LEADERSHIP & MANAGEMENT SUMMARY REVISION

 CONFLICT MANAGEMENT AND RESOLUTION

Define conflict                 (6%)

• Conflict is a discord, a state of disharmony, open or prolonged fighting, strife or friction OR
• Conflict is a disagreement resulting from individuals or groups that differ in Opinions, Attitudes, Beliefs, Needs, Values or Perceptions

(ii) Mention five (5) effects of conflict on the organisation                      

a)   Absenteeism

b)   Staff turnover – Joining and leaving

c)    De-motivation

d)   Non-productivity

e)   Reduced trust

f)    Poor decisions because of withheld or distorted information

g)   Tension,

h)   Anxiety

i)     Drives out low conflict tolerant people

j)     Stress

b)  Briefly explain eight (8) common causes of conflict at work place  24%

a)   Lack of communication

b)   Feelings of being undervalued

c)    Undefined/not clearly defined roles

d)   Poor use of managerial criticism

e)   Preferential treatment

f)    Poor management/leadership

g)   Impractical expectations

h)   Overworked employees

i)     Stress

j)     Internal conflict

c)   Using practical ward examples, explain five (5) conflict management styles you would use when faced with conflict at  workplace                    30%

Use avoidance

—  This is a lose - lose situation

—  Both parties are neither assertive nor cooperative

—  It is used when an issue is trivial (less important)

—  It is also used to temporarily delay, allow emotions to cool then negotiations begins later

Use accommodation

—  This is a win-win situation

—  When using this style, it requires that one part is more cooperative and less assertive than the opponent

—  It is used when you find you are wrong and your opponent is right

—  It is acts as a favor

—  It is necessary to use when one wants to  build relationship

Use competition

—  This is a win-lose situation,

—  For this style to be used, one part should be more assertive than opponent

—  It is used in situations when quick, decisive action vital

—  It is necessary strategy to use when one don’t trust the opponent

Use compromise

—  This is a  lose-lose situation

—  This strategy is used where both parties are neither fully assertive nor fully cooperative

—  It is used in situations in which goals are important but not worth the effort/disruption of more assertive approach

 

 

Use collaboration

—  This is a win-win situation,

—  This style requires that both parties are assertive and cooperative

— It is used When concerns are too important to be compromised

— It is also used when the objective is to merge insights, gain commitment

—  It a necessary strategy to use when you have the time

d)   Identify and explain five (5) forms of power that a nurse manager posses, indicating how each form of power should be appropriately used while running a ward or department                                                     (30%)

a)   PUNISHMENT OR COERCIVE POWER

—  This is the form of power a midwife leader/manager posses based on penalties that a manager might impose if the individual or a group does not comply with authority.

—   This form of power can be effectively used by the manager to leader the staff when:-

—  Rules and requirements are explained and ensured that the staff has understood the serious consequences for the violations.

—  Punishment must be applied in line with the organisations’ disciplinary code.

—  A manager should respond to infractions promptly and consistently without showing favouritism to certain individuals or group of staff.

—  Investigations must be instituted to get the truth before using any reprimands and avoid jumping into conclusions or making quick accusations

—  Sufficient oral and written warnings must be provided before restoring to punishment, unless for very serious infractions.

—  Warnings and punishments should be administered in privacy and marking of rash threats avoided.

—  There must be expression of sincere desire to help the person comply with the role expectations and thereby avoid punishment.

—  The person must be invited to suggest ways to correct the problem and seek agreement on concrete plan

—  A manager should maintain credibility by administering punishment when non compliance continues after several threats and warnings have been made

b)  LEGITIMATE POWER

—  A midwife leader/manager’s power which stems from manager’s right to make a request due to authority associated with the job and ranking in organisational hierarchy.

     To effectively apply this power to lead the staff, the manager should:-

—  Make polite and clear requests ,

—  Explain the reasons for the request,

—  Not exceed their scope of authority as this may lead to abuse of office and authority’

—  Verify authority whenever necessary’

—  Follow proper channels established formally’

—  Follow up to verify compliance and

—  Insist on compliance if necessary to the requests made.

c)   Expert power

—   A midwife leader/manager s’ power which is based on peculiar skills, knowledge and competence a manager posses

—  For it to be effectively used to lead the staff, the nurse manager should:

—  Give reasons for a request or proposal and explain its importance,

—  Provide evidence that the proposal will be successful’

—  Not make hasty, careless or uncoordinated statements’

—  Not exaggerate or misrepresent the facts’

—  Listen seriously to the persons’ concerns and suggestions and

—   Act confidently and decisively during a crisis or a critical situation.

d)  Referent power

—  The power a midwife leader/manager posses which is based on admiration and respect as an individual.

—  To effectively utilize this power in leading staff, the nurse manager should:

—  Show acceptance and positive regard

—  Act supportively and helpfully to subordinates

—  Use sincere forms of ingratiation’

—  Defend and back up the staff when appropriate’

—  Do unsolicited favours’

—  Make self-sacrifices to show concern, and

—  Adhere and keep promises made to the staff and others.

e)   Information power

—  The form of power a midwife leader/manager poses based on an individual’s access to valued data that is needed to by others.

      To effectively utilize this power in leading staff, one should:

—  Be able to debrief the staff the deliberations that were discussed in important gatherings such as seminars or conferences.

—  Should be able to write full reports and circulate the reports to the other members of staff of what was discussed in the gatherings attended, more especially that which concern them.

—  Demonstrate great skill in teaching patients difficulty self care activities and is sought out by colleagues to help them teach their patients

—  Should show insight and understandings during meetings and presentations being done and be able to direct the talks in the right direction using the valuable information he/ she posses

f)    Reward power

—  The form of power that is the midwife as a leader/manager posses based on an inducements offered to subordinates by the manager in exchange for the contributions that advance her/ his objectives.

—  To effectively use this power in leading the staff, the manager should:

—  Offer rewards that are in line with organisational policies and fair’

—  Promises made are only those he/she can manage

—  Explain well the criteria for giving the reward  and keeping the explanations simple’

—  Should provide rewards as promised when requirements are met by the staff,

—  Given rewards are those which the staff desire.

—  Ensure rewards are used symbolically and not in a manipulative way

a)   Describe three (3) leadership/management skills a nurse manager should posses in order to effectively and efficiently manage a ward or department                                                                                                    24%

1.   Technical skill – 9%

Ø  Technical skills refer to persons’ knowledge and ability in any type of process or technique.

Ø  This includes the knowledge of equipment, work methods, processes, procedures and technologies for conducting a specialised activity.

Ø  It is also the ability to use tools and equipment relevant to that activity, which is basically the actual way of doing work.

Ø  As one is promoted to higher leadership position, it becomes proportionally less important, at this stage, the leader depends more on technical skills of his or her subordinates.

Ø  Although technical skills are viewed as being of less importance as one grows in the hierarchy, inadequacy may result into:-

Ø  The leader  failing to identify and diagnose job related inefficiencies in the subordinate performing the task.

Ø  The leader failing to appreciate difficulties inherent within the task the subordinates may be performing.

Ø  The leader failing plan in order to address the job related inefficiencies subordinates may be faced with.

Ø  The subordinates will lose confidence in his or her leadership/management.

Ø  The nurse leader/manager lacking in technical skills may also be easily taken advantage of by both colleagues and subordinates who may be practicing in unacceptable ways in those areas that may need her/his supervision subordinates.

2.   Human skill – 9%

Ø  Is also known as interpersonal skill.

Ø  It is the ability to work effectively with people and build teamwork.

Ø  No single leader/manager in an institution or unit can escape this requirement.

Ø  It is the major part of all leadership/management behaviour

Ø  It can be achieved Open door leadership, a humanistic technique where subordinates are encouraged to visit their immediate leaders/manager s and present their problems, if their problems are not resolved, then the top leadership/management may be approached.

Ø  The goal in open door technique is to remove barriers to upward communication

Ø  When using humanistic skill, Management-by-exception leadership can also be used. This technique entails appropriately rewarding employees in recognition of certain specifications being met in relation to service delivery.

Ø  When no tangible results are attained for performing one’s task, some form of sanctions should follow.

Ø  This technique can equally be practiced at all level of leadership/management in health institutions.

Ø  This technique produces effect for rewarding good performance

3.   Conceptual skill – 6%

Ø  Conceptual skill refers to the leader/managers’ ability to use his mind in terms of models, frameworks and broader relationships to view the operations of the institution and its parts holistically.

Ø  It involves leader/manager’s thinking and strategically planning abilities.

Ø  It is mostly utilized as one goes up in the hierarchy

Ø  It is  skill that requires mental use

Ø  Theories and policies are espoused to find solutions to problems

Ø  It may involve evidence based solutions by carrying out research 

b)  Explain autocratic, Democratic and Laissez-faire leadership styles and their appropriate use when managing the ward                                            36%

1.   AUTHORITARIAN/ AUTOCRATIC STYLE

—  Autocracy is a form of governance where a single person controls all the affairs of the organization.

—  In this system all the decisions are taken for the people and the organization lie in the hands of one single person ruling the organization.

—  The decisions taken by this single individual are considered supreme and are not subjected to legal restraints.

—  There is also a clear division between the leader and the members.

—  Authoritarian leaders make decisions independently with little or no input from the rest of the group

—  He/she does not take into account any other person's advice.

—  There is no law and the voices of the people are unheard

—  Decision-making is less creative under authoritarian leadership.

—  It  tends to create dysfunctional and even hostile environments.

—  This style is often described as controlling and close-minded.

—  Authoritarian leadership is best applied to situations where there is little time for group decision-making or where the leader is the most knowledgeable member of the group.

—  Potential positives of stressing rules, expecting obedience and taking responsibility.

—  It’s a approach can be a good when the situation calls for rapid decisions and decisive actions e.g in emergencies like breech delivery

2.   DEMOCRATIC / PARTICIPATIVE LEADERSHIP STYLE

—  Is typically the most effective leadership style.

—  Democratic leaders offer guidance to group members, but they also participate in the group

—  Members contribute or input is solicited from other group members.

—  Leaders encourage group members to participate but retain the final say in the decision-making process

—  Group members feel engaged in the process

Benefits

—  Followers are motivated

—  Creativity is promoted in followers

—  Followers are more productive.

—  Democratic leaders make followers feel like they are an important part of the team, which helps foster commitment to the goals of the group.

—  Communication is more open

3.    LAISSEZ-FAIRE (DELEGATIVE ) LEADERSHIP STYLE

—  Is the least productive of all three groups

—  Members make more demands on the leader, while showing little cooperation

—  Followers are unable to work independently.

—  Leaders offer little or no guidance to group members

—  Decision-making  are left up to group members.

—  It often leads to poorly defined roles and a lack of motivation.

—  Laissez-faire leadership result in groups that lack clear direction

—  Followers  blame each other for mistakes

—  Follower  refuse to accept personality responsibility.

—  Productivity is low

—  There is lack of progress and work

Use

—  This style can be useful in situations involving highly qualified experts who knows what to do and a mature enough e.g. Good midwives in Labor ward/ MCH

 

 

 

 

 

 

 

c)   Using Lewin Change theory, explain how you as a nurse manager would change the attitude of old midwives on the use of partograph when managing women in labour ward                                                   30%

 

—  Lewin change theory or model is based around a 3-step process that provides a high-level approach to change

—  It gives a manager or other change agent a framework to implement a change effort, which is always very sensitive and must be made as seamless as possible.

—  The Lewin change theory or model can help a leader do the following: -

—  Make a radical change

—  Minimize the disruption of the structure’s operations during transitional phase of change

—  Make sure that the change is adopted permanently

—  It gives a manager or change agent an idea of what implementing change means when dealing with people. 

—  It provides guidance on how to go about getting people to change: a manager will implement new processes and re-assign tasks, but change will only be effective if the people involved embrace it and help putting it into practice it.

1.    FIRST STEP - UNFREEZE – GETTING READY TO CHANGE

—  When a structure has been in place for a while, habits and routine naturally sets in. 

—  Normally, the organization as a whole is seen going in the right direction, but people or processes may have strayed off course.

—  For example, tasks that are not relevant or useful anymore like just recording in a women’s file despite a women being in active phase of labour are still being performed by force of habit, without anyone questioning their legitimacy.

—  Similarly, people might have learned to do things one way, without considering other, more efficient methods.

—  Unfreezing means getting people to gain perspective on their day-to-day activities, unlearn their bad habits, and open up to new ways of reaching their objectives.

—  At this stage, the nurse manager should call the midwives and informed them about the new and correct way of plotting and interpreting the partograph in labour ward.

—  This stage requires the nurse manager together with the midwives in labour ward to reassess current practices and processes in order for the wheels of change to be set in motion

 

 

2.   SECOND STEP: CHANGE – IMPLEMENTATION

—  Once team members have opened up their minds, change can start.

—  The change process can be a very dynamic one and, if it is to be effective, it has to probably take some time and involve a transition period.

—  In order to gain efficiency, midwives will have to take on new tasks and responsibilities, which entails a learning curve that will at first slow the ward or organization down.

