LEADERSHIP AND PLANNING REPORT

Leadership

1. The privilege to have the responsibility to direct the actions of others at varying
levels of authority and with accountability to both successful and failed
endeavors. ( Roberts 1989)

2. The process of influencing the activities of an organized group in its effort toward
goal achievement. (Stogdill, 1974)

3. A means of persuasion and example by which an individual induces a group to

take action in accord with a purpose common to everyone. ( Gardner 1993)

4. A process by which one inspires others to work together for the achievement of a
common mission and goal, a social transaction. ( Merton 1969)

5. A vital ingredient which transforms a mere crowd into a functional and useful
organization. It can be taught and it is a transferable skill. ( Adair 1983)

THEORIES

1. Max Weber
• Bureaucratic Organization Theory (1922)

2. Henry Fayol
• Management functions theory (1925)

3. Douglas Mc Gregor
• Theory X and Theory Y (1960)

4. Fredrick Taylor
• Scientific management Theory (1900-1930)

5. Kurt Lewin-
• Categorized Leadership Styles (1939)
• Develop Field Theory of Human behavior (1951)

6. Abraham Maslow
• Father of humanistic psychology theorized that man's various needs form
a hierarchy starting with their basic needs.

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Styles of Leadership:

1. AUTHOCRATIC
• Decisions are made with little or no staff input.
• The manager does not delegate responsibility . Staff dependence are
fostered.

2. PARTICIPATIVE
• Problems are identified by the manager and presented to the staff with
several solutions.
• Staff members are encouraged to provide input but the manager makes the
final decision

3. DEMOCRATIC
• Staff members are encouraged to participate in the decision making
process whenever possible.

4. LAISSEZ- FAIRE
• Little direction, structure or support is provided by the manager

5. CONSULTATIVE
• The first consultative (also called collective) leadership style is:
o The leader shares the problem with the relevant team members
individually getting their ideas and suggestions without bringing
them together as a group. Then the leader makes the decision that
may or may or reflect team member influence.
• The second consultative leadership style is:
o The leader shares the problem with the relevant team members as a
group, obtaining their collective ideas and suggestions. Then the
leader makes the decision that may or may not reflect team
member influence.

KURT LEWIN’S LEADERSHIP STYLE/SYSTEM

A group of psychologists led by Lewin , Lippit, & White (1939) focused on their theory
on three leadership styles.

1. AUTHORITARIAN LEADER
Autocratic leaders – cause the worst level of discontent because they make decisions
without consulting anyone.
 Maintains strong control
 Does the planning
 Makes the decisions
 Gives the orders

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  Directive, critical and punitive
 Make decisions that are not in the best interest of the group
 Give themselves a higher status than the group members-reduces
open communication & trust
 Tend to get good quantity and quality of output but little autonomy ,
creativity, or self-motivation.
 This can be appropriate for an emergency situation when the
leaders know what to do, but it does not develop people.
 In Lewin’s experiments, this approach caused the worst level of
discontent and can lead to revolution.
 It sometimes happens in healthcare situations when the
administration decides on a change without consulting nursing.
 Revolution may not result , but low morale , bad feelings, and
undercover retaliation can occur.
o Leaders makes decision alone
o Tend to be more concerned with task accomplishment than
with concern for people.
o Tends promote hostility and aggression or apathy and to
decrease initiative.
Output: highly quantity good quality

2. DEMOCRATIC LEADER- involves others in their decisions.

 Maintain less control

 Ask questions and make suggestions rather than issue orders
 Get the group involve in planning, problem solving, and decision
making
 Participation tends to increase motivation and creativity.
 It works when people have knowledge and skills and work well
together over time.
 It can be cumbersome.
 It is often less efficient than autocratic control
 Involve people in their decisions, although they may make final
decision.
 Participants may appreciate being consulted, but they may be
confused when confronted by a wide range of opinions with no
clear way to reach a decision.
 When using the democratic style of leadership, provide staff with
examples of specific ways to reach a decision.
o Involve their followers in the decision-making process.

