Luther Gulick:: Controlling

Luther Gulick:
He was influenced by Taylor and Fayol. He used Fayal‘s five elements of

administration viz.Planning,Organizing,Command,Coordination and Control as a
frame work for his neutral principles. He condensed the duties of administration into
a famous acronym‖POSDCORB‖.Each letter in the acronym stands for one of the
seven activities of the administrator as given below:
 Planning (P): working out the things that need to be done and the methods for
doing them to accomplish the purpose set for the enterprise.
 Organising (O): establishment of the formal structure of authority through which
work subdivisions are arranged, designed and coordinated for the defined
objective.
 Staffing (S): the whole personnel function of bringing in and training the staff, and
maintaining favourable conditions of work.
 Directing (D): continuous task of making decisions and embodying them in
specific and general orders and instructions, and serving as the leader of the
enterprise.
 Coordinating (CO): all important duties of interrelating the various parts of the
work.
 Reporting (R): keeping the executive informed as to what is going on, which
includes keeping himself and his subordinates informed through records, research
and inspection.
 Budgeting (B): all that goes with budgeting in the form of fiscal planning,
accounting and control.
Controlling
Controlling can be defined as the regulation of activities in accordance with the

requirements of plans.
Steps of control:
o The control function, whether it is applied to cash, medical care, employee morale
or anything else, involves four steps.
1. Establishments of standards.
2. Measuring performance
3. Comparing the actual results with the standards.
4. Correcting deviations from standards.
Concepts of management
The concept of management is not fixed. It has changing according to time and circumstances.
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,
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The concept of management has been used in integration and authority etc.
The concept of management.
The concept of management is not fixed. It has changing according to time and circumstances.
The concept of management has been used in integration and authority etc. Different authors on
management have given different concepts of management. The main concepts of management
are as follows:
Functional Concept:
According to this concept 'management is what a manager does'. The man followers of this
concept are Louis Allen, George R. Terry, Henry Fayol, E.F.L. Brech, James L. Lundy, Koontz
and O. Donnel, G.E Milward, mcfarland etc. The functional concept as given by some of the
authors is given below:
I. Louis Allen, "Management is what a manager does."
II. James L. Lundy, " Management is principally the task of planning, coordinating, motivating
and controlling the effort of others towards a specific objective. Management is what
management does. It is the task of planning, executing and controlling."
III. George R. Terry, "Management is a distinct process consisting of planning, organizing,

activating and controlling performed to determine and accomplish the objective by the use
of human beings and other resources."
IV. Howard M. Carlisle, "Management is defined as the process by which the elements of a
group are integrated, coordinated and/or utilized so as to effectively and efficiently achieve
organizational objectives."
V. Henry Fayol, "To manage is to forecast, and plan, to organize, to command, to coordinate
and to control."

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PADMASHREE INSTITUTE OF NURSING. M.Sc. NUrsing II years (2009-2011 batch)
'Getting Things Done Through Others' Concept:
According to this concept, 'Management is the art of getting things done through others'.
It is very narrow and traditional concept of management. The followers of this concept are
Koontz and O Donnell, Mooney and Railey, Lawrence A. Appley, S. George, Mary Parker Follet
etc. Under this concept, the workers are treated as a factor of production only and the work of the
manager is confined to taking work from the workers. He need not do any work himself. Modern
management experts do not agree with this concept of management. Some of these authors have
explained this concept in the following words:
I. Mary Parker Follet, "Management is the art of getting things done through others."
II. Harold Koontz, "Management is the art of getting things done through and wit people in
formally organized groups. It is the art of creating and environment in which people can perform
as individuals and yet cooperate towards attaining of group goals.
III. J.D. Mooney and A.C. Railey, "Management is the art of directing and inspiring people."
Leadership and Decision-making Concept:
According to this concept, "management is an art and science of decision-making and

leadership." Most of the time of managers is consumed in taking decisions. Achievement of
objects depends on the quality of decisions. Similarly, production and productivity both can be
increased by efficient leadership only. Leadership provides efficiency, coordination and
continuity in an organization. Leadership and decision-making concept as given by some authors
is given below:
I. Donald J. Clough, "Management is the art and science of decision-making and leadership".
II. Ralph, C. Davix, "Management is the function of executive leadership anywhere."
III. Association of Mechanical Engineers, U.S.A., "Management is the art and science of
preparing, organizing and directing human efforts applied to control the forces and utilize
the materials of nature for the benefit to man."
IV. F.W. Taylor, "Management implies substitution of exact scientific investigation and
knowledge for the old individual judgment or opinion, in all matters in the establishment."
Productivity Concept:
According to this concept, "management is an art of increasing productivity."
Economists treat management as an important factor of production. According to them,

"Management is also a factor of production like land, labor, capital and enterprise." The main
followers of this concept of management are John F. Mee, Marry Cushing Niles, F.W. Taylor
etc. The productivity concept, as given by the authors is given below:

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I. Jon, F. Mee, "Management may be defined as the art of securing maximum prosperity with a
minimum of effort so as to secure maximum prosperity and happiness for both employer and
employee and give the public the best possible service."
II. F. W. Taylor, "Management is the art of knowing what you want to do in the best
and cheapest way."
III. Marry Cushing Niles, "Good management achieves a social objectives with the best use of
human and material energy and time and with satisfaction of the participants and the public.
Universality Concept:
According to this concept, "Management is universal". Management is universal in the sense that
it is applicable anywhere whether social, religious or business and industrial. The followers of
this concept are Henry Fayol, Lawrence A. Appley, F.W. Taylor, Theo Haimann etc. According
to-
I. Henry Fayol, "Management is an universal activity which is equally applicable in all types
of organization whether social, religious or business and industrial".
II. Megginson, "Management is management, whether it is in Lisbon, or in London or in Los

Angeles."
III. Theo Haimann, "Management principles are universal. It may be applied to any
kind of enterprises, where the human efforts are coordinated."
Management is principally the task of planning, coordinating, motivating, and controlling the
efforts of others towards a specific objective. -James lundy 1963
Management is the creation and control of technological and human environment of an

organization in which human skill and capacities of individuals and groups find full scope for
their effective use in order to accomplish the objective for which an enterprise has been set up. It
is involved in the relationship of the individual, group, the organization and the environment.
-A dasgupta 1969
Management is a good planning, organizing directing, co ordinating and controlling to eliminate
chaos, errors and waste and get better utilization of manpower and materials.
-George A Melresh
Management is the process and agency which directs and guides the operations of an
organization on the realizing established aims.

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NURSING MANAGEMENT
MISSION STATEMENTS
A Mission Statement defines the organization's purpose and primary objectives. Its prime
function is internal – to define the key measure or measures of the organization‘s success – and
its prime audience is the leadership team and stockholders. Mission statements are the starting
points of an organisation‘s strategic planning and goal setting process. They focus attention and
assure that internal and external stakeholders understand what the organization is attempting to
accomplish.
Dimensions of Mission statements:
According to Bart, the strongest organizational impact occurs when mission statements contain 7
essential dimensions.
 Key values and beliefs
 Distinctive competence
 Desired competitive position
 Competitive strategy
 Compelling goal/vision
 Specific customers served and products or services offered
 Concern for satisfying multiple stakeholders
 The mission statement of an; organization describes the purpose for which that
organization exists.
 Mission statements provide information and inspiration that clearly and explicitly outline
the way ahead for the organization. They provide vision.
 Individuals want productive and meaningful lives .therefore, the purpose of the
organization and of each of its units should be defined a teamwork approach should be
properly trained: and all individuals within the organization should be treated with
respect.
 Organizational purpose moves and guides the organization toward a perceived goal.
 Many writers indicate that the purpose or mission statement should be created from
mission statement should be properly trained and all individual s within the organization
should be treated with respect.
 Organizational purpose moves and guides the organization toward a perceived goal.
 The mission or purpose statement incorporates the culture of the organization, including
strong leadership, rules and regulations, achievement of goals, and the notion that people
are more important than work.

