CONTROLLING PROCESS • Highlights problem related to quality care and

GLORIA P. DE LEON, MAN. Ed.D. determines areas that require priority attention
LEARNING OBJECTIVES: • Provides an indication of the cost of poor quality
Upon completion of this chapter the student should be • Justifies the use of resources
able to: • Provides feedback for improvement
• Define controlling as a management function of
the nurse manager. EVALUATION PRINCIPLES
• Describe the components of the controlling 1.Must be based on behavioral standards of
process performance with the position requirement.
• Discuss the principle of control 2.There should be enough time to observe
• Explain the importance of performance appraisal. employee’s behavior.
The Control Process 3. Employee should be given a copy of the ff.
CONTROLLING- also called Evaluating • Before scheduled evaluation
 An on-going function of management which • Job description
occurs during planning, organizing and • Performance standards
directing activities • Evaluation forms
 The “Controlling Process” is a method that 4. Performance appraisal should include both
can be used to make sure standards are satisfactory and unsatisfactory results.
being met within an organization. 5.Areas needing improvement must be prioritized.
 It involves the careful collection of 6.Should be scheduled and conducted at a convenient
information about a system, process, person, time for both evaluator and employee.
or group of people in order to make 7.Should be structured in such a way that it is
necessary decisions about each. perceived and accepted positively as a means of
 An ongoing function of management which improving job performance.
occurs during planning, organizing and
directing activities CHARACTERISTICS OF EVALUATION TOOL
 Process wherein the performance is
measured and corrective action is taken to OBJECTIVE
ensure the accomplishment of organizational Free from bias
goal
RELIABLE
PURPOSES OF CONTROLLING Accurate and precise that it will produce the same results
• Open opportunities for improvement if administered twice.
• Compare performance against set standard
• Provides information about how well processes and SENSITIVE
people function Instrument can measure fine lines of differences
among criteria being measured
Steps in Control Process VALID
• Establish standards and criteria
• Measure performance TYPES OF PERFORMANCE STANDARDS
• Compare results with standards 1.STRUCTURE
• Match with standards? Focus on the management system or structure used by
• YES- do nothing to improve the agency in the delivery of care.
• NO- take corrective action Includes:
• Number and categories of nursing personnel
REASONS FOR CONDUCTING EVALUATION • Education
• Ensures that quality services is provided • Personal and professional qualities
• Allow for setting of sensible objectives and ensures • Function
compliance • Physical facilities
• Provides standards for establishing comparisons • Equipment's
• Promotes visibility and means for employees to
monitor own performance PROCESS STANDARDS
Decision and actions of the nurse relative to the nursing Evaluator ranks according to how Employee fared with
process co-workers
INCLUDES:
Assessment RATING SCALE
Plan of care Includes a series of items representing the different
Nursing intervention tasks or activities in job description or the absence or
presence of desired behaviors.
3. OUTCOME STANDARDS
Designed to measure the results of care provided FORCED-CHOICE COMPARISON
in terms of: The evaluator is asked to choose the statement that
Changes in health status of client served best describes the employee being evaluated.
Changes in level of their knowledge, skills and The evaluator is forced to choose from favorable as
attitude well as unfavorable statement.
Satisfaction of those served
ANECDOTAL RECORDING
PERFORMANCE APPRAISAL Describe experience with a group or a person, or
• A control process in which employee's invalidating technical skills and interpersonal
performance is evaluated against standards’ relationship.
• The most valuable tool in controlling human
resources and productivity Anecdotal report should include:
• Reflects how well personnel have performed 1. Description of the particular occasion
during a specific period of time 2. Delineation of the behavior noted including:
3. WHO, WHAT, WHY, WHEN, WHERE AND
PURPOSE OF PERFORMANCE APPRAISAL HOW?
1.Determine salary and merit increases
2. Select qualified individual for promotion or The evaluator’s opinion or assessment of the incident or
transfer behavior
3.Identify unsatisfactory employees for demotion • QUALITY ASSURANCE
or termination Assurance
4.Make inventories of talents within an institution • Achieving sense of accomplishment and implies a
5.Determine training and developmental needs of guarantee of excellence
employees Quality
6. Improve performance of work group • the degree of excellence
7.Improve communication between supervisors
and employees QUALITY ASSURANCE:
8.Establish standards of supervisory • A process of evaluation that is applied to the
performance healthcare services b health workers.
9.Provide recognition of employee for
accomplishments • Focuses on the care and services the patient
10.Inform employees “where they stand’ receives than on how well the professionals performs
the duties that the position required
METHODS OF MEASURING PERFORMANCE
PRINCIPLES UPON WHICH QUALITYASSURANCE
ESSAY PROGRAM ARE BASED
The appraiser writes a paragraph about the workers 1.All health professionals should collaborate in the effort
strength, weaknesses and potential to measure and improve care.
2.Coordination is essential in planning a comprehensive
CHECKLIST QAP
A compilation of performances expected of a worker 3.Resource expenditure for QA activities is appropriate
4.There should be focus on critical factors
RANKING 5.Quality patient care is accurately evaluated through
adequate documentation6.
6. The ability to achieve nursing objectives depends upon
the optimal functioning of the entire nursing process and METHODS USED
its effective monitoring. Patient care audit
Patient care profile analysis
7.Feedback to practitioners is essential to improve Peer review
practice. Quality circles
8.Peer pressure provides the impetus to effect prescribed
changes based on the result of assessment and needed NURSING AUDIT COMMITTEE
improvements on the quality of care. Composed of a representative from all levels of
9.Reorganization in the formal organizational structure the nursing staff
may be required if assessment reveals the need for a The audit team designate a day within the week
different pattern of health care. to be the audit day.
