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APPLICATION OF MODERN TECHNIQUES IN NURSING SERVICE ADMINISTRATION

By Mrs Swapna Sukumaran MSc (N), RN RM Lecturer, Samaritan College of Nursing Pazhanganad

WWHAT IS NURSING SERVICE ADMINISTRATION
Nursing administration is a body of knowledge which results in the output of clients whose health is unavoidably deteriorating, maintained or improved through input of personnel and material resources used in an orderly process of nursing services.

We always think about what is new and modern . Is it ??

APPLICATION OF MODERN TECHNIQUES IN NURSING SERVICE ADMINISTRATION

What do you mean by “modern” ?
Some thing that is up-to date………… new, or from “the present time”

FEATURES OF MODERN ADMINISTRATION
EQUAL OPPURTUNITIES

ESSENTIAL

EFFICIENCY

MULTILINGUALISM

TRANSPARENCY

ECOMMUNICATION

ETHICS AND CONDUCT

ENVIRONMENTAL
FRIENDLINESS

• Establish priorities and allocate task • Professionalize human resources • Decentralize financial management with personal ability and individual actions • Simplify tools and procedures – Do by a bottom-up approach – Review internal procedures – Easy access to digital technology

• For legitimacy and accountability • Access to documents and information • Simplify and improve the regulatory frame work • Promote a dialogue of culture and anticipation • Follow the code of good administrative behaviour

• Improves Objectivity and impartiality • Increases the sense of autonomy and client responsibility • Openness and right to freedom and expression • Financial liability of the staff – in case of breech of legal obligation • Safeguard to ensure high professional standards.

• No discrimination in policy • Gender equality • Adaptation In the workplace for people with disabilities • Fight against harassment • Respect for personal dignity • Respect for position • Right to work in condusive environment

• • • •

Practice what you preech Good liason between neighbours Save natural resources Mobility and transport services

Best use of information and communication technologies

• Concept of modern nursing administration • Leadership and delegation in nursing • Factors influencing client care in hospital and community • Techniques and styles of nursing supervision. • Stress management, communication, IPR • Human resource development In nursing • Nursing audit as control tool • Ethical and legal issues in nursing

MODERN TECHNIQUES

SOME MODERN TECHNIQUES EMPLOYED IN NURSING ADMINISTRATION
• Management by objective method • Six sigma (6 Sigma) • Performance evaluation and review technique • Critical path method • Decision tree • Gannt chart

• The concept of Management by objectives was first given by Peter Drucker

Management by objective
• Management by objectives is a style of management which utilize participative goal setting, choosing course of actions and decision making. • It can be applied in a large or small department of nursing service regardless of whether the system is used hospitalwide.

• Ideally, the top management level sets broad overall organizational objectives for a target period and from which subordinate levels of management derive their objectives. • Measurable objectives mutually agreed upon by a superior and his subordinate are set which enable one
to predict behavior, appraise the soundness of decisions while they are being made, evaluate work performance, analyze one's own experience, and improve one's performance.

• Employees themselves have been involved with the goal setting and the choosing the course of action to be followed b y them. So they will be more responsible • In MBO method, the measurement and the comparison of the employee’s actual performance with the standards set is done .

DEFINITION
It is a process whereby the employees and the superiors jointly identify common objectives, and set the result that should be achieved by the subordinates .

The major objective of using MBO is to increase the output of work by improving the employee participation.

PROCESS OF MBO
• DEFINE ORGANIZATIONAL GOALS

• DEFINE EMPLOYEES OBJECTIVES
• CONTINOUS MONITORING OF PERFORMANCE AND PROGRESS • PERFORMANCE EVALUATION REVIEWS

• PROVIDING FEEDBACK
• PERFORMANCE APPRASIAL(rewards & punishment)

NATURE
• Goal setting and planning for individual managers and their units • Joint goal setting between the supervisor and the subordinates • Establishing performance goals that are consistent with higher organizational objectives • Clarifying the hierarchy of objectives as a series of welldefined means-end chain.

Why goal setting is needed ?
• Goals always focus on the activity • Goals regulate the expenditure of effort • Difficult goals lead to more persistent effort than do easy goals

GOAL - Go Out And Lead

LIMITATIONS OF MBO
• Time and cost • Failure to teach MBO Philosophy • Problems in objective setting • Emphasis on short term objectives • Inflexibility • Frustration

• The major motto of 6-sigma is to “aim high and track the performance”.

Six Sigma is a business management strategy originally developed by Motorola, USA. Six Sigma seeks to improve the quality of process outputs by identifying and removing the causes of defects (errors) and minimizing variability in manufacturing and business processes

WHAT IS SIX-SIGMA
• It is a management model that starts with understanding that the organization can and must meet very high goals for effectiveness, by acting on information already available within. (Ie on evidence and what we observe)

Central idea is that if the number of “defects” in a process can be measured, one can systematically figure out how to eliminate them and get as close to the zero defect as possible.

