REPORTER: NIKKI Z.

DASCO, RN
TOPIC: MANAGEMENT FUNCTIONS: Directing and Controlling
COURSE: ORG AND ADMIN OF NURSING SERVICES

MANAGEMENT FUNCTIONS:
DIRECTING AND CONTROLLING

DIRECTING
- The issuance of orders, assignments and instructions that enable the nursing personnel to
understand what are expected of them.
- It includes supervision and guidance so that in their doing their jobs well, nurses can maximally
contribute to the organization’s goals in general and objectives of nursing service in particular.
- It must be complete, understandable and given in a logical order. Clear directions, follow-up and
supervision help maintain quality of work.
- The manner in which verbal orders are given also determines to a large extent their acceptability
and the extent to which the workers will be challenged to exert effort to do the job.
- It includes delegation of work to be performed, utilization of policies and procedures, supervision
of personnel, coordination of services, communication, staff development and making decisions.

ELEMENTS OF DIRECTING
A. Delegation
a. The process by which a manager assigns specific tasks/ duties to workers which
commensurate authority to perform the job.
b. In delegation, the ultimate responsibility and accountability still rest on the manager who
assigned the task to his subordinates.
c. It trains and develops staff members who desire greater opportunities and challenges in their
work making them more committed and satisfied in their jobs.

PRINCIPLES OF DELEGATION
i. Select the right person to whom the job is to be delegated.
Make sure that the employee is capable of doing the job. Give the employee the accountability
and authority to do the job.
ii. Delegate both interesting and uninteresting tasks
Uninteresting jobs can be used to challenge, motivate, and increase a person’s performance
and commitment. Interesting jobs draw out the best among employees and inspire them to
higher achievement.
iii.Provide subordinates with enough time to learn.
Expertise can be achieved through training and experience.
iv. Delegate gradually.
New employees may not be able to assume full responsibilities as employees who have stayed
.longer on the job.
v. Delegate in advance.
Specify goals and objectives to be met within a set time frame. Describe the specific results
expected out of the activities to be performed.
vi. Consult before delegating.
Clarification minimizes the problems and promotes team work.
vii. Avoid gaps and overlaps.

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 A gap occurs when a job is left out with no one taking responsibility; an overlap happens when
two or more people have responsibility for the same job, causing confusion and low morale.

WHAT CANNOT BE DELEGATED

 Overall responsibility, authority and accountability for satisfactory completion of all activities
in the unit.
 Authority to sign one’s name is never delegated.
 Evaluating the staff and/or taking necessary corrective or disciplinary action.
 Responsibility for maintaining morale or the opportunity to say a few words of
encouragement to the staff especially the new ones.
 Jobs that are too technical and those that involve trust and confidence.

REASONS WHY NURSE MANAGERS DO NOT DELEGATE

 Lack of confidence in their staff
 Feeling that only they could do the task better and faster
 Fear of loss of control
(These reasons make the subordinate apprehensive on accepting certain tasks for fear of criticism and
incompetence. These can be avoided if there would be an open line of communication among the staff.)

B. Nursing Care Assignment/ Task Nursing

a. May be called modalities of nursing, systems of nursing care, or patterns of nursing care.
b. There are four basic methods of assigning nursing care:
i. Functional Nursing
 Task-oriented in which a particular nursing function is assigned to each worker.
 It is the best system that can be used when there are many patients and
professional nurses are few.
 It is suitable only for short time use. If used for a long time, it fragments the care of
patients to tasks only.
 Advantages: allows most work to be accomplished in the shortest time possible;
workers learn to work fast; they gain skill faster on the certain task.
 Disadvantages: (1) fragmentation of nursing care and therefore holistic care is not
achieved; (2) nurses accountability and responsibility is diminished; (3)patients
cannot identify who their real nurse is; (4)nurse-patient relationship is nor fully
developed; (5)evaluation of nursing care is poor and outcomes are rarely
documented; and (6) it is difficult to find a specific person who can answer the
patient’s and relatives questions.
ii. Total Care Nursing
 Nursing assignment in which one nurse is assigned to one patient for the delivery
of total care.
 The nurse plans, coordinates, implements, evaluates, and documents the nursing
care he/she has given during his/her shift.
 The one-on-one pattern is a common assignment for private duty nurses, for
nurses assigned in critical care and for nursing students.
 The nurse is accountable for his/her own actions.
 The nurse provides holistic care to his/her patient.
 This is the best method when there are plenty of nurses and patients are few.

