ELEMENTS OF MANAGEMENT OF CRITICAL CARE UNIT

Functions/Elements of management of critical care unit

Administration may be defined as all the actions rationally performed by one person or a number of persons to fulfill a common purpose set by someone else of their accomplishment Prof. Luther Gullick(1937)- summed up certain principles or elements in the word POSDCORB. It consist of the initials of a number of words under each of which some administrative activity has been classified and named

POSDCORB
Is of course a made up word designed to call attention to the various functional elements of administration and management
Planning Organizing Staffing Directing CO-ordinating Reporting Budgeting

Planning
Working out a broad outline, the things that need to be done and the methods for doing them to accomplish the purpose set for the enterprises or of the purpose in hand

Organizing
This is the establishment of the formal structure of authority through which work subdivisions are arranged , defined and coordinated for the defined objectives

Staffing
The whole personnel function of bringing in and training the staff and maintaining

favorable conditions of work

Directing
It is the continuous task of making decisions and embodying them, in specific and general orders and instructions and serving as leader of the enterprise

Co- ordinationg
All important duty of interrelating the various parts of the work and eliminating of overlapping and conflict

Reporting
That is keeping those to whom the executive is responsible informed as to what is going on, which thus includes keeping himself and his subordinates informed through records , research and inspection

Budgeting
All that goes with budgeting in the form of fiscal planning, accounting and control

Planning

Planning- introduction
It is the basic of all managerial function because the future course of action is determined by proper planning A manager organizes, directs and control to ensure the accomplishment of predetermined goals

according to plan

Planning- introduction
It is a blue print for action Planning is deciding in advance what is to be done It includes selection of objectives, policies,

procedures, programmes from among alternatives Planning is predetermined course of action to achieve specific goals

Planning- Definition
Planning is a process of determining the objectives of administrative effort and devising the means calculated to achieve them Millet

It is the determination of course of action to achieve the desired results. It bridges the gap from where we are to where we want to go.

Nature of planning
Planning is an intellectual activity, since it involves vision and foresightedness to decide things to be done in future It involves selection among alternatives. Planning process involve finding of all alternative and selection of best alternative to achieve specified objective Planning is a forward duty since the manager attempts to handle future events effectively through process of planning

Nature of planning
Planning is related to objectives and every plan specifies objectives to achieve in future & steps to reach them Planning is most basic of all managerial function Planning is inevitable at all levels of administration

Principles of planning
1. Planning must focus on purpose 2. Planning is a continuous process which includes series of steps 3. Planning should be simple 4. In planning, there should be a good harmony with organization and environment 5. Planning is hierarchical in nature 6. Planning must be precise in its objectives, scope and nature 7. In planning the provision should be made to use all available resources 8. Planning should always be documented so that all the concerned are fully committed to the implementation of the programme

Components/ elements of planning

1. 2. 3. 4. 5. Objectives Policies Procedures Programmes Budget

Components/ elements of planning

Objectives : They are the basic plan which determine the goal or end result Policies : Are written statement or oral understanding. Policies are general statement which may be either verbal or written. Policy provides standing solution for problem Procedures : Indicates the specific manner in which certain activity is to be performed Programmes : it is defined as a single use comprehensive plan designed to implement policy and accomplish the objective Budget : is the statement of expected results in numerical terms; ie in rupees, man hours etc

Levels of planning
Planning function has to be performed at all 3 levels of management ie top level , middle level and lower level Top level: Management has to devote much more time to planning & policy making. It is concerned with strategic plans which are long term in nature covering a life span of 1-5 yrs or 10 yrs.

Levels of planning
Middle level: Has to formulate short term or intermediate plan & devote less time to planning and more time for co- ordination and communication. Specific plans for different areas of management like personal, production, marketing are implemented by middle level managers Lower level: It is directly concerned with operational planning. At this level the first level managers such as HOD concentrates on daily, weekly and monthly operations

Types of planning
1. Directional planning 2. Administrative planning 3. Operational planning

Directional planning
Is often called as policy planning. It is

concerned with the broad general direction of programme. Ie. Setting the framework of intent and philosophy within which the programme will proceed.