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 o People – oriented and focus on human relations and
teamwork.
o Leads to increased productivity and job satisfaction.
Ouput of data: creative, highly quality

3. LAISSEZ-FAIRE LEADERS – are minimally involved in decision making.

 Very permissive
 Nondirective
 Passive
 Inactive
 Members may work independently and possibly at cross purposes
because there is no planning or coordination and little cooperation.
 Chaos is likely to develop unless an informal leader emerges.
 This style can work with very mature, autonomous workers, but it is
more likely to be inefficient and unproductive.
 Minimally involved in decision making.
 This style works best when people are capable and motivated to
decide and are not hindered by a central coordinator.
 When used, people may not work in a coherent manner or put it
in the enrgy they would if they were actively led.
o Leaders are loose and permissive
o Abstain from leading their staff
o They foster freedom for everyone and want everyone to feel
good.
o Results in low productivity and employee frustration.
Output/ result: Variable. Poor quality

Comparison of Autocratic, Democratic, and Laissez-faire leadership

Autocrati Democrat Laissez-
c ic Faire
(Authoritarian- (Participative-group ( Free Rein-individual
leader oriented) centered)
Centered)
Strong control makes Less control,involve No control. Loose and
decision alone their followers in the permissive
decision making
process
Gives orders Offers suggestions Nondirective
Does decision making Makes suggestions Abdicates decision
making
Leader does planning Group does planning No planning
Directive Participative Uninvolved, result in
Promote hostility and Increase productivity low productivity and

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 aggression or apathy and job satisfaction employee frustration

Fosters dependency Fosters independence Fosters chaos

Little freedom Moderate freedom Much freedom

Leader is highly active Highly active Minimal activity
Managers present ideas Managers defines limit, Foster freedom for
ask group to make everyone and want
decision everyone to feel good

Managers and group

jointly make decision

Output;
Highly quantity, good Variable , poor quality
quality Creative, highly quality

Trait Theory-assumes that leaders are born with traits particularly suited to leadership.
 energy
 drive
 enthusiasm
 ambition
 aggressiveness
decisiveness Universal leadership traits:Traits that are related to leadership effectiveness
according to Swanaburg (1993) are as follows:
1. Intelligence Traits - in order to relate well and inspire subordinates to perform well.
 judgment
 decisiveness
 knowledge
 fluency of speech
2. Personality Traits – to facilitate the leadership capability of a nurse manager as he or
she is able to motivate the people so that goals of the organization are achieved.
 adaptability
 alertness
 creativity
 cooperativeness
 personal integrity
 self-confidence
 emotional balance
 control
 independence (nonconformity)

Four Primary Traits by which leader could succeed:

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1. Staying calm under pressure
2. Admitting errors and owning up to mistakes rather than covering them up.
3. Persuading others without resorting to negative or coercive tactics
4. Being an expert in a broad range of areas rather than having a narrow-minded
approach.

1940s- trait theory was the basis for most leadership research:
Early work/theories in this area maintained that traits are inherited.
Later work /theories suggested that traits could be obtained through learning and
experience.

Leadership Traits Identified by Researchers

 self-assurance
 self-confidence
 friendliness
 affection
 honesty
 fairness
 loyalty
 dependability
 technical mastery
 teaching skill
Leaders possesses common leadership traits (Researchers)

1. Leaders need to be more intelligent than the group they lead. However, a highly
intelligent person may not find leadership responsibilities challenging enough, may prefer
to work with abstract ideas and research, and may have difficulty relating to the group.

2. Leaders must possess initiative, the ability to perceive and start courses of action not
considered by others.
3. Creativity is an asset. Having originality – the ability to think of new solutions to
problems and ideas of new ways to be productive-is helpful.
4. Emotional maturity with integrity- a sense of purpose and direction, persistence,
dependability, and objectivity-is another important trait. Mature leaders do what they say
they will and are consistent in their actions. They often work long hours, apply
themselves intensely, and spread enthusiasm to followers. Energy, drive, and good health
are necessary to endure the long hours, overcome obstacles, and sustain continuous
achievement. Self-assurance is self-confidence. It is hoped that leaders perceived
themselves as effective problem solvers who can successfully handle the difficulties that
confront them.
5. Communication skills are important. The leader needs to understand others and speak
and write clearly.

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6. Persuasion often is used by leaders to gain the consent of followers. The leader may
make suggestions, supply supportive data, ask generating questions, make compromises
and request actions to persuade others.
7. Leaders nee to be perceptive enough to distinguish their allies from their opponents
and to place their subordinates in suitable positions.
8. Leaders participate in social activities. They can socialize with all kinds of people and
adapt to various groups. Approachable, friendly, and helpful, they gain the confidence
and loyalty of others in such a way that makes people willing to cooperate.

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PLANNING

• Is deliberative, systematic phase of nursing process that involves decision making

and problem solving .

• It is the continuous process of

-assessing
-establishing goals and objectives,
-implementing and
-evaluating them, and subjecting these to change as new facts are known.

It involves:
• assessing a situation

• establishing goal and objectives based on the assessment of situation or future

trends

• developing a plan of action that identifies priorities, delineates who is responsible,

determines deadlines and describes how the intended outcome is to be achieved
and evaluated.

