NCM 205

Concept of Management

 Management in all business and human organization activity is simply the act of getting people together to accomplish desired goals and objectives. Management comprises planning, organizing, staffing, leading, or directing, and controlling, an organization(a group of one or more people or entities) or effort for the purpose of accomplishing a goal. Resourcing encompasses the deployment and manipulation of human resources, financial, resources, technological resources, and natural resources.

• is the organizational process that includes strategic planning, setting; objectives, managing resources, deploying the human and financial assets needed to achieve objectives, and measuring results. Management also includes recording and storing facts and information for later use or for others within the organization. Management functions are not limited to managers and supervisors. Every member of the organization has some management and reporting functions as part of their job

• The process of planning, leading, organizing and controlling people within a group in order to achieve goals; also used to mean the group of people who do this. • a process of coordinating actions and allocating resources to achieve organizational goals.

Management Theories
• Management theories, evolve from governance of ancient Samaria & Egypt ( 3000 BC) • Classical Theories of Management in (1800) Industrial Age , rise of factories also known as Traditional Management Theory
– Three Subfields
• Scientific Management • Bureaucratic Management • Administrative Management

• Scientific Management • Frederick Taylor ( an engineer), the father of scientific management for his use of the scientific method & the author of Principles of Scientific Management. • Frank & Lillian Gilbreth also contributed to scientific management.
– Focus is on goals & productivity – The organization is viewed as a machine to be run efficiently to increase production. – Managers must closely supervise the work to assure maximum efficiency – Workers must have proper tools & equipment. – There is focus in training the worker to work most efficiently & performance incentives are used. – Time & motion studies are the vehicle for determining how to do and organize the work in the most efficient manner

• Frederick Winslow Taylor • American Mechanical Engineer • Born= 20 March 1856 • Died= 21 March 1915 • Occupation= Efficiency Expert • Known for = Father of Scientific Management

• Scientific management • Taylor believed that the industrial management of his day was amateurish, that management could be formulated as an academic discipline, and that the best results would come from the partnership between a trained and qualified management and a cooperative and innovative workforce. Each side needed the other, and there was no need for trade unions.

 The Principles of Scientific Management, published in 1911. The Eastern Rate Case propelled Taylor's ideas to the forefront of the management agenda. Taylor wrote to Brandeis "I have rarely seen a new movement started with such great momentum as you have given this one." Taylor's approach is also often referred to, as Taylor's Principles, or frequently disparagingly, as Taylorism. Taylor's scientific management consisted of four principles: 1.Replace rule-of-thumb work methods with methods based on a scientific study of the tasks. 2.Scientifically select, train, and develop each employee rather than passively leaving them to train themselves. 3.Provide "Detailed instruction and supervision of each worker in the performance of that worker's discrete task" (Montgomery 1997: 250). 4.Divide work nearly equally between managers and workers, so that the managers apply scientific management principles to planning the work and the workers actually perform the tasks.

Bureaucratic Management
Maximilian Carl Emil Weber German Lawyer , political economist & sociologist Born: 21 April 1864  Erfurt, Prussian, Saxony, Germany Died: 14 June 1920 Munich, Bavaria

Bureaucratic Management
Max Weber, a German theorist for the organizational theory of bureaucracy.
◦ Focus is on superior-subordinate communication from the top down via a clear chain of command, a hierarchy of authority, and a division of labor chain. Uses rational, impersonal management process. ◦ Uses explicit rules & regulations for governing activities focuses on exacting work processes & technical competence. ◦ Uses merit & skill on basis for promotion / reward. ◦ Emphasizes lifetime career service & salaried managers.

Administrative Management
– Focus is on the science of management & principles of an organization applicable in any setting. – Identifies need for Planning, Organizing, Supervising, Directing, Controlling, Organizing, reviewing & Budgeting ( POSDCORB) – Commonly referred to as the management process that involves planning, organizing, coordinating, & controlling. – Concern with the optimal approach for administrators to achieve economic efficiency.

Human Relations
– Focuses on empowerment of the individual worker as the source of control, motivation, & productivity in organizations. – Hawthorne studies at Western Electric plant in Chicago led to belief that human relations between workers and managers and among workers were the main determinants of efficiency. – The hawthorne effect refers to the phenomena of how being observed or studied results in a change of behavior. – Emphasizes that participatory decision making increases worker autonomy. – Provides training to improve work

Basic Management Roles & Functions Mintsberg groups of basic roles performed by
managers – Interpersonal • The Figurehead • The Leader • The liaison – Informational • As a monitor • The disseminator • As a spokesperson – Decisional • The Entrepreneur • The Disturbance handler • As resource allocator

• Interpersonal Role – As a symbol because of the position he/she occupies & consists of such duties as signing of papers/ documents required by the organization. • Informational Role – Monitors information, disseminates information from both external/internal sources, as spokesperson or representative of the organization • Decisional Role – Entrepreneuer or innovator, problem discoverer, a designer to improve projects that direct & control change in the organization. A troubleshooter who handles, firing of subordinates, & losses clients & negotiator when conflicts arise.

