IV.

The Management Process

By: Henri Fayol
A.1 PLANNING
1. Process
a. process of setting goals and choosing the means to achieve the goal
b. bridges the gap between where you are going and where you want to go
c. an intellectual process based on facts and information. Not emotions and
wishes
d. a continuing process to ensure that decisions are really the proper utilization
of resources, people, and environment and ALL towards FUTURE

Integrated Nsg and Mgt process

Nursing process Management

process
Assessing
Planning
Planning
Planning,
Implementing organizing, staffing

Evaluating Organizing,
directing

Controlling

2. hierarchy of plans
- where do plans come from?
- who make plans?

a. Mission statement
- The root of all the plans, in any institution or org all of which is rooted in this
- who makes the mission statement? FOUNDER

b. top level manager

founder
board of trustees / board of directors / president / chancellor
___________________________________________________________________________
c. Strategic plans
- a simple definition is long range plans
- plans that are developmental (takes 10+ years to develop to become a reality)

d. top and middle level manager

- presidents, VC/VP’s, Deans
___________________________________________________________________________
e. operational plans
- short range plans (< 5 yrs)
- aka annual plans, semestral plan, quarterly plans, monthly plans, daily plans

f. middle and first level of manages

- level chairs, department chairs, coordinators, deans
3. Assessment
- first phase of planning
- answer: what do I need to plan?

a. tangible and intangible elements

*tanglible - visible, can be touched, can be measured
*intangible - those that cannot be seen, physically touched can not be measured, but
has a marked impact on organizational life,

Tangible Intangible
- buildings > Cognitive
- grounds - knowledge
- equipments - thinking
- cost - planning
- work performance - problem solving
- policies / - brain storming
procedures - research
- statistics - group dynamics
- patient care - focused group
records discussions/FGDs
- professional - recollection
development >Affective
programs - motivation
- safety measures - satisfaction
- signs and - fear
symptoms - security
- traditions
- social/ethical values
- emotions/attitudes
- anxiety, fear,
contentment, warmth

b. SWOT Analysis
S trengths comprises internal assessment SW
W eaknesses
O pportunities  external assessment OT
T hreats

Strengths
- management development
- qualifications of staff
- medical staff expertise
- staff availability
- financial situation
Weakness
- cash flow position
- marketing efforts
- market share
- facilities, location
- quality of service
opportunities
- recruitment
- referral patterns
- new programs/diversification
 - new markets/facilities
- improved technology
threats
- shortage of nurses
- decrease pts satisfaction
- increased A/R
- decreased demand
- competition/litigations
c. 3Ps
- personnel
- physical plan: buildings, grounds, equipments, facilities
- policies and procedures
3Ms
- man power
- materials, machines, money
- methods, procedures, rules and regulations

4. Priority Setting
Prioritizing Need or Problem
1. Threats to life, dignity, integrity
= hemorrhage(L), child abuse(D), broken side rail, schedule of meds or Tx

2. Threats to destructive changes

= CA, communicable diseases, air pollution, emotional disturbances
 threatens to destructively change individual family community

3. Threats to normal growth and development

= nutrition, exercise, immunization, dental care
 threatens the individual family community

5. Major concepts and definitions

• BELIEF – conviction that certain things are true
• VISION – mental image of something not actually visible now but in the future
• Strategic planning - long range planning; 3-5 yrs into the future
• Operational panning - short range planning; deals with day to day maintenance
activities
• VALUE – the worth, usefulness or importance of something
• MISSION/PURPOSE - an aim to be accomplished; mission statement
• PHILOSOPHY – statement of beliefs and values that directs behavior
• GOAL – the end to be accomplished
• OBJECTIVE – something aimed at or striven for; things done to achieve the goal
• POLICY – governing plan for accomplishing goals and objectives
• PROCEDURE – chronological sequence of steps within a process
• PROTOCOLS – documents of agreement

Strategic planning
External assessment  opportunities, threats
Internal Assessment  weakness, strengths

Classic ex of plan: NURSING CARE PLAN

- provides records of nursing needs for a particular patient
- provides continuity, communication, coordination, documentation
- provides evidence that standards of care have been maintained
 - guides nurses of their responsibility and accountability