Theme song of 6 sigma
• Accentuate the positive • Eliminate the negative • Latch on to the affirmative • Don’t mess with in between

Process - six sigma DMAIC model
• Define opportunitiesrecognize how the process affect the customer satisfaction • Measure the performance – develop measurement plan and establish baseline performance

Process - six sigma DMAIC model
• Analyze opportunity – establish relationship between response variables and control variables. • Improve performance – reduce major sources of variation and re-target the process. • Control performance – for sustained improvement

Use of six sigma in nursing
• It reinforces current development in health care management –EBPN, serviceline management . • Fits the real health care world in dealing with manual task and exceptional needs of the client • It provide guidelines on the use of in-hand data to improve client safety, client care by data informed decision making.

• Program evaluation and review technique (PERT) and the critical path method (CPM) are used to plan, coordinate, and control the performance of activities that comprise complex projects. • Together, PERT and CPM rationalize the central tasks of project management—forecasting the completion date of projects, while coordinating resource allocations to maximize efficiency and effectiveness.

In PERT, we identify the interdependent phases of a project and the correct sequences of activities that lead to completion. Critical path method helps in identifying the sequence of activities that most directly influence the length of a project.

• used to track planning activities required to complete a large scale, non repetitive project.

PERT methods typically include the preparation of a network diagram. Constructing a PERT diagram requires a manager to identify the interdependent phases of a project and the correct sequences of activities that lead to completion. Furthermore, when combined with applications of probability, PERT may be used to predict the duration of activities and forecast the complete date of a project.

Steps involved in PERT…
– Preparation of the list of all activities necessary to complete the project. – determine the proper sequence of activities – Design the actual PERT network relating to all activities to one another in a proper sequence. – Estimate the time schedule for each activity – Determine the critical path – Update the PERT chart as the program progresses

Steps ….ctd

– How to Estimate the time required to complete each activity. Optimistic time (O) – the shortest time an activity may take if every thing goes well Pessimistic time(P) - amount of time an activity will take if every thing if every thing goes wrong Most probable time(M) – most realistic estimate of how much an activity will take. Expected time Te is calculated as Te = O + 4M+P / 6

A= meeting to finalize the idea of setting up an ICU B = planning the infrastructure C = prepare the list of articles needed to the unit and put tender notice d =finalize the tender G =order for the articles aa E = prepare the budget, both capital and operating F = draw the plan of ICU, and estimate the cost H- give the work to the contractors to start the work I – get the materials like cemnt gravel tiles electric and plumbing materials J = start the project

PERT network diagram

Benefits of PERT
It provides information about the
• expected project completion time • probability of completion before the specified date • the critical path activities that directly impact the completion time • the activities that can slack time • activity start and end dates

Weakness of PERT
• • • • Is probabilistic in nature Is time and labor intensive Time estimate is subjective Despite the well planned time distribution the actual plan may be different • Any delay in any activity can alter the path and cause delay in the progress • Mostly used in large complex projects

Estimates the time needed for each activity, the longest possible time . a cost estimate is figured for both normal and crash operating conditions

• CPM techniques are used to guide project managers in making resource allocation decisions • CPM enhances a manager's ability to use resources in an efficient way by providing a strategy for determining which activities can be expedited to minimize total project costs. during the life of a project.

Definition of CPM
• It’s a mathematical based algorithm for scheduling a set of project activities, which is a set of sequential task upon which the project completion date depends – or the longest full path. For an evaluation the managers observe the critical path and compare with the progress

Utility value of CPM
To construct a model of the project • A list of activities required to complete a project • Time duration that each activity will take to completion • Dependencies between activities • Also make use of PERT in CPM

CPM in health care
• First CPs in hospital was developed by nurses for nursing care alone • Then it was adopted by multidisciplinary team • Helps the Management to plan in such a way that displays goal for clients and provide the corresponding ideal sequence and Provide timing of the staff actions to achieve those goals with optimal efficiency

Need for CPM in nursing field
• Increased competition in he medical and nursing field • Need to reduce cost while maintaining the quality of care • Reduce the resource utilization while maintaining the quality of care • Develop the ideal sequence and timing of staff actions achieving client centered goals with optimal efficiency

Goals of CPM in nursing administration
• Selecting the best practice when the practice styles vary unnecessarily • Define the standards for the expected duration of hospital stay and use of test and treatment • Examining and co-coordinating the various steps in the care process to find ways to time spend • Developing a common game plan from which to understand the role of different staff in the overall care process

Goals of CPM in nursing administration
• Providing a frame work for collecting data on the care process • Decreasing the nursing and medical documentation burden • Improving the client satisfaction with the care by educating and involving the client and family fully in the care implementation process

Format of CPM
• Outline the patient care process based on time matrix • List the components of care in one column, cross aligned with columns pertaining to time • Give specific actions for each day of hospitalization • Mark transition points of patient progress • Layout a co-ordinated map of staff activites to achieve the transitions in the most effective way as possible.

