CONTROLLING

Controlling
The use of formal authority to assure the
achievement of goals and objectives.
Involves assisting, regulating, monitoring,
and evaluating individual and group
performance.
Also called “coordinating” since
management control can have a negative
connotation.
Can be critical determinant of
organizational success.
Functions both a means and an end
(promotes effective use of resources,
Principles of Controlling
1. Critical Few- fewer people involved in control
brings about the best results
2. Point of Control- centralization or
decentralization of authority
3. Self-control or Discipline- personal acceptance
of responsibility and accountability

Kinds of Formal Control

1. Pre-action Control- personal supervision and
utilizing control checks consisting of procedures
for any given task or function
2. Post-action Control- controlling as the task is
being performed and correcting deviations from
the standards or plans
Types of Control
1. Feedforward Controls
* Focus on operations before they begin
* Goal is to prevent anticipated problems
* Examples: preparing all supplies and equipment before doing
procedures, safety systems, training programs, and budgets

2. Concurrent Controls
> Apply to processes as they are happening
> Enacted while work is being performed
> Include any type of material or supplies for therapeutic care
which requires direct supervision or the use of automated systems

3. Feedback Controls
+ Focus on the results of operations
+ Guide future planning, inputs, and process designs
+ Examples: timely (weekly, monthly, quarterly, annual) reports
so that almost instant adjustments can be made
Characteristics of Effective Controls
1. Must be designed appropriately.
2. When control standards are inflexible or
unrealistic, employees cannot focus on the
organization’s goals.
3. Control systems must prevent, not cause, the
problems they were designed to detect.
 
Designing Effective Control Systems (Guidelines)
1. Control at all levels in the health care delivery
system. All nursing units must have a standard
control system.
2. Acceptability of those who will enforce decisions.
(Manner of influence to her staff to comply with the
policies or procedures)
3. Flexibility of the enforcers and the
implementors to enforce decisions based
on practical situations.
4. Accuracy. Steps or mechanisms of control
must be clear and vivid with significant
implications.
5. Timeliness. Activities are planned with
time target set.
6. Cost effectiveness. Resources used are
well maintained and enough or adequate to
meet the needs of the unit.
7. Understandability. Policies and procedures
are simple, easy to understand and can be
implemented with less difficulty.
8. Balance between objectivity and
 The Control Process
1. Establish and Specify Criteria and Performance
Standards
Serve as the criteria against which performance is
measured and give an idea of the level of performance that
managers can expect a person
a. Standards
- created when objectives are set during the planning
process
- any guideline established as the basis for measurement
- a precise, explicit statement of expected results from a
product, service, machine, individual, or organizational unit
- usual expressed numerically and is set for quality,
quantity, and time
b. Resource Controls
- Time controls- deadlines and time
constraints
- Material controls- inventory and material-
yield controls
- Equipment controls- built into the
machinery, imposed on the operator to
protect the equipment or process
- Cost controls- ensure cost standards are
met
- Employee performance controls- actions
and behaviors of individuals and groups of
employees
- Budget control cost or expense related
standards- identify the quantity of
c. Financial Controls
- facilitate achieving the organization’s profit motive
- one method is budgeting
- budgets allocate resources to important activities
and provide supervisors with quantitative standards
against which to compare resource consumption
d. Operation’s Control
- assess how efficiently and effectively an
organization’s transformation process create goods
and services, includes Total Quality Management
(TQM)
e. Statistical Process Control
-use of statistical or mathematical methods and
procedures to determine whether production
operations are being performed correctly to detect
any deviations and to find and eliminate their causes
f. The Just-in-Time (JIT) System
-timely application of medications, and purchased
materials just in time to be transformed into parts
- Deliver the smallest possible quantities at the latest
possible date at all stages of the transformation process to
minimize inventory costs

