MANAGEMENT BY OBJECTIVES (MBO)

I.NTRODUCTION
Management by objectives is a Boon for healthcare administration. The concept
of management by objectives (MBO) was introduced by Peter Drucker in 1954.
MBO is both a philosophy and a technique. MBO is both a philosophy and a
technique of management. It represents a rational and systematic approach to
management where in measurable goals are set up in consultation with
subordinate managers and the contribution of each individual is judged in terms
of such goals.
II.DEFINITION
MBO is defined as ‘a process whereby the superior and subordinate managers of
an organization jointly identify its (the organization’s) common goals, define
each individual’s major area of responsibilities in terms of the results expected of
an individual, and use these measures as guides for operating the unit and
assessing the contribution of each of its members
- Odiorne

MBO is a result-centered, non specialist, operational managerial process for the

effective utilization of material, physical and human resources of the
organization by integrating the individual with the organization and organization
with the environment.
-SK Chakraborty
The philosophy of MBO is a collective endeavor to create an environment in
which each individual is provided with optimum opportunity to realize his full
potential. It is a system in which each employee participates in determining
personnel objectives as well as the means by which he or she hopes to achieve
these objectives. It makes each employee a manager of his or her own particular
work.
-George Terry

III.CONCEPT OF MBO

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MBO is an approach of management that respects on the participation of
subordinates, allowing them to make decision and participate in decision making
process. Traditionally, the top level management team formulated goals and
objectives of the organization before giving instructions down to middle
management, who then communicated that information on to the lowest level
employees. It was a method that did little to encourage participation or
cooperation from the lowel group of employees of the organization. Whereas
MBO ensures that everyone is included in the decisions process, from the top, all
the way down to the lowest employee level.
IV.OBJECTIVES OF MANAGEMENT BY OBJECTIVES
Management by objectives is intended primarily:
1. To measure and judge performance

2. To relate individual performance to organisational goals

3. To clarify both the job to be done and the expectations of accomplishment

4. To foster the increasing competence and growth of the subordinate

5. To enhance communications between superiors and subordinates

6. To serve as a basis for judgements about salary and promotion

7. To stimulate the subordinates’ motivation; and to serve as a device for

organisational control and integration.

V.CHARACTERISTICS OF MANAGEMENT BY OBJECTIVES
i. MBO focuses attention on what must be accomplished (goals) rather than on
how it is to be accomplished (methods). It Is a goal-oriented rather than work
oriented approach
ii. MBO involves participation of subordinate managers in the goal setting
process. It requires all key personnel to contribute maximum to achieve the
overall objectives.
iii. MBO stresses measurable and verifiable goals in key result areas. It attempts
to blend and balance the goals of all key personnel.
iv. MBO is a dynamic system which seeks to integrate the company's need to
achieve its objectives with the manager’s need to contribute and develop
himself.

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v. MBO is an overall philosophy of management that allows management to
attain maximum results from available resources. It is not a set of rules or
procedures but a way of thinking about managing.
vi.. MBO has an operational thrust involving linkage between organisational
goals and individual goals.
vii. MBO is a continuous process of goal setting, periodic appraisals arid
modification of goals and performance.
viii. It sets an evaluative mechanism by which the contribution of each individual
can be measured.
VI. PROCESS OF MBO
MBO is essentially a philosophy of management based on identifying
purpose, objectives, strategy, desired results and evaluating performance in
achieving them.

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1. Preliminary Goal-setting: The first phase of MBO is the clarification of the
objectives which the organisation is to attain. The long-term overall goals of the
enterprise are laid down in the key result areas. These goals are laid down
keeping in view the internal and external environments of the organisation.
These goals are preliminary and tentative subject to modification as the full
range of verifiable objectives is evolved by the organisation. While the strategic
objectives may be verbal, operational goals must be measurable so as to serve
definite yardsticks of goals accomplishment.
2. Setting Subordinates Objectives: The organisational objectives are achieved
through individuals. Therefore, each individual must know what he is expected
to achieve. In setting objectives for subordinates, the organisational goals,
subordinates’ ability and resources available to him should be duly considered.
Subordinates’ objectives must be set in consultation with the individuals
concerned. The allocation of resources should also be made in consultation with
subordinates. There must be proper matching of goals and resources.
3. Recycling Objectives: Under MBO goals-setting is not direction from the top.
Rather it is a two-way process in which the superior suggests a goal that is
acceptable to the subordinate. Goal-setting is a joint and interactive process. A
network of objectives is created so that every lower level objective contributes
effectively to the achievement of the objectives next to it.
4. Action Planning: Once goals are established at all levels, action programmes
are developed for their accomplishment. Detailed procedures are set up for the
utilisation of resources and for achievement of pre-determined targets. Action
planning may call for revision of existing organisation structure. The
organisation charts, manuals and job descriptions should be suitably amended.
The authority and responsibility of each job and its relationship with other jobs
should be clearly defined. Check-points should be established for evaluation of
results in key areas.

5. Periodic Performance Reviews: At specified intervals, progress towards the

accomplishment of goals is reviewed in consultation with subordinates. Such
reviews are made to identify shortcomings and to take timely steps to improve
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results. Feedback from these reviews is provided to each individual to facilitate
self-regulation and control. Progress towards the goal is discussed and potential
for improvement is identified. In such reviews, the superior serves as a
counsellor and guide to the subordinates.

6. Final Appraisal: A thorough evaluation of performance is made at the end of

the year. Achievements are analysed in the light of established goals and
standards. Organisational goals and action plans are suitably modified. Rewards
are decided on the basis of such appraisal. The focus is on improving
performance and on development rather than on downgrading poor performance.