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 Employees who participate in developing the vision statement believe in their own
abilities and are more committed to the organization.
 The vision statement is shared companywide so that employees live the vision.
 The mental exercise of creating one is more meaningful than the contents of the statement
itself. Vision, values, mission or purpose statements are meaningful only to the creators.
VISION
 Employees who participate in developing the vision statement believe in their own
abilities and are more committed to the organization than employees who do not
participate.
 The vision statement is shared companywide so that employees may live the vision. It is
updated to keep pae with technology and trends. A vision statement is sometimes.
 The mental exercise of creating one is more meaningful than are the contents of the
statement itself.
 Vision values, mission, or purpose statements are meaningful only to the creators.
 Translated for the community, these statements place value on the way nurses care for
people.
 It follows that ethnic populations are considered in developing vision and values
statements for nursing entities. Nursing education teaches the meaning of values such as
tolerance and compromise.
 Examples of values are informality, creativity, honesty, quality, courtesy, and caring.
Philosophy
 Cost effectiveness
In management or administration of any enterprises for organization, the quality,

quantity, timing and cost of the necessary to reach the objective of the enterprises are
interrelated factor which must be given constant attention.
 Execution and control of work plan:

One of the greatest possible contributors to wastage of our precious recourses, whether at
the local or national level, is the failure of those at any level of administration, and at all
stages in the management of the activity, to base all decision on verifiable facts.
 Delegation of responsibility and authority:
The delegation of responsibility and authority is an important aspect of successful
administration, to place the responsibility for decision at the lowest possible
organizational level in order to attain decision as speedily as possible.
 Human relation and good morale:
Since the function of administration is to attain an established objective through the

management of people, administration if deeply concerned with human relation. Good
morale of the staff is essential to the success of any organization.
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 Effective communication:
Effective communication are essential for all aspect of effective administration .staff
must be adequately and correctly informed about plan, methods ,schedules, problems
events and progress.
 Flexibility:
Administrators must be completely flexible to meet the changing needs of

the situation.
PLANNING
INTRODUCTION
Planning is a deliberative, systematic phase of the nursing process that involves decision
making and problem solving. In planning the nurse refers to the client‘s assessment data and
diagnostic statements for direction and formulating client goals and designing the nursing
strategies required to prevent, reduce or eliminate the client‘s health problems.
ROGRAM EVALUATION AND REVIEW TECHNIQUE (PERT)
Meaning
The program evaluation & review technique (PERT) was developed by the Special Projects
Office of the U.S. Navy and applied to the planning &control of the Polaris Weapon system in
1958. It worked then, it still works; and it has been widely applied as a controlling process in
business & industry.
PERT uses a network of activities. Each activity is represented as a step on chart. It is an

important tool in the timing of decisions. In simplest form of PERT, a project is viewed as a total
system and consisting of setting up of a schedule of dates for various stages and exercise of
management control, mainly through project status reports on this progress.
Program Evaluation & Review Technique includes:
1. The finished product or service desired
2. The total time & budget needed to complete the project or program.
3. The starting date & completion date.
4. The sequence of steps or activities that will be required to accomplish the project or program.

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5. The estimated time & cost of each step or activity.
Steps for accomplishing the project are:
a. The optimistic time: This occasionally happens when everything goes right.
b. The most likely time : It represents the most accurate forecast based on normal developments.
c. The pessimistic time: This is estimated on maximum potential difficulties.

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Calculation of the ―critical path‖ , the sequence of the events that would take the greatest
amount of time to complete the project or program by the planned completion date. The reason
this is the critical path because it will leave the least slack time.
USES
Why should nurse managers use the PERT system for controlling?
1. It forces planning and shows how pieces fit together.
2. It does this for all nursing line managers involved.
3. It establishes a system for periodic evaluation & control at critical points in the program.
4. It reveals problems & is forward- looking.
5. PERT is generally used for complicated & extensive projects or programs.
6. Many records are used to control expenses and otherwise conserve the budget.
These include personnel staffing reports, overtime reports, monthly financial reports and
others. All these reports should be available to nurse managers to help them monitor, evaluate,
and adjust the use of people and money as a part of the controlling process.
Modern and Philips enlist the advantages of PERT:
1. It encourages logical discipline in planning, scheduling and control of project.
2. It encourages more long range & detailed project planning
3. It provides a standard method of documenting and communicating project plans, schedules,

and time and cost- performance.
4. It identifies the most critical elements in the plan, thus focusing management attention .i.e.
most constraining on the schedule.
5. It illustrates the effects technical procedural changes on overall schedules.
GANTT CHARTS
Early in this century Henry L. Gantt developed the Gantt Chart as a means of
controlling production. It depicted a series of events essential to the completion of a project or
program . It is usually used for production activities.
Figure shows a modified Gantt chart that could be applied to a manager nursing administration
program or project. The 5 major activities that the nurse administrator has identified are
segments of a total program or project.

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It could be applied to a project such as implementing a modality of primary nursing or

implementing case management.
These are possible nursing actions for a project:
1. Gather data
2. Analyze data
3. Develop a plan
4. Implement the plan.
5. Evaluation, feedback, and modification
Figure is an only an example .Application of these controlling process by nurse managers

would be specific to the project or program, and the time elements for the various activities
would vary with each. Also these 5 major activities with estimated completion times. The nurse
manager‘s goal is to complete each activity or phase on or before the projected date.
ORGANISATION OF NURSING SERVICES:
DIRECTOR (hospital) DIRECTOR OF HEALTH

SERVICE
Chief Nursing Officer Asst. Director of Health Service

Nursing Superintendent Nursing Superintendent Grade-I
Deputy Nursing Superintendent Nursing Superintendent Grade-II
Assistant Nursing Superintendent Head Nurse
Ward Sister - Clinical Supervisor Staff Nurse
Staff nurse Student nurse
ORGANIZING NURSING SERVICE AT VARIOUS LEVELS

The organization of nursing service varies from institution to institution.
Organizational set-up at Directorate General of Health Services

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DGHS
Addl.DG (PH) Addl.DG (N) Addl.DG (M)
ADG ADG ADG

(Community Nsg service) (Nsg-education & research) (Hospital Nsg service)
DADG DADG DADG

Community & Nsg officer Principal Nsg.Supdt
PHN Supervisor Senior Tutor Dy.Nsg.Supt
PHN Tutor Asst.Nsg.Supt
LHV Clinical Instructor Ward sister
ANM Staff Nurse
Organizational set-up of Nursing Service at Central Level

Secretary, Health
Director Nursing Service

Joint/Deputy Director Nursing services
ADNS ADNS ADNS

DADNS DADNS DADNS

DADNS DADNS DADNS

Dist. Nsg officer DADNS Nsg.Supdt
PH. Nsg officer Principal Dy.Nsg.Supt
PHN at PHC Senior Tutor Asst.Nsg.Supt
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batch)
LHV Tutor Ward sister

ANM Clinical Instructor Staff Nurse
Organizational set-up of Nursing Service at State Level

Director Nursing Services
Deputy Director Nursing Services
Assistant Director Nursing Services
Deputy Assistant Director Nursing Services
DMO DNO DHO
ADNO (Hosp&Nsg.Edu) ADNO (Community)
Nsg Supt/Dy.Nsg.Supt Principal tutor Dist.PNO

