CONTROLLING NCM 119 – Leadership and Management (Semi-finals)

Controlling
Feedforward Controls
 Is the use of formal authority to assure the
o Focus on operations before they begin to
achievement of goals and objectives
prevent anticipated problems.
 Performance is measured and corrective
action is taken to ensure accomplishment of Concurrent Controls
organizational goals. o Apply to processes as they are happening.
 It involves assisting, regulating, monitoring,
and evaluating individual and group Feedback Controls
performance o Focus on the results of operations.

HALLMARKS OF EFFECTIVE QUALITY CHARACTERISTICS OF EFFECTIVE

CONTROL PROGRAMS CONTROLS
1. Support from top-level administration
 Control systems must be designed
2. Commitment by the organization in terms of
appropriately to be effective
fiscal and human resources  When control standards are inflexible or
3. Quality goals reflect search for excellence unrealistic, employees cannot focus on the
rather than minimums. organizational goals.
4. Process is ongoing (continuous)  Control systems must prevent not cause the
problems they were designed to collect.
HEALTH CARE QUALITY
EFFECTIVE CONTROL SYSTEM
 Health-care quality as “the degree to which
health services for individuals and populations  All nursing units must have a standard control
increase the likelihood of desired health system.
outcomes and are consistent with current  Acceptability of those who will enforce
professional knowledge”. (IOM) decisions.
 Flexibility of the enforces and the
 Quality control a specific type of controlling implementors to enforce decisions based on
that refers to activities that are used to practical situations.
evaluate, monitor, or regulate services  Accuracy
rendered to consumers.  Timeliness
 Cost effectiveness
PRINCIPLES  Understandability
Clinical Few  Balance between objectivity and subjectivity
o Fewer people involved in control brings about  Coordinated with planning, organizing, and
the best results. directing.

Point of Control CONTROL PROCESS

o Centralization or decentralization of authority  A continuous flow between measuring,
Self-control or Discipline comparing, and action.
o Personal acceptance of responsibility and
STEPS:
accountability.
1. Establishing performance objectives and
standards
KINDS OF FORMAL CONTROL
2. Measuring actual performance
Pre-action Control 3. Comparing measured performance against
o Personal supervision and utilizing control established objectives and standards.
checks consisting of procedures for any given 4. Taking necessary corrective action
task or functions.
1. Establish and Specify Criteria and
Post-action Control Performance Standards
o Controlling as the task is being performed or
may have been performed and correcting a. Standards
deviations from standards or plans. o Any guideline established as basis for
measurement
TYPES OF CONTROL
b. Time control Includes resource inputs such as the
o Deadlines and time constraints. environment in which health care is
delivered.
c. Financial Control
o Budget allocated to resources SITUATION: Structure, Process, Outcome
Measures
d. Operations Control o You are a charged nurse on a postsurgical
o Assess how efficiently & effectively an unit. Retrospective survey data reveal that
organization’s transformation processes create many patients report high levels of
goods and services. postoperative pain in the first 72 hours after
surgery. You decide to make a list of possible
e. Statistical process control structure process and outcome variables that
o Use of statistical methods & procedures to may be impacting the situation.
determine whether production operations are o One of the structure measures you identify
being performed correctly. is that the narcotic medication carts are
located some distance from the patient rooms
f. Just in time system
and that may be contributing to a delay in pain
o Timely application of materials for use in case medication administration
nurses need it for patient care such as giving o One of the process measures you identify is
of medications for the illness of a patient. that licensed staff are inconsistent in terms of
2. Monitor and Measure Performance of how soon they make their initial pain
Nursing Care Services and Evaluate it assessments on postoperative patients as well
against the standards through records, as the tools they use to assess pain levels.
reports, and observations o An outcome measure might be the average
wait time from the time a patient requests pain
a. Nursing rounds medication until it is administered.
o Pays particular attention to issues of patient
care and nursing practice NURSING AUDIT
o It prioritizes nursing care by promoting
b. Quality Assurance
optimum nursing care
o Monitors compliance to established standards o It can identify deficiencies in the organization
c. Nursing Audit and administration of nursing care and may be
o Documentation of the quality of nursing care used to correct such deficiencies through
in relation to the standards established by the continuing education and administrative
nursing department. changes.
o It may also be used to increase performance to
AUDIT assure that improvements have been
A systematic and official examination of a record, monitored.
process, structure, environment, or account to SUPERVISORS IN NURSING AUDIT
evaluate performance. Collect data to measure actual performance of the
a. Retrospective audits staff to determine variation from standard:
performed after the patient receives the o Written data might include timecards,
service. production tallies, inspection reports and sales
b. Concurrent audits tickets.
performed while the patient receives the o Personal observation, statistical reports, oral
service reports, and written reports.
o Management by walking around or
c. Prospective audits observation of employees working.
Attempt to identify how future performance o Oral reports allow for fast and extensive
will be affected by current interventions. feedback.
d. Outcome audit
End result of care 3. Compare performance with standards,
models, or criteria to determine deviations or
e. Process audit differences.
Measuring how nursing care is provided a. Program Evaluation and Review Technique
b. Benchmarking = the process of measuring
f. Structure audit products, practices, and services against best
 CONTROLLING NCM 119 – Leadership and Management (Semi-finals)
performing organizations. chain of management activities and brings the
functions of management cycle in full circle
PERT CHART  Allows for all the performance standard
within the group to be set and
communicated.