VII.ADVANTAGES OF MBO
1. Improved Planning: MBO produces clear and measurable performance
goals. A network of goals is created and appropriate action plans are
formulated for goal achievement. Research reveals that people tend to set
their goals higher than superiors would set them. Joint goal-setting ensures
that managers understand their goals. T here is effective matching of goals
and resources. Clear goals and action plans generate concrete thinking and
lead to result-oriented and forward planning. MBO forces managers to plan
for results rather than plan for work. It ensures that goals of each department
are consistent with the overall objectives of the organisation.
2. Team Work: MBO results in better communication between superiors and
subordinates which reduces conflicts. The whole management team is
actively involved in goal-setting. There is integration of lower level goals
with organisational goals. Each individual knows clearly what is expected of
him. This helps to avoid goal erosion, duplication of efforts and wasted
efforts. Different individuals are fused into a cooperative team. MBO clarifies
the job assignment and responsibility of each individual.
3. Effective Self-control: A clear set of verifiable goals provides effective
standards for self-control. Managerial efforts are concentrated on critical
areas of performance (key result areas). Leadership is freed from the routine
tasks and. therefore, concentrates its efforts and time on piloting the

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 enterprise through the turbulent environment. Problems hindering high
performance can be identified and plans can be developed to solve such
problems. MBO provides a mechanism by which managers can ensure that
enterprise is moving in right direction.
4. Objective Appraisal: MBO permits impartial appraisal because employee
performance is evaluated against verifiable and mutually agreed criteria.
Managers are measured by what they accomplish rather than how they spend
their time. MBO does away with the judgemental role of the supervisor. The
performance of every individual is evaluated in terms of the mutually agreed
targets. Under MBO, the superior does not evaluate the subordinate but his
performance. Moreover, the performance review is aimed to assist the
subordinate to improve his performance. MBO also allows employees to
monitor and control their own performance. Such self-appraisal facilitates
personal development. MBO helps to develop managers who have potential
for growth. Appropriate training programmes can be formulated on the basis
of performance reviews.
5. Motivation and Morale: MBO leads to better interpersonal relations
through involvement and recognition of people at all levels. It provides greater
opportunities to make personal contribution and to accept more responsibility.
Participative goal setting and two-way communication improve the
commitment and morale of employees. Superior managers assume a
supportive role and subordinates are allowed to exercise self-direction and
self-control. This results in innovation and creativity 0n the part of
subordinate managers.
VIII.DISADVANTAGES OF MBO
1. Goal-setting Problems: Very often, it is very difficult to set timely
verifiable and measurable goals. Over-emphasis on quantifiable and easily
measurable goals may result in neglect of crucial qualitative goals like job
satisfaction. Similarly, overemphasis on short-term goals may be at the cost
of long-term goals. Goals may take precedence over the individuals who use

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 them. Focus on end results may result in use of questionable actions. Goals
once set may be followed rigidly leading to inflexibility in the organisation.
2. Time Consuming: MBO requires a great deal of time in setting
measurable goals through consensus. In the initial stages several meetings
may have to be held to instil confidence in subordinates. The formal periodic
reviews and final appraisal sessions also consume a lot of time. In this way,
the patience of those responsible for its implementation is taxed.
3. Increased Paperwork: MBO results in a plethora of newsletters,
instruction booklets, training manuals, performance reports. etc. Subordinates
have to {ill in forms and submit detailed reports on their performance. This
reduces the effectiveness of MBO.
4. Pressure-oriented: Under MBO managers are forced to assume a
supportive role. A fundamental change is required in their thinking and acting
style which is not easy. In many cases, MBO programmes indiscriminately
force improvement 011 all employees. The programme is used as a ‘whip’ to
control performance thereby attacking the integrity of subordinates’
personality. An MBO programme based on reward-punishment psychology
may prove self-defeating in the long run.
5. Undermining Leadership: In a scheme of MBO, leadership does not find a
central place. To much reliance is placed on rational attitudes and intelligent
consensus. M80 is based on a particular type of democratic leadership which
may not be successful in all situations. Where personal relationships between
superior and his subordinate are not cordial, the participative approach may fail
to work. MBO is based on the assumption that employees always work
rationally and objectively. In reality, there may be a tug of war in which the
subordinate tries to set the lowest possible targets and superior the highest.
There may also be conflicts between organisational goals and individual goals.
Failure to teach the philosophy to all participants is also an obstacle in
successful implementation of MBO.
6. Participation Problem: MBO requires internal goal-setting by the superior
and the subordinate. In many cases, the goals are set by the superior because he

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 has no time to discuss it with the subordinate or he is not willing to share power
with the subordinate. In other cases, the subordinate may not be willing to set
goals for himself because he is incompetent or he fears criticism from the
superior.
7. Inflexibility: MBO may introduce inflexibility in the organisation. Once
goals are set down, the superior may not like to modify them due to fear of
resistance from the subordinate.
IX. SUGGESTION FOR MAKING MBO EFECTIVE
Successful implementation of MBO requires the following conditions:
1. Purpose: MBO is a means rather than an end in itself. It may be used for
different purposes, e.g., long-range planning, performance appraisal, productivity
improvement. etc. The details and mechanics of MBO programme vary with the
purpose for which it is used. Therefore, the purpose should be clearly defined
before installing an MBO programme.
2. Top Management Support: MBO cannot be implemented successfully
without complete support and commitment of top management. An effective
programme of managing by objectives must start at the top of the organisation. If
the top manager uses the objectives as an instrument for managing. the practice
will be followed down in the organisation. Top executives can create
commitment and involvement of subordinate managers only when they
themselves are fully convinced of the utility of an MBO programme. MBO
should be integrated into the planning and control system of the enterprise.
3. Orientation and Training: MBO requires a fundamental change in the
thinking and attitudes of executives. Planning for work should give the way to
planning for results. Initial resistance to change needs to be overcome. It is.
therefore, necessary to expose managers to the philosophy and mechanics of
MBO through group discussions and seminars. A climate of mutual trust and
confidence has to be created if MBO is to thrive. Training in interpersonal
relationships and group dynamics must, therefore, be provided to people at all
levels. In the initial stages, an MBO adviser may be appointed to resolve
conflicts in goals and measures of performance. Initial enthusiasm and good faith