Asst.Nsg.Supt Tutor PHN Supervisor (CHC)
Ward Sister Clinical Instructor PHN (PHC)
Staff Nurse LHV
ANM
KEYS:
 DGHS - Director General of Health Services
 Addl. DG (PH) - Additional Director General (Primary Health)
 Addl. DG (M) - Additional Director General (Medical)
 Addl. DG (N) - Additional Director General (Nursing )
 ADG - Assistant Director General
 DADG - Deputy Assistant Director General
 PHN - Primary Health Nurse
 LHV - Lady Health Visitor
 ANM - Auxiliary Nurse Midwives
 ADNS - Assistant Director Nursing Service
 DADNS - Deputy Assistant Director Nursing Service
 DMO - Director of Medical Office
 DNO - Director of Nursing Office
 DHO - Director of Health Office
INDIAN NURSINGINSTITUTE
PADMASHREE COUNCIL (INC)
OF NURSING. M.Sc. NUrsing II years (2009-2011
batch)
The Indian Nursing Council is an Autonomous Body under the Government of India and
was constituted by the Central Government under the Indian Nursing Council Act, 1947 of
parliament. It was established in 1949 for the purpose of providing uniform standards in nursing
education and reciprocity in nursing registration throughout the country. Nurses registered in one
state were not registered in another state before this time. The condition of mutual recognition by
the state nurses registration councils, called reciprocity was possibly only if uniform standards of
nursing education were maintained.
Functions of Indian Nursing Council.
 To establish and monitor a uniform standard of nursing education for nurses midwife,
Auxiliary Nurse-Midwives and health visitors by doing inspection of the institutions.
 To recognize the qualifications under section 10(2)(4) of the Indian Nursing Council
Act, 1947 for the purpose of registration and employment in India and abroad.
 To give approval for registration of Indian and Foreign Nurses possessing foreign
qualification under section 11(2) (a) of the Indian Nursing Council Act, 1947.
 To prescribe the syllabus & regulations for nursing programs.
 Power to withdraw the recognition of qualification under section 14 of the Act in case
the institution fails to maintain its standards under Section 14 (1)(b) that an institution
recognized by a State Council for the training of nurses, midwives, auxiliary nurse
midwives or health visitors does not satisfy the requirements of the Council.
 To advise the State Nursing Councils, Examining Boards, State Governments and
Central Government in various important items regarding Nursing Education in the
Country.
THE EXISTING NORM BY INC WITH REGARD TO NURSING STAFF FOR WARDS
AND SPECIAL UNITS:
Staff nurse Sister(each Departmental sister/ assistant nursing

shift) superintendent
Medical ward 1:3 1:25 1 for 3-4 weeks
Surgical ward 1:3 1:25 1 for 3-4 weeks

Orthopedic ward 1:3 1:25 1 for 3-4 weeks
Pediatric ward 1:3 1:25 1 for 3-4 weeks
Gynecology ward 1:3 1:25 1 for 3-4 weeks
Maternity ward 1:3 1:25 1 for 3-4 weeks

including newborns
ICU 1:1(24 hours) 1
CCU 1:1(24 hours) 1
Nephrology 1:1(24 hours) 1 1 department sister/assistant nursing

superintendent for 3-4 units clubbed
together
Neurology and 1:1(24 hours) 1
& neurosurgery
Special wards- eye, 1:1(24 hours) 1
ENT etc.
Operation theatre 3 for 24 hours 1 1 department sister/asst nursing

per table superintendent for 4-5 operating
rooms
Casuality and 2-3 staff nurses 1 1 department sister/assistant nursing

emergency unit depending on the superintendent
number of beds
Staffing pattern according to the Indian Nursing Council (relaxed till 2012) Collegiate
programme-A
Qualifications and experience of teachers of college of nursing-

1. Professor-cum-Principal
 Masters Degree in Nursing
 Total 10 years of experience with minimum of 5 years of teaching experience
2. Professor-cum- Vice Principal
 Masters Degree in Nursing
 Total 10 years of experience with minimum of 5 years in teaching
3. Reader/Associate Professor
 -Masters Degree in Nursing
 Total 7 years of experience with minimum of 3 years in teaching
4. Lecturer
 Masters Degree in Nursing with 3 years of experience.
5. Tutor/Clinical Instructor
 M.Sc.(N) or B.Sc. (N) with 1 year experience or Basic B.Sc. (N) with post basic
diploma in clinical specialty
For B.Sc. and M.Sc. nursing:

Annual intake of 60 students for B.Sc. (N) and 25 for M.Sc. (N) programme
B.Sc. (N) M.Sc. (N)

1
Professor cum principal
1
Professor cum vice
principal
1 2
Reader/Associate
professor
2 3
Lecturer
19
Tutor/clinical instructor
24 5
Total
One in each specialty and all the M.Sc. (N) qualified teaching faculty will participate in both
programmes.
Teacher-student ratio = 1:10
GNM and B.Sc. (N) with 60 annual intake in each programme
1
1
Professor cum vice
principal
1
Reader/Associate
professor
4
Lecturer
35
42
Total
Basic B.Sc. (N)

Admission capacity
40-60 61-100
Annual intake
1 1
1 1
Professor cum vice
principal
1 1
Reader/Associate
professor
2 4
Lecturer
19 33
24 40
Total
Teacher student ratio= 1:10 (All nursing faculty including Principal and Vice principal)
Two M.Sc (N) qualified teaching faculty to start college of nursing for proposed less than or
equal to 60 students and 4 M.Sc (N) qualified teaching faculty for proposed 61 to 100 students
and by fourth year they should have 5 and 7 M.Sc (N) qualified teaching faculty respectively,
preferably with one in each specialty.
Part time teachers and external teachers:
Microbiology
1.
Bio-chemistry
2.
Sociology.
3.
Bio-physic
4.
Psychology
5.
Nutrition
6.
English
7.
Computer
8.
Hindi/Any other language
9.
Any other- clinical discipliners
10.
Physical education
11.

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The above teachers should have post graduate qualification with teaching experience in
respective area
School of nursing-B
Qualification of teaching staff-

M.Sc. (N) with 3 years of teaching experience or B.Sc.(N)
1. Professor cum principal basic or post basic with 5 years of teaching experience.
Professor cum vice M.Sc. (N) or B.Sc. (N) (Basic)/Post basic with 3 years of
2. principal teaching experience.
M.Sc. (N) or B.Sc. (N) (Basic) / Post basic or diploma in
3. Tutor/clinical instructor nursing education and Administration with two years of
professional experience.
For School of nursing with 60 students i.e. an annual intake of 20 students:

No. required
Teaching faculty
1
Principal
1
Vice-principal
4
Tutor
1
Additional tutor for interns
7
Total
Teacher student ratio should be 1:10 for student sanctioned strength
MATERIAL MANAGEMENT
CONCEPTS
Material management is concerned with providing the drugs, supplies and equipment needed by
health personnel to deliver health services. The right drugs, supplies and equipment must be at
the right place, at the right time and in the right quantity in order that health personnel deliver
health services. Without proper material, health personnel cannot work effectively, they feel
frustrated and the community lacks confidence in the health services and unless appropriate
materials are provided in proper time and is required quantity, productivity of personnel will not
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be upto expectation.
Definition
Planning and control of the functions supporting the complete cycle (flow) of materials, and the
associated flow of information. These functions include (1) identification, (2) cataloging, (3)
standardization, (4) need determination, (5) scheduling, (6) procurement, (7) inspection,(8)
quality control, (9) packaging, (10) storage, (11) inventory control, (12)distribution, and (13)
disposal. Also called as materials planning.
Objectives of material management
 To reduce cost of material

 Ensure a good support with suppliers(vendors)
 Effective and efficient handling of materials at all stages and in all sections.
In other hand objectives of material management
 Low purchase price
 Maintaining continuous supply
 Maintaining quality
 Cordial relationship with supplier
 Low pay roll cost
 Development of vendose
 Good record
 Low storage cost
 Favourable reciprocal relation
 New material & products
 Standardization

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 Product improvement
 Interdepartmental harmony
 Economic forecasting.
Aim of Material Management
To get
1. The right quality
2. Right quantity of supplies
3. At the right time
4. At the right place
5. For the right cost.
Purpose of Material Management
 To gain economy in purchasing

 To satisfy the demand during period of replenishment
 To carry reserve stock to avoid stock out.
 To stabilize fluctuations in consumption
 To provide reasonable level of client services
 Increase efficiency of health care systems.
 Develop knowledge and skills of health care
 Provide materials in required quantity and quality as when required.
Basic Principles of material Management
 Effective management and supervision; it deals on material functions of; planning,

organizing, staffing, controlling, report and budgeting.
 Sound purchasing method
 Skillful and hard poised negotiation
 Effective purchase system
 Should be simple
 Simple inventory control program.
Functions of Material Management
 Material planning & budgeting

 Purchasing
 Inventor control

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 Cost reduction

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 Value analysis
 Receiving & inspection
 Stocking & distribution
 Disposal.
Elements of Material Management
 Material planning
 Purchasing
 Receiving & warehousing
 Store keeping
 Inventory control
 Value analysis
 Standardization
 Production control
 Transportation
 Material handling
 Disposal scarp
PROCEDURE
Good material managers adopt the following procedures:
 Taking inventory regularly and systematically

 Requisitioning at indenting according to actual needs
 Receiving and inspecting incoming items
 Storing and protecting items
 Issuing items for use
 Proper use of items.

