CONCEPT OF MANAGEMENT.

 Question 1. CONCEPT OF MANAGEMENT.

·       Management

It is the process of working through nursing members to achieve Organizational objectives. It is the coordination and integration of nursing resources by applying the management process in order to accomplish care and service, goals and objectives. Successful nursing management must use managerial functions; planning, organizing, directing and controlling in an interrelated form to solve the problem.

Planning

Organizing

Motivation

Controlling

n  Planning

The process of selecting and developing the best course of action to accomplish an objective.

n  Organizing

Involves the assignment of tasks, grouping of tasks into departments, and allocation of resources.

 

n  Motivation

The use of influence to motivate employees to achieve the organization's goals             

n  Controlling

 Monitoring employees' activities, determining if the   organization is on target toward its goals, and making corrections as necessary.

 

Question2. DIFFERENCES BETWEEN LEADERSHIP AND MANAGEMENT.

 What is the Difference between Management and Leadership?  Mangers come from the “headship” (power from position) category. They hold appointive or directive posts in formal organizations. They can be appointed for both technical and leadership competencies, usually needing both to be accepted. Managers are delegated authority, including the power to reward or punish. A manager is expected to perform functions such as planning, organizing, directing (leading) and controlling (evaluating).  Informal leaders, by contrast, are not always managers performing those functions required by the organization. Leaders often are not even part of the organization. Florence Nightingale, after leaving the Crimea, was not connected with an organization but was still a leader.  Managers focus on results, analysis of failure, and tasks, management characteristics that are desirable for nurse managers. Effective managers also need to be good leaders. Manager-leaders ask for information, provide positive feedback, and understand the power of groups. Mistakes are tolerated by manager-leaders who challenge constituents to realize their potential.  

DIFFERENCES BETWEEN MANAGEMENT AND LEADERSHIP.

Leadership produces Change and Movement

Management produces Order and Consistency

                                                

Establishing Direction	Set time tables
Create a vision	Allocate resources
Clarify big picture	Make job placements
Set strategies	Establish rules and procedures
Aligning People	Establish agendas
Communicate goals	Provide structure
Build teams and coalitions

 

                                                                                                                                                                                        

                                                              

                                                                                                                                                                                       Question3. MANAGEMENGANT PROCESS OF THE INSTITUTION

 It is called a process because the work of attaining objectives through a series of interrelated and interdependent activities and these activities each one is considered a process in itself.

The management process always begins by planning and ends by controlling. Traditionally management process consisted of four elements: Planning, Organizing, leading (Directing), and controlling. At Children’s Hospital the Management process composed of departmental heads that identify institutional needs and problems and present them to top management which consist of Senior Medical superidetendent, Head clinical care, Administrator, Human Resources Manager, Chief Accountant and Chief Nursing Officer. The top management makes the final decision.

Some decisions are made at ward level as well as hospital management level except decisions that are beyond them and need the opinion of the board. The resources are organized and implementation is facilitated. Monitoring is done to ensure that quality is not compromised and evaluation is done at the end of the project to make sure the goals are met.

Question4. THE INSTITUTIONAL ORGANOGRAM

An Organogram is a graphical presentation of the structure of an organization showing groups and departments and their interconnections and interresponsibilities. The organogram is important as it defines division of work and specialization which finally leads to efficiency and cost effective health care services.

TYPES OF ORGANOGRAM

Horizontal or flat

 Matrix

 Hierarchical

Children’s Hospital has a hierarchical kind of organogram, which has levels of management power or authority. The top level of management composed of the Senior Medical Superidendent, Head Clinical Care, Hospital Administrator, Humam Resources Manager, Accounts department, Public Relations Manager and Chief Nursing Officer. The lower level of management comprises of departmental heads followed by support staff.

 

 

 

 

 

Question5. (a) HOSPITAL POLICIES

 SCOPE OF PRACTICE- every patient has a right to quality health care services.

 LAUNDRY POLICY - linen is washed and ironed whenever it is received from the departments.

INFECTION CONTROL POLICY - infection prevention protocols are followed in every department where NEMCAM are contracted to clean the floor using recommended disinfectants.

NURITIONAL POLICY- malnourished children admitted to children’s hospital are put in a special ward where they are provided with mixed diet according to severity of the condition.

INFORMATION MANAGEMENT –Patient’s information is kept confidentially by use of smart care cards and hard copy files.

 HEALTH AND SAFETY POLICY - patient and staff safety standards are granted when admitted to the hospital and working in the hospital respectively.

HEALTH AND ENVIROMENTAL MONITORING POLICY - The institution observes the guidelines in the environmental safety.