—  A change process has to be viewed as an investment, both in terms of time and the allocation of resources.

—  Therefore, a nurse manager should lobby the administration for in house training of midwives on how to use the partograph. Allocate time for each midwife to practice women care using the partogram, plot and interpret the process of labour on the partograph.

—  After the new organization and processes have been rolled out, certain chaos might ensue, but this is the price to pay in order to attain enhanced effectiveness within the structure.

3.   THIRD STEP: FREEZE (REFREEZE)- “MAKING IT STICK”

—  Change will only reach its full effect if it’s made permanent.

—  Once the organizational changes have been made and the structure has regained its effectiveness, every effort must be made to cement them and make sure the new organization becomes the standard.

—  Further changes must be made down the line, but once the structure has found a way to improve the way it conducts its operations, “re-freezing” will give the people the opportunity to thrive in the new organization and take full advantage of the change.

—  To cement new virtues, send them for workshops that are talking about management of women in labor such as EMOC or those organized by MAZ.

—  In this way the learnt practices on how to correctly use partograph will be adhered to and made part of the midwives

 

 

 

 

 

You have been appointed as a ward manager and you must immediately start Performing your duties

a)   Outline any three (3) theories of management                                        15%

b)   b) Explain any 10 principles of management you are going to reinforce in your ward                                                                                                  50%

c)     During your discharge of duties as ward manager, you discover that you have so many activities to perform and you decide to delegate some activities

               i.        State five (5) advantages of delegation 15%

              ii.        Outline five (5) reasons why some managers are reluctant to delegate 20%

      ANSWERS

·       A management theory is a collection of ideas which set forth general rules on how to manage an organization or a business.

·        A Management theory addresses how managers and supervisors relate to their organizations in the knowledge of its goals, the implementation of effective means to get the goals accomplished and how to motivate employees to perform to the highest.

·       Management theories are concepts surrounding recommended management strategies.

·       These may include tools such as frameworks and guidelines that can be implemented in modern organizations. Generally, professionals will not rely solely on one management theory alone, but instead, introduce several concepts from different management theories that best suit their workforce and company culture.

·       There are many theories of management but for the purpose of revision we shall only discuss five of them

Outline any three (3) theories of management (15%)

1.   BEHAVIORAL MANAGEMENT THEORY

·       This theory states that workers conditions affect the quantity and quality of their works.

·       The workers conditions influence the work behavior of employees towards work.

·       Therefore, management must be concerned with the workers condition in order to improve the quantity and quality of work output.

1.   SYSTEM MANAGEMENT THEORY

·       The system management theory views an organization as a system that has interrelated parts.

·       These parts work or operate as one or a whole in order to achieve a specific goal.

·       This theory signifies that the manager of an organization should be able to understand the various parts of the system that makes up the entire operation.

3. QUANTITATIVE MANAGEMENT THEORY

·       The quantitative management theory focuses on the use of quantitative tools to help plan and control nearly everything in an organization.

·       A Manager who adopts this Theory will try to quantify the tasks in his planning of task allocation.

4. SCIENTIFIC MANAGEMENT THEORY (CLASSICAL MANAGEMENT THEORY)

·       The scientific or classical management theory places emphasis on finding the one best way to perform and manage tasks, simplifying tasks, standardization of tasks, rewarding and punishing employees according to job performance to increase productivity.

·       It focuses on Observation and Measurement of outcome

·       Frederick Taylor is recognized as a father of scientific management.

·       He conducted time and motion studies to time workers, analyzed their movements and set their standards.

·       Frederick Taylor developed the “scientific management theory” which proposed careful specification and measurement of all organizational tasks.

·       Tasks were standardized as much as possible. Workers were rewarded and punished according to the job performance to increase production or performance of an Organization.

5. CONTINGENCY MANAGEMENT THEORY

·       This theory states that a leader’s effectiveness is dependent (contingent) on how well the leader’s style matches a specific setting or situation Fred Fielder introduced the contingency model of leadership in 1960s. He argued that a leadership style will be effective or ineffective depending on the situation.

Explain any 10 principles of management you are going to reinforce in your ward (50%)

Note that this question is not just about stating the principles of management but it also

Requires application. The first part requires you to state the principle while the second

Part should address the application aspect of it.

PRINCIPLES OF MANAGEMENT

·       Most managers of organizations base their day to day running of the organizations using Henry Fayols Principles of Management.

·       Henry Fayol known as the Father of Management came up with 14 principles of Management.

 

HENRY FAYOL’S PRINCIPLES OF MANAGEMENT

1. Unity of Command

·       This principle states that every subordinate should receive orders and be accountable to one superior

·       . If an employee receives orders from more than one superior, it is likely to create confusion and conflict.

·        I will reinforce this principle by emphasizing the reporting system within the ward.

·       I will tell my subordinates to be receiving orders from me as a ward in-charge to avoid confusion.

2. Unity of Direction

·       This principle states that all those working in the same line of activity must understand and pursue the same objectives.

·        This principle seeks to ensure unity in an organization.

·        The entire organization should be moving towards a common objective in a common direction.

·        I will reinforce this principle by sharing with my subordinates the objectives of our ward so that everyone must aware and contribute towards their achievement.

3. Scalar Chain/ Chain of Command

·       Scalar chain refers to the chain of superiors ranging from top management to the lowest rank.

·       The principle suggests that there should be a clear line of authority from top to bottom linking all managers at all levels.

·       It is considered a chain of command.

·       I will reinforce this principle by explaining to my subordinate about the ward management structure so that everyone can understand the structure.

4. Division of Work

·       This is the specialization of the workforce according to the skills of a person, creating specific personal and professional development within the labor force and therefore increasing productivity.

·        I will reinforce this principle by allocating tasks to my subordinates according to their skills and abilities.

 

5. Authority and Responsibility

·       Authority means the right of a superior to give orders to his subordinates and responsibility means obligation for performance.

·       When authority is exercised, responsibility arises.

·        I reinforce this principle by giving orders to my subordinates so to enhance performance of duties.

6. Esprit de Corps

·       This is maintaining team work spirit. Team spirit helps develop an atmosphere of mutual trust and understanding.

·        Team increased productivity and effectiveness.

·       I will reinforce this principle by applying team building activities.

7. Equity

·       Employees must be treated kindly and alike, provide equal opportunities and justice must be enacted to ensure a just workplace.

·       As a manager I will be fair and impartial when dealing with my subordinates.

8. Discipline

·       Discipline refers to obedience to rules, proper conduct in relation to others, and respect of authority.

·        Discipline is essential for the smooth functioning of all organizations.

·        I will reinforce discipline by spelling out rules and promoting compliance to these rules for smoothing operations of ward.

9. Subordination of Individual Interest:

·       This principle states that the management must put aside personal considerations and put company objectives first.

·        Therefore the interests of goals of the organization must prevail over the personal interests of individuals.

·       I will reinforce this principle by putting the interests of my ward above mine as a ward manager.

10. Remuneration

·       According to this principle workers must be paid sufficiently as this is a chief motivation of employees and therefore greatly influences productivity.

·        The means and methods of remuneration should be fair, reasonable and rewarding of effort.

·        I will reinforce this principle by being an advocate for improved conditions of service for motivation of staff.

 

 

 

11. Order: -

·       The principle states that the Material and people should be in the right place all the time.

·       I will reinforce this principle by encouraging my subordinates to put materials within the ward in their correct places for easy access and use.

12. Initiative:

·       Using the initiative of employees can add strength and new ideas to an

·       Organization and employees are likely to take greater interest in the functioning of the organization.

·        I will reinforce this principle by encouraging my subordinates to be innovative as they perform their duties.

13. The Degree of Centralization

·       Centralization implies the concentration of decision making authority at the top management.

·        Sharing of authority with lower levels is called decentralization.

·       The Organization should strive to achieve a proper balance.

14. Stability of Tenure of Personnel:

·       The period of service should not be too short and employees should not be moved from positions frequently.

·       An employee cannot render useful service if he is removed before he becomes accustomed to the work assigned to him.

State five (5) advantages of delegation (15%)

ADVANTAGES OF DELEGATION

·       It reduces the work load of the manager

·        Makes work easier because of shared responsibilities

·        It allows manager to concentrate on aspects of job which require her personal knowledge experience and skills

·        It promotes staff growth and development

·       There will be less office / work politics where delegation is done properly

 

Outline five (5) reasons why some managers are reluctant to delegate (20%)

1. Subordinate can mess up the job

·       Some managers are not willing to delegate because they think that assigning work to a subordinate may lead to substandard work by the subordinates.

·       This may be due to the belief that the manager is the only one who can do the job better than anyone else.

2. Fear of Deprivation of Some Duties

·       Delegation deprives the manager certain duties that she/he enjoys doing when these duties are assigned to a subordinate such that some managers will not be very willing to delegate.

3. Lack of Confidence in the Subordinates

·       The manager may be reluctant to delegate due to lack of confidence in the subordinates that they will not do the work as the manager would like it to be done

4. Fear that the Subordinate may take Over

·       Delegation may make the manager feel that the subordinate will take over his/her job because the subordinate may perform the work better than the manager.

5. Fear of Deprivation of being a boss

·       Some managers want to feel they are bosses, and delegation deprives them of this feeling.

6. Unwillingness to take Risks

·       Delegation has some risks involved such as doing the work again because it was not done well hence some managers are unwillingness to take the risks involved in depending on others.

7. Time involved in explaining the task

·       Delegation requires that the manager takes time to explain the task involved to the subordinate

·        For this reason some managers are reluctant to delegate and prefer just to do the work.

 

 

 

DELEGATION

A.   Definition-It is the assignment to another person of formal authority and responsibility for carrying out specific activities.

B.   FIVE RIGHTS OF DELEGATION

The five rights to delegation from are:-

·       Right task

·        Right circumstance

·        Right person

·       Right direction/communication

·       Right supervision/evaluation

C.   ESSENTIALS OF DELEGATION

·       Entrusting work or responsibility to another

·       Entrusting power, authority and accountability

·        Creating an obligation on part of the person

·        Accepting the delegation to perform in-terms of standards

D. WHEN TO DELEGATE

·       When the work load has exceeded the managers physical and psychological Capacity

·        When supervisor has to go somewhere for sometime

·        When the manager wants subordinates to learn

E.   HOW TO DELEGATE

·       Get acceptance and understanding of the subordinates

·       Specify goals and objective

·        State the end result expected

·       Leave the subordinate to work on her own without interference

·        Follow her work privately to check progress

F.   WHAT NOT TO DELEGATE

·       Do not delegate the power to discipline’

·       Responsibility for maintaining morale

·       Overall control

G.   ADVANTAGES OF DELEGATION

·       It reduces the work load of the manager

·       Makes work easier because of shared responsibilities

·       It allows manager to concentrate on aspects of job which require her personal knowledge experience and skills

·       It promotes staff growth and development

·       There will be less office / work politics where delegation is done properly

 

H.  SUCCESSFUL DELEGATION RESULTS IN THE FOLLOWING

·       Makes work easier.

·        Improves efficiency.

·       Increases employee effectiveness.

·       Develops employees.

·       Ensures that the right people do the right jobs.

I.    RELUCTANCE TO ACCEPT DELEGATION

(Subordinate resistance to delegation)

·       Failure of the delegator to see the subordinate’s perspective

·       Workload assigned are highly challenging both physically and mentally

·       Belief of employees that they are incapable of completing the delegated task

·       Inherent resistance to authority

·        Due to over delegation

·       Low self-confidence and insecurity

·        Vague job description

·        Lack of experience

·        Avoidance of responsibility 

J.    OVERCOMING BARRIERS TO EFFECTIVE DELEGATION

·       Managers must be willing to give subordinates real freedom to accomplish delegated tasks.

·        Improved communication between managers and subordinates will bring about high mutual understanding and help make delegation more effective.

·        Managers who know their subordinate’s abilities can more realistically decide which tasks can be generated

·        Subordinates who are encouraged to use their abilities and who feel their manger will back them up will in turn be more likely to accept delegated tasks.

K.   STEPS OF SUCCESSFUL DELEGATION

·       Define the task: Confirm in your own mind that the task is suitable to be delegated. Does it meet the criteria for delegating

·        Select the individual or team: What are your reasons for delegating to this person or team? What are they going to get out of it? What are you going to get out of it?

·       Assess ability and training needs: Is the other person or team of people capable of doing the task? Do they understand what needs to be done? If not, you can't delegate.

·        Explain the reasons: You must explain why the job or responsibility is being delegated. Why to that person or people? What is its importance and relevance?

·        State required results: What must be achieved? Clarify understanding by getting feedback from the other person. How will the task be measured? Make sure they know how you intend to decide that the job is being successfully done.

·       Consider resources required: Discuss and agree what is required to get the job done. Consider people, location, premises, equipment, money, materials, other related activities and services.

·        Agree deadlines: When must the job be finished? Or if an ongoing duty, when are the review dates? When are the reports due? And if the task is complex and has parts or stages, what are the priorities?

