Seminar on Application of Modern techniques in nursing service

By Karthikeyaprasath.P M.Sc IInd year

• Management , which basically is concerned with administration. pervades all spheres of life and activity. • Likewise , nursing too is a field where management plays a pivotal role in accomplishing organizational goals

• Management techniques are systematic procedures of investigating, planning, controlling and supervising which can be applied to the problems, management techniques are two types,
• Based on the principle of behavioral sciences. • Quantitative methods

• • • • • Organizational design Personnel management Communication Information system Management by objectives (MBO)

Organizational design
• • poor organization results in waste of resources. Its is a theory of management that organization must be suited to its current situation and the needs to be serviced. The organization of the health needs and demands of the people. Further the organizational design should be reviewed every few years because of changing concepts of purpose, Changing problems and changing technology.

Personnel management
• This is skill use of human resources. Proper methods of selection, training and motivation, division of responsibility, distribution of roles. • incentives for better work, opportunities for promotion and professional advancement are all fundamental techniques of personnel management which would contribute the efficiency of health service delivery

• Better communication contributes to effective functioning of an organization. • Communication barriers are responsible for delays in regular reporting and notification, delays in the compilation of static’s, delays in the institution of prompt remedial measures, and release of supplies and salaries

Information system
• Information is needed for the day to day management of health system. • The function of an information system consists of collection, classification, transmission, storage, retrieval, transformation and display of information. • A good information system provides data for monitoring and evaluation of health programmes and gives the requisite feedback to health administration and planners at all levels

Management by objectives (MBO)
• It is a participants approach for developing and sharing performance expectations among staff members at all the levels of. • The concept was developed by Drucker and also advanced by Odiorne and humble. • MBO is defined by odiorne as a process, whereby superiors and their followers jointly identify and set goals, define individual areas of responsibility, plan strategies and designate tasks for achieving goals and measure the evaluates success.

• The MBO approach, when effectively implemented enables expectation between followers and superiors to be public. • Potential conflict is hereby reduced because of negotiation between involved parties and then a contract is set, mutual commitment is therefore gained. • MBO can provide a framework for achieving organizational goals and employee satisfaction

The process of MBO
• • • • • • Setting of organizational purposes and objectives Key result areas Setting subordinates objectives Matching resources with the objectives Appraisal Recycling

Setting of organizational purposes and objectives
• the first basic step in MBO is the definition of organizational purposes and objectives. Questions such as “why does the organization exist?” what business are we in?” and “what should be our business?” provides guidelines for the statement of purpose.

Key result areas
• organizational objectives and planning premises provide the basis for the identification of key result areas(KRAs). • KRAs are derived from the expectations of various stake holders and indicate the priorities for organizational performance. • KRAs also indicate the present state of an organization’s health and the top management prospective in future

Setting subordinates objectives
• The organizational objectives are achieved through individuals. Therefore, each individual manager must know in advance what is expected to achieve. • Every manager in the managerial hierarchy is both superior and subordinate, except the person at the top level and lowest level. Therefore there is a series of superior and subordinate relationships.

• The process of objectives setting brings with superior’s proposed recommendations for his subordinate’s objectives. In turn, the subordinate states his own objective as perceived by him. Thereafter a final objective for the subordinate is set by the mutual negotiation between superior and subordinate.

• •

Matching resources with the objectives
• • When objectives are set carefully, they also indicate the resource requirement. Resource availability is an important aspect of objective setting as it is the proper application of resources, which ensures objective achievement. Therefore there should be matching between objectives.

• A superior manager is better able to see the need and economy of allocating resources. • The allocation and movement of resources should be done in consultation with the subordinate manager

• Appraisal aspect of MBO tries to measure whether the subordinate is achieving his objectives or not. • If not what are the problems can be overcome, • Appraisal is undertaken as an ongoing process with a view to find out deficiency in the working and also to remove it promptly

• • • Though appraisal is the last aspect of MBO process. It is used as an input for recycling objectives and other actions. The three objectives involved in recycling process include setting of objectives at various levels, action planning, which in turn, gives basis for objectives and action planning. This process goes on a continuous basis

Benefits of MBO
• • • • Better managing Clarity in organizational action Personal satisfaction Basis for organizational changes

Better managing
• • MBO helps in better managing the organizational resources and activities. Resources and activities are put in such a way that they result in better performance.