Scope Planning
1. Top level Manager
• make decisions affecting the entirety of the firm. Top managers do not direct the
day-to-day activities of the firm; rather,

• they set goals for the organization and direct the company to achieve them. are

• ultimately responsible for the performance of the organization, and often, these
managers have very visible jobs.

• have a great deal of managerial experience and have moved up through the ranks
of management

• Top management

• Nursing Directors

• Chief Nurses

• Directors of Nursing and their Assistant

2. Middle Level Manager

• are responsible for carrying out the goals set by top management. They do so by
setting goals for their departments and other business units.

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• motivate and assist first-line managers to achieve business objectives.

• may also communicate upward, by offering suggestions and feedback to top

managers. Because they are more involved in the day-to-day workings of a
company, they may provide valuable information to top managers to help improve
the organization's bottom line.

• they have aspirations to hold positions in top management in the future.

Middle Manager
• Different Floor supervisor

• Unit Supervisor

3.First Level manager

• are responsible for the daily management of line workers—the employees who
actually produce the product or offer the service.

• typically do not set goals for the organization, they have a very strong influence
on the company.

• interact on a daily basis, and if the managers perform poorly, employees may also
perform poorly, may lack motivation.

First Level Manager

• Head Nurses

• Senior Nurses (including Charge Nurses or team leaders)

• First-level managers are also called first-line managers or supervisors.

4. Operational Level manager

• Conducted many operational efficiency studies including audits of laboratory
work-flow, establishing best practices in purchasing and operations, reviewing
staffing patterns, and establishing productivity measurements

• development of laboratory sales and marketing skills through establishment of a

sales organization, training of staff, determination of sales focus through market
segmentation, development of the process to target key customers, and
development of value pricing for a "commodity" market.

Max Weber
• is a well known German Sociologist.

• The need for legalized, formal authority and consistent rule and regulations for
personnel in different positions.

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 • Proposed the bureaucracy as an organized design.

His Life
Was born on april 21,1846 died June 14,1920
• In 1882 Weber enrolled in the University of Heidelberg as a law student.

• Intermittently, he served with the German army in Strasbourg.

• In 1886 Weber passed the examination for "Referendar", comparable to the bar
association examination in the British and American legal systems.

• Throughout the late 1880s, Weber continued his study of history. He earned his
law doctorate in 1889 by writing a doctoral dissertation on legal history entitled
The History of Medieval Business Organizations.

His Achievements:
• One of the founders of modern sociology and consider also as a historian and
economist.

• The affinity between capitalism and Protestantism, the religious origins of the
Western world, the force of charisma in religion as well as in politics, the all-
embracing process of rationalization and the bureaucratic price of progress, the
role of legitimacy and of violence as offsprings of leadership.

Henry Fayol

• A french mining engineer a Director of mines

• He first identified the management functions of planning, organizing, command,

and control.

• Principle of management and a general theory about business administration

His Life
• Was born on july 29,1841 at istanbul died nov. 19,1925 at paris.

• When 19 years old he started as an engineer at a mining company

• became director in 1888, when the mine company employed over 1,000 people,
and held that position over 30 years until 1918. Fayolism is one of the first
comprehensive statements of a general theory of management

• He has proposed that there are six primary functions of management and 14
principles of management

• Forecasting, planning, organizing, commanding, coordinating, controlling

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 Principles of Management according to Henry Fayol
• Authority. Managers must be able to give orders. Authority gives them this right.

• Discipline. Employees must obey and respect the rules that govern the
organization.

• Unity of command. Every employee should receive orders from only one
superior.

• Unity of direction. Each group of organizational activities that have the same
objective should be directed by one manager using one plan.

• Subordination of individual interests to the general interest.

• Remuneration. Workers must be paid a fair wage for their services.

• Centralisation -refers to the degree to which subordinates are involved in decision

making. Whether decision making is centralised (to management) or decentralised
(to subordinates) is a question of proper proportion.

• Scalar chain. The line of authority from top management to the lowest ranks
represents the scalar chain.

• Order. People and materials should be in the right place at the right time.

• Equity. Managers should be kind and fair to their subordinates.

• Stability of tenure of personnel. High employee turnover is inefficient.

• Initiative. Employees who are allowed to originate and carry out plans will exert
high levels of effort.

• Esprit de corps. Promoting team spirit will build harmony and unity within the
organization.

Kurt Lewin

• Was born on September 9, 1890

Prussia died on February 12, 1947.

• was a German-american psychologist,

• known as one of the modern pioneers of social, organizational, and applied

psychology.

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• Lewin is often recognized as the "founder of social psychology" and was one of
the first to study group dynamics and organizational development.

