CONTROLLING

CONTROLLNG – (according to Swans berg…)

It includes the process of evaluating the implementation of
the adopted plan, the given orders and the established principles
through establishing standards, comparing performance with the
standard, and correcting deficiencies.

MANAGEMENT AUTHORS INCLUDING NURSES HAVE

DESCRIBED THE CONTROLLING PROCESS AS FOLLOWS:
• Establish standards for all elements of management in terms of expected
and measurable outcomes.
• Apply the standard by collecting data and measuring the activities of the
nursing management, comparing standards with actual care.
• To make improvements deemed necessary from the feedback.
• keep the process continuous for all areas including :
• Management of the nursing division and each sub unit.
• Performance of personnel
• Nursing process/product.
THE PRINCIPLES OF CONTROL BY URWICK:

1. The principle of uniformity ensures that controls are

related to the organizational structures.
2. The principles of comparison ensure that the controls
are stated in terms of the standards of performance
required, including past performance.
3. The principles of exception provide summaries that
identify exceptions to the standards.
 PRINCIPLES OF CONTROL (LAURA MAE
DOPUGLASS)
1. Strategic point control – control should point out exceptions at the ranges.
2. Feedback – the process of adjusting future actions on the basis of information about the
past performance.
3. Flexible control – control should be stable yet flexible. It must be responsive to changing
conditions, adaptable to new developments.
4. Organizational Stability – control should take into consideration organizational structure.
5. Self control – Department must have a control system of its own but this must be tied up
with other sections by an overall control system
6. Direct control – any control system should designed to maintain a direct contact between
the controller and the controlled.
7. Human factor – people are affected by the psychological manner in which they view the
system
8. Principle of standard – people should know what they should know the system of control,
the standard operation procedure (SOP’s) rules/ policies etc. must be well understood
9. Principles of objectives – control should serve the needs for which it is intended.
10. Control must be economical
11. Control must assure corrective actions
12. Control must be forward looking
 PHASES OF CONTROL

• Pre – action phase – personal supervision is before any

work performance.
• On – going phases – evaluation is done during
performance.
• Post – action phase – evaluation after performance.
 ELEMENTS NEEDED IN ANY CONTROL SYSTEM

A. A PREDETERMINED GOAL, PLAN, STANDARD, NORM, DECISION,

RULE, CRITERION YARDSTICK.

This answer the question. “what should be results?” This elements focuses
on the future and what is desired and expected.

B. MEASURING CURRENT ACTIVITY (Quantitative if possible)

• MEASURING – is the gathering of information about work performance and

assessing its effectiveness. And this information is retained in a form of
records and reports.

• RECORDS – are accounts, documents, memorandums, of activities, facts

or previous experiences.

• REPORTS – are statement of facts or figure ascertained by investigation.

THE DIFFERENT KINDS OF RECORDS AND REPORTS:

patient chart
policies and procedures, including the data they were reviewed
job and performance description
employee files, including applications references and other appropriate records
statistic reports such as daily census, time sheet (DTR)narcotics records and
untoward incident report
Organizational activities record (which include the number and kind of laboratory
study performed and types of surgeries performed)

C. COMPARE CURRENT ACTIVITY WITH CRITERION

The purpose of comparing past performances with planned

performances is not to determine when a mistake has been made, but
to enable the manager to pre-determined future problems.
 CONTROL AS MANAGEMENT
In the process of measuring the degree to which pre-determined goals are
achieved. Applying necessary corrective actions to improve performance, policies
and procedures are used as standards.

TEN CHARACTERISTIC OF A GOOD CONTROL SYSTEM:

1. Controls must reflect the nature of the activity

2. Control should report errors promptly
3. Control should be forward – looking
4. Control should point out expectation at critical points
5. Control should be objection
6. Control should be flexible
7. Control should reflect the organizational pattern
8. Control should be undesirable
9. Control should be economical
10. Control should indicate corrective action
 BASIC STEPS IN CONTROL PROCESS
1. STANDARD – predetermined level of excellence that serves as a guide for practice.

CHARACTERISTICS:
predetermined
established by an authority
communicated to and accepted by people

ex. Philippine nurses association

Scope of nursing practice
Standards of nursing practice
policy procedures manual

THREE TYPES OF STANDARD:

1. Structure Standards – are those that focuses on the structure management or

Management system used by an agency to organize and deliver Care. .
2. Process Standard – refer to actual nursing procedures those activities engaged
in by nurses to administer care.
3. of the standard - are designed for measuring the results of nursing care.
 METHODS FOR MEASURING PERFOMANCE:

• Task Analysis – are used to determine issues such as how

long it takes a nurse to give medication, or how long it
takes a nurse to give bath.
• Anecdotal – is a written note/record of an observation
about a person and a person’s behavior.
• Quality control – generally focuses on measuring inputs,
organizational functions and outputs.
ESTABLISHING STANDARD & METHODS OF PERFORMANCE

STANDARDS METHODS
- Structure -Task analysis

- Process -anecdotal
- Outcome - quality control etc.

