Source: Introduction to Nursing Management Functions by Florence Cayong-Cawaon Unit II. Chapter 1.

PLANNING Learning Objectives: Upon completion of this chapte, the student should be able to: 1. Explain the meaning of planning and its importance to nursing management. 2. Discuss the nature and purpose of planning. 3. Describe the various phases of the planning process. 4. Describe the six steps in the decision-making process. 5. Define budgeting process. Introduction Planning is the most basic and functional activity of the planning process. All other management functions are dependent on planning. Planning is forecasting of events, making decisions, setting goals, setting of priorities, developing policies and setting standards. Rowland and Rowland (1992) describe planning as always future-oriented. It is the process whereby management bridges the time span between where it is at present and where it wants to be at some point in the future. Planning involves the choice of objectives alog with the policies, strategies, programs, procedures, and rules that are necessary for the accomplishment of these objectives. Planning directs our thinking toward: What activity we expect to do Why it will be done Where it will be done When we expect to do it How it will be done Who is going to do it This chapter describes the types, nature, and purposes of planning, steps in arriving at decisions and the budgeting process. Types of Planning There are two major types of organizational planning: strategic or long-range planning and operational and short-range planning. Strategic Planning refers to determining the log term objectives of the institution and the policies that will be used to achieve these objectives. It is mostly done at the executive level of management. It is future-oriented. Some of the purposes of strategic planning are to: Help clarify the beliefs and values of the organization Give direction to the organization Improve communication and coordination of activities Improve efficiency Eliminate duplication of efforts Allow adaptation to the changing environment

Set realistic and attainable goals The main output of strategic planning is to set the goals for the organization. It is suggested that a situational analysis be done before making strategic plans. A tool that can be used is the WOTS analysis. What are the strengths and weaknesses and potential opportunities of the organization and the threats to it?

Weaknesses

Strength

Threats

Opportunities

WOTS Analysis Chart The internal weaknesses or strengths of a health care organization may include the following: Expertise of nursing and medical personnel staff Qualifications Over- and understaffed Financial status Quality of patient care Abundance o scarcity of medical equipment and supplies, etc. Threats may be: Competition Decrease of patient load Shortage of nurses and other personnel Low patient satisfaction Increase of charges Legal threats Opportunities would include: Improved or new facilities Recruitment of medical and nursing personnel Referrals New health care programs Others

Operational Planning deals with day-to-day maintenance activities. It is done in conjunction with the preparation of the budget. Planning may also relate to the improvement and maintenance of facilities. Nurse managers are most likely to be involved in this type of planning. Unit Planning is another type. In nursing, planning for a department or unit should be done on a daily, weekly or long-range basis. Daily planning is related to the care done on the client or patient. It may include among ot5her things the taking of the health history of the client, assessing his or her health status, formulating the nursing diagnosis and implementing care plan. The following are practical day-to-day planning actions suggested for the nurse manager: 1. At the beginning of each day, make a list of actions to be accomplished for the day. Cross out the actions as they are accomplished or at the end of the day. At the beginning of the next work day, carry over actions not accomplished, either do them first or decide whether they really need to be done. Do not hold tasks over from one day to the next indefinitely. 2. Plan meetings ahead. If the meeting is a nursing responsibility, prepare and distribute a copy of the agenda in advance. 3. Identify developing problems and place them in the appropriate portion of the divisions operational or management plan. 4. Review the operational or management plan on a scheduled basis. Review it with () managers in that each knows his/her personal responsibilities for accomplishment of activities. 5. Review the appropriate portions of the department operational or management plan () with () nurse managers when they are being counseled. Review department, unit or clinic plans at the same time. 6. Plan ideas gleamed from professional publications for discussion. These ideas may help integrate research results into practice. Nature of Financing Planning includes the following concepts: 1. Both strategic and tactical planning are incorporated. Strategic planning involves determining the direction in which an organization should be headed. Tactical planning involves allocating resources that enable an organization to realize stated objectives. 2. Plans are primarily mechanisms for guiding organizational efforts. The real test of planning is the ability to direct efforts on a daily basis, that is, to move from the abstract to the implemented. It is not enough just to create plans. They must be articulated and then put into action. Planning should not occur just at the top echelons; it should be implemented throughout the organization. 3. Planning is a continual process that moves from setting the mission to setting operational objectives. 4. Values and expectations often determine what mission and strategies to adopt. 5. Reviewing and evaluating plans support control. Planning does not occur in a vacuum. Accomplishments or failures are ultimately analyzed, and the information gained is sized to revise plans where necessary. 6. In nursing, goal planning ensures that clients will receive quality nursing care.

Purposes of Planning To ensure success in planning the activities of the nursing department or unit, the nurse manager should recognize the purposes of planning. According to Swansburg, planning: Leads to success in achieving goals and objectives Gives meaning to work Provides for effective use of available personnel and facilities Helps in coping with crisis situations Is cost-effective Is based on past and future, thus helping reduce the clement of change Can be used to discover the need for change Is needed for effective control The Planning Phase The planning process consists of different phases that are interdependent and continuous. Each phase is important and significant and determines the action needed to solve nursing problems related to nursing management. Viewed in phases, the planning process includes the following steps: determining objectives, collecting data, developing the plan of action, and evaluating the plan. 1. Determining Objectives Nursing concerns requiring assessment by planning groups should first be identified. Then a study outline should be completed for each concern. The outline should list influential factors, information needed for assessment, sources of data, and any required special studies. The completed study outline provides a basis 2. Collecting Data 3. Developing the Plan of Action 4. Evaluating the Plan SETTING OF TIME FRAME Programs are determined, developed and targeted within a time frame to reach the set goals and objectives. Kron has developed a planning formula which may be used for daily duties, or for shortand long-range projects. The Planning Formula 1. WHAT: what has be done? What should be done? What equipment and supplies have been used or are needed? What steps are necessary in the procedure? What sequence of activities was previously used? What other methods may be used? 2. WHEN: When should the job be done? When was it formerly done when could it be done? 3. WHERE: where is the job to be done? Where does an activity occur in the relation to those activities immediately preceding and following it? Where could supplies be stored, cleaned, and so forth?