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Some more procedures
 Identification of need
 Establishment of standards and specification, character, quality with full description
 Preparation of requisition or indents in the predesigned
 Selection of the right source that is supplier
 Determine right price, availability and delivery time
 Placement of purchase order
 Follow up
 Arranging of receipt, inspection, rejection replacement for defective pieces.
 Verification of invoices
 Payment of bills
 Maintenance of record.
PLANNING AND PROCUREMENT PROCEDURES IN MATERIAL MANAGEMENT
Material management is a scientific technique, concerned with planning, organizing and

controlling the flow of materials from their initial purchase through internal operations to the
service point through distribution. The material management in the health care system is
concerned with providing the drugs, supplies and equipment needed by health personnel to
deliver health services. About 40 percent of the funds in the health care system are used up for
providing materials. It is of great importance that materials of right quality are supplied to the
consumers. Material management integrates all material functions;
 Planning for materials

 Demand estimation
 Purchasing
 Inventory management
 Inbound traffic
 Warehousing and stores
 Incoming quality control

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MATERIAL PLANNING
"Material planning is the scientific way of determining the requirements that goes into
meeting production needs within the economic investment policies‖.
- Gopalakrishnan & Sunderasan
It is done at all stages and all levels of management. Material planning is based on certain
feedback information and reviews.
Aim of material management planning
To get:
 The Right quality

 Right quantity of supplies
 At the Right time
 At the Right place
 For the Right cost
Purpose of material management planning
 To gain economy in purchasing

 To satisfy the demand during period of replenishment
 To carry reserve stock to avoid stock out
 To stabilize fluctuations in consumption
 To provide reasonable level of client services
Objectives of material management planning
Primary objectives
 Right price
 High turnover
 Low procurement and storage cost
 Continuity of supply
 Consistency in quality
 Good supplier relations
Secondary objectives:
 Development of personnel
 Good information system
 Forecasting
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 Inter-departmental harmony
 Product improvement
 Standardization
 Make or buy decision
 New materials and products
 Favorable reciprocal relationships
Basic principles of material management Planning
Effective management and supervision depends on managerial functions of:
 Planning
 Organizing
 Staffing
 Directing
 Controlling
 Reporting
 Budgeting
 Sound purchasing methods
 Skillful and hard poised negotiations
 Effective purchase system
 Should be simple
 Must not increase other costs
 Simple inventory control programme
Techniques of Material Planning
 Bill of Material technique:

 BOM is the simplest technique of materials planning.
 Explosion of bill of materials refers to splitting the requirements for the product to
be manufactures in to its basic components. E.g. in health care is drugs
manufactured in the pharmacy
 This technique is ideally suited to engineering industries.
 The technique is based on demand forecasts.
 Requirement for various materials are listed with their complete specifications
 Past Consumption Analysis Technique

 In this technique future projection is made on the basis of the past consumption
data, which is analyzed taken in to consideration the past and future plans.
 Statistical tools like mean, median, mode and standard deviation are used in
analyzing the past consumption.

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Elements of Material Management Planning
 Demand estimation
A large number of items are used in the hospital. The advisory committee for
development of surgical instruments, equipment and appliances (1963) identified 3200
items of instruments, equipments and appliances being used in the hospital.
 Identify the needed items

 Need for variety reduction-less number of materials, less will be the problems of
planning
 Lying down proper specification based on ISI or other standards
 Calculate from the trends in Consumption

 Review past the consumption in the past
 Review with resource constraints

 Availability of funds
 Procurement process planning
Problems affecting material planning
 Corporate/ Government objectives and plans

 Technology available
 Market demand
 Lead time and rejection rates
 Working capital available
 Nature of inventory required
 Capacity and its utilization of the organization
 Seasonal variations
 Information and data available
 Overall material policy
QUALITY ASSURANCE- CONTINUOUS QUALITY IMPROVEMENT
Introduction
Quality management (QM) and quality improvement (QI) are the basic concepts
derived from the philosophy of total quality management (TQM). Now it is preferred to use the

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term Continuous Quality Improvement (CQI) since TQM can never be achieved. And the
method of monitoring of healthcare for CQI is done with Quality Assurance (QA).
Definition
―Quality assurance is a judgment concerning the process of care based on the extent to
which that care contributes to valued outcomes.‖ -Donabedian 1982
―Quality assurance is the measurement of provision against expectations with

declared intention and ability to correct any demonstrated weakness.‖ -Shaw
―Quality assurance is a management system designed to give maximum guarantee

and ensure confidence that the service provided is up to the given accepted level of quality, the
standards prescribed for that service which is being achieved with a minimum of total
expenditure.‖ -British Standards Institute
―CQI is an ongoing quality improvement measure using management and scientific

methods of quality assurance involving data collection, its analysis, and formulating ways to
improve performance outcome according to proposed standards.‖
Quality assurance vs. Continuous quality improvement (Koch, 1993)
Quality improvement is not necessarily a replacement for existing quality assurance activities,
but rather an approach that broadens the perspectives on quality.
Quality assurance (QA) Quality Improvement (QI)
 Inspection oriented (detection)  Planning oriented (prevention)

 Reaction  Proactive
 Correction of special causes  Correction of common causes
 Responsibility of few people  Responsibility of all people involved
with the work
 Narrow focus  Cross- functional
 Leadership may not be vested  Leadership actively leading
 Problem solving by authority  Problem solving by employees at all
levels

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Objectives
 To successfully achieve sustained improvement in health care, clinics need to design

processes to meet the needs of patients.
 To design processes well and systematically monitor, analyze, and improve their
performance to improve patient outcomes.
 A designed system should include standardized, predictable processes based on best
practices.
 Set Incremental goals as needed.
NASA Ames Research Center Health Unit
 Public accountability- It provides evidence that the funds are being spend both
effectively resulting in optimum utilization of the resource resulting in operational
efficiency and efficiency of services provided.
 Management improvement- This is to provide quality assurance programme as a tool

for managerial problem solving. It includes identification of the problem in areas of
technical quality, efficiency, risk and patient satisfaction to assess its nature, causes and
taking effective actions to reduce or eliminate the identified problems.
 Facilitation of adoption of innovations- It includes evaluation of performance of

individuals professionals, preparation of appropriate criteria for assessment of processes
and outcome, exchange of information within and outside the organization, and
introduction of innovations with assessment of their impact on patient care outcome, risk
and satisfaction by using the patient as a unit for analysis.
Quality assurance whether in health or education had two main objectives:
 To provide technical assistance in designing and implementing effective strategies for

monitoring quality and correcting systemic deficiencies and
 To refine existing methods for ensuring optimal quality health care through an applied
research programme
(Decker, 1985 and Schroeder, 1984).
Purposes/ Need
 Rising expectations of consumer of services.

 Increasing pressure from national, international, government and other professional
bodies to demonstrate that the allocation of funds produces satisfactory results in terms of
patient care.

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 The increasing complexity of health care organizations.

 Improvement of job satisfaction.
 Highly informed consumer
 To prevent rising medical errors
 Rise in health insurance industry
 Accreditation bodies
 Reducing global boundaries.
Principles
 QM operates most effectively within a flat, democratic and organizational structure.

 Managers and workers must be committed to quality improvement.
 The goal of QM is to improve systems and processes and not to assign blame.
 Customers define quality.
 Quality improvement focuses on outcome.
 Decisions must be based on data.
According to W Edward Deming; (Deming‘s 14 points)
 Crete consistency of purpose for improvement of product and service.

 Adopt the new philosophy
 Cease dependence on inspection to achieve quality.
 End the practice of awarding business on the basis of price tag.
 Improve constantly and forever the systems of production and service.
 Institute training on the job.
 Institute leadership.
 Drive out fear.
 Break down barriers between departments.
 Eliminate slogans, exhortations, and target for the workforce.
 Eliminate numerous quotas for the workforce and numerical goals of management.
 Remove barriers that rob people of pride and workmanship.
 Institute a vigorous programme of education and self-improvement for everyone.
 Put everyone in the company to work to accomplish the transformation.
Approaches
 General approach
 Specific approach
General approach: - It involves large governing or official bodies evaluating a person or

agencies‘ ability to meet established criteria or standard during a given time.

