LEADERSHIP & MANAGEMENT

ENHANCEMENT PROGRAM | Lecturer: Raymund Kernell B. Manago, RN, UKRN, USRN | Transcribed by: AMCRN

Leadership & Management

OUTLINE • Strength (internal advantage)

I. Leader vs Manager • Competitive staff
II. Leadership Theories
III. Management Function (POSDC) • Improved hospital policies
A. Planning • Efficient administration
B. Organizing • New technology/equipment
C. Staffing
D. Directing
E. Controlling • Weakness (internal disadvantage)
• Incompetent staff
• Outdated hospital policies
Leader Manager • Indecisive administration
Power through influences Legitimate power by • Old equipment
(directs willing followers) authority (directs willing and
unwilling subordinates) • Opportunities (external advantage)
May not be part of formal Position in formal • Increased salary grade (SG 15 (35-37K Gov’t)
org organization (job title)
• Global demand for nurses
Focus: inspiring others Focus: getting work done
• Increased health budget of PH
Greater roles Expected duties
• Threat (external disadvantage)
Leadership Theories
• Decreased salary grade
Great Man/Trait Theory
• Oversupply of nurses
• Leaders are born, not made
• PH budget cut
• Leaders arise when situation demands
• Nurse going abroad
*obsolete; aristotle’s era
(brain drain = competent nurses leaves)
Leadership Styles ADVANTAGE DISADVANTAGE
Authoritarian INTERNAL STRENGTH WEAKNESS
• Strong control through commands EXTERNAL OPPORTUNITIES THREATS
• Downward communication
• Sole decision-making Planning Hierarchy
• Emergency situations
• E.g., armed forces Vision • future aims “By 2020, Hospital X will
• “What do you be the leading center for
Democratic want to be?” cancer in the
• Control through guidance Philippines.”
• Upward and downward communication Mission • Reason for “Hospital X is a tertiary
existence care facility that provides
• Collective decision making • “What do you evidence-based, holistic
• Takes longer time want to do?” care to all patients.”