4. HOW: How will the job be done? What are the steps to be followed in doing the procedure? How will the time and energy of personnel be used? How much will it cost? How much time will it require? 5. WHO: Who has been doing the job? Who else could do it? Is more than one person involved? 6. WHY: To each of the questions, ask why. Why is this job, this procedure, this step necessary? Why is this done this way, in this place, at this time, by this person? 7. CAN: Can some steps or equipment be eliminated? Can this activity be efficiently combined with other operations? Can somebody else do it better? Can we get a machine to help? Can we get enough money? Time Management Time management is a technique for allocating ones time through the setting of goals, assigning priorities, identifying and eliminating wasted time, and using managerial techniques to reach goals efficiently. There a number of basic principles that managers can use to cultivate good time management habits. Planning for contingencies. Think of other options or alternatives, if the desired option is not possible. Listing of tasks. Calendar all activities. Inventory. Looking at task done and not done. Sequencing. Prioritizing activities. Setting and keeping deadlines. Do not procrastinate or else nothing is done. Deciding on how time will be spent. Indicate time allotted for each activity, set time targets. Delegate. A portion of the task can be given to another who can equally accomplish the task on time. Multitasking The net effect of multitasking is that when several tasks are done at once, some or all of them end up being performed to a haphazard manner. This can have disastrous consequences. Nurses, therefore, must learn to prioritize the tasks at hand even if they have to them one after the other, as this remains the best way to make sure that they get done properly. Tools in Project Management Gantt Chart Gantt charts show task and schedule information. The tasks are numbered and listed vertically. A bar shows the starting date and projected completion date of each task. Color or shading is sometimes used to show how much of each task has been completed. It is both a management tool and a communication tool. Performance Evaluation and Review Technique (PERT)

The PERT is a network system model for planning and control which involves identifying key activities, sequences them in a flow diagram and assigning a specific duration for each phase of work. A PERT system involves extensive research and development. Multiple time estimates are used for each activity that allow for variation in activity, which are assumed to be at random, with assumed probability distribution (probabilistic). Activities are represented as arrowed lines between nodes. Critical Path Method (CPM) The CPM can calculate time and cost estimates for each activity. This method is used to create a cost estimate using either normal or crash operating conditions. Normal operating conditions are those involving the least cost, while crash operating conditions have much less available time than under normal conditions. CPM is useful where time and cost are significant factors because both can be estimated based on past experience. CPM is a tool to analyze a project and determine duration, based on identification of a critical path through an activity network, knowledge of the critical path can permit management of the project to change duration.

PREPARING THE BUDGET Budgeting is defined as a systematic financial translation of a plan, the allocation of scarce resources on the basis of forecasted needs for proposed activities over a specified period of time. It is a tool for planning, monitoring and controlling cost and meeting expenses. Budgeting is a function of management. Employees need to have resources to be able to perform their tasks. Purposes of Budgeting 1. Ensure the most effective use of scarce financial and non-financial resources 2. Coordinate efforts among organizational departments 3. Establish a frame of reference for managerial decisions 4. Provide a criterion for evaluating managerial performance Types of Budgeting Centralized Budget: Centralized budgeting is developed and imposed by the comptroller, administrator and/or director of nursing with little to no consultation with lower level managers. Decentralized Budget: Decentralized budgeting has the middle level manager involved in the planning and budgeting process with ARA(?) placed on the practitioner level. Components of Total Institutional Budget Manpower Budget: This consists of the wages and salaries of the regular employees and the fees paid in outside registries through which the institution contracts short-term employees. Capital Expenditure Budget: This involves the large expense of purchasing lands, buildings, and major equipment meant for long-term use.

Operating Budget: This includes the cost of supplies, minor equipment repair and maintenance as well as other overhead expenses.

The Budgeting Process The budgeting process is summarized as follows: Phase 1: Planning 1. Set short- and long-term goals 2. Form a budget committee 3. Prioritize objectives 4. Analyze past performance 5. Predict future costs and revenues 6. Develop budget guidelines Phase 2: Preparation 1. Translate objectives into projected costs and revenues 2. Write justifications for all requested expenses 3. Eliminate lowest priority objectives as necessary 4. Present proposed budget Phase 3: Modifications and Approval 1. Prepare preliminary master budget from all department requests 2. Compare projected costs with estimated revenue 3. Eliminate lowest priority items until budget is balanced 4. Approve final master budget 5. Communicate final budget to all departments Phase 4: Monitoring 1. Prepare monthly summaries of departmental expenses and revenues 2. Compare actual expenses with budgeted expenses 3. Investigate any variance above 5% 4. Readjust budget and/or improve performance as necessary 5. Continue to monitor on monthly basis