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a) Credentialing- It is the formal recognition of professional or technical competence

and attainment of minimum standards by a person and agency. Credentialing
process has 4 functional components
 To produce a quality product
 To confirm a unique identity
 To protect the provider and public
 To control the profession
b) Licensure- It is a contract between the profession and the state in which the
profession is granted control over entry into an exit from the profession and over
quality of professional practice.
c) Accreditation- It is a process in which certification of competency, authority, or
credibility is presented to an organization with necessary standards.
d) Certification
e) Charter- It is a mechanism by which a state government agency under state law
grants corporate state to institutions with or without right to award degrees.
f) Recognition- It is defined as a process whereby one agency accepts the
credentialing states of and the credential confined by another.
g) Academic degree
Specific approach: - These are methods used to evaluate identified instances of provider and
client interactions.
a) Audit- It is an independent review conducted to compare some aspect of quality

performance, with a standard for that performance.
b) Direct observation- Structured or unstructured based on presence of set criteria.
c) Appropriateness evaluation- The extent to which the managed care organization provides
timely, necessary care at right levels of service.
d) Peer review- Comparison of individual provider‘s practice either with practice by the
provider‘s peer or with an acceptable standard of care.
e) Bench marking- A process used in performance improvement to compare oneself with
best practice.
f) Supervisory evaluation
g) Self-evaluation
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h) Client satisfaction
i) Control committees
j) Services- Evaluates care delivered by an institution rather than by an individual provider.
k) Trajectory- It begins with the cohort of a person who shares distinguishing
characteristics and then follows the group going through the healthcare system noting
what outcomes are achieved by the end of a particular period
l) Staging- It is the measurement of adverse outcomes and the investigation of its
antecedence.
m) Sentinel- It involves maintaining of factors that may result in disease, disability or
complications such as;
 Review of accident reports
 Risk management
 Utilization review
Elements/ components
 According to Donabedian;
 Structure Element- The physical, financial and organizational resources provided
for health care.
 Process Element- The activities of a health system or healthcare personnel in the
provision of care.
 Outcome Element- A change in the patient‘s current or future health that results
from nursing interventions.
 According to Manwell, Shaw, and Beurri, there are 3A‘s and 3E‘s;
 Access to healthcare
 Acceptability
 Appropriateness and relevance to need
 Effectiveness
 Efficiency
 Equity
STANDARDS
Standards are written formal statements to describe how an organization or professional

should deliver health service and are guidelines against which services can be assessed. Kirk and
Hoesing (1991) stated that standards are needed to;

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 Provide direction
 Reach agreement on expectations
 Monitor and evaluate results
 Guide organizations, people and patients to obtain optimal results.
Standards are directed at structure, process, and outcome issues and guide the review of systems
function, staff performance, and client care. The organizations providing quality indexes are;
•AHRQ –Agency for Healthcare Research and Quality

•IHI –Institute for Healthcare Improvement
•JCAHO –Joint Commission on Accreditation of Healthcare Organizations
•NAHQ –National Association for Healthcare Quality
•IOM –Institute of Medicine
•NCQA –National Committee for Quality Assurance
Areas of QA
The assurance in various key areas are;
 Outpatient department- The points to be remembered are;

 Courteous behavior must be extended by all, trained or untrained personnel.
 Reduction of waiting time in the OPD and for lab investigations by creating more
service outlets.
 Provide basic amenities like toilets, telephone, and drinking water etc.
 Provision of polyclinic concept to give all specialty services under one roof.
 Providing ambulatory services or running day care centers.
 Emergency medical services
Services must be provided by well trained and dedicated staff, and they should
have access to the most sophisticated life- saving equipment and materials, and
also have the facility of rendering pre- hospital emergency medical aid through a
quick reaction trauma care team provided with a trauma care emergency van.
 In- patient services
Provide a pleasant hospital stay to the patient through provision of a safe, homely
atmosphere, a listening ear, humane approach and well behaved, courteous staff.
 Specialty services
A high tech hospital with all types of specialty and super- specialty services will
increase the image of the hospital.
 Training
A continuous training programme should be present consisting of ‗on the job
training‘, skill training workshops, seminars, conferences, and case presentations.

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MODELS
1. Donabedian Model (1985): It is a model proposed for the structure, process and outcome of
quality. This linear model has been widely accepted as the fundamental structure to develop
many other models in QA.
2. ANA Model: This first proposed and accepted model of quality assurance was given by Long
& Black in 1975. This helps in the self- determination of patient and family, nursing health
orientation, patient‘s right to quality care and nursing contributions.
Evaluate Identify
outcome of standards
structure
and criteria
, standard and criteria
Apply the process,

standards and criteria

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3. Quality Health Outcome Model: The uniqueness of this model proposed by Mitchell & Co
is the point that there are dynamic relationships with indicators that not only act upon, but also
reciprocally affect the various components.
System
(Individual,
Group/ organization)
Intervention Outcome
Client
(Individual, Family & Community)
4. Plan, Do, Study, Act cycle: It is an improvement model advocated by Dr. Deming which is
still practiced widely that contains a distinct improvement phase.
Use of PDSA model assumes that a problem has been identified and analyzed for its most
likely causes and that changes have been recommended for eliminating the likely causes. Once
the initial problem analysis is completed, a Plan is developed to test one of the improvement
changes. During the Do phase, the change is made, and data are collected to evaluate the results.
Study involves analysis of the data collected in the previous step. Data are evaluated for
evidence that an improvement has been made. The Act step involves taking actions that will
‗hardwire‘ the change so that the gains made by the improvement are sustained over time.
5. Six Sigma: It refers to six standard deviations from the mean and is generally used in quality
improvement to define the number of acceptable defects or errors produced by a process.
It consists of 5 steps: define, measure, analyze, improve and control (DMAIC).
 Define: Questions are asked about key customer requirements and key processes to
support those requirements.
 Measure: Key processes are identified and data are collected.
 Analyze: Data are converted to information; Causes of process variation are identified.
 Improve: This stage generates solutions and make and measures process changes.
 Control: Processes that are performing in a predictable way at a desirable level are in
control.

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Quality tools
 Chart audits
It is the most common method of collecting quality data using charts as quality
assessment tool.
 Failure mode and effect analysis: prospective view
It is a tool that takes leaders through evaluation of design weaknesses within their
process, enable them to prioritize weaknesses that might be more likely to result
in failure (errors) and, based on priorities decide where to focus on process
redesign aimed at improving patient safety.
 Root- cause analysis: retrospective view
It is sometimes called a fishbone diagram, used to retrospectively analyze
potential causes of a problem or sources of variation of a process. Possible causes
are generally grouped under 4 categories: people, materials, policies and
procedures, and equipment.
 Flow charts
These are diagrams that represent the steps in a process.
 Pareto diagrams
It is used to illustrate 80/ 20 rule, which states that 80% of all process variation is
produced by 20% of items.
 Histograms
It uses a graph rather than a table of numbers to illustrate the frequency of
different categories of errors.
 Run charts
These are graphical displays of data over time. The vertical axis depicts the key
quality characteristic, or process variable. The horizontal axis represents time.
Run charts should also contain a center line called median.
 Control charts
These are graphical representations of all work as processes, knowing that all
work exhibit variation; and recognizing, appropriately responding to, and taking
steps to reduce unnecessary variation.
Indicators of quality assurance
 Waiting time for different services in the hospital

 Medical errors in judgment, diagnosis, laboratory reporting, medical treatment or surgical
procedures, etc.
 Hospital infections including hospital- acquired infections, cross infections.
 Quality of services in key areas like blood bank, laboratories, X- ray department, central
sterilization services, pharmacy and nursing.

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Quality improvement process- Steps
QI process steps include;
 Identify needs most important to the consumer of health care services.