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often wane as difficulties develop. An outside MBO adviser can sustain such
enthusiasm and good faith.
4. Adequate Time and Resources: An effective MBO programme cannot be
installed overnight. It may take three to five years before the M80 programme
Starts yielding results. Therefore. managers must be allocated adequate time and
resource for the installation and operation of the M80 programme. Adequate
authority Should be given to persons responsible for administering the
programme. The responsible and relationships concerning MBO must be clearly
defined. A manual of procedures may be prepared to facilitate goal-setting and
performance appraisal in MBO.
5. Decentralisation: Success in M80 requires active participation of
subordinates in goal-setting and in performance appraisal. Therefore,
subordinates should be given adequate authority to accomplish their goals. If the
superior does not delegate sufficient authority, subordinates will not be willing to
accept new assignments and they will resist the setting of clearly defined goals.
6. Timer Feedback: Periodic review, counselling and control are mandatory to
the success of an M80 programme. Therefore, superiors must constantly monitor
the programme and provide advice and encouragement to subordinates from time
to time. Feedback on performance should be provided to every individual to
enable him to learn and improve himself on sustained basis. There should be an
effective two-way communication in the organisation.
7. Politics: MBO may result in redistribution of power and can alter the status of
people in the organisation. Therefore, it may generate hostile reactions in the
forms of infighting, overt conflict. Managers must be sensitive to and effectively
handle these political considerations while implementing MBO programme. An
open two way communication system must be set up. Superiors must be prepared
to give Subordinates the opportunity to participate actively in goal-setting and
performance appraisal.

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 C. PLANNING FOR CHANGE
I. INTRODUCTION
Most organizations today find themselves undertaking a number of projects as
part of change efforts directed at organizational restructuring, quality
improvement, and employee empowerment. Davidhizar (1996) suggests that
the three major drivers of change in contemporary healthcare are technology,
information availability, and growing populations. Regardless of the type of
change, all major change brings feelings of achievement, loss, pride, and stress.
What differentiates a successful change effort from an unsuccessful one is often
the ability of a change agent-a person skilled in the theory and implementation
of planned change-to deal appropriately with these very real human emotions
and to connect and balance all aspects of the organization that will be affected
by that change. It becomes clear, then, that initiating and coordinating change
requires well developed leadership and management skills. Dye (2000) goes so
far as to say that one of the most fundamental values that differentiate effective
leaders from average leaders is the desire to “make a difference.” This value
impels effective leaders (change agents) to become high achievers, to
constantly seek out and address flaws and implement positive change to
improve the organizations in part and society as a whole.
II. MEANING
The word ‘change’ is translated in Sanskrit language as ‘vishwa'.
Etymologically it comes from root word ‘vish’ meaning spreading, that which
is never same at two different points of time. It is not an occurrence but the way
of existing. To change simply means to alter, to become different, or to
transform. Change refers to an alteration in a system whether physical,
biological, or social. These alterations come from as a result of internal forces
or external forces impinging on an individual or organization.
III. DEFINITION
Planned change, is the deliberate application of knowledge and skills by a
leader to bring about a change.
Bessie. L. Marquis

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Planned change entails planning and application of strategic actions designed
to promote movement towards a desired goal.
Deepak
Planned change is a change that results from a well thought out and
deliberates effort to make something happen. It is the deliberate application
of knowledge and skills by a leader to bring about a change”.
Tappen,
IV.CHANGE AGENT
1. A change agent is someone who deliberately tries to bring about a change

or innovation, often associated with facilitating change in an organization

or institution. To some degree, change always involves the exercise of

power, politics, and interpersonal influence. It is critical to understand the

existing power structure when change is being contemplated.

2. A change agent must understand the social, organizational, and political

identities and interests of those involved; must focus on what really

matters; assess the agenda of all involved parties; and plan for action.

3. The change agent should have the following qualities

a. The ability to combine ideas

b. The ability to energize others

c. Skills in human relations

d. Integrative thinking

e. Flexibility modify ideas

f. Persistent, confident and has realistic thinking

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V. ASSUMPTIONS REGARDING CHANGE
1. Change represents loss. Even if the change is positive, there is a loss of
stability. The leader of change must be sensitive to the loss experienced by
others.
2. The more consistent the change goal is with the individual’s personal
values and beliefs, the more likely the change is to be accepted. Likewise the
more difficult the goal is from the individual’s personal values; the more likely
it is to be rejected.
3. Those who actively participate in change process feel accountable for the
outcome.
4. Timing is important in change. With each successive change in a series of
changes, individual’s psychological adjustment to the change occurs more
slowly. And for this reason the leader of change must avoid initiating too many
changes at once.
VI. DIMENSIONS OF CHANGE

The dimensions of change have been classified depending upon how the

organization is viewed by the managers.

1. When the organization is viewed as a multivariate system

Planned change attempts to cover all aspects of organization, which are

closely interrelated: technology, task, structure and people

Structure

Task
Technology

People

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1. Technology related changes
These types of changes aim at improving the efficiency of technology and
works by changing man- job, job-job and man- man relationships. Man –
job relationships are changed due to changes by improving managerial
technology e.g. use of computers for managerial planning like data
processing, problem solving and decision making, which makes jobs
easier and improving the employees efficiency. Job-job relationships are
improved by transferring the employees to a new group of supervisors.
Any changes in technology is going to affect other variables like tasks,
process, etc.
2. Structure related changes
These types of changes redefine the nature of relationship, formal
interaction pattern, work assignment, and authority structure. Replacing
the key personnel, by modifying the structure and by providing new
administrative guidance., can bring this type of change.
3. Task related changes
These types of changes determine the types of task that may be required
to complete an operation. These tasks may be designed ranging from
simplification to job enrichment. The changes must be focused on
competencies and skill in work performance and work motivation
4. People related changes
These types of changes are the changes required in employees, in
their behaviour, attitude and skill and knowledge. Socio psychological
factors do matters in shaping the behaviour of the employees that may be
done by training and development. To bring desired changes in behaviour
and attitude of employees is the most difficult task in planning a change in
the organization. The change in one of the dimension will touch off a
square of related and supporting changes. This is called “Domino effect”.
Therefore in making a change or creating a change in nursing unit, all the
dimensions of planned change need to kept in mind to make the changes
successful.

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 2. When the Organization is viewed as an Integral System
There is another view of looking at the organization i.e. the integral view.
Integral approach proposes that any phenomenon has two fundamental
dimensions of existence. These are the interior-exterior (subjective-
objective) dimension and the individual collective dimension.