·        Support and communicate: Think about who else needs to know what's going on, and inform them.

·       Feedback on results: It is essential to let the person know how they are doing, and whether they have achieved their aims. If not, you must review with them why things did not go to plan, and deal with the problems. You must absorb the consequences of failure, and pass on the credit for success

-----------------------------------------------------------------------------------------------------------

QUESTION 2

You have been asked by your area Nursing Officer of your hospital to be part of

the planning committee for the nursing department.

a)   Define planning 5%

b)   State five (5) reasons why planning is important 15%

c)    Outline three (3) types of planning 15%

d)   State five (5) elements of planning 15%

Following completion of the planning cycle, you have been tasked to Communicate the plan to your subordinates.

e)   Using seven points, discuss the process of communication that you are going to follow 35%

f)     State any five barriers to communication 15%

ANSWERS

Define planning (5%)

Definition of planning:

·       Planning is deciding in advance what to do, when to do it, how to do it and who to do it.

·       It can also be defined as the process of setting goals, developing strategies, and outlining tasks and schedules to accomplish the goal.

·        Planning includes deciding WHAT is to be done, HOW it is to be done, WHEN it is to be done.

·       Planning is the foundation or basic function of management. It is a principal duty of all managers.

State five (5) reasons why planning is important (15%)

·       Planning reduces overlapping and wasteful activities by deciding in advance what needs to be done at a particular time.

·       Planning facilitates decision making by identifying what needs to be implemented to achieve specific goals.

·       Planning establishes standards for controlling through identification of what needs to accomplish.

·        It enables to determine resources that are needed to perform a planned task.

·       It enables us to assess progress toward achieving the set objectives\

·       It prevents possibility of crisis management since there are schedules for activities

·        Planning provides directions by showing in advance what has be to be done.

Outline three (3) types of planning (15%)

1.   Strategic planning:

·       Strategic planning is an organizational management activity of defining its strategy, or direction, and making decisions on allocating its resources to pursue this strategy.

·       Strategic planning is conducted by top management and improves allocation of scarce resources, including time and money. It is a long range type of planning, e.g. for three years.

·       Strategic plans are all about why things need to happen

·       It can also be defined as strategic the process of allocating resources and initiating actions to accomplish predetermined objectives and goals.

·       It is used to set priorities, determining overall objectives of an organization, focus energy and resources on achieving organizational goals and strengthen operations.

2.   Intermediate planning/Administrative Planning/Tactical Planning

·       Administrative or intermediate planning is done at the level of middle management who have a task of polishing up on top management’s plans.

·       It is done to allocate organizational resources and coordinate internal subdivisions of the organization.

·       Intermediate plans are for a short span of time ranging between a few months to about a year.

·        Tactical plans are about what is going to happen

 

3.     Operational planning:

·       Operational plans are about how things need to happen,”

·       An operational planning is planning done by a component of an organization that clearly defines actions it will take to support the strategic objectives and plans of upper management.

·        This is planning done by lower level managers and the plans made are short range plans covering a life span of one week to one year.

·        These plans are more specific and determine how the specific job should be done in the best possible way.

·        It is the organization and directing of the delivery of activities. e.g planning at a ward level.

4.    Functional planning

·       Functional planning refers to the process of managing the work and tasks within a given department of a larger business.

·       This is planning performed at departmental level.

·       It is generally related to a specialty service within the organization.

·       This work includes tasks with a specific project and general planning to improve the work environment in a department.

5.   Contingency Planning

·       Contingency plans are made when something unexpected happens or when something needs to be changed.

·        Contingency planning can be helpful in circumstances that call for a change.

·       Although managers should anticipate changes when engaged in any of the

primary types of planning, contingency planning is essential in moments when changes can’t be foreseen.

·       As the business world becomes more complicated, contingency planning becomes more important to engage in and understand.

6.    Unit planning:

·       it is planning that extends to the operational units of the organization e.g. wards. Planning done at a daily basis, weekly, and long term basis e.g time tables, task allocation and/or patient allocation.

State five (5) elements of planning (15%)

·       Diagnosing the problem: Planning helps in solving potential or actual problems

·        Setting up priorities and formulate objectives

·        Finding the most suitable solutions by comparing and analysing alternatives

·        Selecting the best plan and implement it

·       Showing in advance who, what, when, how, where and why.

 

 

Following completion of the planning cycle, you have been tasked to

Communicate the plan to your subordinates.

Using seven points, discuss the process of communication that you are going to follow (35%)

·       This question requires application of the steps in the communication process other than outlining the steps.

COMMUNICATION PROCESS

·       The communication process starts with conceptualizing an idea or message by the sender and ends with the feedback from the receiver.

1.   Sender or communicator:

·       The person who intends to convey the message with the intention of passing information and ideas to others through a channel to the receiver.  

·       In this regard I am the sender or communicator of the plan.

2.   Message/Idea:

·        is the subject matter of the communication.

·        It can be an opinion, attitude, feelings, views, orders, or suggestions.

·        In this regard the subject matter of the communication is the plan to be communicated to my subordinates.

3.   Encoding:

·       is the process of converting subject matter into symbols such as words, actions or pictures since communication is theoretical and intangible.

·        I will choose appropriate ways of converting the subject matter into words and symbols.

4.   Channel:

·       The person who is interested in communicating has to choose the channel for sending the required information, ideas etc.

·        which can be formal or informal.

·        I will select a channel for sending the information e.g. a presentation of the plan through a discussion.

5.   Receiver:

·       The person who receives the message or for whom the message is meant.

·       It is the receiver who tries to understand the message in the best possible manner in achieving the desired objectives through decoding and sends back some type of signal or feedback.

·        In this regard the receiver are the ward staff.

6.   Decoding:

·       The person who receives the message or symbol from the communicator tries to convert the same in such a way so that he may extract its meaning to his complete understanding.

·        As I present the plan, I will allow for time for the ward staff to make meaning of what is presented to them.

7.   Feedback:

·       Is the process of ensuring that the receiver has received the message and understood in the same sense as sender meant it.

·        I will request for feedback from the ward staff to evaluate their understanding of the communicated plan.

State any five barriers to communication (15%)

·       Filtering: deliberate manipulation of information to make it appear more favorable to the receiver

·       Emotions: How the receiver feels when a message is received influences how he/she interprets it.

·        Information overload: majors have a lot of meetings, e-mails messages, calls, and faxes, professional reading, these make them have more information than they can process. So they tend to ignore, forget, or selective choosing information.

·        Defensiveness: when people feel threatened, they tend to react in ways that hinder effective communication and reduce their ability to achieve mutual understanding, they become defensive-verbally attacking others, making sarcastic remarks, judgmental.

·        Language differences and the difficulty in understanding unfamiliar accents.

·       Expectations and prejudices which may lead to false assumptions or stereotyping. People often hear what they expect to hear rather than what is actually said and jump to incorrect conclusions.

·       Cultural differences. The norms of social interaction vary greatly in different cultures, as do the way in which emotions are expressed. For example, the concept of personal space varies between cultures and between different social settings.

--------------------------------------------------------------------------------------------------

QUESTION 3

The Zambian government on 15th August, 2017 through the Republican President announced a policy change regarding HIV testing from voluntary to compulsory testing.

a)   Define the following terms

                      i.        Policy 5%

                     ii.        Policy Development 5%

                   iii.        Policy analysis 5%

b)   i. List any ten (10) health related policies in Zambia 20%

          ii. State five (5) reasons why is important to have policy regarding health care15%

c)    Explain four (4) steps that are involved in policy development 20%

 You have been asked to be part of the team to analyze the current policy     regardingHIV

Testing in Zambia

d) Discuss in detail five (5) methods of policy analysis 30%

DEFINITIONS

·       A policy is a general plan of action used to guide the desired outcome. It is a guideline or rule used to make decisions.

·        Policy development is the decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.

·       Policy analysis involves the systematic comparison and analysis of a set of policy alternatives to determine which option is most likely to achieve a set of objectives.

HEALTH POLICY

·       Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society.

·        According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people

List any five (5) health related policies in Zambia (10%)

·       HIV work place policy

·       Malaria Treatment policy

·       Infection prevention policy

·        TB treatment policy

·       HIV Post Exposure Treatment policy

·       Public health policy

·        Mental health policy

·        Health care services policy,

·       Personal healthcare policy,

·       .Pharmaceutical policy

·       Vaccination policy

·       Tobacco control policy

·        Breastfeeding promotion policy

State five (5) reasons why is important to have policy regarding health care

 (15%)

The purpose of a policy (or health care procedure)

·       To provide standardization in daily operational activities.

·       Policies and procedures provide clarity when dealing with issues and activities that are critical to health and safety, legal liabilities and regulatory requirements that have serious consequences.

·       Policy is also used to communicate to employees the desired outcomes of the organization. They are usually broad, state what has to be achieved and why and answer major operational issues.

·        Policies again can help employees understand their roles and responsibilities within the organization.

·       Policies generally to help them run organizations efficiently in achieving their objectives.

Explain four (4) steps that are involved in policy development (20%)

PROCESS OF POLICY DEVELOPMENT.

There are four typical and main steps in the policy development process:

1.    Identifying a problem,

2.    Formulating a policy,

3.     Implementing the policy change, and

4.     Evaluating the result.

Each step is usually followed in the order listed to make sure that the process is done correctly.

A.   IDENTIFYING THE PROBLEM.

·       The first step in the policy process is to outline the problem since a policy is usually developed to provide solution to identified problem.

·       This involves not only recognizing that an issue exists that needs to be addressed but also studying the problem and its causes in detail.

·        This stage involves determining how aware the public is of the issue, deciding who will participate in fixing it, and considering what means are available to accomplish a solution.

 

 

 

B.   FORMULATING A POLICY TO RESOLVE THE PROBLEM

·       After identifying and studying the problem, a new policy may be formulated or developed.

·       This step is typically marked by discussion and debate to identify potential obstacles, to suggest alternative solutions, and to set clear goals and list the steps that need to be taken to achieve them

·        Once the policy is developed, the authorities must agree to it.

C.   IMPLEMENTING THE POLICY

·       This is the step of actualizing the policy. A new policy must be put into effect to address the identified problem.

·       This steps also involves communicating the new policy to the frontline implementers as well as supervisors.

·        Coordination, as well as sufficient funding, are also needed to make this step a success.

D.   EVALUATING THE EFFECT OF THE POLICY

·       The final stage in the policy process, known as evaluation, is typically ongoing. This step usually involves a study of how effective the new policy has been in addressing the original problem, which often leads to additional policy changes.

·       It also includes reviewing funds and resources available to ensure that the policy can be maintained.

·       Historically, this step has not always been treated as very important, but policy makers are increasingly finding ways to make sure that the tools needed for evaluation are included in each step of the policy process.

You have been asked to be part of the team to analyze the current policy

regarding HIV testing in Zambia

Discuss in detail five (5) methods of policy analysis (30%)

·       The following is a review of the most prominent methodologies used in policy analysis to describe, analyze, and compare policies.

1) Needs Assessment.

·       This involves identifying the nature, scope, and extent of the problem whether the current policy addresses the problem adequately or not. An assessment of the extent of need in a variety of ways is made and the nature of the problem through analysis of existing information

·        This information is used to describe the current state of need and to forecast likely needs.

 

 

2) Cost–Benefit Analysis

·       Cost–benefit analysis is an approach that attempts to relate the direct and indirect costs of policies to the direct and indirect benefits of those policies. Cost–benefit analysis requires that both the costs and the benefits of policies be calculated in monetary form.

·       This is frequently difficult to do, because policy analysts are often unable to give a precise dollar figure for saving a life for example.

3) Cost-Effectiveness Analysis

·       Cost-effectiveness analysis looks at the costs of different policies in achieving the desired policy results.

·       Unlike cost–benefit analysis, this methodology does not require the monetization of the benefits of each policy.

·        Although policy analysts may not know the dollar value of certain benefits, they can compare which policy costs less to achieve the same desired outcome, regardless of monetary value of the expected benefits.

4) Outcome Studies

·       Outcome studies document the comparative effectiveness of different policy alternatives.

·        Policy analysts are able to assess the extent to which some policy intervention has had the intended impact on the problem it was designed to address.

5) Case Studies

·       Case studies involve the systematic and detailed description and analysis of the formation, implementation, and evaluation of specific policies.

·       Examples include analysis of the impact of the Zambian health policy on access to health.

6) Meta-analysis

·       Meta-analysis uses a statistical approach to combine the results from multiple studies in an effort to increase power (over individual studies), improve estimates of the size of the effect and/or to resolve uncertainty when reports disagree.

·       Meta-analysis can provide guidance to policymakers in the early phases of policy development by summarizing existing quantitative studies and can assist them after a series of policy outcome studies have been conducted.