B. ORGANIZE
- establishing formal structure for 2 purposes:
1. to coordinate resources
2. and determination of position and job description

1. Types of HC Organizations
Profit/proprietary – exist for profit Not for Profit / nonproprietary
Businesses Voluntary
Sale of bonds/shares Charitable
Insurance payments Religious
Government reimbursements Public / government operated agency

**where do they get money to operate?
1. managed like a business
2. HMO – health maintenance
organization; insurance card
3. PhilHealth – government HC system
LGU – local government unit (pontevedra)
Municipal health unit/Rural health unit
Provincial health unit (TLJ)
City Health Unit (san carlos, Bacolod)
Regional health unit (CLMMRH)
National Health Unit (phil heart center,
NKI, RITM)

**Funding comes from the region

Rural  county  local

Provincial/regional  state  region
National  federal  ministry

2. Organizational Structure
structure - a way of grouping or forming relationship
- depicts the ff: ^^QUIZ
1. channel of authority, responsibility and accountability
2. span of control - structure
3. lines of communication - structure
4. formal organizational pattern

3. Organizational Chart
- chart is simply a drawing that shows how the parts of the organization are
linked together
- depicts the ff:
1. division or clusters of work
2. chain of command
3. type or cluster of work
4. levels or hierarchy of management

4. Forms of Organizational Structure

4.A
Centralized structure
Advantages:
- Highly cost effective
- Concentrated range of skills
- Eliminates duplication of efforts
Disadvantages:
 - Becomes very large and more complex organization
- Does not readily adopt to change
- Obtaining decisions really require more time
Matrix
- benefits of both centralized and decentralized control are used
- provides for both vertical and lateral coordination across
departments
- applies specialized skills to solve problem
- interdisciplinary cooperation
Decentralized
Advantages:
- structure are broken down into smaller units
- authority is delegated to those closer to majority
- have a voice in decision making
- increase communication interdependentally
- better interpersonal relationships
- problem solving allows greater imagination and creativity
Disadvantages:
- initial cost of staffing

4. B
Flat
- horizontal development
- shortens administrative distance (top to bottom)
- communications are direct, simple, fast, minimize distortions
- places tremendous pressure on each manager because of the
amount of authority responsibility
- overburdened manager
Concentric
- a chart that shows the outward flow of authority from the center moving
outward. Therefore the smaller the circle it refers to the top level of
management
Tall
- vertical development
- lends to authoritarianism, require rapid changes and precise
coordination
- levels are expensive because of large number of executives needed
with high salaries
4C.
Line
- chain of command
- direct line between the manager and the staff depicted by a SOLID
LINE in the chart
- associated with direct achievement of organizational objectives
Staff
- functions 3 folds: 1. Staff is considered a SUPPORT 2. Staff
ADVISORY function 3. SERVICE function
- support line authority relationship
- either advisory or service in nature
- depicted in DASHED line
- handles details, offers counsel
- functions through influence for they do not have authority to accept,
use, modify or reject plans
- advisory, service, control, functional
EXAM: drawing of CHARTS

4D.
Beaurocratic – conservative, technical, scientific aproach
Human relations – democratic, participative, liberal

5. New Trend and Issues about Organization

a. Lean Manning aka Lean Staffing – cut down cost; less staff
b. mergers
c. contract work – aka job out or outsourcing, agency work
d. pooling of resources - a nurses’ pool

C. STAFF
- staff involves the ff:
a. selection of personnel
b. assignment systems
c. determination of staff schedules
d. containing the cost while
e. providing high quality care

**OBJECTIVE: containing the cost while

providing high quality care

C.1 what are the categories of nursing personnel

^Registered nurse – BSN graduate
Expanded roles of Nsg:
^Nurse practitioners
- receives special training in patient management to a select group of clients.
- Ex pediatric nurse practitioners, family NP, psychiatric mental health NP, cardiac
nurse practitioner
- Outpatient basis, home health, hospital unit
^Clinical nurse specialist
- receives additional education from a college or university in order to render high
quality care and case management
- hospital based
^Unlicensed assistive personnel UAP’s
- nurse aide, nurse assistant, nurse orderly, nurse clerk, ward secretary, ward clerk,
nurse techs, nurse attendant,
clinical ladder
1yr – aide
2yr – practical nurse, vocational nurse
3yr – licensed PN/VN
4yr – BSN, RN
** issue is the “respondeat superior”