Major Functions of Management Process
 Henri Fayol- 1916,French Industrialist, he 1st described the Four functions of Management:


Henri Fayol 1916 French Industrialist He identified the Four Functions Management
◦ ◦ ◦ ◦ Planning Organizing Directing Controlling

He developed the 14 principles of Management

1.DIVISION OF WORK: Work should be divided among individuals and groups to ensure  that effort and attention are focused on special portions of the task. Fayol presented work specialization as the best way to use the human resources of the organization.                                                                                                                    2.AUTHORITY: The concepts of Authority and responsibility are closely related. Authority was defined by Fayol as the right to give orders and the power to exact obedience. Responsibility involves being accountable, and is therefore naturally associated with authority. Whoever assumes authority also assumes responsibility.                                                               3.DISCIPLINE: A successful organization requires the common effort of workers. Penalties should be applied judiciously to encourage this common effort.                                                                               4.UNITY OF COMMAND: Workers should receive orders from only one manager.                                                                                               5.UNITY OF DIRECTION: The entire organization should be moving towards a common objective in a common direction.                                                                               6.SUBORDINATION OF INDIVIDUAL INTERESTS TO THE GENERAL INTERESTS: The interests of one person should not take priority over the interests of the organization as a whole

The 14 Principles of Management


REMUNERATION: Many variables, such as cost of living, supply of qualified personnel, general business conditions, and success of the business, should be considered in determining a worker’s rate of pay.                                                                                                   8. CENTRALIZATION: Fayol defined centralization as lowering the importance of the subordinate role. Decentralization is increasing the importance. The degree to which centralization or decentralization should be adopted depends on the specific organization in which the manager is working.                                                                    9. SCALAR CHAIN: Managers in hierarchies are part of a chain like authority scale. Each manager, from the first line supervisor to the president, possess certain amounts of authority. The President possesses the most authority; the first line supervisor the least. Lower level managers should always keep upper level managers informed of their work activities. The existence of a scalar chain and adherence to it are necessary if the organization is to be successful.                                                                              10. ORDER: For the sake of efficiency and coordination, all materials and people related to a specific kind of work should be treated as equally as possible.                                                                      11. EQUITY: All employees should be treated as equally as possible.                                                                                                                  12. STABILITY OF TENURE OF PERSONNEL: Retaining productive employees should always be a high priority of management. Recruitment and Selection Costs, as well as increased product-reject rates are usually associated with hiring new workers.                                                                                                  13. INITIATIVE: Management should take steps to encourage worker initiative, which is defined as new or additional work activity undertaken through self direction.                                                     14. ESPIRIT DE CORPS: Management should encourage harmony and general good feelings among employees.

Four Major Functions Management Process by: Henri Fayol

1. 2. 3. 4.

Planning Organizing Delegating Controlling

Th P l M ink ann ak in in To g i g Ac Pro ng Ah je Fu ea hi e ct t d Re ved ion ure su D s lts es ire d

Se t-u Str p O Gr uctu rgan A ou re iza Re ping Ide tion lat s, R ntif al ion y De sh oles te ips , rm De ve Ne ine Di Sta lop ede St Es str fin & s af ib u g m ta t Pa ai bl OR ne e in tte ntai ish G ed ar rns n in A ed ea sa g N f Fo IZ s IN rm G al Au th Materials- Methods or ity Manager

b Jo lop tion ve De scrip & De fice ation De alific s of on l Qu e cti fun sonn r pe


Specify Criteria & Standards utilize Performance Standards

s ng rts al cti Effo Go re Di ting hing a lis ctu omp A c Ac To

se C s on Pe sing tro rf o / R l l i n rm e g g an ul c e at i Monitor & evaluate n
Nsg Care/Services Utilize various methods


Moments of Time Money-Men-Machinery

2 3 4


Performance Appriasal Assess Interpret Correct Apply discipline

5 7 6

A. Establish policies procedures, definite course of action & methods B. Prepare budget , allocate resources C. Develop & Schedule Programs D. Define Activities needed & set time frame E. Set objectives

1. 2. 3. 4. 5. Delegate Nursing Care Assignments Utilize update policies & procedures Supervise harmonize goals thru guidance Coordinate unite personnel & services Communicate, ensure common understanding via various routes 6. Develop people, provide staff development programs 7. Decide/ make judgement

    Is defined as pre-determining a course of action in order to arrive at a desired result. Means to decide in advance what is to be done. It aims to achieve a coordinated & consistent set of operations aimed at desired objectives. Main activities are the formulation of strategies and setting the objectives.
 Strategy- is the set of decisions that determine the character ( size, scope, & mix of services ) of a health services organization & give direction in the market place.