Administrative planning
Is concerned with implementation of the

policies developed and with the mobilization and co- ordination of the personnel and material available in the administrative unit

Operational planning
It is concerned with the actual delivery service to the community

Planning process in health service

Health planning is an orderly process of defining health problems, identifying correct needs and surveying the resources to meet them , establishing priority goals that are realistic and feasible and projecting administrative action to accomplish the purpose of the proposed programme

Steps of Planning process in health service

1. Analysis of the health situation 2. Establishing objectives and goals 3. Assessment of resources 4. Fixing priorities 5. Write up the formulated plan 6. Programming and implementation 7. Evaluation

Benefits of planning
It focuses attention on objectives: Laying down objectives is the first step in planning. If the

objectives are lay down clearly the execution of planning also be directed towards this objectives

Benefits of planning
Ensures economical operation: Planning involves lot of mental exercise which is directed towards achieving efficient operation in the enterprise. It helps better utilization of resources & thus minimizing the cost

Benefits of planning
It reduces Uncertainty: Planning reduce uncertainty of future because it involves anticipation of future events

Benefits of planning
It facilitates control: Planning helps the managers to perform their function of control Encourages innovation and creativity: It helps for innovative and creative thinking among managers because many new ideas come to the mind of managers while planning

Benefits of planning
It improves motivation: A good planning system ensures participation of all

managers and workers which improves their motivation

Disadvantages of planning
1. It depends upon facts and information 2. Planning may lead to internal inflexibilities and procedural rigidity 3. It is time consuming and expensive

Organization

Introduction
Is an essential part of human life. We are born in organization, educated in organization and spend most of our time working for

organization Organization is a process of dividing and combining efforts of a working group for making such joint efforts more productive, effective and fruitful

Definition
Organization is the form of every human association for the attainment of common purpose and the process of relating specific duties or functions in a whole -J.D.Mooney Organization is a formal structure of authority through which work subdivisions are arranged, defined and coordinated for the defined objective. -Luther Gullick

Importance of organizing
1. Focus on objectives and facilitate the attaining of objectives. 2. Arrangement of positions and jobs within the hierarchy. 3. Define responsibilities and line of authority of all levels. 4. Creating relationships that will minimize friction

Basic elements of formal organizations

1. Centralization and decentralization. 2. Delegation of authority. 3. Span of control (supervision). 4. Division of service. 5. Departmentation.

Centralization and decentralization:

it refers to the level at which most of the decisions are made within the organization. Centralization Concentration of decision-making and action at high-level management. Decentralization Consistent delegation of authority to the lower levels where the work is performed

Centralization
Advantages 1. Provide Power and prestige for manager. 2. Promote uniformity of policies, practices decisions. 3. Minimize duplication of function is. 4. Extensive controlling procedures and practices are not required. Disadvantages 1. Neglected functions for mid. Level, and less motivated bedside personnel. 2. Nursing supervisor functions as a link officer between nursing director and first-line management instead of acting as a manager .

Decentralization- Advantages
Raise morale and promote interpersonal relationships. Relieve from the daily administration. Bring decision-making close to action. Develop Second-line managers. employees enthusiasm and Promote coordination. Facilitate actions by lower-level managers. Improves coordination, especially for services.

Decentralization- Disadvantages:
Top-level administration may feel it would decrease their status. Managers may not permit full and maximum utilization of highly qualified personnel. Increased costs. It requires more managers and large staff. It may lead to overlapping and duplication of effort. It may lead to lack of uniformity and lowering of standards in decision -making. Emergency decision may not be possible.

Basic elements of formal organizations 2. Delegation of authority.

Delegation: Process of assigning work from a top

organizational level to a lower one or from superior to subordinate, and giving that person the authority to accomplish them.

The delegation process

Allocation of duties. Delegation of authority. Assignment of responsibility. Creation of accountability. Accountability: subordinates must be held answerable to their carried out duties.

Factors determining degree of authority delegation:

1. Organizations size. 2. Importance of duty or decision. 3. Task complexity. 4. Organizational culture 5. Qualities of subordinates.

Main principles of delegation

Barriers to successful delegation

Lack of superiors ability to direct the subordinates. Lack of confidence in subordinate. Absence of control .

Major causes of managers refusal to delegate

Tendency to do things personally. Desire to dominate the knowledge,

information, and/or skills. Unwillingness to accept risks of wrongs

Reasons for subordinates avoidance of accepting delegation

Decision-making is a hard mental work, and people seek ways of avoiding it. Fear of criticism for mistakes. Lack of necessary information and resources to do a good job. Overload of work. Positive incentives may be inadequate.