Prepare the CPM Developing a CPM CPM development
Step 1 – evaluate the current process of care Step 2 – evaluate the med-surg evidence and current practises Team composition – multidisciplinary local nurses, physician, hospital administrator

Topic selection - hospital care associated with high volume, high cost diagnosis and procedures, particulary those with inefficient variation in care process

Documentation and varience
Variances has to be documented with the reason for the variance. Variance is that action that do not meet the expectation of CPM. • Variances in staff action –
Omissions that are suggested in CPM Extra actions that may represent over utilization

• Reason for variance – documented by the nurse caring for the patient • These data are used in the evaluation of pathway and care process

Advantages of CPM
• To nursing staff
Is a nursing documentation tool Account for nearly every action Improves nurse-physician interaction Provide better quality nursing care

• To clients
Improves client empowerment Reduce hospital stay Reduced infections and deviations Increased compliance with generally accepted standards of care

Named after its developer, Henry L Gannt . Highly developed schedules that allow one to visualize multiple tasks that have to be done

UTILITY VALUE OF GANNT CHART
For planning and scheduling projects, because they allow you to indicate actual progress versus planned progress directly on the chart To monitor the project development, resource allocation and progress Allow managers to start, track and report projects Show immediately that what should have been achieved at ant point of time Shows how remedial action may bring the project back on course Also used in IT to represent data that has been collected.

Strength of Gannt chart
Easily created and maintained Displays the status of each task at a glance Also used as a reporting tool Easily understood

Weakness of gannt chart
• Unwidely used for projects with more than about 30 activities • Focus is primarily on scheduled management • Relatively little information per unit area of display • All activities planned shows to have work load as equal • Does not show the magnitude of a behind schedule condition • Large number of dependencies may cause clustered chart

EXAMPLE OF GANNT CHART
TASK PERS MON TUES WED THU FRI ON

Collect information ME Type report ME Revise report Submit report
ME ME

Advantages disadvantages , risk and out come of a single alternative being listed

WHAT IS DECISION TREE ??
Decision tree is a graphic method that can help managers to view and visualize the available alternatives, the outcomes, the risks and information needed for a specific problem in a specific time.

Need for decision tree ?
It helps to … see the possible directions that action may take from each decision point evaluate the consequences of the series of decisions.

Research evidences

In May 1991 Mount Clemens General Hospital (MCGH) began investigating the critical path method (CPM) as a tool for extending total quality management in clinical areas. A STUDY was performed by Hofmann PA of Mount Clemens General Hospital to assess if the CPM would be beneficial. Six months into the study a preliminary review of coronary artery bypass graft paths was conducted. There were 44 patients in the study group (35 men, 9 women). Twenty-four patients were cared for before the critical path form was available.

• Preliminary findings indicated a lower rate of complications in patients cared for with the critical path form. The data revealed a 5% complication rate with the critical path compared to a 16.6% rate for those whose care was not guided by the form. In addition, patients with the path on their clipboards had an overall shorter length of stay than patients without the path.

• Dr. Bradley J. Besta; Dr. Jeremy R. T. Lewisb Encyclopedia of Public Administration and Public Policy March 2003

• A study was conducted to assess the effectiveness of MBO among 70 participants in a company that was seeking to get people to work more collaboratively than individually. The participants were given objectives that they cannot achieve alone. There is no explicit requirement to work together, but the people soon find that the only way to succeed is to collaborate.

• Discussion - MBO uses a 'what-how' approach. The people in question are told what to do, but not how. The 'how' thus becomes a part of their contribution to a successful conclusion. The work was done by them in one week and one day which others took to complete 2 weeks and 3 days in an average. Done well, MBO, causes people to invest personally in the work as they become involved in what is their plan rather having to blindly comply with imposed and detailed commands.

BIBLIOGRAPHY

BOOK REFERENCES
Basavanthappa B T, Nursing administration. 2nd edition. Yaypee Brothers Medical Publishers; St Louis USA;2009 B.M Sakharkar. Principles of hospital administrationand planning.1st edition.jaypee brothers.2006. Joshi D C, Mamta Joshi, Hospital administration, Jaypee brothers Medical Publishers, 1st edition, 2009. Ann Mariner Tomey.Nursing management and leadership. 8th edition. Missouri: Mosby Publishers;2009 Davar RS. Personnel Management & Industrial relations.10th edition.New Delhi:Vishal printers;1996

INTENET REFERNCES

http.www.pubmed/critical path in administration.PMID: 8401809 [PubMed indexed for MEDLINE] downloaded on 23.04.10 at 3.05 pm http.www.medline/PERT/CPM. Downloaded PDF (~223 KB) on HTML on 24.06.10 at 2 pm. www.decision tree.google.com http://www.chrmglobal.com/Replies/1680/1/ decisiontree.html http://business.pv.in/starting_business/MBO .php

JOURNAL REFERENCES
The nursing Journal Of India, October 2005, Vol. 18 . No. 10. A TNAI Publications. Guptha,Sunil Kant.Hospital and health care administration.1st edition.Jaypee brothers:2004. Dr. Bradley J. Besta; Dr. Jeremy R. T. Lewisb. Encyclopedia of Public Administration and Public Policy March 2003. Hofmann PA. Critical path method: an important tool for coordinating clinical care , 1993 Jul;19(7):235-46.

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CONCLUSION
Today Advancing technologies are the indicators for development . So be tactful enough to equip ourselves with the latest techniques to keep our profession in its glory