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 iii. Team Nursing
 A decentralized system of care in which a qualified professional nurse leads a
group of nursing personnel in providing for the nursing needs of a group of
patients/ clients through a participative effort.
 The team leader assigns patients and tasks to team members according to job
descriptions.
 The team leader is responsible for coordinating the total care of a group of
patients.
 The intent of team nursing is to provide patient-centered care.
 The heart of team nursing is the team conference.
iv. Primary Nursing
 Each registered nurse is responsible for the total care of a small group of patients.
 The primary nurse assesses the patient’s needs for care, sets care goals, writes a
nursing care plan, administers care according to that plan, evaluates the outcomes
of care, and makes the necessary changes or adjustments as necessary. She
provides pre-discharge planning and teaching.
 The primary care nurse assumes a 24 hour responsibility for nursing care, thus
secondary or associate nurses executes the nursing care plan during the afternoon
and night shifts and on days when the primary nurse is off-duty.
 The primary and secondary nurses are freed from administrative and
housekeeping responsibilities to maximize their time for patient care.
Accountability, authority and autonomy rest with the primary nurse.
 The advantages of primary nursing: (1) provision of or increased autonomy on the
part of the nurse thereby increasing motivation, responsibility and accountability;
(2) assures continuity of care; (3) makes available the increased knowledge of the
patient’s psychosocial and physical need; (4) leads to increased rapport and trust
between the nurse and the patient thereby establishing therapeutic relationship;
(5) improves communication with the members of the health team ; (6) and
eliminates the use of nursing aides in the provision of direct nursing care.
v. Other Nursing Assignments
1. Modular Method
 Modification of team and primary nursing.
 It differs from team nursing in that the registered nurse provides direct
nursing care with the assistance of aides.
 The greatest responsibility falls on the registered nurse who assesses
the patient’s needs, plans and implements care, and assesses outcomes
including guiding and instructing his/her partners.
2. Case Management
 A system of patient care delivery that focuses in the achievement of
outcomes within effective appropriate time frames and resources.
 It focuses on an entire episode of illness, crossing all settings in which
the patient receives care.

c. Utilizing/ Revising/ Updating Nursing Service Policies and Procedures

i. Nursing service exist for the standardization and as a source of guidance for the
nursing staff.
ii. Policies fall into several categories; for patients, personnel, environment in which
patients are cared for and where personnel work, and those that pertain to
relationships with other discipline or department.

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 iii. Policies promote consistency of action and stability. They speed up decision making.
Uniformity of standards promotes fairness and prevents conflicts. Policies are usually
written and made available as manuals and used by personnel.
iv. A procedure manual outlines a standard technique or method in performing duties. It
serves as guide for action. It contains detailed plans for nursing skills and includes
steps in proper sequence.
v. A manual is used by employees to review a procedure which is not familiar to them or
which they have not done for some time. It is used to teach new employees or orient
them to procedures that are commonly done in the institution but which the
employees may not be familiar with.

C. Supervision
a. Supervise = “supervide” = to oversee or view directly.
b. It is providing guidelines for the accomplishment of a task or activity with initial direction and
periodic inspection of the actual accomplishment of the task or activity.
c. It is the active process of directing, guiding and influencing the outcome of a person’s
performance of an activity.
d. It appraises not only the quantity and quality of work performed, but also the time within
which the work is accomplished, the proper and economic utilization of resources, the amount
of assistance needed by the worker and the need for staff development or continuing
education programs.
e. RESPONDEAT SUPERIOR = let the superior answer for the acts of the subordinates.
f. Supervisors should bring to management‘s attention concerns that affect quality nursing care
such as inadequate staffing and resources.