 Assemble a multidisciplinary team to review the identified consumer needs and services.
 Collect data to measure the current status of these services.
 Establish measurable outcomes and quality indicators.
 Select and implement a plan to meet the outcomes.
 Collect data to evaluate the implementation of the plan and achievement of outcomes.
Quality assurance cycle:
In practice, QA is a cyclical, iterative process that must be applied flexibly to meet the needs of a
specific program. The process may begin with a comprehensive effort to define standards and
norms as described in Steps 1-3, or it may start with small-scale quality improvement activities
(Steps 5-10). Alternatively, the process may begin with monitoring (Step 4). The ten steps in the
QA process are discussed.
1. Planning for Quality Assurance

This first step prepares an organization to carry out QA activities. Planning begins with a review
of the organizations scope of care to determine which services should be addressed.
2. Setting Standards and Specifications

To provide consistently high-quality services, an organization must translate its programmatic
goals and objectives into operational procedures. In its widest sense, a standard is a statement of
the quality that is expected. Under the broad rubric of standards there are practice guidelines or
clinical protocols, administrative procedures or standard operating procedures, product
specifications, and performance standards.

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3. Communicating Guidelines and Standards

Once practice guidelines, standard operating procedures, and performance standards have been
defined, it is essential that staff members communicate and promote their use. This will ensure
that each health worker, supervisor, manager, and support person understands what is expected
of him or her. This is particularly important if ongoing training and supervision have been weak
or if guidelines and procedures have recently changed. Assessing quality before communicating
expectations can lead to erroneously blaming individuals for poor performance when fault
actually lies with systemic deficiencies.
4. Monitoring Quality
Monitoring is the routine collection and review of data that helps to assess whether program
norms are being followed or whether outcomes are improved. By monitoring key indicators,
managers and supervisors can determine whether the services delivered follow the prescribed
practices and achieve the desired results.
5. Identifying Problems and Selecting Opportunities for Improvement

Program managers can identify quality improvement opportunities by monitoring and evaluating
activities. Other means include soliciting suggestions from health workers, performing system
process analyses, reviewing patient feedback or complaints, and generating ideas through
brainstorming or other group techniques. Once a health facility team has identified several
problems, it should set quality improvement priorities by choosing one or two problem areas on
which to focus. Selection criteria will vary from program to program.
6. Defining the Problem

Having selected a problem, the team must define it operationally-as a gap between actual
performance and performance as prescribed by guidelines and standards. The problem statement
should identify the problem and how it manifests itself. It should clearly state where the problem
begins and ends, and how to recognize when the problem is solved.
7. Choosing a Team
Once a health facility staff has employed a participatory approach to selecting and defining a
problem, it should assign a small team to address the specific problem. The team will analyze the
problem, develop a quality improvement plan, and implement and evaluate the quality
improvement effort. The team should comprise those who are involved with, contribute inputs or
resources to, and/or benefit from the activity or activities in which the problem occurs.
8. Analyzing and Studying the Problem to Identify the Root Cause

Achieving a meaningful and sustainable quality improvement effort depends on understanding
the problem and its root causes. Given the complexity of health service delivery, clearly
identifying root causes requires systematic, in-depth analysis. Analytical tools such as system
modeling, flow charting, and cause-and-effect diagrams can be used to analyze a process or
problem. Such studies can be based on clinical record reviews, health center register data, staff or
patient interviews, service delivery observations.
9. Developing Solutions and Actions for Quality Improvement

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The problem-solving team should now be ready to develop and evaluate potential solutions.
Unless the procedure in question is the sole responsibility of an individual, developing solutions
should be a team effort. It may be necessary to involve personnel responsible for processes
related to the root cause.
10. Implementing and Evaluating Quality Improvement Efforts

The team must determine the necessary resources and time frame and decide who will be
responsible for implementation. It must also decide whether implementation should begin with a
pilot test in a limited area or should be launched on a larger scale. The team should select
indicators to evaluate whether the solution was implemented correctly and whether it resolved
the problem it was designed to address. In-depth monitoring should begin when the quality
improvement plan is implemented. It should continue until either the solution is proven effective
and sustainable, or the solution is proven ineffective and is abandoned or modified. When a
solution is effective, the teams should continue limited monitoring.
JCAHO quality assurance guidelines/steps:
1. Assign responsibility:
According to the Joint Commission, ―The nurse administrator is ultimately responsible for the
implementation of a quality assurance program. Completing step one of the Joint Commission‘s
ten step process require writing a statement that described who is responsible for making certain
that QA activities are carried out in the facility. Assigning responsibility should not be confused
with assuming responsibility.
2. Delineate scope of care and services:

Scope of care refers to the range of services provided to patients by a unit or department. To
delineate the scope of care for a given department personnel should ask themselves,‘ what is
done in the department?‘
3. Identify important aspects of care and services:

Important aspects of nursing care can best be described as some of the fundamental contribution
made by nurses while caring for patients. They are the most significant or essential categories of
care practiced in a given setting. There is no prescribed list of important aspects of care that
every organization must monitor.
4. Identify indicators of outcome (no less than two; no more than four):
A clinical indicator is a quantitative measure that can be used as a guide to monitor and evaluate
the quality of important patient care and support service activities. Indicators are currently
considered as being of two general types i.e. sentinel events and rate-based. Indicators also differ
according to the type of event they usually measures (structure, process or outcome).
5. Establish thresholds for evaluation:

Thresholds are accepted levels of compliance with any indicators being measured. Thresholds
for evaluation are the level of or point at which intensive evaluation is triggered. A threshold can
be viewed as a stimulus for action.

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6. Collect data:
Once indicators have been identified, a method of collecting data about the indicators must be
selected. Among the many methods of data collection is interviewing patient/family, distributing
questionnaires, reviewing charts, making direct observation etc.
7. Evaluate data:
When data gathering is completed in the process of planning patients care, nurses make
assessments based on the findings. In the QA process as a whole, when data collection has been
completed and summarized, a group of nurses makes an assessment of the quality of care.
8. Take action:
Nurses are action-oriented professionals. For many nurses, the greater portion of every day is
spent on patient‘s intervention. These actions and interventions conducted by nurses promote
health and wellness for patients. Converting nursing energy into the QA process requires
formulating an action plan to address identified problems.
9. Assess action taken:

Continuous and sustained improvement in care requires constant surveillance by nurses of the
intervention initiated to improve care.
10. Communicate:
Written and verbal messages about the results of QA activities must be shared with other
disciplines throughout the facility.
NURSING AUDIT
Audit in nursing management is the professional evaluation of the quality of the patient care, by
analysing through all the facilities , services rendered, measures involved in diagnosis, treatment
and other conditions and activities that affect the patients.
Definition
―Nursing audit refers to the assessment of the quality of clinical nursing.‖ - Elison
―Nursing audit is the means by which nurses themselves can define standards from their
point of view and describe the actual practice of nursing.‖ - Goster Walfer
Characteristics
 It improve the quality of nursing care

 It compares actual practice with agreed standards of practice.
 It is formal and systemic.
 It involves peer review.
 It requires the identification of variations between practice and standards followed by the
analysis of causes of such variations.

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 It provides feedback for those whose records are audited.

 It includes follow- up or repeating an audit sometimes later to find out if the practice is
fulfilling the agreed standards.
Objectives
 To evaluate the quality of nursing care given.

 To achieve the desired and feasible quality of care.
 To provide a way for better records.
 To focus on care provided and care provider.
 To provide rationalized care thereby maintaining uniform standards worldwide.
 To contribute to research.
Methods of Audit
There are mainly two methods;
 Retrospective view- It refers to the detail quality care assessment after the patient has
been discharged. The records can be reviewed for completeness of records, diagnosis,
treatment, lab investigations, consultations, nursing care plan, complications, and end
results.
 Concurrent view- It is achieved by reviewing patient care during the time of hospital stay
by the patient. It includes assessing the patient at the bed- side in relation to
predetermined criteria like errors, omissions, deficiencies, as well as efficiencies and also
excess in the care of patients under them. It involves direct and indirect observation,
interviewing the staff responsible for care, and reviewing the patients‘ records and care
plan.
It can be also done to identify the job satisfaction of staff nurses in accordance with their
work performance.
Audit cycle
According to Payne, the steps in audit or utilization review include;
 Criteria development
 Selection of cases
 Work sheet preparation
 Case evaluation
 Tabulation of evaluation
 Presentation of reports
The basic audit cycle can be depicted as;

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4. implement
1. set
change
standards
2. observe
practice
changes
3. compare
with standards
In general, the stages of audit cycle are;
 Identify the need for change

 Setting criteria and standards
 Collecting data on performance
 Assess criteria against criteria and standards
 Identify need for change (re- evaluation)
Advantages
 Patient is assured of good service.