Subjective objective

I It
Individual (Personal meaning, (Observable behaviour)
self level value )

Collective We Its
(Culture, shared value) (Organizational- systems and
Process)

Four quadrants of organizational reality

The domain of individual-subjective quadrant represents the personal

experiences and meaning. Domain of individual exterior is the behaviour
quadrant; domain of collective subjective is the cultural quadrant and the
domain of collective exteriors quadrant is the tangible social system and
processes. The integral view of change is based on Wilber’s (2002) four-
quadrant approach of reality. This approach facilitate the social event to be
analyzed in terms of its multilevel nature, i.e. its micro, meso, and macro forms
thus can be used in the held of organization development, leadership, change
management, etc.

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 3. Two Dimensions of change are viewed
Organizational transition or improvement and organizational transformation.
Looking from the integral perspective organizational transition and improvement
related change efforts are more focused on right quadrants, representing
observable individual behaviour and organizational systems, processes and
design aspects. Whereas organizational transformation is more holistic approach
involved individuals and cultural transformation.
4. The Seven Dimensions of Change
An average project manager has to contend with seven critical dimensions of
change in his every day work. These seven dimensions are further grouped into
three levels of complexity:

Level one: 1. Client requirement

2. Technology
Level two: 3. Client environment
4.Team
Level three: 5. Organization change
6.External environments
7. Competency expectation

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VII. PURPOSES OF PLANNED CHANGE

i. To bring the organization’s mode of adaptation to changes in

the environment, therefore bringing the organizational equilibrium for its
existence.
ii. To achieve the individual adaptation
iii. To make useful changes in the organizational structure
iv. To incorporate the new technology
v. To bring task adaptation, by defining the new roles, recruiting new staff
matching with the job requirement and by job enrichment methods.
VIII. ELEMENTS OF PLANNED CHANGE
a. VISION
First essential element for implementing change, whether it is at the micro or
macro level is the clear vision what is to be accomplished
b. GUIDING PRINCIPLES
One’s ability to accomplish vision
MISSION
A mission statement tells why the group exists
c. ORGANIZATIONAL STRUCTURE
Organization may choose any combination of the models;team model, whole
group model, hierarchal model
d. SITUATIONAL ANALYSIS
It is to highlight internal and external factors that can aid or hinder the group.
(Strength, weakness, opportunities, Threats)
e. GOALS AND OBJECTIVES
Goals are reached through objectives. An objective is a short term, practical
target related to a goal. Objectives are specific, measurable, attainable,
realistic and time bound.
f. PROJECT WORK PLANS
Outlines what needs to be done to meet each objective
g. FINANCIAL PLAN
It should be based on the goals and objectives of the group

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 h. COMMUNICATION PLAN
A communication strategy for the organization
i. EVALUATION PLAN
It includes outcomes, indicators and measures
IX. PRINCIPLES OF CHANGE MANAGEMENT
1. Involve people and agree support from them within system. The system is
environment, processes, culture, relationships, behaviours, etc., whether
personal or organizational.
2. Understand Where the organization is at the moment.
3.Understand where you want to go, when, why, and what the measures will
be for having got there.
4.Plan development in appropriate achievable and measurable stages.
5. Communicate, involve people and enable and facilitate them as early and
openly and as fully as is possible.
X. TYPES OF CHANGE
Hohn (1998) identified four different types of change: Change by exception,
Incremental Change, Pendulum Change and Paradigm Change.
i. Change by Exception: This occurs when someone makes an exception to an
existing belief system. For instance, if a client believes that all nurses are bossy,
but then experiences nursing care from a much modulated nurse, they may
change their belief about that particular nurse, but not all nurses in general.
ii. Incremental Change: A change that happens so gradually, that an individual
is not aware of it.
iii. Pendulum Changes: Are changes that result in extreme exchanges of points
of view.
iv. Paradigm Change: Involves a fundamental rethinking of premises and
assumptions, and involve a changing of beliefs, values and assumptions about
how the world works.

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 XI. THEORIES AND MODELS OF CHANGE MANAGEMENT
Various models and theories are proposed in the literature for effectively
managing and leading change. On the basis of the basic assumptions being
followed change models can be put on a continuum represents deterministic
models in which change is considered as predictable phenomenon. Lewin’s
three-step model and John Kotter’s model are the most widely referred
models in this category. On the other end of the continuum represents the
change models and approaches in which change is considered to be a
complex phenomenon. Models in this category are drawn from system
approach.
1. Kurt Lewin’s change theory
The theoretical foundations of change theory are robust: several theories
now exist, many coming from the disciplines of sociology, psychology;
education, and organizational management. Kurt Lewin (1890 1947) has
been acknowledged as the “father of social change theories” and presents a
simple yet powerful model to begin the study of change theory and
processes. He is also lauded as the originator of social psychology , action
research as well as organizational development. Kurt Lewin model change is
described in three phases, from a top down perspective unfreezing,
changing, and freezing as input, transformation and output.
Unfreezing : Where old ideas and processes are identified and tossed aside
to make room for newer ideas and change. The individuals involved must be
informed of the need for change and should agree that change is needed.
Faced with a dilemma or disconfirmation, the individual or group becomes
aware of a need to change. It needs planning.
Changing :This is the stage where new ideas and processes are defined,
learned and implemented. For example this stage might include retraining
staff in new methods. During this stage driving forces should exceed
restraining forces. The initiator of change, change agent, should recognize
that change takes time, should be accomplished gradually and should be

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planned systematically before implementation. The situation is diagnosed
and new models of behaviour are explored and tested.
Refreeze : This is where the changes made are institutionalized and are
identified as the ‘accepted’ way of doing things. During this phase,
stabilization occurs. If the stabilization is successful, the change is
assimilated into the system. Change disrupts the comfort of the status quo, it
leads to disequilibria, and hence resistance to change should be anticipated
and expected. Application of new behaviour is evaluated and if reinforcing,
adopted. This theory describes the forces that push towards change balance
against the forces that restrain change. The external and internal forces that
push towards change are called driving forces. A driving force encourages or
facilitates movement to a new direction, goal or outcome. Forces that push
against change are called restraining forces. A restraining force has the
opposite effect; restraining forces block progress towards the goal. When the
forces are in equilibrium, the current status is maintained. In planned change,
driving forces should be identified and be increased or the restraining forces
must decrease. The change agent must identify the driving and restraining
forces in order to determine the best plan for implementing change.