• Unfreezing stage

the need to change is recognize, driving, restraining forces are

unidentified, alternative solutions are generated, and participants are motivated to
change.
It involved overcoming inertia and dismantling the existing "mind set". Defense
mechanisms have to be bypassed.
• Moving

the participants agree the status quo is undesirable and the actual change is
planned in detail and implemented.
typically a period of confusion and transition. We are aware that the old ways are
being challenged but we do not have a clear picture as to what we are replacing
them with yet.
• Refreezing

the change is integrated and stabilized.

The new mindset is crystallizing and one's comfort level is returning to previous
levels. This is often misquoted as "refreezing

Douglas Mc Gregor
• He reinforces these ideas by theorizing the managerial attitudes about the
employees can be directly correlated with employee satisfaction.

• THEORY OF X AND Y

• Theory X Managers believe that their employees are basically lazy, needs
constant supervision and direction.

• Theory Y Managers believe that their workers enjoy their work, are self
motivated, and are willing to work hard to meet personal and organizational goals.

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 Frederick Taylor
• Scientific Management Theory

• -Father of Scientific Management.

• -Frustrated with what he called “systematic soldiering”, where workers achieved

minimum standards doing the least amount of work possible.

Four overriding Principles of SCIENTIFIC MANAGEMENT:

• 1. Traditional “Rule of Thumb” means organizing work must be replaced with
scientific methods.

• 2. A scientific personnel system must be established so workers can be hired,

trained and promoted based on their technical competence and abilities.

• 3. Workers should be able to view how they “fit” into the organization and how
the contribute to overall organizational productivity.

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• 4. The relationship between managers and workers should be cooperative and
interdependent, and the work should be shared equally.

Abraham Maslow
was born on april 1, 1908 and raisedin Brooklyn New York.
Died June 6, 1970
His Life
• his childhood as lonely and rather unhappy, because, as he said, "I was the little
Jewish boy in the non-Jewish neighborhood. It was a little like being the first
Negro enrolled in the all-white school. I was isolated and unhappy. I grew up in
libraries and among books, without friends.

• He would pursue law, but he went to graduate school at the University of

Wisconsin to study psychology. While there, he married his first cousin Bertha in
December 1928, and found as his chief mentor, professor Harry Harlow.

Maslow on Management
• about "enlightened management," describing the type of workplace that would be
most conducive to the workers' reaching a point of self-actualization (happiness).
If we adhere to the concept that management is hardware and leadership is
software, what he is really writing about is leadership - although he calls it
management.

• Enlightened management assumes that everyone prefers to be a prime mover

rather than a passive helper. And what follows are the 36 principles of
enlightened management as defined in Maslow on Management:

• Assume everyone is to be trusted.

• Assume everyone is to be informed as completely as possible of as many facts
and truths as possible

• Assume in all your people the impulse to achieve...

• Assume that there is no dominance-subordination hierarchy in the jungle

sense or authoritarian sense (or "baboon" sense).

• Assume that everyone will have the same ultimate managerial objectives and
will identify with them no matter where they are in the organization or in the
hierarchy.

• Eupsychian economics must assume good will among all the members of the
organization rather than rivalry or jealousy.

• Assume that the individuals involved are healthy enough.

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• Assume that the organization is healthy enough, whatever this means.

• Assume the "ability to admire"...

• We must assume that the people in eupsychian plants are not fixated at the
safety-need level.

• Assume an active trend to self-actualization--freedom to effectuate one's own

ideas, to select one's own friends and one's own kind of people, to "grow," to
try things out, to make experiments and mistakes,

• Assume that everyone can enjoy good teamwork, friendship, good group
spirit, good group homonomy, good belongingness, and group love.

• Assume hostility to be primarily reactive rather than character-based.

• Assume that people can take it, that they are tough, stronger than most people
give them credit for.

• Eupsychian management assumes that people are improvable.

• Assume that everyone prefers to feel important, needed, useful, successful,

proud, respected, rather than unimportant, interchangeable anonymous,
wasted, unused, expendable, disrespected.

• That everyone prefers or perhaps even needs to love his boss and that
everyone prefers to respect his boss ...

• Assume that everyone dislikes fearing anyone (more than he likes fearing
anyone), but that he prefers fearing the boss to despising the boss.

• Eupsychian management assumes everyone prefers to be a prime mover rather

than a passive helper, a tool, a cork tossed about on the waves.

• Assume a tendency to improve things, to straighten the crooked picture on the

wall, to clean up the dirty mess, to put things right, make things better, to do
things better.

• Assume that growth occurs through delight and through boredom.

• Assume preference for being a whole person and not a part, not a thing or an
implement, or tool, or "hand."

