CONTROLLING

coordinating or
evaluating
A process of
monitoring
performance and
taking action to
ensure desired
results
 Why is there a need to conduct
Evaluation?
It ensures that the quality of care is
provided
To provide standards for establishing
comparisons
It promotes visibility for employees
to monitor their own performance
Provides feedback for improvement
 Kinds of Control
Pre-action Control – personal
supervision and utilizing
standards or procedure

Post-action Control – correcting

deviations from standards and
plans
 Tools for controlling organizational
performance
Feed-forward Control
- A control that prevents anticipated
problems before actual occurrence
of the problem.

Concurrent Control
- A control that takes place while the
monitored activity is in process.
Feedback Control
- A control that takes place
after an activity is being done.
 The Control Process
1. Establish
objectives and
standards.
2. Measure actual performance.
3. Compare results with
objectives and standards.
4. Take necessary action.
 Model of Control Process

Measurement
Desired Actual of Actual
Performance Performance Performance

Implementation Comparison of
Of Actual
Correction Performance
against Standards

Program of Analysis and Identification

Corrective causes of of deviations
Action deviations
1. Establish objectives and
specify
Criteria/standards and
Performance
 Standards -guidelines
 Time - deadlines
 Financial - budgeting
 Operation – good services &
quality, inventory
2. Measure, Monitor &
Actual Performance of
Nursing Care Services
Nursing Rounds
Quality Assurance
Nursing Audit
 Quality Assurance
is a process of evaluation that is applied
to the health care system and the
provision of health care services by
health workers

TQM & CQI (continuous quality

improvement)

Customer satisfaction
The primary purpose of QA
programs in nursing is to measure
and improve the quality of nursing
delivery in the agency.

The patient is the best and

sometimes the only judge of the
interpersonal aspects of care, like
empathy, communication, room &
food services.
Quality Assurance
-focuses on the care and service
the patient receives than on how
well the professional performs the
duties the that the position
requires.
Performance Evaluation
-focuses on the worker. It asks
questions about how well the
worker satisfies the requirements
of his or her job within the
organization.
 4 main principles in CQI
1. Customer focus
2. Identification of key processes to
improve quality
3. The use of quality tools and statistics
4. Involvement of all people in problem
solving
 Nursing Audit Commitee
A nursing audit is composed of a
representative from all levels of the nursing
staff:
–A member of the training staff
–Supervising Nurse
–Head/Senior Nurse
–Staff Nurse
• Patient Care Audits
Patient care audits may be concurrent or
retrospective.
Concurrent Audit
1. Is one in which patient care is observed and evaluated.
It is given through:
2. A review of the patient’s charts while the patients are
still confined in the hospital.
3. Observation of the staff as patient care is given.
4. Inspection of patients and/or observation of the affects
of patient care where the focus is on the patient.
Retrospective Audit
-Is one which patient care is evaluated through
A review of discharged patient’s charts;
Questionnaires sent to or interviews conducted on
discharged patients.
• Peer Review
-Patient care audits may be done by peers
(employees of the same profession, rank, and
setting) evaluating another’s job performance
against accepted standards.
• Quality Circles
-One of the most publicized approaches to
quality control introduced by the Japanese.
-A group of workers doing similar work who
meet regularly, voluntarily, on normal working
time, under the leadership of their supervisor, to
identify, analyze and solve work related problems
and to recommend solutions to management.
• Utilization of Results
-The Nursing Staff in the unit is given a
feedback on the results of the quality
assurance study.
-Positive Feedback reinforces desirable
performance. Consistent positive findings
deserve a commendation from the nursing
service.
-Negative Feedbacks should tactfully be
conveyed in a face-to-face situation so that
assessment results may easily be clarified.
 3. Compare performance with
standards, criteria to determine
deviations
 4. Enact Remedial measures or steps
to correct deviations
Maybe done by changing the
number of personnel, training
subordinates, minimizing resources
or increasing quality care.
 PERFORMANCE APPRAISAL
a control process in which an
employee’s performance is evaluated
against standards. It is the most
valuable tool in controlling human
resources and productivity.
 Different tools in Measuring
Performance
 Essay – strength & weaknesses
Checklist – compilation of all nursing
performances
Ranking – educational level,clinical
efficiency, ska
Anecdotal Recording
Rating scale – 1-5
Trait scale – job description,
personal trait
Peer review
Self appraisal
 Rate the staff member on the items
below
1 = never
2 = sometimes
3 = always

Observation of working hours 1 2 3

Ability to get along with others1 2 3

Forced Choice comparison
Ex. Select the statement that best
describes the nurse being evaluated and
the statement that least describes
him/her.
1- respects ideas for other
2 – limited communication ability
3 – even tempered
4 – capable of enduring long hours
5 – tends to be a loner
Common errors in appraisal
 halo effect or Logical error –
impressions
Central tendency error – used when
feedback tools are inadequate, staff is
rated average
Leniency error – overlooking the
weaknesses of the subordinate
Hawthorne effect
Horn’s effect – low rating because of an
error committed
 Discipline
Discipline means rigid obedience to
rules and regulations, the violation of
which resulted in punitive actions in
the past.
Today, discipline is regarded as
constructive and effective means
employees take personal responsibility
for their own performance and
behavior.
Disciplinary Action
Any employee charged for breach of the
rules and regulations, policies, norms of conduct
shall be given due process.
Counseling and Oral warning
The employee is given a fair chance to air
his/her side

Suspension
is given after an evidence of oral and written
warnings. Suspension is applied when
management feels that the employee can still
be rehabilitated.

Dismissal is invoked only when all the other

disciplinary efforts have failed.
Steps in progressing discipline

termination
suspension
2nd
reprimand
Official
reprimand

counseling
 Providing feedback

Suggestions
Positive Negative
for
feedback feedback
improvement
 Principles of Disciplinary Action
Have a positive attitude – expect the best
from your staff; very important in
correcting undesirable behavior
Investigate Carefully – collect facts
Be prompt – do not delay
Protect privacy – save face
Focus on the act
Enforce rules consistently – it reduces the
possibility of favoritism
Be flexible- consider length of service,
intent
Advise the employee – that their conduct
is not acceptable/anecdotal notes can be
useful here
Take corrective action
Follow up
Potential errors in performance
evaluations

Falling to investigate

Criticizing the employee

rather than the performance

blaming
Modification of employee behavior
Reinforcement
Acknowledgement, praise, pay,special
assignments, merit with pay
Shaping
I see you were in 30 minutes today, 15
mins….
Extinction
Never praise everyone all the time, not
worth
Punishment