Laissez-faire Philosophy • Set of values and “Hospital X believes

• Little/no control and direction beliefs that…”
• Communication and decision making among members • “What do you
• Reqts: (1) highly motivated. (2) self-directed members believe in?”
Goals & • Desired result
Management Functions (Henri Fayol) Objectives • Goal: general
POSDC (cyclic) • Objectives: specific
• “What do you want to happen?”
1. Planning Policies • Guide for decision-making
2. Organizing • “How should you behave?”
3. Staffing • Expressed: written policies
4. Directing • Implied; expected
5. Controlling Procedures • Step-by-step plan for doing specific tasks
• “How should you do it?”
PLANNING Rules • Do’s and don’ts
A. Strategic Planning • Allows organization structure
• “Should you do it?”
• Long term (3 to 5 years)
• Complex
Fiscal Planning
• Yearly, monthly, q shift
Budget
• Ex. endorsement
• Cost-effectiveness: good value for money
B. Operational Planning *Highest quality for the lowest cost
• Short term (<3 years)
TYPES OF BUDGET
• Less complex 1) Personnel
SWOT Analysis • Salary of staff
*Internal = within company/your jurisdiction • Largest budget: health care is labor intensive
*External = outside company
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2) Operating /Operational Patient Care Delivery Methods
• Day to day costs Total Patient Assigned cases per nurse
• Maintenance, bills, supplies Care or Case Nurse is responsible to meet all needs of
*Scheduled; anticipated Method assigned patients
Nursing Oldest; common
3) Capital Reqt: highly skilled staff
• Equipment; real property assigned cases per nurse
• Long-term; expensive Functional Based on tasks; not patients
*Company investment Method e.g., BP monitoring, medications,
*Ex. CT Scan, MRI, ambulance, building hygiene
fragmented care
4) Petty Cash Team Nursing Saff follow the team leader (nurse)
• Emergency; repairs Max. 5 per team
*Unexpected; shookt Reqt: team leader is efficient and
organized
ORGANIZING RN = leads the team
COMPONENTS manages staff and patient
Chain of Command Modular Mini-team (3 members)
• Formal paths of communication and authority Nursing Care pairs (2 members)
1) Line positions: legitimate authority (solid lines) Smaller teams (much doable)
*pwedeng sumunod or dapat sumunod Primary 24 hour care
2) Staff positions: advisory positions, no legit authority, Nursing Care from admission to discharge
(broken lines) Associate nurse: substitute when primary
*advising purposes only nurse is off-duty
Reqt: primary nurse is self-directed
Unity of Command primary = makes NCP
• employees report to 1 boss only (vertical solid line) associate nurse = can’t plan or decide
*to avoid confusion; immediate superior Case Collaborative: multidisciplinary action
Management plan (MAP)
Span of Control Goal: cost-effective outcomes
Reqt: case manager
• No. of people directly reporting to manager
Tertiary level of care = rehabilitative
• Higher span, flatter structure
• Lower span, taller structure
*larger no.; wider span STAFFING
*smaller no.; narrow span • Healthcare as labor-intensive
• First step: Determine staffing needs
Managerial Levels • Use history to predict future.
Top-level • Strategic planner (complex)
• Policy making Economy improves → Shortage
• Chief nurse (director of nursing) Economy declines → Excess (d/t global recession)
Middle-level • Facilitate communication
between top and first-level Staffing Functions (ReSePI)
• Nursing supervisor 1) Recruitment
First-level • Operational planner (less • Active search for applicants
complex) • Ongoing process (continuous)
• Day-to-day operations • Turnover: replacement of new staff
• Head nurse o No Turnover: stagnation (no dev’t)
o Low Turnover: retention, staff development
Power and Its Types (may nagtatagal; increased patient safety)
o High Turnover: expensive; decreased patient
Reward Granting favors/rewards (incentive)
safety (new/beginner staff = unexperienced)
Coercive Fear of punishment (last resort) 2) Selection
Legitimate Formal position/title
A. Requirements
Authority = source of power
Authority =/= • Minimal Criteria: minimum (lowest possible standard)
Limit commands • Preferred Criteria: ideal (standard)
Expert Knowledge, expertise
(specialized; training; education) B. Interview
Ex. doctor prescribed • Types
Referent Association with powerful people a) Unstructured
Ex. lakad/kakilala • not prepared; most common
• no guide questions; spontaneous; anything
Charismatic Personal influence
under the sun
Major power of leaders
b) Semi-structured
Ex. vlogger, celebrity
• focused; directed
Informational Knowledge that others do not have
• with guide questions; follow-up questions
Ex. gossip;witness
c) Structured
• strict; specific
• specific questions

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C. Evaluation Verbal vs Nonverbal Communication

• JOB DESCRIPTION: avoid under/overqualified Verbal Communication
applicants; basis ▪ use of words (written or spoken)
• Personal bias: minimize 1. Assertive
• NEVER ask discriminatory questions. o Age, race, marital o direct, honest, acceptable. “I” statements
status, sexual preference, etc. (always correct; straightforward; no sugar coating)
• Background Check: Check references, verify 2. Passive
credentials o silence, avoids conflict (correct if buying time)
• Preemployment Testing: Personality and psychiatric 3. Aggressive
tests o threatening, bullying (always wrong)
• Physical Examination: physical reqts for the job 4. Passive-aggressive
*to ensure that no disease/disorder that may impair work o aggressive message conveyed passively
(sarcasm; always wrong)
3) Placement
• Assignment to department Nonverbal Communication
• Proper placement → increased efficiency • body language
1. Silence: use therapeutically
4) Indoctrination 2. Space (Proxemics)
▪ Intimate: 0 to < 4 feet
• Adjustment of employee to organization (IOS)
▪ Personal: 18 inches to < 4 feet
A. Induction
▪ Social: 4 to < 12 feet
• General information (about hospital)
▪ Public: >12 feet
• Employee handbooks 3. Appearance and posture
*done by HR; everyone is included 4. Eye contact
*sick leave; vacation leave 5. Gestures and facial expressions
• Note: verbals and non-verbals must be congruent.
B. Orientation
• Specific information for position Channels of Communication
• Promote belongingness of employee 1. Upward: subordinate to superior (democratic)
• Personnel policies: first-level manager (head 2. Downward: superior to subordinate
nurse) (authoritarian/democratic)
3. Horizontal: peer to peer (laissez-faire)
C. Socialization 4. Diagonal: different levels and jobs
• Learning the behaviors associated with role 5. Grapevine: informal, random, source of rumor