QUALITIES OF GOOD SUPERVISION

1. Good technical, managerial and human relation skills
2. Ability to communicate well in both spoken and written language and ability to listen
3. Firmness with flexibility to adjust to the needs of the situation
4. Fairness in dealing with employees
5. Familiarity with hospital and nursing policies that affect patient care
6. Good decision-making skills
7. Willingness to grow and develop
8. Ability to accept changes and consider them as challenges
9. Dignified and pleasing personality
10. Ability to motivate employees and provide opportunities for continuing professional
growth and development
11. Advocacy for nurses and nursing

PRINCIPLES OF GOOD SUPERVISION

1. Good Supervision requires adequate planning an organization which facilitate
cooperation, coordination and synchronization of services
2. Good supervision gives autonomy to workers depending on their competency,
personality and commitment. It fosters the ability of each worker to think and act for
himself/herself.
3. Good supervision stimulates the worker’s ambition to grow into effectiveness. It
provides for opportunities and incentives for staff education and continuous
professional grants and development.

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 4. Good supervision creates an atmosphere of cordiality and trust. It creates a suitable
environment for productive work.
5. Good supervision considers the strengths and weaknesses of employees.
6. Good supervision strives to make the unit an effective learning situation. It promotes a
teaching-learning environment where learners are stimulated to exercise critical
thinking and creativity especially in patient care.
7. Good supervision considers equal distribution of work considering age, physical
condition, and competence.

TECHNIQUES IN SUPERVISION
1. Observation of the worker while making the rounds
2. Spot checking of charts through nursing audits
3. Asking the patients about the care they receive
4. Looking into the general condition of the units
5. Getting feedback from co-workers or other supervisors or relatives
6. Asking questions discretely to find out the problems they encounter in the wards
7. Drawing out suggestions from the workers for improvement of their work or work
situation.

Participatory Management
 There is mutual trust and support.
 There is an increased accountability of the Head Nurse and of employees through
self-supervision.
 Participation increases individual and organizational capacities to learn, adapt,
and develop toward higher levels of excellence.
Leading
 To find, to go before and show the way
 Leadership is the art of developing people
 Leadership activities include directing which is actuating efforts to accomplish
goals, supervising or overseeing work of employees, and coordinating or unifying
personnel and services among others.
 Leadership Roles
Adminitrator

Supervisor/ Clinical Managers/Clinical Coordinator

Head Nurses/ Senior Nurses

Staff Nurses/ Nursing Attendants

 Managers at each level of the hierarchy direct, supervise and coordinate the efforts
of their subordinates.
 Administrators are concerned with the over-all planning and setting up of
objectives, developing and scheduling of programs, budget proposals and
establishment of policies. The supervising nurse assumes the responsibility of
managing nursing care and services in two or more nursing units. The head nurse
or the senior nurse is responsible for the management and supervision of a
particular nursing unit.

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 Leadership Qualities
o The leader possesses a striking physical personality and as energetic.
o A leader possesses a sense of purpose and direction.
o A leader has the power of ready speech.
o A leader is enthusiastic about the purpose of the group and is devoted
to its cause
o A leader has keen insight into the human nature of people.
o A leader displays courage and persistence even in the face of
opposition
o A leader is decisive.
o A leader is cheerful and even-tempered.
o A leader shows technical mastery that inspires others to do above
average performance in their jobs.
o A leader in intelligent, versatile, and has a keen sense of humour.
o A leader has moral vision, integrity and idealism
 Leadership Styles
o Autocratic Leadership
o Democratic, Participative and Consultative Leadership
o Permissive, Ultraliberal, or Laissez Faire Style Leadership
 Leadership Skills
o Skills in personal behaviour.
o Communication Skills
o Organization Skills
o Skills in self-analysis
 Essential Qualities of Nurse Leaders
The nurse leaders should have:
o Intellectual, technical and administrative skills
o Integrity, honesty and ability to work with others
o Tact and emotional stability
o Ability to win the support and loyalty of fellow-workers
o Good human relationships with co –workers
 Leadership Theories
o Situational Theory of Leadership
 The leader behaves according to a given situation which may
vary from one setting to the other.
 Five kinds of leaders in this theory:
 The natural leader who becomes a leader in spite of
himself/herself. S/he does not seek the role but the group
thrusts the leadership upon him/her by the tide of events.
 The charismatic leader who is an authentic hero in the
eyes of his/her followers.
 The rational leader who is consistent and persistent in
what he/she thinks is right.
 The consensus leader who is perceived to be acceptable to
all.
 The leader who dominates by force and fear.