Planning Action Results

 Preliminary  Learning  Changes in
diagnosis process behaviour
 Data
 Action  Data
gathering
planning gathering
 Feedback of
results  Action  Measurement
 Action steps
planning
Changing Refreezing
unfreezing

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Lewin also created a model called “force field analysis” which offers
direction for diagnosing situations and managing change within organizations
and communities. According to Lewin's theories, human behavior is caused by
forces beliefs, expectations, cultural norms, and the like within the “life space”
of an individual or society. These forces can be positive, urging us toward a
behavior, or negative, propelling us away from a behavior.
1.“Driving Forces” :Driving forces are these forces affecting a situation that are
pushing in a particular direction; they tend to initiate a change and keep it going.
In terms of improving productivity in a work group. pressure from a supervisor,
incentive earnings, and competition may be examples of driving forces.
2.“Restraining Forces”: Restraining forces are forces acting to restrain or
decrease the driving forces. Apathy, hostility, and poor maintenance of
equipment may be examples of restraining forces against increased production.
3.“Equilibrium": This equilibrium, or present level of productivity, can be
raised or lowered by changes in the relationship between the driving and the
restraining forces. Equilibrium is reached when the sum of the driving forces
equals the sum of the restraining forces.
2. Lippitt’s phases of change theory
Lippitt’s theory is based on bringing in an external change agent to put a plan in
place to effect change. There are seven stages in this theory. The first three
stages correspond to Lewin’s unfreezing stage, the next two to his moving stage
and the final two to his freezing change. In this theory, there is a lot of focus on
the change agent. ’ The third stage assesses the change agent’s stamina,
commitment to change and power to make change happen. The fourth stage
describes what the change agent’s role will be so that it is understood by all the
parties involved and everyone will know what to expect from him. At the last
stage, the change agent separates himself from the change project. By this time,
the change has become permanent.
The seven phases shift the change process to include the role of a change
agent through the evolution of the change.
Phase 1:Diagnose the problem

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Phase 2:Assess the motivation and capacity for change
Phase 3:Assess the resources and motivation of the change agent(commitment
the change, power, and stamina)
Phase 4:Define progressive stages of change
Phase 5: Ensure the role and responsibility of the change agent is clear and
understood (communicator. facilitator, and subject matter expert)
Phase6: Maintain the change through communication, feedback, and group
coordination
Phase 7: Graduaily remove the change agent from the relationship, as the change
becomes part of an organizational culture.
3. Havelock’s change model
Havelock’s change theory has six stages and 'is a modification of the Lewin’s
theory of change. The six stages are building a relationship, diagnosing the
problem. Gathering resources, choosing the solution, gaining acceptance and self
renewal. In this theory, there is a lot of information gathering in the initial stages
of change during which staff nurses may realize the need for change and be
willing to accept any changes that are implemented. The first three stages are
described by Lewin’s unfreezing stage the next two by his moving stage and the
last by the freezing stage.
4. John P Kotter’s model
John Kotter’s highly regarded books “Leading Change’ (1995) and the follow-up
‘The Heart Of Change’ (2002) describes a helpful model for understanding and
managing change. Each stage acknowledges a key principle identified by Kotter
relating to people’s response and approach to change, in which people see, feel
and then change: Kotter’s eight step change model can be summarized as
i) Increase urgency :Inspire people to move, make objectives real and
relevant.
ii) Build the guiding team :Get the right people in place with the right
emotional commitment, and the right mix of skills and levels.

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iii) Get the vision: right Get the team to establish a simple vision and
strategy focus on emotional and creative aspects necessary to drive
service and efficiency.
iv) Communicate for buy: Involve as many people as possible,
communicate the essentials. simply, and to appeal and respond to people's
needs. De-clutter communications make technology work for you rather
than against.
v) Empower action: Remove obstacles, enable constructive feedback and
lots of support from leaders reward and recognize progress and
achievements.
vi) Create short-term wins: Set aims that are easy to achieve in bite-size
chunks. Manageable numbers of initiatives. Finish current stages before
starting new ones.
vii) Don’t let up: Foster and encourage determination and persistence
ongoing change encourage ongoing progress reporting highlight achieved
and future milestones.
viii) Make change stick: Reinforce the value of successful change via
recruitment, promotion and new change leaders.
XII. STRATEGIES FOR CHANGE
Various strategies can be used to create change, but in general there are three
main types of strategies: empirical-rational strategies, power-coercive
strategy, and normative educative strategy.
a. Power Coercive Strategy :In using Power-coercive strategy by a nurse who
wishes to be a change agent, would need official authority in order to bring
change. Regulations and rules originate from this type of strategy. It may be
used to force a change for the common good but may become very costly and
fail due to the resistance.
b. Empirical :Rational strategy is based on the facts and rationales. This type
of strategy, when used, a change will be accepted by a person, or group, or
organization when it is seen as desirable. It is primarily used for technological
changes.

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c. Normative Educative Strategy : This strategy is based on achieving the
changes in attitudes, beliefs, values, skills and norms of those who are
affected by the change. The change agent must involve those who are most
affected in working out the plans of achieving the change.

XIII. PROCESS OF PLANNING CHANGE

Planned change can be used to prepare the organization for change and
facilitate the process. The change is successful if it is taken in a planned
way which proceeds in a sequential form.

Identify need for change

Identify areas for change

Assessing the situation

Feedback

Planning for change

Assess change force

Monitoring and
evaluating change

Action for change/ implementing

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 Step 1: Identify Need for Change

Identify the need for change by analyzing the gap between existing and
desire state of affairs. It should be continuous process. The change in any of
the dimension of organization requires change in other dimensions. The
most information will come from feedback, control data. Assess internal
and external factors of organization that require change. Apply Gleicher’s
Formula to propose desired degree of success in planned change.

Step 2: Identify Areas for Change

Usually change is required in organization structure, technology and

people. The nature and size of area depend on type and severity of problem
identified and difference in the evident gap.