2. Monitor and Measure Performance of Nursing Care

Services and Evaluate it against the Standards
through Records, Reports, and Observations
a. Nursing rounds- attention to issues of patient care and
nursing practice
b. Quality Assurance- monitors compliance with
established standards
c. Nursing Audit- documentation of the quality of nursing
care in relation to the standards established by the nursing
department
3. Compare Performance with
Standards, Models, or Criteria to
Determine Deviations or Differences
-ensures that tasks are being carried out as
planned
- actual accomplishment is matched with
the acceptance standard to check if there
are delays or deviations from the standard.
a. the Program Evaluation and Review
Technique (PERT)- matrix that uses network
of activities represented in a chart,
including the goals or product desired, time
management, budget and estimation of
critical paths
b. Benchmarking- seeks out the best so as
4. Enact Remedial Measures or Steps to
Correct deviations or Errors
a. Correction of deviations or errors by
modifying the plan either by changing the
number of personnel or by better selection
and training of subordinates or by changing
the other factors of production or by adding
more materials or resources.

b. A Master Control Plan- depicting

functions, goals, and objectives to be
accomplished and its specific activities.

c. Take necessary actions. Find the cause

of deviation from standard.
Characteristics of the Control Process

1. Cyclical which means it is never finished

2. Controlling often leads to management

expecting employee behavior change

3. Control is both anticipatory and retrospective

4. Ideally, each person in the health care

delivery views control as his/her responsibility.

5. Controlling builds planning, organizing, and

leading
Management Control Strategies
1. Market control- first relies primarily on
budgets and rules, made up of external
forces

2. Bureaucratic control internal forces,

social needs
3. Clan- control through feeling a valued
part of the business

4. Self- control- aka adhocracy control;

complimentary to market, bureaucratic,
and clan control
Performance Appraisal Tools
A method of acquiring and processing
information needed to improve the
individual’s performance and
accomplishments
Consists of setting standards and objectives
against determined standards and objectives;
reviewing progress, having on-going
feedback between the appraiser and the one
who is being appraised; planning for
reinforcement, deletion or correction of
identified behavior as necessary
To assess the appropriateness, adequacy,
effectiveness, and efficiency of services

1. Trait Rating Scale

-rating a person against a set standard
2. Job Dimension Scales
-focuses on job requirements and the quality of work
performance

3. Behaviorally Anchored Rating Scale (BARS)

-focuses on desired behaviors to improve performance

4. Checklist
-composed of behavioral statements that represent desirable
behavior.

5. Peer Review
- collegial evaluation of the performance done to promote
excellence in practice and offer information, support, guidance,
criticism, and direction to one another .

6. Self- Appraisal
-allows the employee to evaluate own performance
Common Errors in Appraisal
1. Halo Effect- tendency to overrate staff based on
the raters first impression of the ratee based on the
good traits or good things one sees in a person
2. Logical Error- often based on first impressions of
the rater to the ratee
3. Central Tendency Error- rates the staff as
average; used when feedback tools are inadequate
4. Leniency Error- overlook the weakness and
mistakes of the person being evaluated leading to
an inaccurate picture of the job performance
5. Hawthorne Effect- the behavior of the ratee
changes simply because he is observed by the rater
6. Horn’s effect- occurs when rating an employee
very low because of an error committed
Development of Standards
> In developing a performance standard, it is mandatory
that a criterion is established and specified
> Example: Competency of the nursing profession in the
Philippines
 
Types of Standards
a. Structure Standards
-focus on the structure of management system used by
an agency to organize and deliver nursing care who
provides that care
b. Process Standards
-refer to actual nursing care procedures or those activities
engaged in by nurses to administer care
c. Outcome Standards
-designed for measuring the results of nursing care
include Conflict Management, Budgeting, and discipline
Dysfunctional Consequences of Control
a. Game Playing- a game between the “boss and me and
I want to win”
b. Resisting Control- passive aggression or negative
reaction to too much control
c. Providing Inaccurate Information- lack of
understanding of why the information is needed
d. Following Rules to the Letter- following dumb and
unprofitable rules in reaction to “do as I say”
e. Sabotaging- stealing, discrediting other workers,
chasing customers away, gossiping about the firm to
people in the community
f. Playing One Manager Off Against Another- Exploiting
lack of communication among managers, asking a second
manager if don’t like the answer of the first manager.
 DIRECTING

- Is the issuance
of assignment,
orders and
instructions ,
delegation
• It is through directing that the manager;
– encourages personnel to accomplish their assigned tasks
– achieving the objectives
– laid down the organization while planning and organizing
the operations.