DEATH OF A PATIENT POLICY - when the patient dies the hospital takes the body to the hospital mortuary or relatives’ mortuary of choice.

COMPLAINT POLICY - every complaint is cautiously investigated.

CLINICAL RECORDS POLICY - clinical records are kept safe for confidential purpose.

BLOOOD TRANSFUSION POLICY - every blood must be screened properly before being transfused.

COMMUNICABLE DISEASE STAFF MANAGEMENT POLICY - Every communicable diseases should be reported to the district and admit to isolation ward.

Question5 (b) OBJECTIVES OF THE INSTITUTION

To provide quality health care services to all patients regardless of their status in the society.

To provide efficiency and cost effective health care services.

 

Question6. ESSENTIAL MANAGEMENT SKILLS GENERALLY USED.

What are Management Skills?

 Managerial Skills Managers can also be differentiated by the extent to which they use certain skills: conceptual, human relations and technical skills. All managers use human relation skills because they accomplish work through people. Human relations skills include motivation, leadership and communication skills. The degree to which each is used varies with the nature of the position, scope of responsibility, work activity, and number, types and skills of subordinates. Senior managers use disproportionately more conceptual skills in their jobs than do middle level or first line managers. These include recognizing and evaluating multiple complex issues and understanding their relationships, engaging in planning and problem solving that profoundly affect the health service organization, and thinking globally about the organization and its environment. In contrast first line managers tend to use job related technical skills

                                                                                                                                                     

Management skills generally applied at children’s Hospital are:

n  Technical skills—such as clinical expertise and nursing knowledge.

n  Human skills—the ability and judgment to work with people in an effective leadership.

n  Conceptual skills—the ability to understand the complexities of the overall organization and where one's own area of management fits into the overall organization.

 

 

 

 

 

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And these three managerial skills are applied in:

·       Verbal communication.

·       Managing time and stress.

·       Managing individual decisions.

·       Recognizing, defining, and solving problems.

·       Motivating and influencing others.

·       Controlling.

·       Setting objectives and articulating a vision.

·       Self-awareness.

·       Team building.

·       Managing conflict.

 

Question7. PROBLEM SOLVING SKILLS

Critical thinking skills enhance the quality of clinical judgment, problem solving, and decision making. Critical thinking skills are one of the top-rated competencies required for staff nurses (Del Bueno, 2005) and nurse leaders and managers (Lemire, 2002) within this chaotic health care delivery system.
Nursing problems may be complex and high-risk, necessitating thorough deliberation and some creativity. Problems can be solved and decisions made using a variety of tools and strategies. The nurse manager does not have to personally solve all the patient care problems that occur on a day-to-day basis.
The focus of leadership and management decision making is more closely related to the nurse’s role as care coordinator and systems problem solver. Some problems, such as those requiring disciplinary action, do require the manager’s direct intervention.

When there is a problem between staff members or between family and staff members, the manager uses negotiation and other forms of conflict management that could be viewed as indirect intervention because the manager does not actually solve the problem but, rather, persuades others to solve the problem themselves. The sometimes principal Nursing officer delegates the problem solving to others.  Most problem solving and decisions are made within the confines of collaboration and consultation with management. Shared governance initiatives have shown that collaboration and consultation result in high-quality patient care delivery systems. Therefore a critical role for nurse managers and leaders is facilitation by fostering a climate that encourages creativity and interdependence. Nurse Managers and leaders have many competing demands on their time. Deciding which problems need immediate attention and which can wait involves the ability to prioritize one’s actions. Clinical decision-making skills can be focused and enhanced by the use of critical thinking. Nurses use decision making in all aspects of care management, but the nurse manager deals more with system-level issues rather than the day to-day direct patient care decisions.
 Hospital filing system and information systems are used to capture data such as length of stay, reviews and patients admitted with communicable conditions.

Question8. HOW THE GENERAL SYSTEM WORKS IN THE HOSPITAL.

The world we live in is a complex system composed of subsystems that interact among each other with each having clearly defined boundaries and coherent dynamics. A system as a representation of life’s phenomena is used by humanity in everyday life to describe the functioning of these phenomena. For example, a hospital is a system of inputs, processes and outputs. The hospital itself is a component of a larger system which is the health care system.

Systems theory can be used to clearly and concisely understand health care structures, processes and outcomes and their interactions within a health care system. Systems theory can be used as a framework to describe the components of systems and the relationships between these components, the boundaries of the system, the goals of the system, and system's ability to change and adapt in response to internal and external forces. Systems theory and thinking response to internal and external forces. Systems theory and thinking can help us understand how health care organizations and systems behave and it allows us to clearly assess, visualize, analyze and understand the structure, processes, and feedback loops that make up the organization. This correct and clear understanding of the organization as a system is a necessity to be able to manage organizations effectively and efficiently and to achieve organization's goals.