• Assume the preference for working rather than being idle.

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• We must assume the defense and growth dialectic for all these positive trends
that we have already listed above.

• Assume that everyone but especially the more developed persons prefer
responsibility to dependency and passivity most of the time.

• The general assumption is that people will get more pleasure out of loving
than they will out of hating (although the pleasures of hating are real and
should not be overlooked).

• Assume that fairly well-developed people would rather create than destroy.

• Assume that fairly well-developed people would rather be interested than be

bored.

• We must ultimately assume at the highest theoretical levels of eupsychian

theory, a preference or a tendency to identify with more and more of the
world, moving toward the ultimate of mysticism, a fusion with the world, or
peak experience, cosmic consciousness, etc.

• Finally we shall have to work out the assumption of the metamotives and the
metapathologies, of the yearning for the "B-values," i.e., truth, beauty, justice,
perfection, and so on.

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PHILOSOPHY

• It is the study of general problems concerning matters such as existence,

knowledge, truth, beauty, justice, validity, mind, and language.
• Philosophy is distinguished from other ways of addressing these questions (such as
mysticism or mythology) by its critical, generally systematic approach and its
reliance on reasoned argument.
• The word philosophy is of Ancient Greek origin: (philosophia), meaning "love of
wisdom."- Wikipedia

In Nursing Philosophy

• Is the statement of beliefs and values that direct one’s life. In an organization the
philosophy is the sense of purpose of the organization and the reason behind its
structure and goals.
• The nursing philosophy may be broad and general. But it directs nursing behavior
• The statement of the philosophy emphasized the following:

a. Quality
b. Quantity
c. Scope of service
d. Decision making (factual information)
e. Appropriate delegation of function
f. Achievement of organizational goals
g. Vertical and horizontal communication
h. Flexibility to meet change

NOTE: The Philosophy of nursing service dovetails with the philosophy of the agency.

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Vision Statement

• A vision statement is sometimes called a picture of your company in the future

but it’s so much more than that. Your vision statement is your inspiration, the
framework for all your strategic planning.

- “Where do we want to go”

- It outlines the organization future role and function; it also gives the
agency something to strive for.
- It is a guiding image of success formed in terms of a contribution to
society. If a strategic plan is the "blueprint" for an organization's work,
then the vision is the "artist's rendering"of the achievement of that plan. It
is a description in words that conjures up a similarpicture for each member
of the group of the destination of the group's work together.

Mission

• A mission statement is a brief statement of the purpose of a company,

organization.
• The mission statement outlines the agency’s reason for existing, who the
target clients and what services.

Values
• Values are traits or qualities that are considered worthwhile; they represent an
individual’s highest priorities and deeply held driving forces.
• Values are also known as core values and as governing values.
• It defines how people want to behave with each other in the organization.

Goals and Objectives

• Goals are broad, generalized statements about what is to be aimed. Think of them
as a target to be reached, or "hit."
• Objectives on the other hand tend to be more specific and concrete.
• Both are action commitment through which an organization’s mission and
purpose will be achieved. It is stated In terms of results to be achieved

Develop Programs, Project, Activities and Strategies

• Kron has developed a planning formula which may be used for daily duties, or for
short and long range project.

The planning formula:

1. What
2. When
3. Where
4. How
5. Who

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 6. Why
7. Can

Time Management
• Is a technique for allocating ones time through the setting of goals, assigning
priorities, identifying and eliminated wasted time, and using managerial
techniques to reach goal efficiently.

Time management principles:

1. Planning anticipates the problem that will arise from actions without thought.
2. tasks to be accomplished should be done in sequence
3. setting deadlines
4. learning to understand why one procrastinates makes him aware that a plan can be
initiated
5. Delegation

Nursing Standards / Policies /Procedures

• Standard is an established norm or requirement. It is usually a formal document

that establishes uniform engineering or technical criteria, methods, processes and
practices.
• A Policy is typically described as a deliberate plan of action to guide decisions
and achieve rational outcome(s). Policy differs from rules or law. While law can
compel or prohibit behaviors (e.g. a law requiring the payment of taxes on
income) policy merely guides actions toward those that are most likely to achieve
a desired outcome.
• Policies are broad guidelines to managerial decisions that are necessary in an
organizational and departmental planning. They served as a basis for the future
actions and decisions it helps coordinate plans, direct performance.

Three general areas in nursing that require policy formulation:

1. Areas in which confusion about the locus of responsibility might result in

neglect or malperformance of an act necessary to patient’s welfare.
2. Areas pertaining to protection of patient’s right.
3. Areas involving personnel management welfare.