• Directing goes beyond giving orders and instructions;

- final major step
- ensure that the organization’s goal is
accomplished
- thus, must ensure that she has assigned the works
properly
-gotten the right person for each task that needs to
be accomplished.
 - employee must have a genuine interest in the
task that needs to be accomplished
  -employees are able to get along harmoniously
-directing employees invariably depend on the
relationships existing among them.
- in a nursing care environment where continued
interaction among the various employees
 
• Definition of Directing

- issuing of orders assignments, instructions to

accomplish the organization’s goals and objectives.
- process of getting the organization’s work done.
- explaining what is to be done, to and by whom, at
what time, how and why.

• Remember: All directions must be consistent with

the department policies
 • Characteristics of Good Direction
1. Direction must be clear, concise, consistent and
complete.
2. Apart from being understandable, the person giving
directions must explain the rationale well and make
certain that it is understood.
3. The words used in the directions indicate their
importance. For example, the words “must” ,”shall” and
“will” indicate that the directions are mandatory. The
word “may” denotes that action is recommended, while
the word “should” places the directive somewhere
between mandatory and recommended action
• The person giving directions must speak distinctly
and slowly. Directions must come across as
requests not commands, using a specific tone and
set of words. She should give directions in logical
manner and prioritize the tasks directed to be
done by importance and time.
• It is important, furthermore.
 To avoid giving too many directions at one time:
To personalize directions
To always check to make sure directions have been
followed.
 Tools in directing

 
A. Nursing Care Plan
 
• outlines the nursing care to be provided to a
patient
• set of actions the nurse will implement to
resolve nursing problems identified by
assessment
• guides in the ongoing provision of nursing care
and assists in the evaluation of that care.
 
• Element of Directing
 
1. Delegation
– Act of assigning to someone else a portion of work to be done with corresponding
authority, responsibility and accountability (ARA)
– An assignment is a task done with ARA.
– Skill to be learned and mattered beginning with learning what cannot be delegated
and what will be delegated and to whom.
 
• What cannot be delegated?
 
• Certain matters cannot be delegated,
a. Overall ARA,
b. File evaluation of staff performance and
c. Correcting and disciplining staff
d. Activities which the nurse to whom the task is delegated does not
know how or does not want to do because it is unpleasant.
e. Delegated tasks must be based on policies, job description and
capacities of workers.
  Five“rights”
Delegation of delegation:

 Right task
 Right

• Manager decides circumstances

what task should  Right person

be delegated,  Right direction

when, where and and
by whom. communication
 Right

supervision
• Why manager do not want to delegate

1. Mistakes in delegation can be costly

2. Failure to delegate wisely increases management
costs and contributes to personnel dissatisfaction,
3. Fear on the part of the director, of her own ability
to delegate
4. Fear of losing control of staff
5. Fear of failing to get others to do works
6. Fear of criticism.
• Common Delegation Errors
 
A. Under delegating
 
• managers’ false assumption that delegation may be interpreted as
lack of ability on his or her part to do the job correctly and
completely. The manager manifests his desire to do the job himself.
He has trust issues and thus lacks the trust in his subordinates. He is
insecure that he fears that subordinates will resent the work
delegated to them.
 
• Under delegating also occurs when the manager lack experience in
the job. Thus, there is excessive need to control and be perfect.
 
B. Over delegating
 
- unnecessarily burdens the subordinates with tasks that are either
inconsequential or irrelevant to the delivery of the goal. The culprit
is usually poor management of time and insecurity in the art of the
nurse manager in her ability to perform tasks.
 