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 o Trait Theory of Leadership
 Based on the belief that leaders are born with certain qualities
that properly develop to enable them to be successful leaders.
 A broad classification of six categories of traits is as follows:
 Physical characteristics such as age, built, height,
weight, bearing
 Background information which includes education,
social status, experience
 Intelligence – knowledge, judgement, ability
 Personality – decisiveness, authoritarianism,
extroversion, alertness, aggressiveness, enthusiasm,
independence, self-confidence
 Task-oriented characteristics – persistence,
responsibility, achievement need, initiative
 Social – characteristics – supervisory activity,
popularity, prestige, tact, diplomacy
 According to this theory, leaders are gifted with certain
qualities that are developed and which show in their ability to
get along well with people and persuade them to a course of
action.
o Theory Z
 This theory has a humanistic viewpoint and focuses on
developing better ways of motivating people.
 It includes: (1) collective decision making; (2) Long-term
employment; (3) Slower promotion ; (4) Indirect Supervision;
(5) Holistic Concern
D. Motivation
a. A motive is a need or desire that incites and directs a person’s actions.
b. Motivation, according to Mills, is a force within the individual that influences strength or
direction of behaviour.
c. In setting a motivating climate, the manager must create conditions that encourage
interdependent work; a competitive environment that recognizes and rewards work well
done.
d. Good managers inspire team work, consider the uniqueness of each worker, communicate
clearly and effectively the expectations from each worker.
e. Intrinsic Motivation – motivation that comes from within the person driving him/her to be
more productive.
f. Extrinsic Motivation – motivation that is enhanced by the environment or external rewards.
This may come in the form of promotions, increases in salary, added benefits or external
rewards.
g. Motivational Theories
i. Need Theory
1. Abraham Maslow’s Hierarchy of Needs
2. Two-Factor Theory
3. McClelland Three Basic Need’s Theory
ii. Expectancy Theory
iii. Operant Theory
iv. Equity Theory

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E. Communication
a. The transmission of information, opinions and intentions between and among individuals.
Communication facilitates work, increases motivation, effect change, optimizes patient care,
increases worker’s satisfaction and facilitates coordination.

PRINCIPLES OF EFFECTIVE COMMUNICATION

1. Clear lines of communication serve as the linking process by which parts of the organization
are unified toward goal achievement.
2. Simple, exact, and concise messages ensure understanding of the message to be conveyed.
3. Feedback is essential to effective communication.
4. Communication thrives best in a supportive environment which encourages positive values
among its personnel.
5. A manager’s communication skill is vital to the attainment of the goals of the organization.
6. Adequate and timely communications of work-related issues or changes that may affect jobs
enhance compliance.

TYPES OF COMMUNICATION
- Verbal Communication - It involves spoken words.
- Written Communication - must be clear, correct, complete and concise
- Non- Verbal Communication - transmission of message without the use of words. It uses
facial expressions, gestures, touch, body language, or vocal tones.

LINES OF COMMUNICATION

 Upward Communication emanates from the subordinates and goes upwards. This is usually
in the form of feedback to show the extent to which downward communication has been
received, accepted and implemented.
 Horizontal Communication flows between peers, personnel or departments on the same
level. It is used most frequently in the form of endorsements, between shifts, nursing
rounds, journal meetings and conference or referrals between departments or services.
 Outward Communication deals with information that flows from the caregivers to the
patients, their families, relatives, visitors and the community

b. Job satisfaction is related to open communication lines, positive communication between

employees and their immediate supervisors, and personal feedback on job performance.
- Communication can be enhanced by carefully choosing the words or information anyone
wishes to convey, by creating an environment that promotes its acceptance, by avoiding
preconceived opinions and biases about a person, by listening to and understanding the
other persons point of view and by being open and supportive.