Authority
The right to take final decisions, to act or to command action of others It moves in a downward direction.

Types of authority
1. Ultimate authority. 2. Legal authority. 3. Technical authority. 4. Operational authority.

Ultimate authority:
It deals with the original source from which one derives the right to take actions. Thus, in the health sector, the ministry of health has ultimate authority

Legal authority
Means that an individual is legally permitted by the virtue of the position to take an action; a hospital director delegates to director of nursing service to act on behalf of the department

Technical authority
It refers to a person who is a recognized expert in some particular field. This does not necessarily mean that it is derived from position.

Operational authority
Is giving someone permission to assure certain responsibilities through delegation of authority.

Responsibility:
The obligation involved when one accepts an assignment.

Types of organizational relationships

The line relation Presents levels of hierarchy, superior-subordinate relationships, and provides the framework for the organization. The superior has the right to give orders and demand accountability. Each member knows from whom he/she receives orders and to whom he/she reports It is showed by a solid line in the organizational chart

Types of organizational relationships

Staff relation Has no command, personnel have only the right to advise, assist, support those in the line authority in the performance of their duties, it is line showed by a dotted line in the organizational chart.

Line & Staff Relationships

Basic elements of formal organizations Span of Control:

Number of subordinates that can be

adequately supervised by one supervisor.

Dimensions of span of control

1. 2. Narrow span of control. Wide span of control.

Narrow span of control

The manager supervises a small number of workers

Narrow span of control.

Advantages:
Close supervision. Close control. Fast communication between subordinates and superiors.

Disadvantages:
Superiors tend to get too much involved in subordinates work. Many levels of management. High costs due to many levels.

Wide span of control

The manager supervises a large number of workers

Wide span of control

Advantages: Superiors are forced to delegate. Clear policies must be made. Subordinates must be carefully selected. Disadvantages: Tendency of overload superiors to take most or all decisions. Danger of superiors loss of control.

Tall versus Flat Organizations

Factors determining the span of control

The competence of both the supervisor and the subordinate. The degree of interaction between the units or personnel being supervised. Other duties of the top manager. Lower-level managers have a wider range of span than top-level manager. The similarity or dissimilarity of activities being supervised. The nature of work (stability, complexity, etc complexity, etc).

Basic elements of formal organizations 4. Division of service

Dividing large activities to be distributed among several people. Advantage: Allow an employee to master a task with a maximum skill, a minimum time and effort. Disadvantages: Creates many different, narrow jobs, which need effective managerial coordination.

Basic elements of formal organizations 5) Departmentation

It is the process of grouping activities into administrative units.

Types of Departmentation
Departmentation can be implemented through one or more of the following types: 1. Departmentation by services 2. Departmentation by time 3. Departmentation by degree of acuteness of illness of the patients 4. Departmentation by function 5. Departmentation by location 6. Departmentation by patient

Types of Departmentation
1. Departmentation by services: activities are grouped according to similarities of skills needed to accomplish the goal, i.e. medical, surgical and pediatric units. It is simple and commonly used. 2. Departmentation by time: activities that need coverage twenty four hours a day, seven days a week (e.g. acute care settings), or activities coverage for eight to twelve hours a day for five or six days a week (e.g. preventive services) at the most.

Types of Departmentation
3. Departmentation by degree of acuteness of illness of the patients: five progressive patient care (PPC), i.e. Intensive Care Unit, Intermediate Care Unit, Self-Care Unit, Long-Term Care Unit, and Home Care Unit. 4. Departmentation by function: This method places all the resources and authority under one manager, e.g. laundry, pharmacy, dietary services.

Types of Departmentation
5. Departmentation by location: activities that are used with wide geographic activities in a given location that are grouped and assigned to a manager, i.e. inpatient department, outpatient department, and administrative department. 6. Departmentation by patient: making sense when service is important and the welfare of the patient is of primary interest, i.e. sex: male, female, age: geriatric, pediatric, economic status: paying, free unit.

Introduction
Once the plan is decided and organization structure is created then next step in the management process is to fill the various post created in the organization. This is

managerial function of staffing.