It is a continuous process of assessing, establishing goals & objectives, implementing and evaluating them, and subjecting these to change as new facts are known.

Thinking Ahead, Making Future Projections

A .Planning • – Is the first function of the management process. – By forecasting one can estimate the future; by setting objectives the results to be achieved can be determined. – Developing & scheduling programs, the activities needed within a set time frame can be defined; by preparing the budget, tools & resources can be allocated while establishing policies & procedures that will define the course of action & standards.

Principles of Planning
1. Planning is always based & focused on the vision, mission, philosophy, & clearly defined objectives of the organizations. 2. Planning is a continuous process 3. Planning should be pervasive w/in the entire organization covering the various departments, services, & the various levels of management to provide maximal cooperation & harmony. 4. Planning utilizes all available resources 5. Planning must be precise in its scope & nature. 6. Planning should be time-bounded. 7. Projected plans must be documented & evaluation as to the extent of its achievement.

Importance of Planning
• It leads to the achievement of goals & objectives. • It gives meaning to work • It provides for effective use of available resources & facilities. • It helps in coping with crises • Planning is cost effective • Planning based on past & future activities • Planning leads to the realization of the need for change. • Planning provides the basis for control. • Planning is necessary for effective control.

Scope of Planning
» Top Management » Nursing Director/ Chief Nurse » Asst. Nursing Director/ Asst. Chief Nurse

• Set the over –all goals & policies of an organization. • Covers the over-all management of the organization’ Nursing Service
» Middle Management » Nursing Supervisors

• Implements the broad operating policies of the organization such as:
– Staffing – Delivery of services to the units
» Lower or First Level Management » Head Nurses or Senior Nurses/ Charge Nurses

• Do the daily /weekly plans for the administration of direct patient care in their respective units.

Characteristics of a Good Plan
• Be precise w/ clearly-worded objectives, including desired results & methods for evaluation. • Be guided by policies & / or procedures affecting the planned action. • Develop actions that are flexible & realistic in terms of available personnel, equipment, facilities , & time. • Include the most practical methods for achieving each objective & • Pervade the whole organization.

Setting the Vision, Mission, Philosophy, Goals & Objectives
• A vision statement- outlines the organization’s future role and function. It gives the agency something to strive for. • A mission statement – outlines the agency’s reason for existing, who are the target clients, and what services will be will be provided. • A philosophy – describes the vision. It is a statement of belief and values that direct one’s life or one’s practice. • Goals & objectives – differ in that goals are more general and cover a broad area. • Objectives- are concrete, they are action commitments through w/c an organization’s mission and purpose will be achieved and the philosophy or belief sustatined.

Establishing Nursing Standards, Policies & Procedures
• Nursing Standards
– Structure, Criteria, and Standards – Guidelines- The Nursing Service Administrator:

• Nursing Service Policies
– Characteristics of Good Policies – The Nursing Service Policy Manual
• Accidents- care reporting, precaution to prevent occurrence • Admissions- receiving consent, notifying doctor, care of patients. • Autopsies- obtaining informed consent • Breakage- classification, responsibility, reporting • Bulletin Boards- location, posting of information • Committees- types, memberships, functions • Complaints- how handled, action taken • Consent – informed consent taken by whom, from whom shared decision- making w/ patient & family & or significant others together w/ members of the health team

• Death- notification, care & identification, care of personnel belonging, death certificate. • Discharge- time, clearances, discharge planning accompaniment of patient. • Doctor’s orders- written, verbal, by telephone. • Equipment & supplies- list of expendable and non expendable items, care, lending, requesting, repairing.