F. Coordination
a. Coordination unites personnel and services toward common objective.
b. It prevents overlapping of functions, promotes good working relationships, and ensures work
schedules are accomplished as targeted.
c. It includes coordination with the Medical Service, Administrative Service, Laboratory Service,
Radiology Service, Pharmacy Service, Dietary Service, Medical Social Service, Medical Records
Service, Community Agencies, Other Institutions and Civic Organization.

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G. Staff Development
a. It is to provide structure and assistance for employees to learn in greater depth and to
translate the knowledge, skills, abilities and principles learned in nursing practice within their
institution of employment.
b. Major staff development includes orientation, in-service education, continuing education, and
organizational development.
c. Staff development is geared ultimately to organizational development. It assists each
employee to improve performance in his/her present position and to maximize possibilities
for career advancement

ORIENTATION - refers to the planned and guided activities of an employee in the

organization, the work environment, and his/her job. It seeks to establish favourable attitudes
toward the organization, unit and department, provide information and education for success
on the job, and instil a feeling of belongingness and acceptance.
It starts with the vision, mission, philosophy and objectives of the nursing
service.

IN-SERVICE EDUCATION – it includes all on-the-job instructions that are given to enhance the
employee’s recent job performance.
It is a planned educational experience provided by the employing agency with
the purpose of assisting the employee to perform more effectively both as a person and as a
worker.
The purpose of continuing education is to enable the employee to move from
satisfactory to excellent performance in the present job or to achieve promotion to a position
of greater responsibility.

SPECIALTY COURSES - examples are renal nursing, critical care nursing, oncology nursing, etc.

FORMAL EDUCATION - Nurses are encouraged to attend formal schooling in Graduate Schools,
not only for promotion but also for career development

H. Ethical Decision Making

a. A decision is a course of action that is consciously chosen from available alternatives for the
purpose of achieving a desired result. It involves a choice utilizing mental processes at the
conscious level and is aimed at facilitating a defined objective.
b. Decision-making process:
i. Definition of the problem,
ii. Data gathering to aid in analyzing the problem, its causes and possible consequences
iii. Developing/Exploring/Evaluating possible alternative solutions
iv. Selecting the solution’Implementing the solution and evaluating results.

I. Conflict Management
a. Conflict is as inevitable as change in any organization because of the complexity of
relationships within the organization, the interaction among its members or their dependence
on one another.
b. Conflict means a clash between two opposing an oftentimes hostile parties.
c. Conflict is a warning to managers that something is wrong and needs solution.
d. Conflict arises because of poorly expressed relationships including unfulfilled expectations.

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e. It can occur within one individual (intrapersonal), between two or more individuals
(interpersonal), within one group (intra group), and between two or more groups
(intergroup)
f. Conflict Resolution
i. Avoidance – method commonly used by groups who do not want to do something that
may interfere with their relationships. Neutrality is maintained at all cost.
ii. Accommodation – means self-sacrifice. The person neglects his/her own needs to
meet the goals of the other party.
iii. Collaboration – inspires mutual attention to the problem and utilizes the talents of all
parties. It focuses on problem-solving to find mutually satisfying solutions.
iv. Compromise - both parties seek expedient, acceptable answers for short periods when
the goals are only moderately important and the parties have equivalent power.
v. Competition – the supervisor or nurse manager exerts power at the subordinate’s
expense. It is expressed through suppression of conflict through authority-obedience
approach.
vi. Smoothing – methods where disagreements are ignored so that surface harmony is
maintained in a state of peaceful co-existence.
vii. Withdrawing – means that one party is removed thereby making it possible to resolve
the issue.
viii. Forcing – method that yields and immediate end to the conflict but leaves the cause of
the conflict unresolved.
g. Conflict management keeps conflict from escalating, makes work productive, and helps
translate conflict into a positive or constructive force.