Introduction
Staffing is the management activity that provides for appropriate and adequate personnel to fulfill the organizations objectives. The nurse manager decides how many and what type of personnel are required to provide care for patients.

Staffing- definition
Selecting the personnel to carry out these actions and placing them in positions

appropriate to their knowledge and skills

Purpose of staffing
To ensure the right number, right type of people are working on the right job at right time and right place. The quatity of human resources to achieve their goal depends upon the quality of human workforce

Elements/ functions of staffing

Manpower planning: involves estimation of size and make up of personnel required Recruitment : concerned with finding out of applicants for job vacancies Selection: involving the choice of best qualified from among the job seekers to fill the job vacancies Placement: of selected people in appropriate position Training and development of employees: to enable them to do their jobs more efficiently Appraisal of performance: to design rewards, promotion, transfer etc

1.Steps in manpower planning

1. Strategic plans 2. Human resource planning
a. Forecasting human resource needs b. Forecasting personnel availability c. Designing and implementing personnel selection policies and procedures

Strategic plans
After developing design the policies the administrators health resource

planning requirement and budget to fit with other plans

Human resource planning

It include forecasting the demand for and supply for required personnel. This planning have 3 major steps
a. Forecasting human resource needs b. Forecasting personnel availability c. Designing and implementing personnel selection policies and procedures

Forecasting human resource needs

This include forecasting of retirement , transfer, termination, resignation etc Also include analysis of turnover to maintain the existing personnel

Forecasting personnel availability

The human resource inventory provide information about the organizations present personnel After completing the inventory, the organization prepares a catalogue indicating the detailed skills, abilities and needs of the work force Thus personnel inventory permits managers to match the organizations present strength and weakness against future needs and requirements

2.Recruitment
Involves seeking and retracting a pool of people from which required candidates for job vacancies can be chosen Recruitment is a process of searching for prospective employees & stimulating and encouraging them to apply for a job in the organization

Sources of Recruitment
Internal: Whenever new vacancies arises people from within the organization will be promoted or will be transfered External : When the organization has exhausted internal sources or find it unsuitable external sources can be used

Process of recruitment
Job analysis- it is the systematic and scientific study of a job in order to determine the nature and characteristic of job and the knowledge, experience and skills required for the successful performance of the job Job description- it follows job analysis. It is an organized, written and factual statement of the job contents in the form of duties. Job specification- Is the formal statement of the minimum acceptable human qualities required for the successful performance of the job

3.Selection
It is the process of choosing a candidate from the pool of applicants created by recruiting The selection is done after the candidate proceed through a series of step that compose selection process It is a negative process

Steps in staffing procedure

1. 2. 3. 4. 5. 6. 7. Preliminary interview Application blank Employment test Employment interview Physical examination References Final Approval
REJECTION

Steps in staffing procedure

Preliminary interview- done in reception counters Application blank- brief written resume . It provide data about the candidate Employment test- designed to measure selected aspect of the candidate Employment interview- personal or face to face interview Physical examination References- before final selection; the prospective employer likes to investigate into the details of the candidate from the reference provided by the applicant Final Approval

4. Placement
Selected candidates are posted in appropriate job. It involve assigning specific job and work places to the selected candidate

5. Training and development of employees The selection of the best person for the job is the first step in staffing The selected persons must be trained to build up an effective work force Training is the process of increasing

knowledge and skills of an employ for doing particular job

Directing

Directing
The function of telling people what to do and seeing that they do it to the best of their ability

Definition
The heart of administration is directing function which involves determining the course giving orders and instruction and providing the dynamic leadership M.E. Dinok

Directing
Once the plans are formulated the organization structure is designed and competent persons are placed at various positions and the organization is ready to go into action. The actual actions begins when orders and

instructions are given to the employees and steps are taken to get them executed. This is the managerial function of directing

Directing
It is the managerial function of instructing, guiding, supervising, inspiring and influencing people towards the achievement of

predetermined objective Directing is basically human resource

management

Importance of direction
Direction initiates action It bridges the gap between the managerial decision and actual execution by people.

It is the integrated team function of management

Direction made it possible to achieve the mission or the objective of the organization

Direction facilitates the introduction of change in an organization

People have a tendency to change in an organization. They need direction to accept and implement changes in the right direction for the betterment of an organization

Principles of direction