 Better planning of quality improvement can be done.
 It develops openness to change.
 It provides assurance, by meeting evidence based practice.
 It increases understanding of client‘s expectations.
 It minimizes error or harm to patients.
 It reduces complaints or claims.
Disadvantages
 It may be considered as a punishment to professional group.

 Medico- legal importance- They feel that they will be used in court of law as any
document can be called for in a court law.
 Many components may make analysis difficult.
 It is time consuming
 It requires a team of trained auditors.

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PERFORMANCE APPRAISAL
INTRODUCTION
A continual and troublesome question facing nurse managers today is why some employees
perform better than others. Making decisions about who performs what tasks in a particular
manner without first considering individual behaviour can lead to irreversible long term
problems. Each employee is different in many respects. A manager needs to ask how such
differences influence the behaviour and performance of the job requirements. Ideally, the
manager performs this assessment when the new employee is hired. In reality, however, many
employees are placed in positions without the managers having adequate knowledge of their
abilities and / or interests. This often results in problems with employee performance, as well as
conflict between employees and managers.
MEANING
Performance appraisal means the systematic evaluation of the performance of an expert or his
immediate superior.
Performance appraisal is a method of evaluating the behavior of employees in the work

spot, normally including both the quantitative and qualitative aspects of job performance.
Performance here refers to the degree of accomplishment of the tasks that make up an
individual's job. It indicates how well an individual is fulfilling the job demands. Often the term
is confused with effort, but performance is always measured in terms of results and not efforts.
The performance appraisal process includes day-to-day manager-employee interactions

(coaching, counseling, dealing with policy/procedure violations, and disciplining); written
documentation (making notes about an employee's behavior, completing the performance
appraisal form); the formal appraisal interview; and follow-up sessions that may involve coach-
ing and/or discipline when needed.
DEFINITION
Edwin b flippo, ―performance appraisal is a systematic, periodic and so far as humanly possible,
an impartial rating of an employee‘s excellence in matters excellence in matters pertaining to his
present job and to his potentialities for a better job‖
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The performance of an employee is compared with the job standards. The job standards are
already fixed by the management for an effective appraisal.
According to scott, clothier and spriegal, ―performance appraisal is a record of progress

for apprentices and regular employees, as a guide in making promotions, transfer or demotions,
as a guide in making lists for bonus distribution, for seniority consideration and for rates of pay,
as an instrument for discovering hidden genius, and as a source of information that makes
conferences with employees helpful‖.
OBJECTIVES OF APPRAISAL.
1. To determine the effectiveness of employees on their present jobs so as to decide their

benefits.
2. To identify the shortcomings of employees so as to overcome them through systematic
guidance and training.
3. To find out their potential for promotion and advancement.
PURPOSES AND BENIFITS
Performance appraisal can serve many purposes and has several benefits. Among them are:
1. To provide backup data for management decisions concerning salary standards, merit
increases, selection of qualified individuals for hiring, promotion or transfer, and
demotion or termination of unsatisfactory employees.
2. To serve as a check on hiring and recruiting practices and as validation of employment

tests.
3. To motivate employees by providing feedback about their work.
4. To discover the aspirations of employees and to reconcile them with the goals of the
organisation,
5. To provide employees with recognition for accomplishments,
6. To improve communication between supervisor and employee, and to reach an

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understanding on the objectives of the job,

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7. To help supervisors observe their subordinates more closely, to so a better coaching job,
and to give supervisors a stronger part to play in personnel management and employee
development,
8. To establish standards of job performance.
9. To improve organisational development by identifying training and development needs to

employees and designing objectives for training programmes based on those needs,
10. To earmark candidates for supervisory and management developments and
11. To help the organisation determine if it is meeting its goals.
IMPORTANCE
Now a day, the management uses performance appraisal as a tool. The scope of performance
appraisal is not limited to pay fixation and is enlarged to include many decisions.
1. Performance appraisal helps the management to take decision about the salary increase of
an employee.
2. The continuous evaluation of an employee helps in improving the quality of an employee
in job performance.
3. The Performance appraisal brings out the facilities available to an employee, when the
management is prepared to provide adequate facilities for effective performance.
4. It minimises the communication gap between the employer and employee.
5. Promotion is given to an employee on the basis of performance appraisal.
6. The training needs of an employee can be identified through performance
appraisal.
7. The decision for discharging an employee from the job is also taken on the basis
of performance appraisal.
8. Performance appraisal is used to transfer a person who is misfit for a job to the
right placement.
9. The grievances of an employee are eliminated through performance appraisal.

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10. The job satisfaction of an employee increases morale. This job satisfaction is
achieved through performance appraisal.
11. It helps to improve the employer and employee relationship.
CONCEPT OF PERFORMANCE APPRAISAL
1. The appraisal should be in writing and carried at least once a year.

2. The performance appraisal information should be shared with the employee.
3. The employee should have the opportunity to respond in writing to the appraisal.
4. Employees should have a mechanism to appeal the results of the performance
appraisal.
5. The manager should have adequate opportunity to observe the employees job
performance during the course of the evaluation period.
6. Anecdotal notes on the employee‘s performance should be kept during the entire
evaluation period.
7. Evaluator should be trained to carry out the performance appraisal process.
8. As for as possible, the performance appraisal should focus on employee behaviour
and results rather than on personal traits or characteristics.
CHARECTERISTICS AND OBSTACLES
The following characteristics are essential elements of effective performance appraisal:
1. The philosophy, purpose, and objectives of the organisation are clearly stated so that
performance appraisal tools can be designed to reflect these.
2. The purposes of performance appraisal are identified, communicated, and understood.
3. Job descriptions are written in such a manner that standards of job performance can be
identified for each job.
4. The appraisal tool used is suited to the purposes for which it will be utilised and is
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accompanied by clear instructions for its use.

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5. Evaluators are trained in the use of the tool.
6. The performance appraisal procedure is delineated, communicated, and understood.
7. Plans for policing the appraisal procedure and evaluation appraisal tools are developed
and implemented.
8. Performance appraisal has the full support of top management.
9. Performance appraisal is considered to be fair and productive by all who participate in it.
The principal obstacles to effective performance appraisal are:
1. Lack of support from top management.
2. Resistance on the part of evaluators because:
a. Performance appraisal demands too much of supervisors efforts in terms of time,

paperwork, and periodic observation of subordinates performance.
b. Supervisors are reluctant to play god by judging others.
c. Supervisors do not fully understood the purpose and procedures of performance

appraisal.
d. Supervisors lack skills in appraisal techniques.
e. Performance appraisal is not perceived as being productive.
3. Evaluation biases and rating errors, which result in unreliable and invalid ratings.
4. Lack of clear, objective standards of performance.
5. Failure to communicate purposes and results of performance appraisal to employees.
6. Lack of a suitable appraisal tool.
7. Failure to police the appraisal procedure effectively.

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PRINCIPLES OF PERFORMANCE APPRAISAL
1. Single employee is rated by two ratters. Then, the comparison is made to get accurate
rating.
2. Continuous and personal observation of an employee is essential to make effective
performance appraisal.
3. The rating should be done by an immediate superior of any subordinate in an
organization.
4. A separate department may be created for effective performance appraisal.
5. The rating is conveyed to the concerned employee. It helps in several ways. The
employee can understand the position where he stands and where he should go.
6. The plus points of an employee should be recognised. At the same time, the minus points
should not be highlighted too much, but they may be hinted to him.
7. The management should create confidence in the minds of employees.
8. The standard for each job should be determined by the management.
9. Separate printed forms should be used for performance appraisal to each job according to
the nature of the job.
KINDS OF PERFORMANCE APPRAISAL
There are many kinds of performance appraisal available. But the management wants to
adopt only one of the types of performance appraisal. The appraisal is done adopting any one
of the two approaches. These two approaches are traits and results. The traits approach refers
to appraising the employee on the basis of his attitudes. The result approach refers to
appraising the employee on the basis of results of his accomplishments of a job.
1. Ranking method
This method is very old and simple form of performance appraisal. An employee is
ranked one against the other in the working group under this method.
Example: if there are ten workers in the working group, the most efficient worker is
ranked as number one and the least efficient worker is ranked as number ten.