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 MANAGEMENT FUNCTIONS:
DIRECTING AND CONTROLLING

CONTROLLING
- Also called evaluating.
- An ongoing function of management which occurs during planning organizing and directing
activities.
- It includes assessing and regulating performance in accordance with the plans adopted, the
instructions issued and the principles established.
- The controlling process opens opportunities for improvement and compares performance
against set standards. It provides information about how well processes and people function
so they can be motivated to perform better in the future.

REASONS FOR CONDUCTING EVALUATION

 It ensures that quality nursing is provided.
 It allows for the setting of sensible objectives and ensures compliance with them
 It provides standards for establishing comparisons.
 It promotes visibility and means for employees to monitor their own performance.
 It highlights problems related to quality care and determines the areas that require
priority attention
 It provides an indication of the costs of poor quality.
 It justifies the use of resources.
 It provides feedback for improvement.

EVALUATION PRINCIPLES
 The evaluation must be based on the behavioural standards of performance which the
position requires.
 There should be enough time to observe employee’s behaviour.
 The employee should be given a copy of the job description, performance standards, and
evaluation form before the scheduled evaluation conference.
 The employee’s performance appraisal have to include both satisfactory and
unsatisfactory results with specific behavioural instances to exemplify these evaluative
comments.
 Areas needing improvement must be prioritized to help the worker upgrade his/her
performance.
 The evaluation conference should be scheduled and conducted at a convenient time for
the rater and the employee under evaluation, in a pleasant surrounding and with ample
time for discussion.
 The evaluation report and conference should be perceived and accepted as a means of
improving job performance.

- The evaluation tool should be objective, reliable, valid and sensitive. Objectivity means that
the evaluation tool is free from bias; Reliability refers to the accuracy or precision of the tool
such that it will produce the same results if administered twice. Validity refers to the
relevance of the measurement to the performance of the employee while sensitivity means
that the instrument can measure fine lines of difference among the criteria being measured.

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 BASIC COMPONENTS OF THE CONTROL PROCESS
 Establishment of standards, objectives and methods for measuring performance.
 Measurement of actual performance.
 Comparison of results of performance using standards and objectives and identifying
strengths and areas for correction or improvement.
 Action to reinforce strengths or successes
 Implementation of corrective action as necessary.

1. ESTABLISHING OF STANDARDS FOR MEASURING PERFORMANCE

 Standards on STRUCTURE – those that focus on the structure or management system

used by the agency to deliver care. They include the number and categories of nursing
personnel, their education, personal and professional qualities and proficiencies, their
function, physical facilities and equipment.
 PROCESS STANDARDS – decisions and actions of the nurse relative to the nursing
process which are necessary to provide good nursing care
 OUTCOME STANDARDS – designed to measure the results of care provided in terms of
changes in the health status of client’s 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.

ESTABLISHING OF OBJECTIVES AND METHODS OF MEASURING

PERFORMANCE

 Measurable criteria or objectives specific to giving nursing care must b developed to

evaluate process and outcome. The establishment of objectives provides clear direction
and communication of expected levels of achievement.
 Methods for measuring nursing care:
o Task Analysis – actions and procedures such as written guides, schedules,
rules, records, and budgets are inspected.
o Quality Control – refers to the activities and techniques employed to achieve
and maintain the quality of product, service or process.

2. MEASURING ACTUAL PERFORMANCE

 It is an on-going, repetitive process with the actual frequency dependent on the type of
activity being measured.

3. REINFORCING STRENGTHS OR SUCCESSES AND TAKING CORRECTIVE

ACTION AS NECESSARY
Responsibility of the Head/Senior Nurses
o They have the responsibility to instruct subordinates regarding the
appropriate methods and procedures in providing nursing care. They should
inform the staff of the likely causes of errors or defects and the preventive
measures necessary.