 

 

QUESTION 4

Your ward in-charge has been called to attend a one month workshop and the

Area Nursing Officer has appointed you to act as a ward manager to be a ward

leader and manage the ward affairs until when your ward In-charge will be back.

a)   Define the following terms

b)   Leadership 5%

c)     Management 5%

d)   Outline three ways through which people become leaders 15%

e)    Discuss any four (4) leadership styles you are going to use 20%

f)     Describe any five (5) functions of management that you are going to perform as a ward manager 30%

g)    Outline five (5) principles of management according to Henry Fayol 25%

 

 ANSWERS

Define the following terms

Leadership 5%

·       Leadership is a process whereby an individual influences a group of individuals to achieve a common goal.

Management 5%

·       Management is the process of planning, organizing, leading and controlling the work of organizational members and of using all available resources to reach stated organizational goals.

Discuss any four (4) leadership styles you are going to use 20%

Outline three ways through which people become leaders 15%

BASS' THEORY OF LEADERSHIP

·       Bass' theory of leadership states that there are three basic ways to explain how people become leaders. These theories are:

TRAIT THEORY

·       This theory postulates that people are either born or not born with the qualities that predispose them to success in leadership roles.

·        That is, that certain inherited qualities, such as personality and cognitive ability, are what underlie effective leadership.

·       Some personality traits may lead people naturally into leadership roles.

THE GREAT EVENTS’ THEORY

·       A crisis or an important event may cause a person to rise to the occasion, which brings out extraordinary leadership qualities in an ordinary person.

·       such great events bring out extraordinary leadership qualities in an ordinary person

·       this is a subset of the trait theory

TRANSFORMATIONAL OR PROCESS LEADERSHIP THEORY

·       leader works with teams to identify needed change, creating a vision to guide the change through inspiration and executing the change in tandem with committed members of a group

·       This is the most widely accepted theory today and the premise on which this guide is based.

Discuss any four (4) leadership styles you are going to use 20%

__________________________________________________________________

STYLES OF LEADERSHIP

·       A leadership style is how a leader uses interpersonal influence to accomplish goals of an organization.

·       Leadership style refers to a leader's behavior.

·        It is the result of the philosophy, personality and experience of the leader.

___________________________________________________________________

1. Democratic Leadership Style

·       Democratic leadership style encourages team members to participate in the decisions which need to be made.

·        It creates a form of shared leadership where each team member is invited to share their knowledge, experience, or opinion about a project or situation.

·       Democratic leadership in an organization involves the redistribution of power and authority between employees and managers to provide employee involvement in decision making.

·        It encourages employees to be a part of the decision making.

·       I will use this leadership style most of the times to encourage everyone’s participation and improve staff morale.

 

 

2. Dictatorship leadership style

·       It is a style of leadership where there is always personal control by the leader/manager over the decision-making process for the team.

·        It is one in which the manager/leader retains power, decision-making, authority, goal setting, and control and assume full responsibility for all actions

·        A leader using this style may choose to receive feedback from their team, but any decision is his to make alone.

·       I will use this leadership style when decisions have to be made quickly as there will be no enough time to consult my subordinates.

2.   Bureaucratic Leadership Style

·       Bureaucratic leadership style is where the manager manages "by the book¨ everything is done according to procedure or policy.

·       If it isn't covered by the book, the manager refers to the next level above him or her.

·       This manager is really more of a police officer than a leader. He or she enforces the rules.

·       Bureaucratic leaders also tend to prefer rules, laws, or regulations that are rigid.

·       I will use this leadership style my subordinates need to understand certain standards or procedures are performing routine tasks over and over.

3.   Laissez-Faire /Free-Reign/ Delegative Leadership Style

·       Laissez-faire leadership, also known as delegative leadership, is a type of leadership style in which leaders are hands-off and allow group members to make the decisions.

·       The leader is only a figure head; he does not give any directive. A free-rein leader does not lead, but leaves the group entirely to itself. The leader leaves workers without direction, supervision, or coordination. Such a leader allows maximum freedom to subordinates.

·        I will use this leadership style when dealing with non-critical issues where my subordinates will have freedom to make their own decisions.

 

 

 

 

 

 

 

Describe any five (5) functions of management that you are going to perform as a ward manager 25%

MANAGEMENT FUNCTIONS.

PLANNING.

·       Planning is deciding in advance what to do, when to do it, how to do it and who to do it.

·       It can also be defined as the process of setting goals, developing strategies, and outlining tasks and schedules to accomplish the goal.

·       Though planning I will be able to determine what needs to be done, who to do it, and when to be done e.g. Making a time table for the ward and a duty allocation each day.

ORGANIZING

·       Organizing is the process of identifying and grouping of the works to be performed, defining and delegating responsibility and authority and establishing relationships for the purpose of enabling people to work most efficiently.

·        It is simply getting prepared for action by arranging for required resources.

·        The function of organizing involves the determination of activities that need to be done and arranging for all required logistics/resources in order to reach the organization goals.

·        Through the function of organizing, I will be able arrange for what to use in the ward e.g. drugs and medical supplies.

DIRECTING

·       Directing means giving instructions, guiding and counseling, motivating and leading the staff in an organization in doing work to achieve Organizational goals.

·       This is making other people work by giving them the plan and leaving them to do the work on their own.

·       Directing involves delegation, supervision, co-ordination, motivation and evaluation.

·        Through directing, I will be able to influence and oversee the behavior of the staff in achieving the Organization’s goals, as well as assisting them in accomplishing their own personal or career goals.

 

 

 

CONTROLLING

·       Controlling is determining what is being accomplished - that is, evaluating performance and, if necessary, applying corrective measures so that performance takes place according to plans".

·       It is ongoing, It involves establishing performance standards based on the Organization’s objectives, and evaluating and reporting actual job performance. Once management has done both of these things, it should compare the two to determine any necessary corrective or preventive action.

·       Through controlling, I will be able to identify any potential problems and take the necessary preventative measures.

·        I will also be able to identify any developing problems that need to be addressed through corrective action.

COORDINATING

·       This is bringing people and activities of different group members into harmony to ensure everything that needs to be done is done.

·        Coordination is enhanced by good communication system.

·        I will perform this function to harmonize all activities in the ward so that there will be order.

STAFFING

·       Staffing is the function by which managers build an organization through the recruitment, selection, and development of individuals as capable employees.

·       Staffing is that part of the process of management which is concerned with acquiring, developing, employing, appraising, remunerating and retaining people so that the right type of people are available in right positions and at the right time in the organization.

·       At ward level, I will lobby for more nurses through the office of nursing officer so that my ward is adequately staff.

·        I will also lobby for staff development through short and long term trainings to improve knowledge and skills in my staff.

 

 

 

 

 

 

Outline five (5) principles of management according to Henry Fayol 25%

HENRY FAYOL’S PRINCIPLES OF MANAGEMENT

·       Henri Fayol laid down the 14 principles of Management. The following are some of the Principles of Management which most of the Managers apply in different Organizations

1.   Unity of Command: -

·       This principle states that every subordinate should receive orders and be accountable to one superior.

·       If an employee receives orders from more than one superior, it is likely to create confusion and conflict.

2.   Unity of Direction:

·       All those working in the same line of activity must understand and pursue the same objectives; It seeks to ensure unity of action E.g. those working in medical wards. They should be under the control of one manager.

·        The entire organization should be moving towards a common objective in a common direction.

3.   Scalar Chain:

·       Scalar Chain refers to the chain of superiors ranging from top management to the lowest rank.

·       The principle suggests that there should be a clear line of authority from top to bottom linking all managers at all levels.

·        It is considered a chain of command.

4.    Division of Work:

·       This is the specialization of the workforce according to the skills of a person, creating specific personal and professional development within the labor force and therefore increasing productivity.

5.   Authority and Responsibility: -

·       Authority means the right of a superior to give orders to his subordinates; responsibility means obligation for performance.

·       When authority is exercised, responsibility arises.

6.   Esprit de Corps:

·       This is maintaining team work spirit.

·        Team spirit helps develop an atmosphere of mutual trust and understanding. Team increased productivity and effectiveness

7.   Equity:

·       Employees must be treated kindly and alike, provide equal opportunities and justice must be enacted to ensure a just workplace.

·        Managers should be fair and impartial when dealing with employees.

 

8.   Discipline:

·       Discipline refers to obedience to rules, proper conduct in relation to others, and respect of authority.

·       Discipline is essential for the smooth functioning of all organizations.

9.   Subordination of Individual Interest:

·       The management must put aside personal considerations and put company objectives first. Therefore the interests of goals of the organization must prevail over the personal interests of individuals.

10. Remuneration:

·       Workers must be paid sufficiently as this is a chief motivation of employees and therefore greatly influences productivity.

·       This means and methods of remuneration should be fair, reasonable and rewarding of effort.

11. The Degree of Centralization:

·       Centralization implies the concentration of decision making authority at the top management.

·        Sharing of authority with lower levels is called decentralization. The organization should strive to achieve a proper balance.

12. Order:

·       The principle states that the Material and people should be in the right place all the time.

13. Stability of Tenure of Personnel: -

·       The period of service should not be too short and employees should not be moved from positions frequently.

·        An employee cannot render useful service if he is removed before he becomes accustomed to the work assigned to him.

14. Initiative:

·       Using the initiative of employees can add strength and new ideas to an organization and employees are likely to take greater interest in the functioning of the organization.

 

 

 

 

 

 

QUESTION 5

As a newly appointed ward manager you have realized that a number of ward activities are not running according to laid down standards and procedures. You decide that the ward needs change in order to perform according to the ideal standard and match with prescribed quality of performance

a) Define the following terms

       i.        Change management 5%

      ii.         Quality improvement 5%

    iii.        Quality assurance 5%

b.  i. List five (5) indications for change 10%

    ii. Outline three (3) stages of change 15%

c   Describe four (4) steps that you are going to take as a ward manager to effect

change in your ward 20%

d  Outline any seven (7) principles of quality assurance 35%

DEFINITIONS

·       Change management is a term used to refer to the introduction of new processes in an organization, or the management of people who are experiencing change in order to improve job performance or quality of service.

·       Quality Improvement: It is the process of engaging appropriate methodologies and quality management tools to close the gap between current and expected levels of quality

·       Organizational change is defined as "the movement of an organization away from its present state and toward some desired future state to increase its efficiency and effectiveness."

·       Quality assurance: It is a systematic, ongoing and continuous review, analysis and evaluation of the level of compliance with the standards set at local, national and international level. It is all the processes within the health system that leads to the institutionalization of a culture of doing the right things right, all the time.

List five (5) indications for change 15%

INDICATIONS FOR CHANGE

·       Conflicts

·       Introduction of new technology

·       Changing needs of the society e.g. new diseases

·       Changes in service delivery system

·        Flesh ideas and knowledge

·       New case management process and procedures

·       Introduction of new drugs

Outline three (3) stages of change (15%)

STAGES OF CHANGE

UNFREEZING:

·       This involves making need for change so obvious so that it can be understood and be accepted easily accepted people can by people

CHANGING:

·       It is the stage of moving or implementing the change. A change agent may be needed to foster new values attitudes and behavior

REFREEZING:

·       In this stage newly introduced change is re-inforced, supported so that it becomes a new norm.

Describe four (4) steps that you are going to take as a ward manager to effect Change in your ward 20%

FOUR STEPS EXIST IN ORGANIZATIONAL CHANGE.

1. Assessing the Need for Change

·       First, I will assess the need for change through recognizing that a problem exists and identifying the problem's source.

·        In a ward set up, this will be done by identifying the gaps in nursing care and the causes of the problem, identifying the gaps in the ward procedures and daily routine by comparing with the recommended practice

2. Deciding on the change needed to be made

·       Secondly, I will decide on the change needed to be made by deciding what is the ward’s ideal future state, as well as the obstacles that may occur during change.

3. Applying the Change

·       Thirdly, I will apply the change and decide whether change will occur from the top down or bottom up, then introduce and manage change.

 

 

4. Evaluating the change

·       Lastly, I will evaluate the change by comparing the situation before and after the change or using benchmarking.

_______________________________________________________________

THEORIES OF CHANGE.

1. Lewin's Change Theory.

·       Kurt Lewin's change theory is widely used in nursing and involves three stages: the unfreezing stage, Moving stage, and Refreezing stage.

·       Lewin's theory depends on the presence of driving and resistant forces.

·       The driving forces are the change agents who push employees in the direction of change.

·        The resistant forces are employees or nurses who do not want the proposed change. For this theory to be successful, the driving force must dominate the resistant force.

2. Rogers' Change Theory.

·       Everette Rogers modified Lewin's change theory and created a five-stage theory of his own.

·       The five stages are awareness, interest, evaluation, and implementation and adoption.

·       This theory is applied to long-term change projects. It is successful when nurses who ignored the proposed change earlier adopt it because of what they hear from nurses who adopted it initially.

3. Spradley's Change Theory.

·       This is an eight-step process for planned change based on Lewin's theory of change.

·        It makes provision for constant evaluation of the change process to ensure its success.

·       The steps are: recognize the symptoms, diagnose the problem, analyze alternative solutions, select the change, plan the change, implement the change, evaluate the change and stabilize the change.