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Advantages
a. Each employee or worker can be compared with the other person.

b. A small organization can get maximum benefits through the ranking method.
Disadvantages
a. A big organization is not able to get sizable benefits from the ranking method.
b. Ranking method does not evaluate the individuality of an employee.
c. It lags objectivity in the assessment of employees.
2. Paired Comparison Method

This method is a part of ranking method. Paired comparison method has been developed
to be used in a big organization. Each employee is compared with other employees taking
only one at a time. The evaluator compares two employees and puts a tick mark against
an employee whom he considers a better employee. In the same way, an individual is
compared with all other existing employees. Finally an employee who gets maximum
ticks for being a better employee is consider the best employee.
Advantages
a. This method is suitable for big organizations.
b. Individual traits are evaluated under this method.
Disadvantages
a. The understanding of this method is difficult one.

b. It involves considerable time.
3. Forced distribution method

A method which forces the rater to distribute the ratings of the overall performance of an
employee is known as forced distribution method. Group wise rating is done under this
method. This method is suitable to large organisations, but the individual traits could not
be appraised under this method.
Example: a group of workers doing the same job would fall into the same group as
superior, at and above average, below average and poor. The rator rates 15% of the
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workers as superior, 35% of the workers as at and above average, 35% of workers as
below average and 15% of workers as poor.
4. Grading
Certain categories of abilities or performance of employees are defined well in advance
to fall in certain grades under this method. Such grades are very good, good, average,
poor and very poor. Here the individual traits and characteristics are identified.
5. Checklist
The appraisal of the ability of an employee through getting answers for a number of
questions is called the method of check list. These questions are related to the behaviour
of an employee. The evaluation is done by a separate department, but the duty of
collection of checklist answers is given to a person who is designated as a rator. The rator
indicates the answers of an employee against each question by putting a tick mark. There
are two columns provided to each question as yes or no.
A model check list is given below.

A. Is the employee satisfied with the job? Yes No
B. Does he finish the job accurately? Yes No
C. Does he respect the superiors? Yes No
D. Is he ready to accept responsibilities? Yes No
E. Does he obey the orders? Yes No
6. Forced choice method
A series of groups of statements are prepared positively or negatively under this method,
both these statements describe the characteristics of an employee, but the rator is forced
to tick any one of the statements either out of positive statements or out of negative
statements. The degree of description of the characteristics of an employee varies from
one statement to another.
The following are the positive statements;
a. The employee completes the job in time usually.
b. The employee has the ability to complete the job and complete the job as and when
there is a need.

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The negative statements are also prepared. The final rating is done on the basis of all such
statements. But the ratter does not know the statements which are for final rating.
7. Critical Incident method

The performance appraisal of an employee is done on the basis of the incidents occurred
really to the concerned employee. Some incidents occurred due to the inability of the
employee, but the rating is done on all the events occurred in a particular period.
Some of the events or incidents are given below.
a. Refused to co-operate with other employees
b. Unwilling to attend further training
c. Got angry over work or with subordinates
d. Suggested a change in the method of production
e. Suggested a procedure to improve the quality of goods
f. Suggestion of a method to avoid or minimize wastage, spoilage and scrap.
g. Refused to obey orders
h. Refused to follow clear cut instructions
8. Field review method

An employee‘s performance is appraised through an interview between the rator and the
immediate superior or superior of a concerned employee. The rator asks the superiors
questions about the performance of an employee, the personnel department prepares a
detail report on the basis of this collected information. A copy of this report is placed in
the personnel file of the concerned employee after getting approval from the superior.
The success of this type of appraisal method is based on the competence of the
interviewer.
9. Essay evaluation
With easy evaluation technique the nurse manager is required to describe the employee‘s
performance over the entire evaluation period by writing a narrative detailing the strength
and weaknesses of the appraise. If done correctly this approach can provide a good deal
of valuable data for discussion in the appraisal interview.

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COMPONENTS TO BE EVALUATED
Nurse engages in a variety of job related activities to reflect the multi

dimensional nature of the job. The performance appraisal form usually acquires
a nurse manager to rate several different performance dimension.
The components are
a. Use of nursing process

b. Professionalism
c. Maintaining safety
d. Continuing education
e. Initiative character.
STEPS FOR PEER REVIEW
1. The employee selects peers to conduct the evaluation. Usually two to

four peers are identified through a pre determined process.
2. The employee submits self evaluation port folio. The port folio might
describe how he or she met objectives and/or pre determined standards
during the past evaluation cycle. Supporting materials are included.
3. The peer evaluates the employee. This may be done individually or in a
group. The individuals are group then submit a written evaluation to the
manager.
4. Manager and employee meet to discuss the evaluation. The manager‘s
evaluation is included and objectives for the coming evaluation cycle
are finalized.

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Luther Gulick:: Controlling

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Luther Gulick:: Controlling

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Luther Gulick:

He was influenced by Taylor and Fayol. He used Fayal‘s five elements of

Controlling can be defined as the regulation of activities in accordance with the

3. Comparing the actual results with the standards.

4. Correcting deviations from standards.

The concept of management.

I. Louis Allen, "Management is what a manager does."

III. George R. Terry, "Management is a distinct process consisting of planning, organizing,

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

'Getting Things Done Through Others' Concept:

Leadership and Decision-making Concept:

According to this concept, "management is an art and science of decision-making and

II. Ralph, C. Davix, "Management is the function of executive leadership anywhere."

According to this concept, "management is an art of increasing productivity."

Economists treat management as an important factor of production. According to them,

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

II. Megginson, "Management is management, whether it is in Lisbon, or in London or in Los

Management is the creation and control of technological and human environment of an

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

In management or administration of any enterprises for organization, the quality,

 Execution and control of work plan:

Since the function of administration is to attain an established objective through the

Administrators must be completely flexible to meet the changing needs of

ROGRAM EVALUATION AND REVIEW TECHNIQUE (PERT)

PERT uses a network of activities. Each activity is represented as a step on chart. It is an

Program Evaluation & Review Technique includes:

1. The finished product or service desired

3. The starting date & completion date.

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

Steps for accomplishing the project are:

c. The pessimistic time: This is estimated on maximum potential difficulties.

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

1. It forces planning and shows how pieces fit together.

2. It does this for all nursing line managers involved.

4. It reveals problems & is forward- looking.

5. PERT is generally used for complicated & extensive projects or programs.

Modern and Philips enlist the advantages of PERT:

1. It encourages logical discipline in planning, scheduling and control of project.

2. It encourages more long range & detailed project planning

3. It provides a standard method of documenting and communicating project plans, schedules,

5. It illustrates the effects technical procedural changes on overall schedules.

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

It could be applied to a project such as implementing a modality of primary nursing or

These are possible nursing actions for a project:

Figure is an only an example .Application of these controlling process by nurse managers

DIRECTOR (hospital) DIRECTOR OF HEALTH

Chief Nursing Officer Asst. Director of Health Service

ORGANIZING NURSING SERVICE AT VARIOUS LEVELS

PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN,

Addl.DG (PH) Addl.DG (N) Addl.DG (M)

ADG ADG ADG

DADG DADG DADG

Organizational set-up of Nursing Service at Central Level

Director Nursing Service

ADNS ADNS ADNS

DADNS DADNS DADNS

DADNS DADNS DADNS

LHV Tutor Ward sister

Organizational set-up of Nursing Service at State Level

DMO DNO DHO

ADNO (Hosp&Nsg.Edu) ADNO (Community)

Nsg Supt/Dy.Nsg.Supt Principal tutor Dist.PNO