Step 3:Assessing the Situation

Assess the situation in which the change is to take place. What are the
difficulties or problems that this change is designed to alter? Is the change
designed to improve the system that is currently working satisfactory? Is
the change being driven externally or internally? Who supports the
potential for change? Who will gain from the change and who will lose?
For example a new computerized documentation system may be efficient,
but nurse who have felt expert at using the current system lose their
feelings of being expert and will face being novices again.

Step 4: Planning for Change

Change is the only constant or so the adage goes. Change is often a

complex and arduous process, and not something you want to attempt
without a solid plan. When organizations need to change, planning process
is often complicated by the need to change many elements in unison. When
planning for change, it is important to consider both the actions to make the
change and the (often far more problematic) problems that might meet in
gaining the required commitment to carry the actions through. Proper

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planning can overcome many problems associated with change
management.

Step 5: Assess Change Forces

Before introducing a change, one should be conscious of existing
practices, processes and cultures that may become hindrances in success.
These hindrances are related to organizational structure, culture norms,
performance matrices, behaviour of management and employees, and
communication. in-group there are some forces favouring and some
opposing change to maintain equilibrium in the organization as explained
by Lewin’s force field. Restringing forces are the forces that decrease the
driving forces, whereas the driving forces are the forces that influence the
change. Hence there should be equilibrium. In change management these
restringing forces are identified and tried to convert into driving forces so
that the employees accept the change.
Step 6: Actions for Change/ Implementing Change
Once plan is completed decide that it will work satisfactorily, it is time to
implement it. This involves directing the resources to complete the
activities specified, and monitoring the execution of the activities so that
corrections can be applied if necessary. Monitoring execution also allows
determining when the task has been achieved and activity can cease.
Several models are developed over the years to help manage change and to
deal with it most effectively. According to Lewin’s change model, action
for change comprises three stages: unfreezing, changing and refreezing as
explained earlier. Welch discussed these three phases of the change
process, to incorporate evidence-based practice into an agency, clinical
setting, or organization and Rogers discussed three stages of adopting a
practice innovation based on the evidence are knowledge, persuasion, and
adoption.

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An Iceberg approach can be used to managing change:
Identify the need
Communicate objectives and processes
Engage people for every ones participation
Build change communities: informal, cohorts and support groups
Evaluate the measure success
Reinforce positive change behaviours
Grow and develop during change.
Step 7:Monitoring and Evaluating the Change Process

During this stage, the situation needs to be monitored and evaluated. A

checklist can be developed during the planning. Is the change achieving the
goals within the allocated time and resources? Is the anticipated change
occurring or not? Are the participants beginning to show hope and
satisfaction with the change? For example, a staff nurse can not complete
charting tasks in the stipulated time of new practice program, the plan
needs to be revaluated, and alternatives needs to be worked out. May be
training program need to be strengthened or the fear of supervision will
have to be readdressed.

Step 8: Feedback

It is important to have feedback and follow-up actions to make sure that

change programme is progressing in a right direction or require
modifications. It should be based on objectives that should be defined
operationally. Depending upon the magnitude of the programme, formal
surveys or informal grapevine and other sources of information can be used
to seek this feedback. A report of the change from start to finish will
provide for reference for others and make the same or similar change move
more quickly and efficiently in the future.

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XIV. ROLE OF A NURSE MANAGER IN CHANGE MANAGEMENT
The role of a nurse manager as a change agent is very challenging to establish
new routines in place of old routines and she is to perform various roles.. She
should:
a) Encourage the staff to identify the areas that require changes
b) Motivate them to bring changes
c) Conduct regular meetings in order to make up their mindsets to accept changes
and avoid resistance
d) Adopt participatory approach and invite suggestions from the staff
e) Respect the ideas and Suggestions given by them
f) Be catalyst to mobilize the support of staff
g) Delegate appropriate responsibility to capable staff of that concerned.
h) Counsel the staff showing resistance and individual meetings with them
i) Discuss and make them understand the pro and cons of the changes to be made
j) Restore accountability in the process of change
k) Be flexible, strong to take risk and stable even if the results are not of expected
level. Look back the problems in the process and solve them.
l) Reward the team members for bringing the successful changes.

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 C. PLANNING A NEW VENTURE
I. INTRODUCTION
Venture planning is a personal assessment of feelings and feasibility of a
venture. Venture planning answers the question. The venture feasibility process
examines seven key factors in any venture. It is nothing but a risky start-up of an
establishment, company.
II. MEANING OF VENTURE
It refers managerial plans that give an opportunity or chance to set up a new
establishment based on innovative concepts It is developed on customer focused
ideas or technology. It is a process composed of various phases. It is not about
writing a Business Plan. Sometimes a business plan is not needed. Venture
Planning does not require detailed funding, source analysis, professional
opinions, entity formation or detailed market analysis.
III. DEFINITION
Venture Planning is development of a means of comparing various business
models, usually through financial modelling to answer the following
questions: Which venture concept produces the most sales, the best margins,
the highest net profit and the lowest breakeven?
1. Which model requires the least investment by entrepreneurs and others?
Which concept requires equity as opposed to debt financing?
2. Which produces the highest "Return on Investment" and the best liquidity?
3. Which model requires the entrepreneur to give up the least equity?

Identify and quantify the risks involved with execution of each model.
IV.MANAGEMENT OF THE VENTURE-BUILDING PROCESS

Management of the venture building process is fundamentally focused on

delivering the annual operating plan. Management of a new high-growth
business is build around a customer-driven idea or a technology it requires:

i) Entrepreneurial mindset and skills

ii) Proceed somewhere despite the risk of possible dangers
iii) Have speculation: an investment that is very risk but could yield great
profits
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 iv) Guess: put forward of a guess in spite of possible refutation
v) Put a risk and be firm to stake good reputation for that

V.PHASES OF VENTURE PLANNING

Venture building process has four phases start up initial growth rapid growth and
continuous growth. At the time of start up create business model a business
plan build management team and develop product strategy that should be
different from the competitive world raise venture capital

VI. PROCESS OF VENTURE PLANNING

Steps to starting a successful small business

1.Before Starting up

i) Examine motivation for business ownership

ii) Organize set up a work schedule
iii) Select business cards stationery advertising brochures etc
iv) Decide on What kind of business should start should be based on the
experiences talent and interest
v) Choose a legal form
vi) Determine where the money will come from