Characteristic of good policies

1. Policies should be written and understandable and known by those who will
affect them
2. Policies should be comprehensive in scope, stable and flexible.
3. Policies should be consistent.
4. Policies should be realistic and should be prescribed limit

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 5. Policies should allow for discretion and interpretation by those responsible for
it.

The Nursing Service Policy Manual

• Department policies must reflect the policies of the hospital

• Define the scope of the departmental responsibility within the
hospital/organization
• The manual is effective when unexpected problem arise as a basis for developing
administrative procedure

Interdepartmental Policies

• Are developed in keeping with overall hospital policies

• Coordination of all activities in obtaining the same final goal may be made
through the use of written policies

Nursing Procedures

Are specific directions for implementing written policies

There are two areas where procedure are needed are those that are related to job
situation, and those involving patient care
• Nursing procedure manual should be available in all units
Has a general format
• It is always reviewed, updated and or revised.

Sample Vision Mission of Different Institutions

SAN JUAN DE DIOS EDUCATIONAL FOUNDATION INC., HOSPITAL

Vision
A world-class, innovative and Christ-centered health care service provider
committed to evangelized healing through compassionate quality care.

Mission
As a living witness to Christ centered gospel values we:

Vigorously sustain world class, innovative and Christ-centered health care services
with compassionate quality care.
Responsively meet the needs of customers through dynamic enhancing of assets.
Continuously conduct training and formation to health care service providers.
Adeptly leverage resources for viability.

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Forecasting
The process of making statements about events whose actual outcomes (typically)
have not yet been observed. A commonplace example might be estimation of the
expected value for some variable of interest at some specified future date.
Forecasting is the science of predicting future outcomes. In business, it applies to the
future of a business, product, or industry. It's extremely important for a business
to do proper forecasting before developing new products or product lines, lest you
spend a lot of time and money developing a product that fails in the marketplace
Forecasting can be described as predicting what the future will look like, whereas
planning predicts what the future should look like.
TYPE OF AGENCY WHICH WILL OPERATE

I. Primary
• Health center, private practitioner’s clinic, barangay health stations
provision of the most basic health services at the community level
first contact of individuals to the health care system
actions to protect against disease and disability, such as getting immunizations,
ensuring the supply of safe drinking water, applying dental sealants to prevent
tooth decay, and guarding against accidents.
Health promotion includes the basic activities of a healthy lifestyle: good nutrition
and hygiene, adequate exercise and rest, and avoidance of environmental and
health risks

Health promotion also includes education about the other interdependent

dimensions of health known as wellness.

Examples of health education programs aimed at wellness include stress

management, parenting classes, preparation for retirement from the
workforce, and cooking classes.

making environmental changes, such as improving the safety and purity of

food and water supplies and providing immunizations

Secondary
District Hospitals, Municipal Hospitals
Facilities either privately owned or government operated such as infirmaries,
municipal, district hospitals and out-patient departments of provincial
hospital.
Should have diagnostic equipment like X-ray and a laboratory.
Includes simple surgery like appendectomy and caesarian sections

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 • Secondary prevention is to identify and detect disease in its earliest stages,
before noticeable symptoms develop, when it is most likely to be treated
successfully. With early detection and diagnosis, it may be possible to cure a
disease, slow its progression, prevent or minimize complications, and limit
disability.

Tertiary Hospitals
• General hospitals, Regional Hospitals, City hospitals
Delivery of highly specialized care
300- 500 bed capacity
a major hospital that usually has a full complement of services including
pediatrics, general medicine, various branches of surgery and psychiatry
Referral for secondary care facilities

Specialty Hospitals
• Philippine Heart Center, Kidney Institute of the Philippines, Lung Center
Specialize in treating patients with serious and often complex medical conditions
requiring a longer length of stay.
Types of specialized hospitals include trauma centers, children's hospitals, seniors'
hospitals, and hospitals for dealing with specific medical needs such as
psychiatric problems, pulmonary diseases, and so forth.

BUDGETING

DEFINITION:
Systematic documentation of one or more carefully developed plans for all
individually supervised activities, programs or sections to meet overall and
specific unit goals.
a plan that outlines an organization's financial and operational goals. So a budget may
be thought of as an action plan; planning a budget helps a business allocate
resources, evaluate performance, and formulate plans.
planning a budget can occur at any time, for many businesses, planning a budget is an
annual task, where the past year's budget is reviewed and budget projections are
made for the next three or even five years.
Plan that expresses the activities of an agency in terms of pesos covering a specific
period of time.
Plan for allocation of resources and a control for ensuring that results comply with the
plans.
A plan or schedule adjusting expenses during a certain period to the estimate or fix
income for the period.
An operational management plan stated in terms of income and expenses

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Nursing budget
A plan for allocation of resources based on preconceived needs for a proposed series
of programs to deliver patient care during one fiscal year.