 

 

 

 

TYPES OF CHANGE

DIFFERENT TYPES OF CHANGE

1.   Planned change

·       This is deliberate change done consciously.

·       It is called proactive change when an organization actively attempts to make changes to the work place or

·       its practices to avoid potential future threats or to capitalize on a potential future opportunity

2.    Organization-wide change

·       Is a large-scale transformation that affects the whole organisation.

·       This could include: restructuring the leadership, adding a new policy, or introducing enterprise technology

3.   remedial change

·       Leaders implement remedial changes when they identify a need to address deficiencies or poor organizational performance.

·       For example, financial distress, usually due to poor performance, requires remedial change.

·       The most common examples of such change could be introducing a new employee training program, or  rolling out a new software.

4.   Coercive change

·       a type of change that is impose on people.

·       There is no mutual goal setting and is characterized by imbalance power and one sided deliberation

5.   Socialization change;

a type of change that involves individuals to conform to the needs of the group.

6.    Technocratic change;

 change that is necessitated by collection, analysis and interpretation of data in order to reach the desired goal.

7.      ACCIDENTAL/REACTIVE CHANGE

·       This is a type of change which takes place in response to an event or a chain of various events.

·        Most of the organizations indulge in reactive change.

·        This kind of change usually occurs when there is an increase or decrease in the demand for company’s products or services.

·       It can also be a response to a problematic situation or a crisis which an organization may be faced with.

·        For example, due to the advancements in technology or growing technological changes, an organization may be forced to invest more in technology to stay ahead to face the stiff competition.

·       Recreation can also be regarded as a reactive change, which involves the entire organization and occurs during the stage when an organization is undergoing a serious crisis.

8.    HAPPENED CHANGE

·       This kind of a change happens when an organization reaches the plateau stage in its life cycle and gets victimized by the environmental pressures or demands. For example, currency devaluation may adversely affect the business of those organizations who have to depend upon importing of raw materials largely.

·        In certain cases, some political, as well as social changes, are unpredictable and uncontrollable.

·        This kind of change is unpredictable in nature and is usually takes place due to the impact of the external factors.

·        Happened change is profound and can be traumatic as it’s consequences are unknown and out of direct control.

9.   Anticipatory Change

·       This is a type of change that occurs with prior anticipation of the happening of an event or a chain of events. Organizations may either tune in or reorient themselves as an anticipatory measure to face the environmental pressures

10.    Incremental Change

·       This is a type of change which is implemented at the micro level, units or subunits of an organization. Incremental changes are introduced or implemented gradually and are adaptive in nature.

·        It is based on the assumption that these small changes will ultimately result in a large change and establish the basis for forming a much healthier and a robust system.

·        It even offers an opportunity to an organization to learn from its very own experiences and create the adaptive mechanisms for meeting the ultimate organizational vision.

·        The extent of damage due to a failed incremental change effort is expected to be much lesser than the change which is implemented on a large scale or introduced universally.

11.    Operational Change

·       Operational change as the name implies means introducing changes in the existing operations for realizing the intended goals.

·       This may include bringing in changes in the current technology, improving/re-engineering the existing work processes, improving the distribution framework or the product delivery, better quality management and improving the coordination at an inter-departmental level

·       This kind of change becomes a requirement or the need when an organization is faced with competitive pressures as a result of which the focus is laid more on quality improvement or improvement in the delivery of services for an edge over the competitors.

12.    Strategic Change

·       Strategic Change is usually implemented at the organizational level, which may affect the various components of an organization and also the organizational strategy.

·       A change in the management style in an organization could be considered as an example of strategic change.

13.    Total Change

·       A Total Change involves change in the organizational vision and striking a harmonious alignment with the organizational strategy, employee morale and commitment as well as with the business performance.

·        Total Change becomes a requirement during those circumstances when an organization is faced with many criticalities such as long-term business failure, incongruence between the employee and organizational values, failure of leaders/management in anticipating the realities of business environment or the growing competitive pressures and concentration of power in the hands of few.

14.     Fundamental Change

·       Fundamental change essentially involves the redefinition of organizational vision/mission.

·       This may be required during extremely volatile circumstances like volatility in the business environment, failure of the leadership, a decline in productivity as well as the overall turnover or problems with the morale of the employee.

________________________________________________________________

Outline any seven (7) principles of quality assurance 35%

·       Customer focus. The customer is always the most important factor for any business, which is why organizations need to understand current and future customer needs and aim to surpass expectations.

·       Leadership Quality assurance principles also suggest that an organization needs leadership in order to have purpose and direction in achieving quality

·       Involvement of people An organization needs to be able to put quality management training into practice. People at all levels of the business need to be motivated, committed and fully involved in the organization. This principle of quality assurance involves people evaluating their own performance and identifying their constraints, as well as actively seeking opportunities

·       System and Process approach

In order to achieve a desired result, resources and activities should be managed as a process. The process should focus on resources, methods and materials which affect the key activities within a business. In order to maintain quality assurance within a service or product, risks, consequences, the impact on customers and suppliers and other relevant parties should be continuously evaluated.

·       Continual improvement Another quality assurance principle is that continual improvement should always be an objective for any business

·       Factual approach to decision making. This quality assurance principle simply ensures that decisions are based on analyzed data and information

·       Teamwork QA focuses on participation and teamwork to solve problems and implement quality solutions, recognizing that the impact of QA activities is most powerful when team members draw on the participation, experience and knowledge of major participants and stakeholders.

·        Mutually beneficial supplier relationships. The Quality management standard ISO 9001 encourages organizations’ to create mutually beneficial relationships with its suppliers.

DIMENSIONS OF QUALITY

A.   TECHNICAL COMPETENCE

·       Technical competence refers to the skills, capability, and actual performance of health providers, managers, and support staff.

·        For example, to provide technically competent services, a village health worker must have the skills and knowledge (capability) to carry out specific tasks and to do so consistently and accurately (actual performance).

·       Technical competence relates to how well providers execute practice guidelines and standards in terms of dependability, accuracy, reliability, and consistency. This dimension is relevant for both clinical and nonclinical services.

·        Competence in health management requires skills in supervision, training, and problem solving.

·        The requisite skills of support staff depend on individual job descriptions.

B.   ACCESS TO SERVICES

·       Access means that health care services are unrestricted by geographic, economic, social, cultural, organizational, or linguistic barriers.

·       Geographic access may be measured by modes of transportation, distance, travel time, and any other physical barriers that could keep the client from receiving care. Economic access refers to the affordability of products and services for clients. Social or cultural access relates to service acceptability within the context of the client’s cultural values, beliefs, and attitudes.

·        Organizational access refers to the extent to which services are conveniently organized for prospective clients, and encompasses issues such as clinic hours and appointment systems, waiting time, and the mode of service delivery. Linguistic access means that the services are available in the local language or a dialect in which the client is fluent

C.   EFFECTIVENESS

·       The quality of health services depends on the effectiveness of service delivery norms and clinical guidelines. Assessing the dimension of effectiveness answers the questions, Does the procedure or treatment, when correctly applied, lead to the desired results?. and .Is the recommended treatment the most technologically appropriate for the setting in which it is delivered?.

D.   INTERPERSONAL RELATIONS

·       The dimension of interpersonal relations refers to the interaction between providers and clients, managers and health care providers, and the health team and the community.

·       Good interpersonal relations establish trust and credibility through demonstrations of respect, confidentiality, courtesy, responsiveness, and empathy. Effective listening and communication are also important. Sound interpersonal relations contribute to effective health counselling and to a positive rapport with patients.

E.   EFFICIENCY OF SERVICE DELIVERY

·       The efficiency of health services is an important dimension of quality because it affects product and service affordability and because health care resources are usually limited.

·       Efficient services provide optimal rather than maximum care to the patient and community; they provide the greatest benefit within the resources available. Efficiency demands that necessary or appropriate care is provided.

F.   CONTINUITY

·       Continuity means that the client receives the complete range of health services that he or she needs, without interruption, cessation, or unnecessary repetition of diagnosis or treatment.

·        Services must be offered on an ongoing basis.

·       The client must have access to routine and preventive care provided by a health worker who knows his or her medical history.

·       A client must also have access to timely referral for specialized services and to complete follow- up care.

·        Continuity is sometimes achieved by ensuring that the client always sees the same primary care provider; in other situations, it is achieved by keeping accurate medical records so that a new provider knows the patient’s history and can build upon and complement the diagnosis and treatment of previous providers.

G.   Safety

·       As a dimension of quality, safety means minimizing the risks of injury, infection, harmful side effects, or other dangers related to service delivery. Safety involves the provider as well as the patient.

 

H.  Amenities

·       Amenities refer to the features of health services that do not directly relate to clinical effectiveness but may enhance the client’s satisfaction and willingness to return to the facility for subsequent health care needs.

·        Amenities are also important because they may affect the client’s expectations about and confidence in other aspects of the service or product.

·       Where cost recovery is a consideration, amenities may enhance the client’s willingness to pay for services.

·        Amenities relate to the physical appearance of facilities, personnel, and materials; as well as to comfort, cleanliness, and privacy.

·        Other amenities may include features that make the wait more pleasant such as music, educational or recreational videos, and reading materials.

PERSPECTIVES/ATTRIBUTES OF QUALITY

According to Glass; quality is a set of (product) attributes, including things such as:

·       Reliability – does the product work as it should?

·        Usability – is it easy to use?

·       Modifiability – can it be modified (maintained) easily?

·       Understandability – is it easy to understand how it works?

·        Efficiency – does it make efficient use of resources (including storage, computing power and time)?

·       Testability – can it be tested easily?

·       Portability – can it be ported to other platforms? This isn’t an issue for all products – some programs need run only on one operating system.

APPROACHES TO QUALITY ASSESSMENT

·       Quality Improvement is a formal approach to the analysis of performance and systematic efforts to improve

·       Quality improvement begins with putting up measures to assess quality of an organization in order to identify the gap between the ideal and the current level of quality

1. Quality assessment

·       Quality assessment is the measure of the quality of a service or product. In a health care setting, quality assessment is the measure of the quality of care provided in a particular setting.

·       Quality assessment is done by finding out if the requirements to provide quality services are available.

·       It includes consulting the beneficiaries whether they are happy with the services provided or not and taking action to solve the problems that are contributing to poor quality.

·        Quality can be assessed as by

       i.        Self-assessment (done by self)

      ii.        Peer assessment (done by colleagues at the same level as yourself)

    iii.        Quality survey (using questionnaire which defines quality).

    iv.        External interview (ask patients as they leave the health center about what has been given)

     v.        Equipment checklist (using a list of normal requirements e.g. having inventory book).

2. Monitoring and Evaluation of Quality of Services

·       Monitoring is the systematic collection, analysis and use of information from projects and programmes for three basic purposes:

     i.        learning from the experiences acquired (learning function);

    ii.        Accounting internally and externally for the resources used and the results obtained (monitoring function);

   iii.        Taking decisions from the learning and monitoring function.

·       Evaluation is assessing as systematically and objectively as possible an ongoing health care services or completed project, program.

·       The objective is to be able to make statements about their relevance, effectiveness, efficiency, impact and sustainability.

·       Based on this information, it can be determined whether any changes need to be made at a project, program or policy level, and if so, what they are. Find out what went well in the Health care services, is there room for improvement?

·       Evaluation thus has both a learning function - the lessons learned need to be incorporated into future proposals or policy - and a monitoring function - partners and members review the implementation of policy based on objectives and resources mobilized.

·       Monitoring and evaluation are complementary in services delivery. During an evaluation, as much use as possible is made of information from previous monitoring.

·       In contrast to monitoring, where emphasis is on the process and results, evaluation is used to provide insight into the relationships between results (for example, the strengthened capacity of an organization), effects (for example, improved services products) and impact (for example, improved service delivery to the target group).

·       Therefore, it is important that as a Leader, you take up monitoring and Evaluation in your organization because:

     i.        You will steer and adjust current program and projects;

    ii.        You will learn more about what works and what does not;

   iii.        In monitoring, you are accountable for the resources used in the light of objectives formulated in advance and results achieved.

·       How monitoring is done /Types of monitoring

     i.        Use of indicator

    ii.         Supervisions

   iii.         Review of document

·       In order to have an effective monitoring system you must have commitment and interest, know how to enter data and know how to change the situation.

MEASURES USED IN QUALITY WORK/ DEVELOPING MEASUREMENT SKILLS

There are 3 types of measures used in quality work. According to Dute University (2005), These are:

·       Structure: Physical equipment and facilities

·       Process: How the system works

·       Outcome: The final product,   and process are easier to measure; outcome is more important.

Defining Process and Outcome

·       Structure is a relatively easy concept to define, as it is typically the physical plant (e.g., buildings, equipment, raw material, parts).

·       What is the difference between Process and Outcome?

·       Process:

     i.        How Healthcare is provided

    ii.         How the system works

Outcome:

     i.        Health status

    ii.         Does it make a difference?