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2.Identify/Market/Demand

i) Get a clear picture of what exactly want to deliver to which customers

ii) Be clear about goals strengths and weaknesses
iii) Ask why you want to set up business

3. Evaluate the feasibility of Chosen Business

Assess the feasibility and potentials of start up business with the help of team
coach market researchers lawyers and accountants Do the market research and
position yourself within the market Ask questions like

i) Is there really a demand for your product or service

ii) Are you able and allowed to produce in so much scale
iii) In what way your product is better that the competitions
iv) Who are the competitors
v) How they can be preventing from copying your ideas
vi) What is the current and long term market potential
vii) Do you have enough money to start you business without going into debt
viii) Are you willing to risk these assets to borrow money
ix) If not where are you going to get your money
x) Can the business generate enough cash to pay its expenses as well as your
desired level of owner profit
xi) Are the rewards from the business both monetary and personal worth the
effort and investment you will make
xii) Are your management skills adequate to oversee and develop the business
operation
xiii) Have you researched market demand or have you just assumed that
people need or want your product or service
xiv) Are you capable and willing to deal with the worst possibility if it occurs

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 4. Consider Start up Requirements

The starts up requirements are

i) Select legal entity and business name and address with clerks office There may
be a nominal fee An attorney is a must when setting up a partnership
ii) Learn which permits licenses rules and regulations are applicable to the

proposed business Gets copies of that

iii) Determine the types of records to keep for tax purposes and for management and

control Set up record keeping systems

iv) Consider professional needs such as legal accounting and tax insurance and

banking
v) Pick a business name and register it

vi) Choose a mailing address

vii) Find a good location for the business

viii) Design a layout of the facility

5. Develop a business plan

i) Develop a strategic plan for development and operation of business

ii) Ensure that business plan met the requirement of investors both in form and
content
iii) Include a description of about the product who the prospective customers are
how you plan to promote and how much money is needed for start-up costs
iv) Have the entrepreneurial blueprint for ensuring success of a small business
venture.
6. Develop financing Request and obtain initial capital

Establish a relationship with a banker. The possible services you may need from
a bank are Credit-card merchant account business checking account small
business loan working capital loan equipment loan As a rule of thumb you will
need to provide a minimum of 25-30% of personal investment towards the total
start-up costs of your business. If you have less than this your chances of
obtaining outside financing are not good

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7. Finalize All start-up Requirements

Now sign contracts and lease agreements pay various licenses permits and fees
obtain utility services and complete all other requirements

i) Open a business checking account

ii) Inform about your new venture

iii) Make your mark

V. EMERGING VENTURE AREAS IN NURSING THAT NEEDS

PLANNING

There are often occurs a crisis situation in the health care industry when nurses
try to defend existing models of practice instead of embracing innovative
changes. In order to gain successful planning of good ventures, we should
examine the traditional models of nursing care such as institution based care,
process oriented care, procedure driven practices, care based on mechanical and
manual intervention, treatment based care and reflection and reflective practice
model of care.
VI. RISKS IN A NEW VENTURE

There are two main sources of risk in a new venture: The risk due to
uncertainty surrounding the business and the risk due to what is at stake if the
business should fail. Following are the risk in starting up a new venture:

1. Market risk is a result of many factors, including whether the market is

large enough to support business whether the market is growing what
trends exist in the industry how the competition is structured and how
distribution works
2. Operational risk deals with whether the business can set up internally to
deliver goods and services to customers effectively
3. Financial risk refers to the risk that the business wont work due to the
numbers For any business you should generate financial projections to get

32
 a picture of where breakeven will occur and what will drive the business
financially.
VII. ROLE OF NURSE ADMINISTRATOR
1. The nurse administrator needs to know the plans and programs of the health
facility of other departments in which personnel contribute to the joint effort
of providing health care services
2. Should be a participatory, voting member of all committees of the
institution including those dealing with budgeting, planning, credentialing,
auditing, utilization, infection control, patient care improvement, library or
any other committees concerned with nursing services, nursing activities
and nursing personnel.
3. Should develop a marketing operational plan based on the overall view of
the agency problems and activities.
4. Marketing plan should include gathering and analysis of data related to
product or service
5. Operational plan consists of pinpointing possible strengths, weakness,
problems and opportunities
6. Before launching a venture, a control plan is made to measure performance
of implementation of venture within a time frame.

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 D. INNOVATIONS IN NURSING

I.INTRODUCTION

Change is a natural social process of individuals, groups, organizations and

society. The source of change originates inside and outside health care
organizations. Change today is constant, inevitable, pervasive and unpredictable,
and varies in rate and intensity, which unavoidably influences individuals,
technology and systems at all levels of the organization. The only constant
feature in this world is change. While all the change may not lead to progress,
there can be no progress without change.
II.DEFINITION
Innovation is defines as introduction of something new. .

Innovation is defined as the generation of new ideas or application of existing

ideas to a new situation resulting in improvement in organization.

Change, innovation and creativity are comparison term9 but can also be
differentiated. Changes occur when the system is disrupts; innovation uses
changes to create new and different approaches to resolve an issue and develop
new products or procedures.
(Huber 1996).
III. NEED OF INNOVATION

a. Growing demands in health services

b. Global workforce shortage
c. Maintenance of quality health services
d. Meeting the increasing demands of healthcare field
e. Compete the global workforce shortage
f. Increasing advances in the healthcare field
g. Emerging clinical/nursing specialities

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IV. CHARACTERISTICS OF INNOVATION

a. Relative advantage: It is the degree to which the new idea is considered

superior to the old one
b. Compatibility: It refers to the degree of congruence between the
innovation and existing values, habits, past experience and need of the
participant
c. Complexity: It describes the amount of difficulty that participants have
in understanding and subsequently using the innovation
d. Trialability: it is the degree to which the new idea can be pretested or
tried on a limited basis
e. Observability: It refers to how visible the innovation is toparticipants
and onlookers

V.PROCESS OF INNOVATION

The process of the innovation may include several steps. They are
Step 1:Assessment
It is the first step of process and it requires a look at both the strength and
problems. An administrator must focus on what is specific content requirement
the expected outcome. Specific content requirement changes often in the health
care, as new technologies and research bring new knowledge needs.
Step 2:Defining objectives

It is the second step. The administrator should search for research or technique
that could address the identical needs. Asking the peers for the suggestion is also
helpful. This is the place where the creativity begins. It is important to look at
many different ways to address the learning objectives before selecting one.