Clarity in organizational action
• MBO tends to provide the KRAs where organizational efforts are needed. • Since organizational objectives are defined clearly, they help in relating the organization with the environment

Personal satisfaction
• MBO provides greatest opportunity for personal satisfaction. • This is possible because of two closely related phenomena participating in objective setting and rational performance appraisal

Basis for organizational changes
• MBO simulates organizational change and provides a framework and guidelines for planned charge, enabling the top management to initiate, plan direct and control the direction and speed of change

Problems and limitations of MBO
• • • • • • Time and cost Failure to teach MBO philosophy Problems in objective setting Inflexibility Emphasis on short term objectives Frustration

• Quantitative methods are derived from the field of economies. Operation, research and budgeting. Some of these techniques have a great role in a management of health services, those are

• • • • • • • Cost benefit analysis Cost effective analysis ABC analysis Cost counting Input- output analysis Systems analysis Net work analysis

Cost benefit analysis
• This is a management technique , which has attracted the widest attention for application in health field. • The economic benefits are expressed in monitory terms to determine whether a given programme is economically sound and to select the best out of several alternative programmes

A cost benefit ratio (Z) is defined as the ratio of the value of benefits of an alternative to the value if alternative cost.

Z=--------------------------------------------------------------PRESENT VALUE OF ECONOMIC COSTS


• The analysis consists of the following steps: • A clear statement of objectives. • Identifying all alternative actions that can achieve the objectives. • Identifying all costs and all benefits with each alternative.


• Converting all costs and all benefits for each alternatives to monetary value and quantitative evaluation of cost and benefits of each • Selection of the best –effective approach

Drawback of cost benefit analysis
• The main draw back with this technique is that the benefits in the health field. • As a result a particular programme cannot always be expressed in monetary terms. We generally express the benefits in terms of births or death or illness avoided or over come. • Hence the scope of applying this method is rather vague

Cost effective analysis
• it is the technique for choosing. From alternative courses of action, a preferred choice when objectives are not very clear in such areas as scales, costs or profiles. • This is more promising tool for application in the health field than the benefit.

• For example number of life saved or number of days free from disease. • Cost effectiveness analysis is easier to make as it clear. It helps the administrator in managing his resources at the local level.

ABC analysis
• it is a technique which would enable a busy executive to choose those activities ardently which would enable the wheels of administrative machinery. • by arranging his work in to an order of priorities he can decide on which item to concentrate first, which others to deal later and which others to delegate to his assistants.

ABC analysis sorts items on cost criteria. • A -Item which are of high cost. • B - Items which are intermediate cost. • C - Items which are low cost.

In so for inventory control is concerned, following guide lines will help in keeping the system optimum: • A items
• • • • tight control Rigid estimates Strict and close watch Management of items should be done at top management level

• B items
– – – – moderate control Reasonably strict watch and control. Safety stock moderate Management should be done at middle level.

• C items
– – – – – ordinary control measures Purchase based on used estimates Control exercise by store keeper Safety stock high Management should be done at lower level

Cost counting
• it provides basic data on cost structure of day programme. • Financial records are kept in manager permitting costs to be associated with the purpose for which they incurred. • The important purposes of cost accounting in health services are cost control and planning, and the allocation of people and the financial resources.

Input- output analysis
• input analysis is an economic technique in the health field input refers to all health service activities which consume resources {manpower, materials and time} • And output refers to such useful outcomes as treated lives saved or inoculations performed. • input –output table shows how much of each input is needed to produce a unit amount of each output

Systems analysis
• The purpose of systems analysis is to keep the decision maker to choose an appreciate course of action by investigating his problems, • searching out objectives , finding out alternative solutions , evaluation of alternative terms of cost effectiveness, • re examination of objectives if necessary and finding out the cost effectiveness of available alternatives.

Net work analysis
A network is a graphic plan of all events and activities to be competed greater discipline in planning. The two common types of network techniques are:
– – Programme evaluation review technique (PERT) Critical path method (CPM)

Programme evaluation review technique (PERT)
• PERT is planning tool developed in the 1950s as a method used by the US Navy to and control the Polar Missile program me. • PERT can be considered as a roadmap of a particular project in which all major events have been identified and relationship among events clearly indicated

The main elements of PERT are activities and events
• An activity is a factor ,which takes time to complete and usually demands resources.An event is a notional point in time at which one set of activity gives way to another. • The important point is that no activity subsequent to an activity can begin, until all activities before that event have been completed

• the longest pathway between events is the critical path. It is used as a planning, scheduling, organizing, coordinating and controlling technique. • A typical PERT analysis may run in to hundreds of events

• • Provides logical sequence activities. Clarifies where delays are permissible and where not, essential deadlines become evident. Clsrifies where additional resources are required to complete the task on time.