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PERFORMANCE APPRAISAL
- Control process in which employee’s performance is evaluated against standards.
- Purpose of Performance Appraisal
a. Determine salary standards and merit increases
b. Select qualified individuals for promotion or transfer
c. Identify unsatisfactory employees for demotion or termination
d. Make inventories of talents within the institution
e. Determine training and developmental needs of employees
f. Improve the performance of work groups by examining, improving, and
correcting interrelationships between members.
g. Improve communication between supervisors and employees and reach an
understanding on the objectives of the job.
h. Establish standards or supervisory performance
i. Discover the aspirations of employees and reconcile these with goals of the
institution
j. Provide employee recognition for accomplishment
k. Inform employees where they stand

- Factors Contributing to an Effective Performance Appraisal System

a. Compatibility between criteria for individual evaluation and organization goals.
b. Direct application of the rated performance to performance standards and
objectives expected of the worker.
c. Development of behavioural expectations which have been mutually agreed
upon by both the rater and the worker
d. Understanding the process and effective utilization of procedure by the rater
e. Rating of each individual by the immediate supervisor.
f. Concentration on the strengths and weakness to improve individual
performance,
g. Encouragement of feedback from the rated employees about their performance
needs and interests. Provision for initiating preventive and corrective action and
making adjustments t improve performance.

METHODS OF MEASURING PERFORMANCE

 Essay
 Checklist
 Ranking
 Rating Scale
 Forced Choice Comparison
 Anecdotal Recording

QUALITY ASSURANCE
- Assurance means achieving a sense of accomplishment and implies a guarantee of
excellence.
- Quality is the degree of excellence and assurance means formal a=guarantee of a degree
of excellence.
- Quality of care is the degree to which health services for individuals and population
increase the likelihood f desired health outcomes and are consistent with the current
professional knowledge. It meets the customer’s satisfaction.

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 - QUALITY ASSURANCE – a process of evaluation that s applied to the health care system
and the provision of health care service by health worker. It promotes collegial and
sharing relationships among workers instead of a feeling of threat when observes
and evaluated.
- QUALITY IMPROVEMENT PROGRAM 0 the umbrella program that extends the many
areas for the purpose of accountability to the consumer and the payor. The program
is a continuous, on-going measurement and evaluation process that includes
structure, process and outcome.
- BEST PRACTICE – service, function or process that has been fine-tuned, improved, and
implemented to produce superior outcomes
- TOTAL QUALITY MANAGEMENT – a way to ensure customer satisfaction by involving
all employees in the improvement of the quality of every product or service.
- CONTINUOUS QUALITY IMPROVEMENT – a process of continuously improving a
system by gathering data or performance and using multi-disciplinary team to
analyze the system, collect measurements and propose changes.

NURSING AUDIT COMMITTEE

- Composed of a representative from all levels of the nursing staff.
- The audit team utilizes the developed process or outcome criteria to evaluate nursing care.

 Patient Care Audits

o Concurrent – patient care is observed and evaluated. It is given a review
of the patient’s charts while the patients are still confined in the hospital,
observation of the staff as patient care is given, inspection of the patient
or observation of the effects of patient care where the focus is on the
patient.
o Retrospective – patient care is evaluated through review of discharged
patient’s charts and questionnaires sent to or interviews conducted on
discharged patients.
 Peer Review
o Evaluating each other job performance against accepted standards.
 Quality Circle
o One of the most publicized approaches to quality control.
o Defined as a group of workers doing similar work who meet regularly
and 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

CONTROL OF RESOURCES
- Consumption of supplies and materials should be proportionate to the number of
patients served, be these in the form of dressings, treatment done, injections given
and other materials,

DISCIPLINE
- Regarded as the constructive and effective means by which employees take personal
responsibility for their own performance and behaviour.

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- Factors that influence self-discipline
a. A strong commitment to the vision, philosophy, goals and objective of the institution.
b. Laws that govern the practice of all professionals and their respective Codes of
Conduct.
c. Understanding the rules and regulations of the agency.
d. An atmosphere of mutual trust and confidence.
e. Pressure from peers and organization.

- Disciplinary Approaches
a. Successful implementation of disciplinary action is characterized by promptness,
fairness, impartiality, non-punitivenes, advance warning and follow-through.

- Disciplinary Action
a. Counselling and Oral Writing
i. best given in private and in an informal atmosphere
b. Written Warning
i. Second step in disciplinary action. It is preceded by an interview similar to
the oral warning.
c. Suspension
i. Given after an evidence of oral and written warnings
d. Dismissal
i. Invoke only when all other disciplinary efforts have failed.

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