• Fire regulations- drills, prevention

• Nursing Care – Administration & preparation of oral meds, IV infusions, blood transfusion – Charting- Forms used, use of various colors of ink, format considering legal implications – Daily assignment – by whom, where, when – Emergency Drug Supply- contents, responsibility, location – Kardex- use, sample form – Medications- card system, responsibility, checking, dosages, errors, reporting, correction. – Property of Patients- responsibility, placement – Private Duty Nurses- engaging, obligations to hospital, supervision, evaluation, remuneration. – Reasonable & Due Care- definition, explanation, legal implication – Referrals- w/in & outside of agency. – Safety Devices- siderails, restraints

• Reports – forms, responsibility • Reporting On or Off- Duty- Information given when leaving unit. • Meeting- frequency, purpose, types, membership, minutes. • Interdepartmental Policies:
– Ensuring unity & harmonious relationships among departments. – The nursing unit will endeavor to make god use of the professional & technical services to render help to the patient. – Coordinating of all activities in obtaining the same final goal may be made through the use of written policies:
• Examples:
– Admissions- type of patients, time, reservation, identification of patients, signing consents.

– Transfers - requests, departments to be notified. – Discharges – notification, against medical discharge, conduction, clearances. – Blood Bank- how obtained, checking information ( type , x-match) , reactions, replacement. – Cashier – safekeeping of valuables, clearances. – Dietary – requisition ( diet list, new diets, therapeutic), discharge planning w/ nutritionist. – Laboratory – requests ( routine, emergency), recordkeeping. – Personnel Department – request for additional personnel, interview ( pre-employment, exit), record keeping, counseling, grievances, health & welfare, training, personnel policies, general orientation, record keeping. – Pharmacy – ordering of drugs, narcotic & barbiturate regulations, inspection of stock drugs, & solutions in the units, safety procedures. – Social Service- referrals from various departments. – X-ray – requests, preparation of patient ( details of the procedure) , transporting of patient.

Nursing Procedures
• Procedures are specific directions for implementing written policies; • Nursing Procedure manuals should be available in each unit to familiarize nurses w/ the common nursing procedures utilize in that unit.
– Examples of Contents in a Procedure Manual
• • • • • • • Admission of Patients A.M. Care Bath: Bed bath, TSB Bed Making- Occupied or unoccupied Bladder, Catheterization of Bladder, Insertion of Foley catheter, Etc.

Decision Making
• Is considering & selecting interventions from a repertiore of actions that facilitate the achievement of a desired outcome. • Five Steps
– Identify the need for a decision – Determine the goal or outcome – Identify alternatives or actions along with the benefits and consequences of each action. – Decide which action to implement – Evaluate the decision.

Decision- Making Process for Nurse Managers
• Managerial Decision Making Process • Set Objectives • Search for alternatives • Evaluate alternatives • Choose • Implement • Follow-up
• Nursing Process – Assess – Problem Identification – Nursing Diagnosis – Plan – Implement – Evaluate

Tools for Decision Making
• • • • Decision Tree Decision Grid Numerical Scoring Program evaluation & review technique (PERT)

• Budget – is the annual operating plan, a financial “road map” & plan which serves as an estimate of future costs & a plan for utilization of manpower, material, & other resources to cover capital projects in the operating programs. • Nursing Budget – Is a plan for allocation of resources based on preconceived needs for a proposed series of programs to deliver patient care during one fiscal year.

Four Components: 1. Revenue Budget – summarizes the income w/c management expects to generate during the planning period. 2. Expense Budget – describes the expected activity in operational & financial terms for a given period of time. 3. Capital Budget- outlines the programmed acquisitions, disposals & improvements in an institution’s physical capacity. 4. Cash Budget – represents the planned cash receipts & disbursements as well as the cash balances expected during the planning period.

Types of Budget
• Capital Expenditure- Long range budget ( usually three years) • Operating – Short term budget ( per fiscal year or annually), that allocate funds for day to day activities of the organization.
– Expenses / Costs – small equipment, medical & non medical supplies, building & equipment maintenance, personnel expenses. – Projected revenues - come from payment sources ( Medicare, Insurance, etc.)

• Cash – accounts for the monthly expenditures & receipts to the dept/ organization. Cash flow is an important element. • Personnel- allocates expenses related to personnel ( salary, vacation, holidays, education, & other benefits.)

Budgetary Process
• • Four major Phases Planning – gathering information related to goals & objectives, setting priorities, conducting an environmental assessment, identifying financial objectives. Development of the budget – collecting & analyzing data from past budgets, allocating amounts based on priority, & approving the operational and capital budgets. Implementation & monitoring – analyzing variances & adjustments during the fiscal period, negotiating & revising the budget as necessary, allocating departmental & cash budgets. Evaluation- obtaining performance reports & analyzing efficiency.

