment regimen. Nursing Audit Committee A nursing audit is composed of a representative from all levels of the nursing staff: A member of the training staff Supervising Nurse Head/Senior Nurse Staff Nurse Patient Care Audits Patient care audits may be concurrent or retrospective.
Concurrent Audit

1. Is one in which patient care is observed and evaluated. It

is given through:
2. A review of the patients charts while the patients are still

confined in the hospital.

3. Observation of the staff as patient care is given. 4. Inspection of patients and/or observation of the affects of

patient care where the focus is on the patient.

Retrospective Audit -Is one which patient care is evaluated through A review of discharged patients charts; Questionnaires sent to or interviews conducted on discharged patients.

Peer Review

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

-One of the most publicized approaches to quality control introduced by the Japanese. -A group of workers doing similar work who meet regularly, voluntarily, on normal working time, under the leadership of their supervisor, to identify, analyze and solve work related problems and to recommend solutions to management.
Utilization of Results

-The Nursing Staff in the unit is given a feedback on the results of the quality assurance study. -Positive Feedback reinforces desirable performance. Consistent positive findings deserve a commendation from the nursing service. -Negative Feedbacks should tactfully be conveyed in a face-toface situation so that assessment results may easily be clarified.

 Control of Resources

-Part of the control process is the periodic review of the utilization of materials and supplies in the various nursing units. -Requisitions of and/ or stocking a large number of supplies and materials should be avoided to prevent pilferage, misuse, or spoilage.

Discipline
Discipline meant rigid obedience to rules and regulations, the violation of which resulted in punitive actions in the past. Today, discipline is regarded as constructive and effective means employees take personal responsibility for their own performance and behavior. Factors that influence self discipline 1. A strong commitment to the vision, philosophy, goals and objectives of the institution 2. Laws that govern the practice of all professionals and their respective codes of conduct. 3. Understanding the rules and regulation of the agency. 4. An atmosphere of mutual trust and confidence 5. Pressure from peers and organization.
Disciplinary Approaches

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

An effective supervision aids supervisor is analyzing the work problems of their subordinates.
Disciplinary Action

Any employee charged for breach of the rules and regulations, policies, norms of conduct shall be given due process. Counseling and Oral warning -The employee is given a fair chance to air his/her side Suspension -Suspension over minor violation is given after an evidence of oral and written warnings. Suspension is applied when management feels that the employee can still be rehabilitated. Dismissal -Dismissal is invoked only when all the other disciplinary efforts have failed. Written warning -The employee must be told after the interview that he will be given a written warning this include the statement of the problem, identification of the rule which was violated, consequences of continued deviant behavior, the employees commitment to take correction action, and any follow-up action to be taken.