Scheduling Options ISBAR

8 hrs/shift or 40 hrs/week • communication tool to increase patient safety
▪ Other countries: 12 hrs/shift • used in referrals

Float pools/Floaters Introduction name, ward (bakit “I am staff nurse Baby

▪ Per diem (day) employees (no work = no pay) tumawag?) of Medical Ward.”
▪ Flexible: Higher pay, no benefits Situation chief complaint “Patient X is
▪ Reqt: Orientation to unit (physical set up), Core experiencing fever with
temperature of 39.5 C.”
competencies (basic skills)
Background patient info (sino “Patient X is 28 y/o
*3rd party agency ba ‘to?) male with hemophilia
*no cc = refuse assignment A.”
*not oriented = ask to be oriented Assessment other findings “He also has chills,
(ano pa?) pallor, and
Flextime (TIME) restlessness.”
▪ Time schedules based on staff (decided by staff) Recommendation suggested action “I recommend that we
administer
▪ Difficult for manager
paracetamol
intravenously.”
Self-scheduling (DAY)
▪ Daily schedules based on staff Listening skill
▪ Difficult for manager • Best communication skill
• Communication failure: common cause of medical error
DIRECTING (The Doing Phase)
• Communication: exchange of thoughts through speech or Delegation
signals (to be coordinated) • Getting work done through others
• Accountability: retained
Communication Process
• Responsibility: transferred

5 Rights of Delegation
1. Right task
2. Right circumstance
(1) unstable: don’t delegate
ex. newly admitted; post-op

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(2) stable: delegate • e.g. health status; patient satisfaction;
ex. for discharge discharged/expired
3. Right person
LVN: Licensed Vocational/Practical Nurse
UAP: Unlicensed Assistive Personnel Quality Assurance vs Quality Improvement
NA: Nursing Assistant Quality Assurance (QA)
4. Right direction (individualized care; never assume; • maintaining quality
instruct delegation) *standard; obsolete
5. Right level of supervision (monitor performance)
Quality Improvement (QI)
Delegation to LVN and UAP
• upgrading quality
Don’ts X *beyond standard; latest
• ADPE, except routine assessment (ex. V/S)
• Baseline/Admission assessment
• Health teaching/Discharge Planning
• Nursing judgment
• Not within scope of practice

Conflict Resolution
▪ Conflict resolution strategies (Goal: Win-win solution)
1. Collaborating
• set aside differences and work together
• win-win
2. Compromising
• parties give up something
• lose-lose
3. Competing
• one party intends to win
• win-lose (ayaw magpatalo)
4. Accommodating
• one party sacrifices
• win-lose (ayaw makipagtalo)
5. Smoothing
• reducing the severity of problem, temporary (can be
used to buy time)
6. Avoiding
• no resolution, temporary (dedma)

Conflict Management
Individual
• Knowledge/skill: Educate
• Behavior: Allow verbalization (confront to listen)

Group
• call a ward/group meeting

CONTROLLING
• quality control

Tasks:
(1) Performance measured against standards,
(2) Praise/Correct actions

Performance Appraisal vs Nursing Audit

• Criteria: Job description
• Performance appraisal: nurse-centered; demonstration-
based
• Nursing Audit: patient-centered, chart-based

Evaluation
1. Structure
• resources
• e.g. environment, staffing (human resources)
2. Process
• how care is delivered
• e.g. medications; nursing procedure
3. Outcome
• end-result