HOW THE GENERAL SYSTEM IS IMPLEMENTED AT CHILDRENS HOSPITAL.

The hospital has a number of departments such as Nursing, Maintenance, human resource, accounts, records, pharmacy, laboratory, radiological, physiotherapy, kitchen and wards. These stated departments are managed by departmental heads. These preside over the affairs of the departments. This includes planning, organizing, controlling and evaluating patients care. The hospital Chief Nursing Officer, being a nurse generally coordinates the affairs of all the departments.

However these departments report to the Senior Medical Superintendent who makes the top management. These are responsible for formulating policies and overall decision making.

 

Question9. MOTIVATION AND MOTIVATION STRATEGIES

Motivation has been described as the ability to influence workers to do what one wants them to do, when and how one wants it to be done. Motivation is central to a number of issues important to nurses and nursing practice. It is a factor in how nurses feel about professional issues and affects the workplace or practice setting. It has implications for leadership as nurse’s struggle with the challenge of how to get members of a team or work group to do something they may not want to do. Also, motivation theory can provide insights into the process of trying to understand how patients’ behaviors are related to health and illness activities and the challenge this relationship presents to nurses as they help patients take on more responsibility for their health. Below are the ways in which Children’s hospital motivates its workers:

·       Members of staff are encouraged to go to school to further their education by maintaining them on the pay roll until they graduate.

·       The members of staff who acting in different positions are given acting allowances.

·       Those are hard working are given presents during Labour Day celebrations.

 

TEAM BUILDING

Team building is defined as the process of deliberately creating and unifying a group into a functioning work unit so that specific goals are accomplished (Farley & Stoner, 1989). A team was defined by Katzenbach and Smith (1993) as “a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable”. Manion and colleagues (1996) modified this definition slightly for health care by noting that the members need to be consistent. When gaps are identified among workers at the hospital in terms of knowledge and skills, the hospital organizes the workshops to equip the workers with necessary information

. Reasons for Team Building:

Team building composed of the following components:

·       Getting to know each other

The team members should interact with each other in order to learn from one another and should be able to know the abilities of each member as well as to support each other for effective team function.

 

·       Making the workplace more enjoyable

This involves formulating polices which create a conducive working environment where team members are able to express their views and concerns freely.

·       Improving communication

The team members share goals of their institution and it includes    sharing responsibilities and giving feed up to members through formal        meetings and correspondences.

·       Teaching the team self-regulation strategies

The team should have norms and guide lines to follow.  This will help to bring unit and harmony in the team. 

 

·       Improving team productivity

There must be unity among workers, regular meeting to discuss the welfare and activities of the institutions.

Question9 (a). STAFF APPRAISAL

Performance appraisal is a systemic review of an individual employee's performance on the job, which is used to evaluate the effectiveness of his/her work. Managing the performance of people is an important organizational strategy designed to exceed expectations of consumers in today’s competitive health care environment. Many complex processes and strategies are involved in managing employee behavior. Managers need to clearly define the roles and expectations that are needed in the variety of settings in which individuals provide their efforts in return for compensation. Performance appraisal is a required process in organizations to help ensure that the quality of care is met and to provide a fair human resources management process. Feedback is needed by all staff employed in a designated role. Performance appraisals provide staff members with the information necessary determine whether they are meeting expectations or can improve their performance to the required level.

 

Purpose:

 • Provide information upon which to base management decisions regarding such matters as salary raises, promotions, transfers, or discharges

 • Helps to assist employees in their personal development

 • Performance appraisal information will help to assess the effectiveness of hiring and recruiting practices 

• Supply information to the organization that will help to identify training and development needs of the employees

 • Helps in the establishment of standards of job performance often used as a criterion to assess the validity of personnel selection and training procedures.

 Characteristics of an Effective Performance Appraisal

• Relate performance appraisal to the job description

 • Understanding the criteria for evaluation 

Tools of performance appraisal

 • Rating scales-the tool consists of a behavior or characteristics to be rated and of some type of scale that will indicate the degree to which the person being evaluated demonstrates that behavior

 • The checklist- it describes the standard of performance and the rater indicates by placing a checkmark in a column if the employee demonstrates the behavior

 • Management by objective- it focuses on the evaluator's observations of the employee's performance as measured against very specific predetermined goals that have been jointly agreed upon by the employee and the evaluator.  