Let us look at the a non-healthcare example:

·       In a facility where you want to see if the cost reductions can come from the

Housekeeping department, specifically linens. Below are his areas for measurement:

 Structure: Laundry facilities, washers and dryers, storage, laundry carts

 Process: Removal and replacement of linens in rooms when cleaned, process of

loading washing machines and dryers, folding and stocking clean linens

 Outcome: Are sheets clean and undamaged? Are beds remade properly?

________________________________________________________________________________

You are working in labour ward and suddenly you discover that women are being

examined in full view of relatives. You have reported the issue to the in-charge who has

not resolved the problem. You then decide to advocate for the patients who may not

express themselves.

a)   Define advocacy 5%

b)   Identify four cooperating partners working with the ministry of health and explain their possible areas of collaboration 16%

c)    Explain the five (5) qualities of an advocator 25%

d)    Explain the elements of advocacy 30%

e)   State six (6) rights of the patient that you will consider during the change process. 24%

Define advocacy (5%)

DEFINITION

·       Advocacy is an activity by an individual or group which aims to influence decisions within political, economic, and social systems and institutions.

·       Advocacy can include many activities that a person or organization undertakes including media campaigns, public speaking, commissioning and publishing research or conducting exit poll or the filing of an amicus brief.

______________________________________________________________________

Identify four cooperating partners working with the ministry of health and explain their possible areas of collaboration (16%)

COOPERATING PARTNERS WITH MINISTRY OF HEALTH

·       The ministry of Health of Zambia has both local and international collaborating partners.

These include

United States Agency for International Development (USAID)

·       This is an international cooperating partner.

·       It collaborates with the ministry by providing financial support in implementing health programmes such as prevention and treatment of HIV/AIDS

 

2. Centers for Disease Control and prevention (CDC)

·       CDC works in partnership with ministry of health of Zambia to help them increase their capacity for leading and managing HIV/AIDS programs.

·       It also supports the ministry by reinforcing staffing through recruitment and paying of health personnel on contract basis

3. The Churches Health Association of Zambia

·       It was formed in 1970 by Catholic and Protestants Church health institutions.

·       It is the largest non-government health provider in Zambia.

·        It provides health services through church based health institutions.

4. Society for Family Health

·       It is a non-governmental organization that focuses on supporting national public health programmes that reduce the HIV/AIDS prevalence rate through HIV prevention initiatives, improving access to family and reproductive health services, and increasing maternal and child survival through social marketing, to promote quality products and healthy behavior practices.

5. Ministry of Information and Broadcasting

·       It is government organization that collaborates with the ministry of health in the area of disseminating health information through radio and television to create public awareness.

Explain the five (5) qualities of an advocator (25%)

1.   Good communication skills

·       An advocator must have good communication skills in order to both get information and disseminate it to the two parties.

·       He/she must be a good listener in order to carefully analyse information given to him and must be a good speaker in order to argue convincingly

2.   Knowledgeable

·       An advocator must gather enough information about the client and the other party which will act as a basis for negotiations.

·        Lack of knowledge can lead to lead to mispresentation of facts and unsuccessful negotiations.

3.   Good Judgment

·       The ability to draw reasonable, logical conclusions or assumptions from limited information is essential to advocate. This will enable him or her look at issues objectively as he or she advocates for the client.

 

4.   Accommodating

·       This is being eager or willing to help other people for example by changing one’s plans.

·       An advocator must be able to accommodate both the client and the other party in order to strike a balance.

5.   Approachable

·       An advocate must be friendly in order to be approachable by clients. This quality will enable the clients to open up and present their issues freely.

6.   Empathetic

·       Empathy is the ability to understand and share the feelings of another. It is a form of communication which involves listening to the client, clarifying his concerns and communicating this understanding to the client.

7.   Patience

·       This is the capacity to accept or tolerate delay, problems, or suffering without becoming annoyed or anxious.

·        This is an important quality of an advocator because some issues an advocator may be advocating for the client may take longer than expected Other qualities include being passionate; being diplomatic; being persuasive; being sensitive being tactful; being resilient; being credible; being dependable; Being resourceful; being strategic; being pleasant

 Explain the elements of advocacy (30%)

a)   Build and maintain trust. Trust is a key element we all need to set aside vulnerability, but it is hard to build, and easy to lose. It is not built on words, but through actions and evidence.

b)   Expect conflict to reach consensus. A conflict and a fight are not the same thing. Conflicts are normal and required factual push backs in business, whereas fights are emotional, often personal, disagreements which do not lead forward to consensus.

c)     Embrace change. Change is the only constant in business, so make it your competitive advantage. Initiate change rather than react to it, and give clear instructions to help the team understand why the change is necessary, and how it will make the situation better.

d)    Improve your self-awareness. Too often how we see ourselves different from how we truly are, and how we are perceived by others. If you are unclear on what you want and need from others, you will rarely find it, and can’t lead others to help.

e)   Establish a level of analysis, structure, and control. The challenge is to strike the right balance. With none, things fall into chaos, but too much can have the effect of slowing innovation, flowing forward movement, and even hampering growth.

f)     Make decisions. In general, any decision is better than no decision. Usually a blended approach is the best, between independent decisions, and collaborative decisions factoring in the best team input. Picking great team members is a required first decision.

g)    Foster continuous communication. Communication is the glue that forms the bond between leaders and teams, and holds great teams together. Actions are stronger than words as the true evidence of the message we deliver. Credibility is a required base.

h)    Build championship teams. Winning teams evolve only from the right players, the right attitude, and the right coach. There has to be a cohesiveness and common focus on shared values and a commitment to reaching their shared and personal goals.

i)      Provide recognition and rewards. These drive human behavior, and human behavior drives results. Recognition validates people, their purpose, and their life. Intangible rewards can have an even greater impact than tangible ones, but they must be relevant.

j)     Create learning experiences. We all have a desire to learn and grow, or we and the team become bored and lethargic. The best learning opportunities are experience and sharing with focus on three styles: see and read, hear and repeat, and touch and feel.

State six (6) rights of the patient that you will consider during the change

Process. (24%)

I will draw these from the bill of rights of patients

a)   Right to confidentiality, human dignity and privacy

b)   Patients have the right to confidentiality human dignity and privacy. Therefore, health care providers should observe strict confidentiality of a patient's condition, with the only exception of potential threats to public health. Physical examination must be done under conditions that promote privacy and human dignity.

c)    Right to informed consent Patients have the right to be asked for their informed consent before submitting to potentially hazardous treatment. Health care providers should clearly explain the risks from receiving the treatment and only administer the treatment after getting explicit written consent from the patient.

d)   Right to safety and quality care according to standards Hospitals must ensure a hygienic and sanitized environment to provide their services in a conducive environment.

e)   Right to be heard and seek redressal Patients have the right to provide feedback and comments to their health service providers and file complaints as required. They additionally have the right to redressal in cases where any of their rights are violated.

f)    Right to Respect and non-discrimination Patients have a right to considerate, respectful care from health that does not discriminate against them based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

g)   Right to take part in treatment decisions Patients have the right to know your treatment options and take part in decisions about their care. They have the right to ask about the pros and cons of any treatment, including no treatment at all.

h)   Right to Choice of providers and plans. Patients have the right to choose health care providers who can give you high-quality health care when you need it.

i)     Right to Refuse or Accept Treatment. Patients have the right to accept choose health care providers who can give them highquality health care when they need it.

 

 

 

You have different levels of nursing staff including the support staff under your

Care and you need to make use of them in order to ensure that you achieve the

goals for your ward.

a)   Define delegation 5%

b)   outline five (5) principles of delegation 20%

c)    Explain (4) advantages and four (4) disadvantages of delegation 40%

d)    Explain five (5) qualities of good ward manager 25%

e)   Being in charge of the ward you need to draw up a duty roster.

f)    State five (5) things you will consider when coming up with timetable. 10%

ANSWERS

Define delegation (5%)

·       It is the assignment to another person of formal authority and responsibility for carrying out specific activities.

·       It is a process through which a manager assigns responsibility to the subordinate to carry out the work on his behalf

Outline five (5) principles of delegation (20%)

·       The principles of delegation are derived from the five rights of delegation

·       The Five rights to delegation from the perspectives of both nursing service administrator and staff nurse are:-

 

a)   Right task

b)    Right circumstance

c)    Right person

d)   Right direction/communication

e)    Right supervision/evaluation

f)    Determine what to delegate/

 

a.   Right task

·       Effective delegation begins with the manager defining his or responsibilities.

·       This involves writing down all of his or her activities and responsibilities and reviewing the master list and categorizing all of the items into two secondary lists: things which the manager alone must do and things that others could do or help you complete. Anything that falls into the second list presents an opportunity for delegation.

b.   Right Circumstance

·       The reason for delegation must be genuine such as to train and motivate subordinates, reduce workload and promote efficiency.

·       A manager must not delegate his/her duties for wrong reasons or circumstances such as not just wanting to work.

c.    Choosing the right person to delegate the task to/ Right person

·       The manager must select a right subordinate to do the job taking into consideration the skills, knowledge, attitude and position of the subordinate.

d.    Clarifying the desired results/ Right direction/communication

·       The results expected to be achieved must be clearly explained to the subordinate. When the results are clear, it allows the subordinate to use his or her own creativity and resources to accomplish the task.

·        An added benefit of effective delegation is the individual may find a better and more effective way to accomplish the task or achieve the desired results.

 Clearly defining the employee's responsibility and authority as it relates to

the delegated task/ Right direction/communication

·       The manager must clearly communicate the responsibilities and the authority and timeline.

·       The manager must be sure that the subordinate has understood the responsibility and authority assigned to him or her.

 Monitoring Progress/ Right supervision/evaluation

·       This can be achieved by conducting follow up meetings.

·       The follow up meetings should be focused on monitoring progress and determining the need for assistance.

·       The number of follow up meetings will vary based on the scope of the task or project and whether the subordinate is new or a long term member of the department.

Explain (4) advantages and four (4) disadvantages of delegation (40%)

Advantages

a)   It reduces the work load of the manager

a)   Through delegation a manager is able to reduce his or her work load by giving subordinates to perform some tasks.

b)   In this way what the manager has to do is reduced.

c)    Makes work easier because of shared responsibilities

d)   As a manager delegates performance of some of his duties to subordinates work becomes easier.

e)    Work would become difficulty to perform in the absence of delegation as the manager will have so many things to do.

f)    It allows manager to concentrate on aspects of job which require her personal knowledge experience and skill. Delegation gives more time to the manager to concentrate on the aspects of the job which require her personal knowledge experience and skills thereby performing these aspects better with an undivided attention.

g)    It promotes staff growth and development Delegation requires that the manager explains how to perform the delegated tasks to the subordinate. This provides opportunity to the subordinate acquire knowledge and skills about the delegated task thereby contributing to staff growth and development

Disadvantages of Delegation

a)   Delegation is Time Consuming

Delegation requires a considerable amount of time as in some cases, managers may have to train staff to handle delegated tasks. Depending on the task, the training may take from a few minutes to several weeks. For simple tasks, managers may feel it is easier and faster to simply do the task themselves than to train staff to take on the responsibility.

b)   Delegation may result in Low Quality Work

·       Managers need to delegate tasks that they have performed for a considerable period of time which has allowed them to gain experience and expertise in performing good quality work. Therefore, managers do lose some measure of quality when delegating tasks, especially to staff members who are unfamiliar with the work or who have little experience performing the task.

 

c)    Delegation may lead to failure of Task Accomplishment

·       There are some tasks that require a certain amount of authority to accomplish. This authority may come in the form of being able to secure funds or get the cooperation of people in other departments. If a task is given to an employee who lacks the proper authority to secure the necessary resources, the delegation is likely to fail.

d)   Delegation may result in Loss of Enjoyment for doing some Tasks

·       Managers who truly love their work may find that delegating places some of their more enjoyable tasks in the hands of others. This downside to delegation can become even more frustrating when managers see their staff members doing work that the manager once enjoyed.

e)   Delegation may result in Loss of Control over Critical Tasks

·       One disadvantage of delegating to employees is giving up control over tasks that should be done by the manager alone.. Examples include conducting performance and salary reviews as well as training, reprimanding and terminating employees.

Explain five (5) qualities of good ward manager (25%)

·       INTELIGENCE: This is not necessarily knowledge about detailed or highly specialized matters but Good common sense.

·       INTEGRITY: This is the capacity to set standards of personal & official conduct which will command the respect of others.

·       PERSUASIVENESS: This is the capacity to win others to acceptance of the point of view embodied in decisions

·       JUDGEMENT: This is the capacity to know the strengths & weaknesses of the people one works with and how to obtain their maximum usefulness to the organization.

·       LOYALTY: This is devotion to a cause and also to the persons with whom one works, & Willingness to defend subordinates against external attack.

Other qualities include

·       Commands respect

·        Exemplary character

·       Passion for their work

·       Trustworthy

·        Confident

·       Function in an orderly manner

·       Tolerant, calm, composed and steadfast: considers storms emotions, and crises as part of the leadership.