C. Improper Delegating
 
- Delegation of tasks and responsibilities beyond which the person
cannot perform properly I improper delegation.
- therefore: manager should be able to determine the talents and
capacities of his subordinates.
 
2. Supervision
 
• process of guiding and directing the work to
be done.
• motivating and encouraging the staff to
participate
• helping the staff to do their work better.
 
• Principle of Good Supervision

– supervisor is in a position to exert strong

influence in motivating individuals
– supervisor can incite in her employees ideas and
emotions
– This means a supervisor:
a. Can produce attitudes which are both
positive and negative in character,
b. Produces positive attitudes when are
positive when an employee is conscious of
the benefits to himself which he attributes
to the influence of the supervisor;
c. Produces negative attitude when the
reaction of workers is resistance to
discipline or actual fear of demotion or
discharge.
• Principles of good supervision for supervisors and
manager in general

1. Good supervision is focused on the improvement

of work rather than upgrading the workers.
2. It is based on lines of authority, organizational
philosophy, vision/mission, the job description,
policies and standards, the needs of the
individual,
3. Focuses on the 3 areas of skills: Conceptual,
Technical and Interpersonal.
4. It is cooperatively planned and accepts both
challenge and change.
5. It uses a democratic process to facilitate:
 
 Effective communication;
Continuous improvement of staff ;
Respect for the individuality of each staff member;
Bring about a harmonious relationship and a
conductive social, psychological and physical
atmosphere
• The ultimate goal of good supervision is to
provide safe, effective, quality care.
• Responsibilities of Supervisors
 
a. Supervisors have the duty to teach and
motivate the staff
b. Facilitate staff work.
c. Should delegate work responsibilities and;
d. Be available for consultation
e. Should also perform assessment
f. Evaluation of work performance condition.
3. Staff Development
  Is planned experience to help employees
perform effectively, and to enrich their
competence in practice, education,
administration and research. It is re-
training them for better performance in
areas of SKA.
• Functions of Staff Development
 
a. To maintain staff efficiency and effectiveness;
b. To create quality employees;
c. To meet the staff needs and address their problems,
such as deficiencies in knowledge, skills and attitude;
d. To motivate them and improve their self confidence;
e. To help them for greater responsibilities, e.g. in
planning, orientation, continuing education- in
service patient education, advisory and research.
• In service Training and Continuing Education
service training
- develop skills in a specific discipline or occupation.
- takes place after an individual begins her work
responsibilities.
- in service training is conducted during a break in the
individual’s work schedule.
 professional continuing education programs
- specific learning activity generally characterized by the
issuance of a certificate or continuing education units (CEU)
- documenting attendance at a designated seminar or course of
instruction.
4. Coordination

– Links the different components of an organization

– Lead towards goal achievement.
– Creates harmony on all activities to facilitate success
of work
– Well-coordinated organization, everything has been
delegated to guard against leaving loose ends.
 
5. Collaboration
 
• All together with other members of the health
care team participate in the decision making
process.
• Sometimes they join forces with another as a
medical group or larger group, like another
health care team or one fulfilling a different
role for this purpose.
6. Communication
 
- ensures common understanding via various
routes.
- process by which a message is sent, received and
understood as interest.
- goal is to narrow the gap between the intended
and the received message
- directions have to be reasonable and
understandable
-not merely trying to make people understand;
but aim to changing people’s behavior.
 Communication process
6 steps:
1. Ideation- decides to share
content of a message
2. Encoding -meaning into symbolic
form
3. Transmission
4. Receiving- receiver’s senses of
seeing and hearing are activated
5. Decoding- receiver defines words
and interprets gestures
6. Response or feedback
LINES OF COMMUNICATION
Four dimensional flow in Nursing care

UPWARD
(to superior)

HORIZONTAL NURSES OUTWARD

(peer) (IFC)