Step 3:Planning
Once a strategy has been selected the third step, planning is important.
Understand who the stakeholders are and what their investment is in the status
quo or in change can be helpful in planning the strategies to bring them on board.
Many stake holders do not like the changes and will resist the new approaches.

35
Using the change theory it can assist in demonstrating the needs and provide
information that can make resistors more amenable to change. It’s important to
take time to develop a support for the strategy. In more complex strategies it may
be important to bring other administrators.
Step 4:Gaining support for the innovation
Some strategies require little resources to implement Where as others require
significant physical and financial resources. If resources are needed then gaining
support for the accusation of those resources are essential. Grants can provide
good funding sources but require time and effort to secure and may be for a
limited time. Administrative support may be required but administrators may
also be an excellent resource to tap to discuss the potential funding or
acquisitions of the physical resource.
Step 5: Preparing faculty members for the innovation
Rehearsal time may be required or additional education may be required.
Planning sufficiently for those activities will increase everyone’s comfort level
with this process. This is the time where everyone agrees how the strategy will
be in run. Use of perception, validate and clarification can be a valuable tool.
Step 6:Implementing the evaluation
In this step it is hoped that the things will get along well, but flexibility may be
required if problems arise. Sometimes unintended consequences, such as
surfacing of emotional issues can occur. Administrator should be alert to the
need for the follow up or referral if problem arise.
Step 7:Evaluating the outcome
It is the final step of the process. It may be possible to measure short term
attainment goals. A strong evaluation process provides an opportunity to
evaluate the outcome of the change.
VI. SOURCES OF INNOVATION

Seven sources for innovative ideas have been identified by (Drucker 1992).Four
sources are found internally within the institutions are

36
 a. Unexpected outcomes: Situation presents themselves that require
different methods to be adopted. Knowing what is happening in an
institution allows an individual to prepare for the impending changes.
b. Incongruous circumstances: Disruptions occur that require change to be
made, discrepancies exists between the reality as it is and reality as it is
assumed to be.
c. Innovations made on the process needs: Procedures and policies need
to be altered to respond to the new regulations, policies or law.
d. Changes in structure: Organizational changes require changes in
method of the operations.
Three sources are outside the institutions
a. Change in the demographics: Alteration in the community statistics
such as age and income levels affect the organizational operations.
b.New information or knowledge: New technological knowledge
requires change in practice.

VII. INNOVATION IN NURSING EDUCATION

1.Handheld computers in nursing education: First personal digital assistant in

1996, According to ANA (2001) all nurses need to use nursing informatics

2.Videoconferencing and web based conferencing: Connects students and

educators across distance, Connects diverse student groups

3.E-learning: Adaptation of different distance learning technologies, Self

directed, active learning, Refocusing from educator to the subject

4.Service-learning: Structured learning experience that combines community

service with preparation and reflection, Achieves a balance between service and
learning objective

5.High fidelity patient simulator: Help student practice decision making and
problem solving skill and to develop human interaction, Simulation is the third
leg in the stool of education and science

37
6.Tele teaching: Online model of education-learner directly interacts with tutor•
Learner oriented learning• Promotes discovery learning

7.Micro Teaching• Miniature classroom teaching, Small duration, Paying full

attention to a particular unit and skill, Content reduced to one unit with a single
concept

Innovation in clinical practice area

Computer assistance: Maintenance of health records

Wireless technology: Nurse have immediate telephone contact with employees

and with patient, Direct and accurate communication between Nurse and
Physician, E.g.. In south Africa nurses uses their mobile phone to support people
living with HIV/AIDS

Evidence based practice: It is combination of professional expertise with

available evidence to produce practice that lead a positive outcome for client.
Steps: 1. Identify a knowledge need and formulate an answerable clinical
question 2. Locate the best available evidence 3. Critically evaluate the evidence
4. Integrate the evidence with patient’s unique biology, preferences and values 5.
evaluate

D. SUMMARY

So far we discussed about management by objective, its definition, objectives,

process of MBO, advantages and disadvantages of management by objectives,
plan for change , its definition, change agent, assumptions for change, theories of
change , process of change, planning new venture, its definition ,its phases,
innovations its definition , process of innovation, sources of innovation.

E. CONCLUSION

Management by objectives (MBO) is a systematic and organized approach that

allows management to focus on achievable goals and to attain the best possible
results from available resources. Change is an inevitable in any organization with

38
advancement of science and technology and revolution in information systems, a
nurse manager is constantly confronted with new challenges. Change should not
be viewed as a threat but as a challenge or chance to do something new and
innovative. Change should only be implemented for good reasons. The term
innovation in nursing may refer to both radical and incremental changes in
thinking, in process or in services. The goal of innovation in nursing is positive
change to make someone or something better. Every nurse has to contribute
positively for development and refining of innovations.

F.BIBLIOGRAPHY

1) D. ElakkuvanaBhaskara raj ,Management of Nursing services and

Education .1st edition .Bangalore :Emmess medical publishers ;2010

2) Prasad L.M. Principles & Practice of Managem2

3) ent. 6th edition. New Delhi :Sultan Chand & sons; (2001)

4) Deepak. K. A comprehensive text book on nursing management. 3rd

edition. Bangalore: Emmess publication; 2007

5) T.N Chhabra. Principles and practice of managemet. 9th

edition.Delhi:Gagan Kapur publication; :2005

6) Jogindra Vati. Principles and practice of nursing management and

administration, 1st edition. Newdelhi: Jaypee publication; : 2013

7) C. Manivannan, T Latha Manivannan. Text book of nursing management

in service and education.1st edition.Jaypee publication: Newdelhi; :2016

8) C.B Gupta. Management theory and practice. 9th edition.

Newdelhi.2006.Sultan chand publication.

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