·       Commitment to excellence

·        Kind, loyal

·       Firm and fair

·       Knowledgeable- A leader should know his subordinates very well, his organization and his role in the organization.

·       Cheerful and polite

·       Reliable

·       Good interpersonal relationships, flexible

State five (5) things you will consider when coming up with time table. 10%

Factors to Consider when coming up with a Time Table

a.   Staff skills/interests

·       This factor is considered in line with patient’s needs.

·       All shits must be adequately covered with skilled staff to meet the patient’s needs. For example it will be not proper to put new nurses in one shift who are still developing their skills i

b.   Avoiding understaffing

·       The staff must be distributed appropriately across all shifts in terms of numbers so that artificial shortages of staff are avoided.

·        For example putting so many nurses on night duty may create some staff shortage when the nurses complete their night duty and go on nights off.

c.    Shift Workload

·       Some shifts are busier than others. For example, night shift is usually longer while morning shit is busier.

·        I will therefore distribute the number of staff according to the work load of the shifts.

·        Busier work shifts will be considered with more staff than less busy shifts.

d.   Staff supervision and training needs

·       New staff may be deliberately be put in same shift with more experienced and skilled staff for the purpose of supervision and mentoring.

e.    Man, Hour Job Requirement

·       Each member of staff has a minimum number of hours to work in a week. I will therefore factor in this requirement so all staff meet the minimum number of working in a week.

f.    Special requests from Staff

·       Some staff members may make special requests regarding work shift in order to enable them to attend to other issues e.g. evening classes.

·        I will consider this when making a duty roster.

 

 

 

You are the nurse in-charge at the health center and you have been tasked to change

the setting of the outpatient department so as to increase efficiency and quality services

given to clients.

a.  State five (5) factors that may influence change 15%

b.  Outline the three (3) phases of change 15%

c. Describe five (5) strategies you would use to effect the change

 40%

d. Discuss three (3) sectors you are going to work with to bring about change in

your department 30%

State five (5) factors that may influence change 15%

a)   Conflicts: Where there is conflict regarding how things are done change may occur especially when there is strong resistance to what is currently happening. Change may be a means of resolving the conflict.

b)   Government policy/Political influence Change in government policy regarding how certain things should be done will automatically influence change.

c)    Introduction of new technology; Technology is designed to make work easier thereby improving efficiency. So introduction of new technology automatically an indication for change.

d)   Changing needs of the society e.g. new diseases; In order to meet the new needs of society change is inevitable. For example if there is a new disease this will require review of the curriculum and curriculum change as well orientation of the health workers so that they will be equipped to handle the new disease.

e)   Flesh ideas and knowledge; New knowledge is generated through research and will necessitate change in the way of doing things e.g. discarding certain practices and bringing new ones on board.

f)    New case management process and procedures; Introduction of new case management processes and procedures requires their implementation by doing away with the old ones.

g)   Introduction of new drugs; This is an indication for change in that it leads to development of new treatment Protocols for treating certain diseases e.g. Malaria, TB

 

 

 

 

Describe five (5) strategies you would use to effect the change 40%

1)   Clearly Defining the Change and aligning it to organizational goals

·       This will involve clearly stating what change has to take place and relating this change to organizational goals.

·        I will conduct a critical review of organizational objectives and performance goals to ensure that change will carry the organization in the right direction.

·        I will explain this to the all the members of staff and the stake holders so that they appreciate the value of this change and quantify the efforts and resources needed to realize this change

2)  Developing effective Communication

·       I will determine the most effective means of communication for my team members and stake holders so that they are brought on body.

·        This communication will include timelines for the change, key messages and the channel of communication.

3)   Providing effective training

·       I will assess what behaviors, attitudes and skills are required to achieve the change and the training delivery methods.

·       Once this has been done, I will provide the training to equip my team members for the change.

4)   Identifying and implementing a support structure

·       I will identify and implement a change support structure in form of a committee to spearhead the change and reinforce the change.

·       This will be a team of change champions.

·       This will help the team members to practically adjust to the change.

5)   Identifying and overcoming stumbling Blocks

·       For change to occur the stumbling blocks or resisting forces must be less than the enabling factors.

·       So I will identify and eliminate possible stumbling blocks to change so that the desired change can take place.

6)  Measuring the Change Process

·       Throughout the change management process, a structure will be put in place to measure the impact of the activities being implemented towards change.

 

 

 

 

 

Discuss three (3) sectors you are going to work with to bring about change in

your department 30%

Sectors

1.   Ministry of Education;

·       I will work with this sector through the surrounding schools.

·        I will collaborate with the teachers to communicate with them changes that will happen at the health Centre so that they can be agents of communication to the pupils and eventually to the community.

2.    Health Centre Committee;

·       This is a committee which is made up of leaders of neighborhood health Committees within the catchment area of a health Centre.

·        I will work with this community structure in disseminating the information to the clients the community members since they will be affected by the change in one way or another.

·        This will help the community members anticipate the change and prepare for the change.

3.    Churches

·       I will hold sensitization meetings with church members to communicate to them about the changes at the health Centre so that they can appreciate the change and pass on the information to their church members for their cooperation and their support

 

 

 

 

 

LEADERSHIP

a)    (i) Define leadership                                                                      (5 Marks)

·       Is the art of influencing & inspiring subordinates to perform their duties willingly, competently & enthusiastically for achievement of group objectives or

·       A relationship through which one person influences the behavior or actions of other people

(ii) DISTINGUISH BETWEEN AUTHORITY AND POWER          (10 Marks)

POWER

·       Power is the ability to exert influence on other people and is a broader concept than authority

·       In organizations managers exert power.

·       It is the ability of a person or a group to influence the beliefs and actions of other people.

·        Power can be personal power. A person gets his personal power from his personality or from his expert knowledge e,g Doctors, Lawyers and nurses get their power from their expertise and professional knowledge.

·       Power can also be legitimate or official power.

·        This power comes from a higher authority or position

AUTHORITY

• Authority is the formal and legitimate right of a manger to make decisions, issue orders and allocate resources to achieve organizational goals. It is also a form of power.
• It is the right given to a manager to achieve the objectives of the organization.
• It is a right to get the things done through others and always flows downwards. It is delegated from the top to the bottom
• It is a right to take decisions. It is a right to give orders to the subordinates and to get obedience from them.
• A manager cannot do his work without authority.
• A manager gets his authority from his position or post. He gets his authority from the higher authorities. The lower and middle-level managers get their authority from the top-level managers.
• The top-level managers get their authority from the shareholders.

 

 

 

 

 

 

b)  Discuss five (5) functions of leadership                                        (15 Marks)

a)   Executive – the ultimate decision maker, the most senior coordinator of policy and its execution

b)   Planner – Determining how the organization, department, team or group achieves its goals.

c)    Policy-maker – Establishing-with others the policies and the goals and policies of the group led

d)   Expert – The leader contributes from what they know that other do not.

e)   Representative – The leader speaks out for the group to the outside world.

f)    Organizer – Designer- the leader creates the organizational structure.

g)   Reward-giver – The leader controls and leads through the power to give rewards and apply punishment.

h)   Exemplar – the leader sets an example of what is expected through personal actions

i)     Arbitrator – the leader is the final court of appeal for the led and controls the interpersonal relationship with the group.

j)     Symbol – The leader is a focus for the group and gives it some unity, additionally helping to set the team apart from other teams

c)   List five (5) qualities of a good leader                               (10 Marks)

a)   Intelligence

b)   Integrity

c)    Persuasiveness

d)   Judgement

e)   Loyalty

f)    Fair/ balanced

g)   Honest

h)   Patient

i)     Confident

j)     Innovative

k)   Courageous

l)     Knowledgeable

m)  Team builder

 

 

 

 

 

 

d)  State any three (3) leadership styles that you would use in your management of the ward                                 30 Marks

1.   AUTOCRATIC STYLE

·       One in which a predominantly task-oriented leader uses her/his positional and personal power in an authoritarian manner, retaining responsibility for all goal setting and decision making and motivating subordinates by manipulation of praise, blame and reward.

·       The leader takes all decisions without involving others and assigns all responsibility to him/herself

·       He/she is firm, insistent, self-assured and dominating.

·       The leader stresses prompt orderliness and predictable performance from employees /subordinates.

·       Often maintains his authority by force, intimidation, threats and punishment

2.    DEMOCRATIC STYLE

·       One in which the leader values the individual characteristics and abilities of each subordinate.

·       The democratic leader uses personal and positional power to draw out ideas from employees and motivates members of the work group to set their own goals, develop their own plans, and control their own practice

·       Leader understands that there is no organization without its people

·       The leader values individual characteristics and abilities of each subordinate.

·       Invites the participation of staff members and others

·       The leader is a catalyst for group decision making and shared responsibility.

3.   PARTICIPATIVE STYLE (NOTE HOWEVER THAT SOME LITERATURE SAYS THIS IS THE    SAME AS DEMOCRATIC)

• A compromise between authoritarian and democratic styles of leadership.
• The manager presents her own analyses of problems and proposals for action to members of the work group, inviting their criticism and comments.
• Having weighed the subordinates’ responses to her/his proposals, the manager then makes final decisions for actions by the group.

4.   LAISSEZ FAIRE (LET ALONE) STYLE

·       One in which the official or appointed manager abdicates leadership responsibility, leaving the workers without direction, supervision, or coordination and forcing them to plan, execute, and evaluate their work in any way they see fit.

·       Lacks direct supervision of employees and fails to provide regular feedback to those under his supervision

·       The leader denies responsibility and abdicates (fail to carry duty) authority to the group

·       The leader leaves all decision making and responsibilities to the subordinates

5.   CHARISMATIC LEADERSHIP

·       Charismatic leaders inspire enthusiasm in their teams and are energetic in motivating others to move forward.

·       Charismatic leaders are often focused on themselves, and may not want to change anything, believes they can do no wrong

·       This can create the risk that a project or even an entire organization might collapse if the leader leaves because success is directly connected to the presence of the charismatic leader.

 

e)   OUTLINE FIVE (5) TYPES OF LEADERS IN MANAGEMENT (30 MARKS)

1.   FUNCTIONAL LEADER

·       This position is influenced by expert knowledge (power).

·       The leader secures his position by what he does rather than by what he is.

·       A functional leader adapts his behavior to meet the competing needs of his situation

2.    APPOINTED LEADER

·       The leader’s influence arises directly out of his position e.g. managers – this is a formal appointment leadership.

·       This position has influence with legitimate power in the hierarchy & it is a bureaucratic type of leadership.

3.   SITUATIONAL LEADER

·       The leader’s influence can only be effective by being in the right place at the right time.

·       This kind of leadership is too temporal in nature to be of value in an organization

4.   TRADITIONAL LEADER

·       This position is assured by birth e.g. kings.

·       This is another category to which few people can aspire or acquire.

·       There are few /no opportunities for traditional leadership at work.

5.   CHARISMATIC LEADER

·       His influences normally comes from personality e.g. Hitler.

·       Very few possess this type of leadership as it is in born.

·       These personal qualities of leadership cannot be acquired by training; these can only be modified by it.

 

 

 

QUALITY ASSURANCE

The Zambia Ministry of Health adopted the Quality Assurance (QA) approach for ensuring quality in health service delivery in the past and has now shifted to the use of the Performance Improvement Approach (PIA) as the main strategy for quality improvement.

(i)         Define Quality Assurance                                          (5 marks)

·       It is a way of measuring what an organisation does against other organisations doing similar work or against set recognized standards.

·       Or it is the maintenance of a desired level of quality in a service or product, especially by means of attention to every stage of the process of delivery or production.

(ii)        Describe the two (2) key approaches to quality improvement you can use to improve quality of care in your ward           

A.   PERFORMANCE IMPROVEMENT APPROACH (PIA)

·       It has its roots in human performance technology and is based on nine step frame work covering;

·       Context analysis, stakeholder and engagement

·       Defining desired performance, measuring actual performance, defining the gap,

·       Analyzing root causes of gap, identifying and designing interventions, implementing , monitoring and evaluation

B.   5S APPROACH

·       5S is a foundational to continuous quality improvement and aims at improving the environment in which work is done

·       5s means

·       Sort-get rid of unused stuff from work station

·       Set- organize everything in proper order

·       Shine- maintain high standard of order/cleanliness

·       Standardize make sort, set and shine the norm

·       Sustain- train and maintain discipline to ensure order and tidiness

 

 

 

 

 

 

 

a)  State five (5) fundamental principles in performance and quality improvement (25 Marks)

a)   Customer or client focus- strive to provide care that is respectful or responsive to individuals’ needs and values.

b)   Leadership – to establish unity, focus on vision, promote and sustain teamwork, motivate and mobilize those involved in quality improvement.

c)    Involvement of people - everyone to be involved in health care delivery (clinical and non-clinical) to succeed

d)   Process and System approach to management - Processes (actions) convert inputs to outputs. Problems may rise from system and process problems.

e)   Continual improvement –Because we can never achieve perfection, we must always evaluate our performance and take measures to improve it

f)    Evidenced based decision – quality improvement undertakings must be based on reliable, valid high quality real time data and information.

g)   Good supplier- customer relationships- the health care delivery service and the suppliers of goods and services to the health care delivery service must have a relationship that creates value for both.

h)   Communication and feedback- effective communication is essential for ensuring quality services and client satisfaction.

b)  Outline two (2) methods you would use in conducting a Nursing Audit in your ward              (10 marks)

·       Retrospective

Ø  Review records after patient has been discharged/death (e.g. maternal death surveillance and response - formerly maternal death review) 

·       Concurrent review

Ø  Refers to the evaluations conducted on patients who are still undergoing care (reviewing patient’s record and care plan)

c)   DIFFERENTIATE BETWEEN QUALITY ASSURANCE AND QUALITY IMPROVEMENT        

1.    QUALITY ASSURANCE

a)   QA was reactive, retrospective, policing, and in many ways punitive.