DOWNWARD
( subordinates)
1. Downward- ex: policies, rules,
regulations, performance
appraisal
2. Upward – ex: grievance
procedure, incident reports,
written reports
3. Horizontal/ lateral -
endorsements
4. Outward - image to the public
7. Evaluation

• important role of the manager is to

determine performance and state desired
outcome of what has been done. 
• purpose of evaluation is to determine how
far or how many of the organization’s
objectives were accomplished.
• Purpose of Evaluation

a. Provide constructive feedback;

b. Determine progress and worthiness of
individual nurse for greater responsibilities;
c. Serve as basic for promotion and increase in
salary or other similar rewards.
 
• Evaluation is also meant to:

a. Recognize and further develop strengths;

b. Minimize weakness;
c. Provide security for patients, personnel,
agency and the community;
d. Develop a fair employments practice and
performance appraisal process that is in
accordance with the law.
• Different Types of Evaluation

a. OUTCOME OR PRODUCT EVALUATION: which

takes note of the response of patients after
nursing care is done.
b. PROCESS EVALUATION: nursing action is
examined to determine if client goals have been
met or have not been met.
c. STRUCTURE EVALUATION: the goal is to obtain
feedback on the systems such as financial and
material resources, nursing personnel, policies
and procedures.
 Legally Sound Performance Evaluation
1. It should be in writing and carried out at least once a year.
2. The information should be shared with the employee.
3. employee should have the opportunity to respond in writing to the
appraisal, mechanism to appeal or question
4. The manager should have adequate opportunity to either directly
observe the employee’s job performance
5. Anecdotal notes on the performance should be kept throughout the
evaluation period and should be shared to the employee.
6. The evaluator should be trained to carry out the appraisal process,
including:
– What constitutes reasonable job performance
– How complete the form
– How to carry out feedback interview

 ** appraisal system is non-discriminatory.

** focus on employee behavior and results rather than an personal traits
or characteristics
• Change Process
 
• Means substituting one thing for another,
• Experiencing a shift in circumstances that cause
differences
• Becoming different from before.
e.g. changing methods and systems to improve the
accomplishment of objectives, changing objectives
and retrenchment to adjust depleted resources to
meet competitions and fluctuations of
environmental factors I a health care system
• Factors that influence change

a. External forces : events or happenings that

influence the organization as a whole or its top
administration.
e.g. population explosion, legislation, or economic
forces.
b. Internal forces: originate primarily from inside
operations
e.g. results of external changes such as the
composition of staffing pattern, and quality of life.
• Steps in change process
a. Begins if needs for change is perceived
b. Identify external and internal forces for
change,
c. Activities during above interaction
 To state the problem;
 Identify constraints;
 List change strategies or possible approaches to
problem solving;
 Select the best change strategy;
 Formulate as a group a plan for implementation
and or develop or select tools for evaluation
• Strategies for managing process
a. Empirical-Rational
- an assumption that people are rational and behave
according to rational interest.
- assume that people are willing to adopt to change if
justified and determine how he can benefit from the
change process
b. Normative Re-Educative
• - based on assumption that people are consistent to
their commitment to socio-cultural norms and values
c. Power-coercive
- use sources of power to bring change
e.g. strikes, sit-in, negations, and conflict confrontation
and administration decision.
• Resistance to change
reason:
-lack of trust
- vested interest in status quo
- fear of failure
- loss of status or income
- misunderstanding and belief that the
change is not necessary.
 