C.2 assignment Systems

1. Case method assignment
- each pt is assigned to a nurse for total patient care while on duty
- this assignment is ideal it is simple it is direct
- this assignment requires highly skilled professionals that are highly paid ex. Private
duty nurse, ICU nurse

2. Functional method of assignments

- implements division of labor or work
- there are procedural descriptions and clearly defined assignments
^cost effective actually
**Disadvantage:
a. HOLISTIC care is not achieved. Therefore, there is fragmentation of care
b. Work is repetitive (error is minimized)

Saturday make Up Class

IV. Management Process
A. Plan B. Organize C. Staff
C.1 categories of NP
C.2 assignment of systems
C.3 scheduling
2a. Case Method
b. functional method
c. team method

d. Modular / District nursing

• this method when there are not enough RNs, and assisted by nonprofessionals
only
• nurses are consistently assigned to the same module for continuity and quality
of care
• a physical setup is necessary or required to implement modular nursing
^can be highly abused

e. Primary Nursing
- is assigning total care and responsibility designed for and adoptable to ambulatory
and outpatient care
- every nurse is responsible for planning care, implementing the care, evaluating the
care that is given to a patient, client, family
^equivalent to community health nursing in the Philippines

f. managed care
- it is nursing care delivery system that uses standard critical path, checklist needed
for reimbursement associated with diagnosis related groups popularly called DRG
^ standard critical path checklist: example – pneumonia, insurance is for 3 days only,
there is a checklist that you should accomplish so that in 3 days time the patient will
feel better. 1. O2 setup 2. Chest X-ray 3. Nebulization 4. CBD exercise 5. Chest
tapping 3x a day

3a. Centralized scheduling

• follows a master staffing pattern for the entire hospital
• this schedule is done in the nursing service office
• any variations or special requests have to be anticipated in order to be
accommodated
^no room for a lot of changes; once its there its already in place; responsive to
individual concerns but you have to anticipate what your schedules are

3b. decentralized scheduling

• the unit managers are given authority and assume responsibility to staff
their own units
• the staff members receive individualized treatment for their concerns and
needs
^unit managers – Head nurses

3c. self scheduling

• a system that is coordinated with other staff nurses
• negotiations are necessary
• BENEFITS: its associated with cooperative atmosphere, improved team
spirit, increased job satisfaction, high morale, decreased absenteeism,
decreased in tardiness
3d. alternating or rotating work shifts
day shift afternoon shift night shift
7-3 3-11 11-7
6-2 2-10 10-6
am pm noc
morning evening graveyard

what is applicable to labor law suggest that if you adopt a rotating Work Shift each
rotation must be 15 days rotation, allows body clock to adopt to different time shifts

3e. permanent shifting / flexi time

^you are able to adopt to own shift

3f. block or cyclical scheduling

- this uses the same schedule repeatedly every 6 weeks, 2 days off a week, every
other weekend off
MTW TH-off F S S
M – off T W Th F FSS-off
Gather all your weeks off, go home to philippines for 6 weeks paid

What is variable
Normal: 8hrs/day/shift
Variable: 10hrs/day/shift 7am-5pm – diagnostic center, OPD, clinic, dialysis unit
12hrs/day/shift 7a-7p 7p-7a = 12hrs/dayx3days = 36hrs considered permanent staff
off on Thursday

MTW – hosp A Th off

7p-7a 7a-7p
F Sa Sun – hosp B

Heavy snow storm or weather conditions

16hrs/day/shift – double shift
24hrs/day

4. determination # nursing personnel

4A. patient census – variable per shift per day
d 4B. patient classification
use a descriptive panel of classification – minimal care, partial care, intensive care
minimal care
- ambulatory patients
- can perform ADL independently
- receives routine medications and treatment
- requires minimal emotional support
- needs brief explanation
partial, moderate care, intermediate care
 - patients with IVF, all types of tubing’s (IUF urine catheter NGT O2
nasal gastrostomy, drainage tubes - hemovac, Jackson pratt;
colostomy; tracheostomy tube, chest tube)
intensive
- requires highly complex/monitoring of care
- constant monitoring, these are patients with ventilators, CVP line,
cardiac monitors, pulse oxymeter
- requires full assistance with ADL, that includes skin care,
positioning, feeding