MEASURING ACTUAL PERFORMANCE

- continuous, on –going, repetitive process

- periodic, scheduled in advanced or announced
- formal and informal
 PERFORMANCE APPRAISAL
COMPARING RESULT OF PERFORMANCE WITH STANDARD
AND OBJECTIVES

- Does performance match the standards and objectives

REINFORCING STRENGHTS OR SUCCESS AND TAKING

CORRECTIVE ACTION AS NECESSARY

- positive aspect translated into encouragement and motivation

- corrective action necessitating changes in standards and objectives
TWO PRINCIPAL FACTORS TO CONSIDER FOR EFFECTIVE
CONTROL:
1. HUMAN ELEMENT OF CONTROL
This involve in the attitude and overt responses of people in an
organization.

REASONS WHY MAN OBJECT CONTROL

• failure to accept objectives
• feeling the part is unreasonable
• belief that measurement is in accurate
• dislike of unpleasant fact
• pressures from illegitimate sources
• social pressure that runs against the company’s control
2. MECHANICAL ELEMENT IN CONTROL
This involved quality control, Example…the firm products.
MANAGEMENT CONTROL TECHNIQUE IN NURSING
1. Nursing Rounds – cover such issues as patient care,
nursing practice and unit management. Part of the
evaluation process takes place as a result of the
communication during rounds.
2. Nursing operating instructions – instructions and policies
becomes standard for evaluation as well as controlling
techniques.
3. Gannt chart – it depicted a series of events essential to the
completion of a project or program. It is usually used for
production activities.
4. Master control plan – a master control plan can be use by
nurse manager to fulfill this management function.
5. Performance rating – is the systematic and uniform method
of appraisal that rate efficiencies in performing his duties and
responsibilities
 STRATEGIES FOR CHANGE IN AN ORGANIZATION
FOR EMPLOYER.

• Orientation
• Training
• Seminar Workshop
• Continue staff development through small group meeting/
conference
• Employees participation in Organizational activities
2. Performance Appraisal

Is a method of acquiring and processing information

needed to improve the individual workers performance and
accomplishments.
Consist of setting standard and objectives, reviewing
progress, having on- going feedback between the appraisal
and the one who is appraised, and planning for
reinforcements, deletion or correction of identified
behaviors as necessary.
 METHODS OF MEASURING PERFORMANCE
A. Informal appraisal – occurs on a routine basis may consist of the following:
1. Observation of work performance while engaged on individual or group functions
2. Incidental face to face confrontation and collaboration with the workers.
3. Responses offered of a workers during conference
4. Nothing the reaction to the worker of an involved person, such as the patient/ client,
family member, or staff person.
5. Noting the effects of a worker’s action on a patient/ clients, family, personnel or
environment.
B. Formal appraisal – Is best accomplished by regularly and methodically collecting
objectives facts that can then be calculated to tell the difference between what was expected
and what actually occurred, to be effective methods used should be.
6. Accurate
7. Timely
8. Objectively
9. Focused on the level of worker’s performance in every workers category.
10. Addressed to major roles expected of the workers (job description)
11. Economical realistic
12. Appropriate for organizational structure
13. Acceptable to the members involved.
 COMPONENTS OF AN EFFECTIVE NURSING
PERFORMANCE APPRAISAL SYSTEM
• There is compatibility between criteria for individual evaluation and
organizational goals.
• The nursing performance rated applies directly the performance
standards objectives expected of the worker.
• behavioral expectations have been developed or mutually agreed on
by the nurses appraiser and the individual being evaluated
• The nurse appraiser understand the appraisal process and uses the
procedure effectively
• Each individual is rated by immediate supervisor
• The performance appraisal concentrates on areas of strength, as well
as note weaknesses, in the individual to improve performance.
• The appraisal process encourages feedback from nursing members
about their performance, needs and interest.
• Provision is made for initiating preventive and corrective actions and
making adjustment to improve the worker’s performance.
3. QUALITY CONTROL / QUALITY ASSURANCE:

• it is monitoring the compliance with established standards

• It is achieved through a variety of preventive and corrective
methods that are intended to ensure compliance with established
standards.