 strategies in handling:
• Communicate
• Clarify information and provide accurate feedback.
• Be open to revisions but firm and clear about what
must remain.
• Present negative
• Emphasize positive
• Keep those resisting change in face to face contact with
supporters, encourages proponents to emphasize with
their opponent, recognize valid objections and relieve
unnecessary fears.
• Maintain a climate of trust, support and confidence.
• Create a different disturbance to distract the attention
of those involved.
• Ability of a change agent:
1. Ability to combine ideas from unconnected
sources
2. Ability to energize others by keeping the
interest level up and demonstrating a high
personal energy level.
• 3. Skills in human relations can be attained with:
– Well-developed interpersonal communication
– Group management and problem solving skill
– Skills in integrating thinking
– Ability to retain a picture focus while dealing with each
part of the system considered all factors in problem
solving and decision making.
4. Sufficient flexibility to modify ideas but firm
enough
5. Enhances confidence level and the tendency
not easily discouraged
6. Realistic on pragmatic thinking in order to
learn how to cope and adapt to change.
7. Trustworthiness, .
8. Ability to articulate a vision
9. Ability to handle resistance through
influence and support
Conflict

• natural, inevitable condition in organizations

• often a prerequisite to change in people and
organizations.
• consequence of real or perceived differences in
goals, values, ideas, attitudes, beliefs, feelings and
actions.
These can occur on several levels namely:
Intrapersonal or within one individual
Interpersonal or within 2 or more individuals
Intragroup or within one group
Intergroup or between 2 or more groups
2 Types of conflicts
1. Competitive conflicts
- 2 or more groups’ attempts the same goals
- only 1 group can attain them.
- victory for one side and a loss for the others.
- resolve by set of rules
2. Disruptive Conflicts
- occur in an environment filled with fear, anger and
stress.
- no mutually acceptable set of rules
- goal of each party is the elimination of its
opponent.
 CONFLICT RESOLUTION:
1. Avoidance – reduce tension(no difference)
2. Accommodation - self sacrifice
3. Collaboration /Integrative (mutual attention)
4. Compromise (agreement of solution)
5. Withdrawing – one party is removed
6. Forcing – immediate end but cause unresolved
7. Win-lose strategy (dominance & suppression)
8. Restriction (autocratic, coercive style)
9. Smoothing Behaviour (diplomatic, persuasion)
10. Major Rules
11. Win-win (goals to meet needs of both parties
12. Lose Lose (no one wins, solution is unsatisfactory)
13. Confrontation (most effective, use knowledge & reason)
14. Negotiation (give and take)
 
 
Conflict Resolution
 
• The use of Dominance and Suppression or win-lose
strategy is a method that represses rather than
settles conflict, creating a win-lose situation in which
the loser is left feeling angry and antagonistic.
• Restriction is an autocratic, coercive style than often
leads to indirect and destructive expression of
conflicts.
• Smoothing Behavior is a more diplomatic way
of suppressing conflict wherein one
persuades the opponent to give in to the
other side.
• Avoidance behavior creates situation in which
there are no differences.
• Major Rule resolves conflict by majority vote.
• Compromise or Consensus Strategy is a
method where each side agrees upon
solutions that meet everyone’s needs.
• Integrative Problem-solving is a constructive
process in which the parties involved
recognize that conflict exists and openly try
to solve problems.
• A win- win Strategy focuses on goals and
attempts to meet the needs of both parties.
• A lose- Lose Strategy is one in which neither
side wins; the settlement reached is
unsatisfactory to both sides.
• Confrontation is regarded as the most
effective means of resolving in which it is
brought out in an open and attempts are
made to resolve it through knowledge and
reason.
• Negotiation is a technique where conflict
parties give and take on various issues.
• Team Building
 
– purpose of sharing and applying their individual
skills towards the achievement of goals
– work together towards achieving a more
productively.
– focuses on both the task and relationship
aspects of group performance to maximize
diffidence and productivity.
• Characteristics of an effective team
1. Has defined goals
2. Work cooperatively and collaboratively
towards achieving these goals
3. Has agreed goals that reflect members need
and values.
4. Has a good definition of its member’s role.
 
Cohesiveness of a Team

1. Share similar values and beliefs;

2. Are motivated by the same goals and tasks;
3. Must interact to achieve their goals and tasks;
4. Work in proximity to each other on the same
unit and on the same shift;
5. Have specific needs that can be satisfied by
involvement in the group.