Hospital budget
Is a financial plan to meet future service expectations. These expectations are derived
from the best judgment of the needs of the community.
Budgeting translates these needs to manpower, equipment and supplies so that both
services are provided at the highest level of quality at a minimum cost.

TYPES OF BUDGETING

1. Sales budget: The sales budget is an estimate of future sales, often broken
down into both units and dollars. It is used to create company sales goals.

2. Production budget: Product oriented companies create a production

budget which estimates the number of units that must be manufactured to
meet the sales goals. The production budget also estimates the various costs
involved with manufacturing those units, including labor and material.

3. Cash Flow/Cash budget: The cash flow budget is a prediction of future cash
receipts and expenditures for a particular time period. It usually covers a
period in the short term future. The cash flow budget helps the business
determine when income will be sufficient to cover expenses and when the
company will need to seek outside financing.

4. Marketing budget: The marketing budget is an estimate of the funds needed

for promotion, advertising, and public relations in order to market the product
or service.

5. Project budget: The project budget is a prediction of the costs associated with
a particular company project. These costs include labor, materials, and other
related expenses. The project budget is often broken down into specific tasks,
with task budgets assigned to each.

6. Revenue budget: The Revenue Budget consists of revenue receipts of

government and the expenditure met from these revenues. Tax revenues are
made up of taxes and other duties that the government levies.

7. Expenditure budget: A budget type which include of spending data items.

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THE BUDGETARY PROCESS
1. Budget Officer
2. Budget Committee
- Well defined in order to assure an orderly and timely development of the budget.
- Can assist the budget officer in budget preparation and in monitoring the budget.
- Member
o Chief Nurse or his/her assistant
 Preparing the budget for the nursing service
• Chief nurse works with
• Supervisors and
• Head nurses
• Nursing personnel participation in budget preparation &
control leads to cost consciousness, awareness of
activities, and increased cost-effectiveness.
• Supervising nurse works with the head nurses to determine the staff requirements
for each unit.
Past operations must be analyzed and the overall master staffing plan must be
reviewed.
• Factors to be considered in Budget preparation
- Assurance of standards according to the philosophy and objectives of the
hospital and the division of nursing
- Anticipated needs of the units
- Percentage of unit occupancy

• Estimation of staff for each unit should be based on

the number of patients
the number of nursing care hours needed
the provision of vacation, sick and other leaves, holidays and average number
of absences per staff member per year.
Other privileges such as attendance in continuing education programs should
also be taken into account. These gives a visible method of interpreting
nursing care needs for the budget committee and the hospital
administration.
• Consider new activities/programs such as new patient services, staff development
programs or changes in hospital services that affect the required nursing services.
• Ascertain the amount and kind of supplies needed for the operation of each
nursing unit. A review of past expenses and consumption provides data for
planning. Requests for the replacement of capital equipment must be supported
with documented justification.

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 • Chief nurse complies and completes the final draft of the budget and presents
this to budget officer or hospital administrator.

Nurse Managers
• Not accountable totally on planning for organizational budget,
• Must be aware of those financial concerns that may effects on nursing department
and the whole organizational system.
• Nurse Managers should actively participate in the budget preparation.

Benefits Derived From the Budgetary Process –Categorized under the major functions of
Management

1. Planning
• Budgeting stimulates thinking in advance.
• Anticipates future opportunities or problems and prepares for them.
• It leads to specific planning such as the
 volume and type of services to be rendered and revenue to be derived
there from
 the number & type of personnel required
 the cost , volume and type of supplies needed
 the cost of fixed assets when needed
 their costs and sources of funds
 cash collection and disbursements
• Budget preparation stimulates action and interaction.
 While mechanical budgeting process gives empirical information,
additional benefits results from the organizational thinking process that is
generated and the worthwhile interrelationships that develop.

2. Coordination
• The budgetary process has a balancing effect on the total organization, that is the
quantity and quality of service to be given a patient should closely equal the
expected revenue.
• If monthly trends are defined, gains and losses can be detected.
• Since hospital departments are interrelated, future plans of one department must
complement the plans of other affected departments.
• Budgeting encourages exchange of information.
• The budgetary process stimulates team play or team approach.

3. Comprehensive control

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 • Budgeting process gives the administration an opportunity to evaluate the
thinking of budget contributor.
• Once budget standards are set, comparisons between actual expenditures and
budgeted standards can be made with little or no effort.
• Though the budgeting process is flexible , it tends to define fixed and agreed
upon goals.
• Cost consciousness is enhanced throughout the institution.