4C. DOH hospital classification – based on total bed capacity

primary hospital – only licensed 25 beds
secondary hospital – 50-75 beds
tertiary hospital – more than 100 beds ex. CLMMRH

4D. Computation of the 3 of nursing personnel needed

IV. Management Process

D. DIRECT (coordinating)
- involves working with others

CONCEPTS:
D1 Supervision
Involves the following:
a. overseeing he activities of others
b. inspecting the work of another person
c. approving and correcting the adequacy of performance
d. encouraging the development of potentials
e. ensuring that quality client care is achieved
D2 delegation
- is sharing the responsibility, authority to subordinates, and holding
the subordinate accountable for its performance
- is a skill (plan is the one intellectual) that work on TRUST
- getting the work done through others
2A. Areas that can be delegated
- routine task: bed bath, changing bed linens
- task which you don’t have time: cleaning of pt’s chart, getting meds
from pharmacy
- problem solving activities: planning for Christmas party, painting of
the ward
- capability building: doing research, CPR training

2B. Areas that can not be Delegated

- the power to discipline
- responsibility for maintaining morale
- overall control
- “The hot potato stuff”: issues and concerns that are personal, legal,
confidential, ethical, moral
2C. Common Errors in delegation
- underdelegating: is a fear that subordinates will resent work
delegated to them. You end up overburdened with work  burn out
 - overdelegating: is giving too much work to the subordinates.
Insecurity of knowledge, skills, and attitude. Labeled as poor
manager at the end
- improperly delegating: delegating at the wrong time to the wrong
person and for the wrong reason  negligence or malpractice
2.D Issue: delegating UAP: respondeat superior

3. MOTIVATION and MORALE

morale is a state of mind related to a degree of cheerfulness or discipline
a. a person who is confident, courageous, with discipline demonstrate a high
morale
b. a person who is cowardly, disorderly, fearful, rebellious demonstrates a low
morale
c. signs and symptoms of low morale:
- interpersonal conflict
- criticism of policies, procedures, and rules
- decrease productivity
- decreased quality of work
- absenteeism
- frequent tardiness
- job turn over:
counteract low morale by STAFF DEVELOPMENT PROGRAM
ex. Attend seminars and updates, conduct organization wide workshops, go on
educational trips or exposures, enroll in educational graduate school, trainings,
clinical ladder, encourage growth, development and promotion

IV. Management Process

(Henri Fayol)
A. Plan
B. Organize
C. Staff
D. Direct
Bring for exams:
1. staffing formula sheet
2. calculator
3. 2 sheets of yellow pad
4. pencil with eraser

D. DIRECT
- working with others
1. supervision
2. delegation
3. motivation and morale

*Organizational morale
- refers to the attitude of the workers or employees toward the quality of their work,
environment, personal life
3 areas affected by attitude: work, environment, personal life
number 1 sign and symptom of low morale: Interpersonal conflict

CONFLICT
- layman’s: a clash, a fight, struggle, challenge
- conflict to the organization: means a warning that something needs attention,
affirmation, acceptance
2 social scientist: French and Raven
- gave a model: conflict resolution
Step 1: determine the basis of the conflict
Intrapersonal
Interpersonal - ^2 persons wit different values and beliefs
Intragroup
Intergroup
Intra-organization

Step 2: Analyze the Sources

Personal differences
Different facts and information
Cultural differences
Different perceptions of the event
Divergent views of power and authority
Role conflicts - ^one of the nurse is more superior
Ambiguous jurisdiction – don’t know where you stand
Communication barriers
Accumulation of unresolved conflicts in the past

Step3: Consider alternative approaches

Win-lose:
- competition is a win lose approach
- majority rule
- physical power
- position power

Lose-lose
- bribery
- arbitration: labor problem, union problems
- general rule: no ID no entry
- compromise
- settlement: divorce