• depicts a larger number of independent activities that makes up the total task. • Every principal activity can be assigned to a person whose attention is constantly drawn to deadlines in particular areas

Critical path method (CPM)
• CPM is the most versatile planning and controlling technique used in business. It was first employed in USA in 1958 by E.I. du Pont de Nemous Company. • Unlike PERT it is applied in those projects where activity timings are relatively well known. • It is used for planning and controlling the most logical sequence of activities for accomplishing the project

• Under CPM the project is analyzed in to different operations or activities and their relationships are determined and shown on the network diagram. • The network or flow plan is then used for optimizing the use of resources and time. CPM marks critical activities in a project and concentrates on them. • It is based on the assumption that the expected time is actually the time taken to complete the project,CPM is suitable for construction of projects and plant maintenance

• CPM requires greater planning than required otherwise. • Thus it increases the planning cost, but this increase in cost is justified by concentrating on critical paths and avoiding expenses on the strict supervision and control of the whole project. • Besides ascentaining time schedule CPM provides standard method of communicating project plans, schedule and costs

• It provides on analytical approach to the achievement of project objectives which are defined clearly. It identifies most critical demands and pays more attention on these activities. It helps in ascertaining the time schedules.

• •

• It makes use of better and detailed planning. • It assists’ avoiding waste a time, energy and money on unimportant activities. • It provides a standard method for communicating project plan, schedules and costs.

Steps in PERT/CPM
• Identification of components
The first step in the application of PERT/CPM is identification of all key activities and phases or events necessary for the completion of the project. For example, a construction company having a project for the construction of a two-storied commercial complex can identify the broad activities from A to J

• Sequencing of activities and events A network diagram is prepared to show the sequence of activities and events. It has a beginning point and a termination point of the project. It also depicts a number of path or activities from beginning to completion of the project. Each event is given a serial number for the sake of convenience.

• Determination of estimated time:
It is essential to determine the expected time required to completer each activity.

• Determination of critical path:
– Under this stage, it is required to identify the sequence of those activities whose completion is critical for the timely completion of the project. – The lines in the network diagram connecting the critical activities from start to finish of the project denote the critical path. In the figure the pick line joining the activities A, B,C,D,H,I&J represent the critical path.

• • Modification in initial plan: The project analysis should not stop after the critical path as been identified. The potential exist for substantially improving upon critical plan.

• Controlling the project: • The project manager as to be in constant touch with the person engaged in critical activities .if they have been any difficulties or obstacles these are to be removed

• Planning, programming, budjeting system (PPBS): • The PPBS is a system to help decision maker to allocated resource so that the available resource of an organization are used in the most effective way in achieve in objectives. Another approach is known as zero budgets i.e. all budget start of zero and no one gets any budget that he cannot specifically justify on year to year basics

• Job analysis:
– It is the process of gathering information on all aspects’ of a specific job. It is a scientific study and statement of all the facts about a job. Which reveal its content and modify factor’s which surrounded it. One of the purposes of job analysis and measurement is to set standards for a specific job. There are no of methods measuring work & setting standards as follows.

• • Analyses of past production records: It is perhaps the strongest method of measuring works and setting standard production records on the activities of the department can be maintained and analyzed. The manager can select the best past performance and used as a standard on the assumption that if it was done before workers should be able to do it again.

• The advantage of this is that it is easily used and at a relatively low cost with no need for highly person ale to administer it. The disadvantage is of course that existing in efficiency are not corrected they are merely recorded an analyzed


Time analysis method:
Here various work activities done by an individual during the day are identified and placed on the form. Then worker records the actual time spend and units produce.


Work sampling method:
It is specific of observation and recording of activities of one or more individual carried out at predetermined or random interval it provides quantitative measurements of various activities. The major parameters that are analyzed are the time needed to do specific jobs or the type of activities performed.


Times study:
It is a method of measuring job performance to establish the time required for performing for each operation at an average pace. The purpose is to measure the output of a worker of average skill who0 is performing is work with average effort under standardized condition so that standard time can be determined.


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Motion study:
It goes beyond mere measurement. Its purpose is to make work performance easier and more productive by improving manual motion. During the end or 19th century Frank gilbreth made a detailed motion study and consider it a scientific method of eliminating wasted effort in work. He suggested that motions study Consists of dividing the work in to the most fundamental elements possible, studying these elements separately and in relation to one another, and from these studies building methods of least waste.

Advantages of job analysis:
Job analysis helps the management in many ways: • It provides solid base upon which to choose the right people and to plan the right training for them. • It reveals the inessentials, the irrelevant practices,which often encounter the job in actual performance. • It shows where there is overlapping.

• It provides the basic material for procedure manual. • It helps to promote good morale that enables the administrator to deal intelligently with complaints. • It also keeps to administrator to establish definite even for promotion.

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