Budget Preparation
• Begins with preparation & planning • Budget are generally developed for a 12- month period. • To prepare a budget, organization gather fundamental information about a variety of elements that influence the organization, including demographic & marketing information, competitive analysis, regulatory influences, & strategic plans. Additionally, it is helpful to review the dapartment’s scope of service, goals, & history.

• Setting shall be confined to hospitals. • The Expert Committee on Organization of Medical Care of the WHO define Hospital as:
– An Integral part of a social and medical organization
• Function:
– To provide for the population it serves » Complete health care both curative & preventive » Reach out to the family in its home environment – Center for the training of health workers and for biosocial research.

Management Process Setting

• Republic Act 4226,
– defines Hospital as a Place devoted primarily to the maintenance & operation of facilities for the diagnosis, treatment and care of individuals suffering from illness, disease or deformity, or in need of obstetrical or other medical & nursing care. – Also be construed as any institution, building or place where there are beds, cribs or bassinets for use by patients for twenty four hours or longer, in the treatment of diseases, diseased conditions, injuries, deformities, and all institutions such as those for convalescence, sanitorial care, infirmaries, nurseries, despensaries, & such other names by which they may be designated.

Classification of Hospitals & Other Health Facilities
• Administrative Order No. 2005- 0029 dated December 12, 2005 amended Administrative Order No 70A series re: Revised Rules & Regulation Governing the Registration, Licensure, & Operation of Hospitals & other Health Facilities in the Philippines.

A. General / Special
• General
– Provides services for all types of deformity, disease, illness or injury.
• Example: PGH, De Los Santos- STI Medical Center.

• Special
– Primarily engaged in the provision of specific clinical care & management. It must have ancillary support services appropriate for a given service capability.
• Example: NKI, Lung Center of the Phils, Phil. Heart Center, San Lazaro Hospital

B. Service Capability
• A. Hospital
1. Level 1
• An emergency hosp. that provides initial care & management to patients requiring immediate treatment, as well as primary care on prevalent diseases in the locality. Clinical services include general medicine, pediatrics, obstetrics, & non- surgical gynecology & minor surgery. General administrative services ( primary clinical laboratory, first level radiology, & pharmacy). Provide nursing care for patients who require minimal category or supervised care for 24 hours or longer.

• • •

• 2. Level 2
– Non- departmentalized hospital that provides clinical care & management on the prevalent diseases in the locality. – Clinical services include general medicine, pediatrics, obstetrics, & gynecolgy, surgery & anesthesia. – Appropriate administrative and ancillary services ( secondary clinical laboratory, first level radiology & pharmacy). – Nursing care provided in lvel 1 Hospital as well as intermediate, moderate, & partial category of supervised care for 24 hours or longer.

• 3. Level 3
– Departmentalized Hospital that provides clinical care & management on the prevalent diseases in the locality, as well as particular forms of treatment, surgical procedures & intensive care. – Clinical services provided in Level 2 Hospital as well as specialty clinical care. – Appropriate administrative and services ( tertiary clinical laboratory, second level radiology & pharmacy). – Nursing Care provided in Level 3 hospitals as well as continuous and highly specialized critical care.

Other Health Facilities
• Birthing Home- a health facility that provides maternity service on pre-natal & postnatal care, normal spontaneous delivery, & care of the newborn babies. • Psychiatric Care Facility- a health facility engaged in the care of mentally ill patients.
– Acute- Chronic- provides medical service, nursing care, pharmacological interventions for mentally ill patients. – Custodial- provides long- term care, inclusing basic human services such as food & shelter, to chronic mentally ill patients.

• 1. Government Hospitals- are operated & controlled either partially or wholly by the national, provincial, municipal, or city government, or other political subdivision, board or other agency thereof.
– Example
• National- directly under the Office of the President:

According to:Ownership & Control

• • • •

Regional – Baliwag District Hospital Provincial- Bulacan Integrated Provincial Hosp. City- QCGH Municipal- Don Formilleza Mem. Hosp.

• 2. Private/ Non- Government Hospitals.
• Privately owned, established & operated w/ funds, raised capital or other means by private individuals, associates, corporations, religious organization, firms, companies, or joint stock corporations.

– Examples:
• • • • Missionary- MJH Civic Organization- Q.I. Community- Romero Community Hosp. Private- De Los Santos- STI Medical Center

• A training Hospital- is a departmentalized hospital with accredited Residency Training Program in one or more specified specialty or discipline.
– Example, POC, DLS-STI Medical Center

Training & Non- Training Hospitals

• A Non- Training Hospital – may be departmentalized but without an accredited Residency Training Program in or more specialty disciplines.
– Example, CGH

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