10.Collection and analysis of data should be utilized to The nurses do not know which unit will be
motivate remedial action. audited.
PATIENT CARE AUDIT
QUALITY IMPROVEMENTPROGRAM 1. CONCURRENT PATIENT CARE AUDIT
One in which patient care is observed and
The umbrella program that extends the many areas evaluated
for the purpose of accountability to the consumer. Done during rounds or patient interview
A continuous, on-going measurement & evaluation Given through:
process that includes structure, process and 1.Review of patient chart while the patients are still
outcome. confined in the hospital
2.Observation of the staff as patient care is given
TOTAL QUALITY MANAGEMENT (TQM) 3.Inspection of patient or observation and/or observation
of the effects of patient care where the focus is on the
• A way to ensure customer satisfaction by patient
involving all employees in the improvement of the 4. RETROSPECTIVE PATIENT CARE AUDIT
quality of every product or service.
• Aims to reduce waste and cost of poor quality ONE IN WHICH PATIENT CARE ISEVALUATED
• It is a structured system for involving entire THROUGH:
organization in a continuous quality improvement 1.A REVIEW OF DISCHARGED PATIENTS’CHART
process targeted to meet and exceed customer 2.QUESTIONAIRES SENT TO OR
expectations. INTERVIEWCONDUCTED ON DISCHARGED
CONTINUOUS QUALITY IMPROVEMENT (CQI) PATIENTS.
• A process of continuously improving a system by:
• Gathering data or performance QUALITY CIRCLES
• Using Multi-disciplinary team to analyze the • One of the most publicized approaches to quality
system control introduced by the Japanese.
• Collect measurements • A group of workers doing similar works who:
• Propose changes • Meet regularly
• Voluntarily
PRINCIPLES OF CONTINUOUS • On normal working time
QUALITYIMPROVEMENT (CQI) • Under the leadership of the supervisor
• 1.Customer focus TO:
• 2.Identification of key processes to improve quality Identify, analyze, and solve work related problem
• 3.Use of quality tools and statistics4.Involvement of Recommend solution to management
all people in problem solving Quality circle members should implement the solution
themselves
QUALITY ASSURANCE CONTROL OF RESOURCES
• Focuses on the care and service the patient receives Consumption of supplies and materials should be
than on how well the professional performs the duties proportionate to the number of patients served.
that the position requires
Requisition or stock of large numbers of supplies and 2. be prompt
materials should be avoided to prevent misuse or 3. protect privacy
spoilage. 4. focus on the act
A high turnover inventory is desired 5. enforces rules consistently Be flexible
A low turnover is Components of disciplinary action program
the result of poor purchasing policies Code of conduct
Overstock or decreased demand for the item Employees must be informed of the nature and meaning
Equipment utilization report should be made including of codes of conduct
frequency of breakdown help to evaluate the: Must understand that the rules are reasonable and
quality of equipment purchased directly related to efficient, effective operation of the
The way it was handled agency
Preventive maintenance Authorized penalties
Requires the regular inspection of equipment to prevent Records of offenses
breakdown or detect needed repairs Right of appeal
Breakdown results in more expenses and non- Should be progressive in nature
productivity of personnel CONSELLING AND ORAL WARNING
Human Resource: Best given in private and in an informal atmosphere
Absences due to leaves, whether scheduled or Employee is given fair chance to air his side
not, should be analyzed Relevant facts are analyzed and evaluated against
Provision for relievers should be included in the past performance.
staffing pattern to maintain quality service COUNSELLING
Unusual number of unscheduled absences Employee is counseled regarding:
should be investigated Expectations of improved behavior/performance
this may necessitate disciplinary action Ways of correcting the problem
DISCIPLINE Warning that a repetition of the same offense may
Rigid obedience to rules and regulations warrant disciplinary action
SELF DISCIPLINE: A constructive and effective The employee must commit to correct the behavior
means by which employees take personal He should be informed of any follow-up action that may
responsibility for their own performance and be taken
behavior.
FACTORS THAT INFLUENCE SELF-DISCIPLINE WRITTEN WARNING
1.Strong commitment to the vision, philosophy, The second step in disciplinary action
goals and objectives of the institution. Preceded by an interview similar to oral warning
2.Laws that govern the practice of all Employee is told after the interview that he will be
professionals and the respective Codes of given a written warning
Conducts. WRITTEN WARNING: includes
3.Understanding of the rules and regulation of Statement of the problem
the agency Identification of the rule that was violated
4.Atmosphere of mutual trust and confidence Consequence of the continued deviant behavior
5.Pressure from peers and organization Employees commitment to take corrective action
DISCIPLINARY ACTION Any follow-up action to be taken
• Any employee charge with breach of the rules SUSPENSION
and regulation, policies, norms of conducts DISMISSAL
should begiven due process • Invoked only when all other disciplinary efforts have
• There must be existing rules of conduct failed
governing is behavior and a documentation of • Disciplinary Committee should be very sure that the
actual violation cause for dismissal conforms with the criteria of a
• The charged employee must be notified in writing major discipline violations as contained in the policy
about the violation and be given the right manual
counsel. • Review is done by higher management
Principles of disciplinary action
1. investigate carefully