FACTORS IN BUDGET PLANNING

Nursing service needs are determined by many factors which the staff should be aware of
as budget planning proceeds. These are the:

1. Type of patient (medical, surgery, maternity, pediatirc, communicable disease,

chronically ill), length of stay in the hospital, and the acuteness of the illness.
2. Size of the hospital and its bed occupancy
3. Physical layout of the hospital, the size and plan of the wards or units , the
nurses station, treatment rooms , etc.
4. Personnel policies
5. Salaries paid to various types of nursing personnel, including pay for overtime
or shift differential.
6. Extent of vacation and sick leaves , holidays
7. Provision for staff development programs including instructional staff
8. Grouping of patients (specialized areas e.g. ICU)
9. Standards of nursing care e.g. kind & amount of care to be given as it affects
the number of hours of bedside care.
10. Method of performing nursing care whether simple or complex
11. Method of documentation
12. Proportion of nursing care provided by professional nurses
13. Amount and quality of supervision available and provided
14. Efficiency of job description and job classification
15. The method and of patient assignment , whether functional, case, team or
primary
16. Amount and kind of labor –saving devices and equipment ,
intercommunication systems
17. Amount of centralized service provided; sterile supply, central oxygen
service, linen supply
18. Nursing service requirements of the ancillary departments : clinics, admitting
office , emergency rooms
19. Reports required by administration whether simple or complex
20. Affiliation of nursing students or medical students e.g. inexperienced students
need more equipment and supplies.

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STRATEGIC PLANNING OR LONG-RANGE PLANNING IN NURSING
MANAGEMENT

1. Is concerned with what the division of nursing should be doing.

2. Its Purpose is to improve allocation of scarce resources: Money & Time, and
to Manage the division of nursing for performance.
3. It provides strategic forecasting from 3 years up to 20 years .
4. It involves top nurse managers and can effectively involve representatives of
all levels of nursing management and practice.
5. It analyze projected technologies advances , the internal and external
environments , the nursing and health care market and industry, the economics
of nursing and health care , availability of human and material resources,
judgment of top management , and other factors.
6. Participants will range from top nursing management to a cross-section of all
levels of management. Including input from clinical nursing personnel that
promotes professional satisfaction throughout the nursing division.

PURPOSE OF BUDGETING

1. Provide a forecast of revenues and expenditures

• i.e. construct a model of how our business might perform financially speaking
if certain strategies, events and plans are carried out.

Budgeting is a critically important part of the business planning process.

The club management committee needs to be able to predict whether
the club will make a profit or not.
A budget is basically a model of how the club might perform, financially
speaking, if certain strategies, events, plans are carried out.

2. Enable the actual financial operation of the business to be measured against

the forecast.
3. A tool for decision making

Once the budget has been set, the budget provides a financial framework
for the decision making process i.e. is the proposed course action
something we have planned for or not.

4. A means to monitor business performance

Once a budget is in place, it enables the actual financial operation of the

club to be measured against the forecast i.e. is the business living up to
our expectations.

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28
STEPS IN BUDGETING

The Rule of Three In Budgeting

• A method to help companies prepare for such a contingency.

• This rule of budgeting says that a company or its individual departments ought to
divide itself into three parts:

1. Part that is considered essential

2. Part that is desirable

3. Part that is dispensable.

The budgeting process requires essentially five steps:

1. Determining the Flow of Information

2. Deciding What You’re Going to Measure
3. Gathering Historic Data
4. Making Projections
5. Determining break-even point

STEPS IN HOSPITAL BUDGETING

Step 1. Define the Organizational Structure

Step 2. Determine Cost Drivers and Controlling Forces for Each Department
Step 3. Forecast Revenue from Clinical Care Departments
Step 4. Define Clinical Pathways and Step-Function & Fixed Costs for Clinical
Care Departments
Step 5. Determine Variable Cost per Resource Unit
Step 6. Estimate Service Department Step & Fixed Costs
Step 7. Calculate Variable Cost per Case Type
Step 8. Compute the Surplus (Deficit) for Each Clinical Care Department
Step 9. Compute Contribution to Hospital Overhead
Step 10. Estimate Administrative Service Costs
Step 11. Compute Hospital’s Clinical Surplus (Deficit)

(Reference: Formulating and Managing a Hospital’s Clinical Care Budget: A Twelve

Step Program, Cambridge, Massachusetts, David W. Young, DBA, July 22, 2004)

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References:

• Formulating and Managing a Hospital’s Clinical Care Budget: A Twelve Step

Program: David W. Young, DBA, July 22, 2004
•

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