COMPONENTS OF QUALITY ASSURANCE PROGRAMS:

1. Standard setting
2. Comparing standards with actual practices
3. Analyzing and interpreting these comparisons
4. Selecting the implementing actions to improve practices
5. Evaluates these action’s effectiveness
 METHODS AND TOOLS OF QUALITY ASSURANCE:

1. Slater nursing competencies rating scale

-for measuring competencies displayed by a nurse
2. Quality patient care scale
-for measuring the quality of nursing care received by a
patient, while on-going care given
-Describe the nurse actions as it was received by the
patient rather than as it was performed by the nurse.
3. Nursing audit
-For measuring the quality of nursing care received by
patient, after a cycle of care received and the patient is
discharged.
 TYPES OF NURSING AUDIT:

1. Retrospective/ Close chart audit

Once the patient is already discharge from the hospital, or
nursing home, or placed in an inactive status of a home
health agency’s case.
2. Current / open chart audit
a. Application and execution of physician legal orders
b. Observation of symptoms
c. Supervision of the patient
d. Supervision of those participating in care
e. Reporting and recording
f. Application of nursing procedures and techniques
g. Promotion of health directions and teaching
 3. Structure audit – assumes that a relationship exist between quality care and
appropriate structure.
• Resource inputs – Environment where health care is delivered (+) unit
• Staffing ratios
• Emergency department wait times
-Safe and effective environment but do not address the actual care provided.
4. Process Audit – Measure the process of care on how the care was carried
out and assume that a relationship exists between process used and
quality of care provided.
• Task Oriented
• Focus on whether practice standards are being fulfilled
Ex. Established policy for institution Doctors order
Documented in NCP, Procedure manuals nursing protocols statements.
5. Outcome Audit – End result of care, change in health status of patient as a result
of intervention
• Outcome demonstrate the quality of care provided
• Valid indicator of quality of acre
 NURSING AUDIT STEPS ARE THE FOLLOWING:

1. Establish standard and criteria

2. Measurement
3. Evaluate the observation variables and decide which are
justifiable in terms of the criteria and acceptable nursing
practice and which are unjustifiable and represent actual
deficiencies.
4. Take suitable corrective actions to prevent recurrence of such
deficiencies.
5. Follow through
6. Prepare an distributed suitable summary reports to nursing
hospital administration, and to the executive committee of the
medical staff,
 QUALITY ASSURANCE PROGRAM:
Is the establishment of standard of care and mechanism for evaluating of
such care.
PURPOSE OF QUALITY ASSURANCE PROGRAM
1. objectively and systematically monitor and evaluate the quality of patient care
as well as its appropriateness
2. Pursue opportunity to improve patient care
3. Resolve identified problems

STANDARD - a descriptive statement of a desired level of performance that

contains criteria by which the quality and appropriateness of patient care can be
measured.
CRITERIA – refers to the elements of structure, process and outcomes of nursing
care or known to be indicators of quality nursing care, a, standard by which
something can be judged or decided.
QUALITY NURSING CARE – Refers to the possible highest standard of nursing
care assured to its clientele by the profession to the continuous evaluation of the
structural components of care.
OUTCOME – Results of care to those served.
TEN STEPS IN MONITORING AND EVALUATION PROCESS:
1.Responsibility 6. data collection
2. scope of care 7. evaluation
3. Important aspect of care indicators 8. corrective actions
4. indicators 9. follow up
5. threshold for evaluation 10. communications
DISCIPLINE:
Is the mode of life in accordance with rules.

FROM EMPLOYEES STANDPOINT

Is a form of self control through which the individuals acts in

accordance with the institution’s code of behavior.
FROM MANAGERS STANDPOINT

Discipline is a process of insuring employees compliance with

the institutional rules and regulations.
 EMPLOYEE CODE OF JUSTICE
An absolute prerequisite for effective discipline awareness of those
institutional rules and regulations that governs workers behavior. Such rules should
be written in clear and concise language, should be incorporated in an employee or
worker handbook that is given to new employees and should be incorporated in an
employee or worker handbook that is given to new employees and should be posted
in all working unit. The following are examples of typical behavior rules imposed by
health agency.
THE EMPLOYEE SHALL NOT:
1. Absent herself from scheduled assignment without approval of her immediate
superior or supervisor.
2. Physically or verbally abused by patient
3. Transmit confidential information concerning patient’s hospital affair to
unauthorized person.
4. Appropriate patients and or hospital belongings for personal use.
5. Refuse to follow direction of a duty authorized superior.
6. Intentionally falsify hospital records.
7. Sleep during duty hours
8. Be under the influence of alcohol of un prescribe drugs while on institutional
premise.