CHARACTERISTICS OF THE CONTROL

PROCESS
 The control process is cyclical which means it
is never finished.
 Controlling often leads to management
expecting employee behavior to change
 Control is both anticipatory and retrospective
 Ideally, each person in the health care delivery
4. Enact remedial measures or steps to correct views control as his or her responsibility.
deviations or errors.  Controlling builds on planning, organized,
a. Correction of deviations or errors and directing.
b. Master control plan
c. Take necessary actions

STEPS IN AUDITING QUALITY CONTROL

Establish control criteria

Identify the information relevant to the criteria

Determine ways to collect the information

Collect and analyze the information

Compare collected information with the

established criteria

Make judgment about quality

Provide information and, if necessary, take

corrective action regarding findings

Reevaluation

Elements of Controlling

I. PERFORMANCE APPRAISAL
- A method of acquiring and processing
TAKE NOTE information needed to improve the individual’s
performance and accomplishments.
 Effective control involves keeping the process
- Consists of setting standards and objectives
in continuous for all areas
against determined standards and objectives,
 This guarantees that plans are being
reviewing progress, ongoing feedback, planning
implemented properly
for reinforcement, deletion or correction of
 Controlling is the final link in the functional
identified behaviors as necessary.
- The purpose of evaluation is to assess the 3. Take steps to ensure the full involvement
appropriateness, adequacy, effectiveness and of the entire workforce in improving
efficiency of services. quality.

FACTORS INFLUENCING EFFECTIVE PARADIGM

PERFORMANCE APPRAISAL
TOTAL
a. Appraisal should be based on a standard Involving the entire organization, the entire
b. The appraisal tool must be adequately and chain, and/or product or outcome life cycle.
accurately assess job performance
c. Employee should have input into development QUALITY
of the standard. With its usual characteristics, with all its
d. Employee must know the standard in advance. complexities to meet total client satisfaction.
e. Employee must know the sources of data
gathered for the appraisal MANAGEMENT
f. Appraiser should be someone who has observed The system of managing the organization.
the employee’s work.
g. Appraiser should be someone who the
employee trusts and respects.
h. Employer support and clarify of expectations
are critical to the employee perceiving the
appraisal as fair.

COMMON ERRORS IN APPRAISAL

Halo effect
- Tendency to overrate
Logical error
- Based on first impressions
Central tendency error
- Rates average due to inadequate

Leniency error
- Overlook weaknesses and mistakes.

Hawthorne effect
- Behavior of the ratee changes because he is
observed by the rater.

Horn’s effect
FOUR PROCESSES OF TQM IN JAPAN
- Low rating because of an error committed.
II. TOTAL QUALITY MANAGEMENT Kaizen
- A management approach for an organization, Improvement must involve all members of a
focused on quality based on the participation company.
of all its members and aimed at long-term
success through customer satisfaction and Atarimae Hinshitsu
benefits to all members of the organization Make things work the way they are supposed to
and to society work.
- TQM is aimed at embedding awareness of
quality in all organizational process. Kansei
Learn from the way a user applies the product to
BASIC PRINCIPLES OF TQM make improvements.
1. Focus on achieving customer
satisfaction. Miryokuteki Hinshitsu
2. Seek continuous and long-term Things should have an aesthetic quality and be
improvement in all the organization pleasing to use.
processes and outputs.
 CONTROLLING NCM 119 – Leadership and Management (Semi-finals)
III. DEVELOPMENT OF STANDARDS
- Pre-determined level of excellence that serves
as guide in practice
- It is used to monitor and measure
performances of nursing care services and
evaluate it against the standards through
records: reports and observations.
- In developing a performance standard, it is
mandatory that a criterion is established and
specified.

TYPES OF STANDARDS
Structure standards
Focus on structure or management system or
management system used to organize and deliver
nursing care

Process standards
Actual nursing care procedures

Outcome standards
Measuring the results of nursing care.