*Win-win
- consensus: everybody is asked
- problem solving^
- collaboration^ set aside interest and go towards the goal of the unit
- cooperation
- participation
- research
- reconciliation
- forgiveness

Step 4: Choose the Appropriate Approach

Step 5: Evaluate the Situation

E. CONTROL: final phase in the management process

- these are the control functions
1. standards are set: standard is a predetermined level of excellence
- who determines the standard?
a. professional organizations: PNA
b. regulatory body: PRC
c. organizational interest: ORNAP, MCNAP, ADPCN, OHNAP: clinic nurses, ANA,
AHA:CPR

2. performance is measured – performance appraisal and evaluation

methods used:
a. anecdotal notes
b. rating scales
c. behavior observation scale: GEF, TBI, peer evaluation, feedback, costumer
evaluation, self appraisal

3. Audit is done
*audit is an official examination
3 things we do an audit on:
a. records
b. process - bidding
c. structure – regional
*financial audit – is implemented by budget; a statement of future expenditures
prepared a year prior; a budget is called a projection
2 types of budget:
a. operating budget – cost of daily expenses or maintenance
- salaries
- utility: electric, water, telephone, cable, internet
- repairs
- supplies: paper, pencil
- mortage/rental/taxes*BEQ
b. financial budget
- capital budget/capital expenditures
o building
o grounds
o facilities
o equipments

CONTROL OBJECTIVES:
Why do control?
P roduction
I nnovation
Q uanlity

CLMMRH – base hospital affiliation; 400bed capacity hospital

Vision – a center of excellence in tertiary care
Mission – shall provide
An institution that:
1. deliver tertiary health care services
2. training and teaching (Dept. is accredited by their respective specialty society)
3. research
Head: Regional Health Director VI
Administrative: personnel, accounting, philhealth, cashier, supply, maintenance,
records, transport, Medical social services, linen/laundry, housekeeping, security,
medicare/billing, dieatary services, medical library

medical division - laboratory

Clinical services
Auxillary Services
Training and affiliation

nursing service division –

assistant chief
_______________________________________________________________________________________
___________________________
ST VINCENT’S HOME – NON-PROPRIETY, CHARITABLE
SOURCE OF INCOME: BOARD OF TRUSTEES looks in the financial aspect on how
to operate
DAMAS de la Caritad – Ladies/Daughters of Charity
Dona Carmen Lizares; Antonio Lizares- donated the lot
Source of income: Family who commit themselves to help SVH

Vision
St. Vincent’s Home, Inc, HAVEN of hope for persons who are poor, rooted in the
charity of Jesus Christ Crucified

Mission
We commit ourselves to the integral development of older persons, indigent
children, unemployed women and migrant families through sustainable
programs and services where resource sharing and participative involvement is
a way of life

Core Values
Commitment to Vincentian service
Family oriented
Focused and collaborative
Holistic and integrated
Innovative
Spiritually rooted

Programs and Services

Residential care for older persons
- home life care
- spiritual/pastoral accompaniment
- health and nutrition
- sociorecreational and physical/occupational therapy

Community development and family welfare program

_______________________________________________________________________________________
_____________________________

NORFI – NON PROPRIETARY, VOLUNTARY

Source of Income: outside the other country funding under WHO, does not exist by
itself
Negros occidental rehabilitation foundation inc

Community based rehabilitation – project of WHO, NORFI is one of the recipients

Occupational therapy
Physical therapy
Hot packs, paraffin dip,

Caters services for patietns with

A, cerebral palsy
Facial paralysis
Post CVA patients

ILHZ – provincial and district funding

BOLM – proprietary ( headed by board of directors and board of trustees)

QOUESTION2
A. Type of budget
1. operating: deals with salaries
2. operating: deals with the people (financial- deals with equipments)
3. operating: salary
4. financial
5. financial
6. financial: new equip is costly

3P’s in Planning: Personnel, Physical Plant, Policies and Procedure

personnel 1
Physical – 6
Policies – 2

QUESTION3
3. coaching – fusion between clinical coaching and feedbacking; being able to
collaborate with the follower; learning something from the supervisor; constructive
and increase efficiency
balance between – what is written, face to face / oral feedbacking