   During the orientation program, progress should be tracked, and competence needs should be reassessed periodically throughout employment, at least every year.
Performance appraisal is a cyclical process that begins when the employee is hired and ends when the employee leaves. Job analysis should identify competencies required for job performance. Next, the job description should identify work standards and the knowledge, skills, and abilities necessary
for the job. The performance appraisal specifies employee behaviors and compares job

Performance with criteria. A variety of measurement methods may be used to ensure that reliable and valid appraisals are conducted. Using the performance appraisal interview, goals are set, corrective action may be taken, or training needs may be identified. Outcome criteria include equitable rewards and recognition that are objectively administered using valid tools (Frank, 1998).
The performance appraisal process is both informal and formal. The informal process includes day-by-day supervision or coaching to moderate, modulate, or refine small parts of performance. Coaching as a management tool is ongoing, face-to-face collaboration and influence to improve skills and performance. By contrast, the formal performance appraisal should include written documentation and a formal interview with follow-up. The employee’s work is measured against some standard for the purpose of determining the level of quality of the job performance.

Question9 (b). CLINICAL AUDIT

Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through a systematic review of care against explicit criteria and implementation of change. Aspects of the structure, processes, and outcomes of the care are selected and systematically evaluated against explicit criteria. Where indicated changes are implemented at an individual team or service level and further monitoring is used to confirm improvement in health care delivery.

WHY IS CLINICAL AUDIT IS IMPORTANT

 Clinical Audit can be retrospective or concurrent. A retrospective audit is conducted after a patient’s discharge and involves examining records of a large number of cases. The patients’ entire course of care is evaluated and comparisons made across cases. Recommendations for change can be made from the perspective of many patients with similar care problems and with the spectrum of care considered.  A concurrent audit is conducted during the patient’s course of care; it examines the care being given to achieve a desirable outcome in the patient’s health and evaluates the nursing care activities bearing provided. Changes can be made if they are indicated by patient outcomes. 

PROCESS OF CLINICAL AUDIT

Stage one- preparing for the audit

Stage 2- selecting criteria

Stage 3-measuring performance

Stage 4-making improvements

Stage 5- sustaining improvement

 

 

 

Question10. CULTURE OF THE INSTITUTION AND MANAGEMENT OF DISPUTES AND STAFF DISCIPLINARY.

Culture is the attitudes and behavior that are characteristic of a particular social group or organization. The culture of an organization can influence how well individuals and institutions adapt to change.

Workers at children’s hospital are good and have passion for patients. They are united for the common purpose of ensuring that quality health care is achieved. They work as a team to achieve institutional objectives.

MANAGEMENT OF STAFF DISCIPLINARY AND DISPUTES

The hospital has a well written disciplinary code that prescribes the penalties for erring workers. This depends on how serious an offense the worker commits. For first offenders the code demands that an officer is given verbal warning. This is followed by a written warning, in a case were an officer commits another offense. The final warning is mated out on the officer after committing another offense. For small cases, the disciplinary committee summons the offender and counsels her or him accordingly. In case of gross abrogation of the code of conduct, the disciplinary code warrants an instant dismissal.

 

CONCLUSION

Our experience at Children’s hospital is unique because we had privileged to work with the Principal Nursing officer throughout our experience. Moreover, we were given an opportunity to participate in decision making in high level meetings chaired by the Senior Medical Superintendent. Our exposure to Children’s hospital has given us much needed practical experience and ready to manager any health institution in Zambia and the world at large.

 

 REFERENCES

·       Gillies, Ann Dee (1994). Nursing Management. A Systems Approach, 3rd. ed. W. B.     Saunders Company, Philadelphia.

·       Junttila, K., Meretoja, R., Seppala, A., Tolppanen, E., AlaNikkola, T., & Silvennoinen, L. (2007). Data warehouse approach to nursing management. Journal of Nursing Management, 15, 155–161

·       Farley, M., & Stoner, M. (1989). The nurse executive and interdisciplinary team building. Nursing Administration Quarterly, 13(2), 24–30

·       Katzenbach, J., & Smith, D. (1993). The wisdom of teams: Creating the high-performance organization. New York: Harper Collins.

·       Cohen, S. (2002). Don’t overlook creative thinking. Nursing Management, 33(8), 9–10

·       Kirton, M. (1994). Adaptors and innovators: Styles of creativity and problem solving. London: Routledge.

Manion, J., & Bartholomew, K. (2003). Community in the workplace: A proven retention strategy. Journal of Nursing Administration, 34(1), 46–53.