·       It often involved determining who was at fault after something went wrong.

·       This term is older and not as likely to be used today and driven by regulatory and accrediting agencies

·       Tends to focus on finding who is responsible for errors

·       Relies on inspections to identify errors

·       Periodically monitors quality

·       Management/leadership is top-to-bottom

2.    QUALITY IMPROVEMENT

b)   QI involves both prospective and retrospective reviews.

·       It is aimed at improvement - measuring where you are, and figuring out ways to make things better.

·       It specifically attempts to avoid attributing blame, and to create systems to prevent errors from happening.

·       Focuses on improving the system

·       QI activities can be very helpful in improving how things work.

·       Trying to find where the “defect” in the system is, and figuring out new ways to do things can be challenging and fun.

·       It’s a great opportunity to “think outside the box.”

·       Internally driven, empowers all personnel to make improvements

·       Seeks to prevent errors by continuously clarifying and improving processes

·       Continuously strives to improve quality

·       Management/leadership is shared governance model

·       It is aimed at improvement measuring where you are, and figuring out ways to make things better.

·       It specifically attempts to avoid attributing blame, and to create systems to prevent errors from happening.

d)  Describe six (6) steps involved  in the process of conducting performance assessment                                 (30 Marks)

·       Preparation for PA by Management Team

Ø  Identify & discuss key issues

Ø  Document review

·       Selection of PA Team

Ø  Selection of PA team members

Ø  Determine schedule

·       Preparation by the Facility

Ø  Self-assessment

Ø  Organize resources

·       Conduction of PA & Facility Teams

Ø  PA Team approach

Ø  Facility responsibility

Ø   

·       Conducting a PA

Ø  Action oriented visit

Ø  Constructive

 

·       Report on the PA

Ø  Consolidated report of findings

Ø  PHO and District Management prepare summary report

 

 

CONFLICT MANAGEMENT 2

You are left in in-charge of a ward at the hospital. The ward nurse reports to you that he is not in talking term with one nurse in the ward. You decide to resolve the problem between the two nurses by coming up with a decision that will resolve the conflict.

a)   Define conflict                                                                       (5Marks)

·       A behavior intended to obstruct the achievement of some other person’s goals

·       It is a struggle over values or claims to status, power, and scarce resources, in which the claims of the conflicting parties are not only to gain the desired values but also to neutralize, injure, or eliminate their rivals

b)   State five (5) common causes of conflict                           (15 Marks)

a)   Differences in perception – can result in different people attaching different meaning to the same stimuli

b)   Limited resources – individuals and groups have to fight for their share

c)    Departmentalization and specialization- differing goals and internal environments of departments if not well understood

d)   The nature of work activities- potential for conflict when one’s task is depended upon the work of others

e)   Individual e.g. attitudes, personality characteristics or particular personal needs, illness or stress

f)    Role conflict – inadequate or inappropriate role definition

g)   Inequitable treatment -where the supervisor favors some nurses over others

h)   Violation of territory- people tend to become attached to their own ‘territory’ e.g. area of work, chair, room, parking space - jealousy may arise over other people’s territory

c)    Explain the five (5) conflict resolution methods you would use  (30 Marks)

·       AVOIDANCE:

Ø  Conflict is kept from coming into the open

Ø  Ignoring the conflict – because matter is trivial or is symptomatic of larger problems

Ø  Imposing a solution – imposing a solution from a higher level when decisive action is required, or a consensus is unlikely.

 

 

 

·       DIFFUSION: the conflict is kept in abeyance by smoothing, playing down its importance or diverting attention by appealing to super ordinate goals.

·       CONTAINMENT: Attempts to contain the conflict by controlling the issues and the manner in which they are discussed by either bargaining or structuring the interaction.

·       CONFRONTATION: Attempts to integrate or reconcile are made so that the needs of both conflicting parties are met, or organizations are redesigned so that conflict from lack of coordination can be eliminated.

·       ACCOMMODATING

Ø  The accommodating strategy essentially entails giving the opposing side what it wants.

Ø  The use of accommodation often occurs when one of the parties wishes to keep the peace or perceives the issue as minor.

·       COMPROMISING- The compromising strategy typically calls for both sides of a conflict to give up elements of their position in order to establish an acceptable, if not agreeable, solution. This strategy prevails most often in conflicts where the parties hold approximately equivalent power.

d)   Explain five (5) negative effects  of conflict                          (15 Mark)

c)    Some people will feel defeated and demeaned hence will not work properly

d)   It increases distance between people thus weakening teamwork

e)   It creates a climate of mistrust and suspicion thereby reducing cooperation

f)    Individuals and groups concentrate on their own narrow interests – moving away from the organisation vision

g)   Can bring about resistance rather than teamwork

h)   Can lead to an increase in employee turnover

e)   Describe the decision-making process                               (35 Marks)

Decision making  

1.   Define the problem. identify a problem or opportunity

·       The first step is to recognize a problem or to see opportunities that may be worthwhile.

·       Will it really make a difference to our clients/staff?

·       Check if it is worthwhile -will it be to solve this problem or realize this opportunity

 

 

2.   Gather information/ Identify limiting factors

·       Get facts  and generate objectives

·       What is relevant and what is not relevant to the decision? This include information, time, personnel, equipment, and supplies

·       What is needed to know before you can make a decision, or that will help you make the right one

·       Identify who knows, who can help, who has the power and influence to make this happen (or to stop it)

3.   Develop potential alternatives.

·       A manager should think through and investigate several alternative solutions to a single problem before making a quick decision.

·       Develop alternatives through brainstorming to generate ideas and alternative solutions.

·       Be creative and positive and generate several possible options

4.   Analyze the alternatives

·       Decide the relative merits of each idea and different interpretations of information

·       Managers must identify the advantages and disadvantages of each alternative solution before making a final decision.

·       Determine the pros and cons of each alternative.

·       Perform a cost-benefit analysis for each alternative.

·       Weigh each factor which is important in the decision, ranking each alternative in terms of feasibility, effectiveness and consequences

5.    Select the best alternative

·       After analyzing all the alternatives, decide on the best one.

·       The best alternative is the one that produces the most advantages and the fewest serious disadvantages.

·       The choice is reasonably straightforward with the most pros and fewest cons.

·       Consider the risks of making this decision

6.   Act/ Implement the decision

·       Put a plan in place to implement the decision.

·       Allocate resources to implement the decision

·       Everyone involved with the decision must know his or her role in ensuring a successful outcome.

·       To make certain that employees understand their roles, managers must thoughtfully formulate programs, procedures, rules, or policies to help aid them in the problem-solving process.

7.   Evaluate/ Establish a control and evaluation system

·       The ongoing actions need to be monitored.

·       An evaluation system should provide feedback on how well the decision is being implemented, what the results are, and what adjustments are necessary to get the results that were intended when the solution was chosen.

·       In order for a manager to evaluate his decision, he needs to gather information to determine its effectiveness.

·       The manager will ask the following question; was the original problem resolved? If not, is he or she closer to the desired situation than he was at the beginning of the decision-making process? The manager needs to figure out what went wrong.

 

 

 

DEFINE SUPPLY CHAIN MANAGEMENT                                                                

A.   DEFINITION: Supply chain management refers to the planning and management of all activities involved in sourcing, procurement and logistic management activities.

B.   List four (4) commodities that are constitute the supply chain and logistics management in Zambia                                                                                                            

·       Essential Drugs

·       ARVs

·       HIV Test Kits

·       Laboratory supplies

C.   Outline three (3) reasons why supply chain management is important                  

1.   INCREASES PROGRAM IMPACT

·       This is achieved by providing a reliable supply of commodities thereby making more people to use health services.

·        Clients feel more confident about the health program when they have a constant supply of commodities.

2.   ENHANCES QUALITY OF CARE

·       Quality of care is enhanced because well-supplied health programs will provide a superior service while poorly supplied cannot.

·        Furthermore, well supplied health workers will be motivated to use their skills and expertise fully.

 

3.   IMPROVES COST EFFICIENCY AND EFFECTIVESS

·       This is achieved by reducing losses due to overstocking, waste, expiry, damage and pilferage thereby protecting other program investments.

·       Effectiveness relates to the outcomes or results of a program or activity. Efficiency is often referred to as ‘doing things right’ that is ‘not wasting resources’.

   State any (5) rights of logistics                                                              15%

a)   The RIGHT Goods/Commodities

b)   In the RIGHT quantities

c)    In the RIGHT condition

d)   Delivered to the RIGHT place

e)   At the RIGHT time

f)    For the RIGHT cost

With aid of a diagram, explain:

The five (5) major activities in the logistics cycle                                 35%

1. Serving Customers

·       Goods or commodities are selected, procured stored or distributed to meet the customer needs.

·       Each activity in the logistic cycle is aimed at ensuring that the customer receives the best commodity and service.

2. Product Selection

• This is done at national level to select the products needed to deliver quality health care which in turn are delivered to health facilities.
•  Relevant products must be therefore selected to meet the needs of the clients. 

3. Quantification

• Quantification is the process of estimating the quantity and cost of each product required for each specific health program or service.
•  After the products have been selected, the required quantity and cost of each product must be determined.
• Correct quantification will prevent overstocking or stocks outs.

4. Procurement

• This refers to the action of obtaining required commodities either through buying or ordering from a central supply unit.
•  Health systems or programs procure from international, regional, or local sources of supply.

5. Inventory Management

• This involves storage and distribution of procured and received items.
•  Each commodity must be accounted for stating its movement from one level to another until it reaches the customer.

The four (4) activities at the heart of the logistics cycle                         20%

1. Organization and staffing

• Well trained staff is needed to monitor stock levels, place orders, and provide products to clients for a logistic system to work well.

1. Budgeting

• Allocation and management of funds directly affect all parts of the logistics cycle including quantities of the products to be procured.
•  Resources must be mobilized for procurement of the required commodities

   3. Supervision

• Staff who works within the logistic system must be supervised so that work is done correctly.
•  Routine and effective supervision of staff will help to prevent and resolve supply problems.

4. Monitoring and evaluation

·       Routine monitoring and periodic evaluation of the pipeline and logistic system activities will help in understanding how well the system is working and the areas that need improvement.

 

                                         THE LOGISTIC CYCLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 MOTIVATION

a.           Definition: Motivation defined as ‘internal and external factors that stimulate desire and energy in people to be continually interested and committed to a job, role or subject, or to make an effort to attain a goal.’

b.           REASONS THAT CAN LEAD TO LOW STAFF MORALE (25%)

·       Poor conditions of service e.g low pay

·       Lack of resources/equipment/supplies for use

·       Lack of supervision

·       Poor interpersonal relationship among staff

·       Lack of delegation

c.           EXPLAIN ANY FIVE (5) THEORIES OF MOTIVATION (30%)  

        THEORIES OF MOTIVATION.

·       There are a number of theories of motivation by different proponents. Here we will consider five theories of motivation. These are not exhaustive. As you read through other materials you will discover many more.

1. INSTINCT THEORY OF MOTIVATION

·       According to the instinct theory, people are motivated to behave in certain ways because they are evolutionarily programmed to do so.

·        An example of this in the animal world is seasonal migration.

·       These animals do not learn to do this; it is instead an inborn pattern of behaviour.\

2. INCENTIVE THEORY OF MOTIVATION

·       The incentive theory suggests that people are motivated to do things because of external rewards.

·        For example, you might be motivated to go to work each day for the monetary reward of being paid.

3. DRIVE THEORY OF MOTIVATION

·       According to the drive theory of motivation, people are motivated to take certain actions in order to reduce the internal tension that is caused by unmet needs.

·       For example, you might be motivated to drink a glass of water in order to reduce the internal state of thirst.

·       This theory is useful in explaining behaviors that have a strong biological component, such as hunger or thirst.

4. AROUSAL THEORY OF MOTIVATION

·       The arousal theory of motivation suggests that people take certain actions to either decrease or increase levels of arousal.

·       When arousal levels get too low, for example, a person might watch and exciting movie or go for a jog.

·        When arousal levels get too high, on the other hand, a person would probably look for ways to relax such as meditating or reading a book.

·       According to this theory, we are motivated to maintain an optimal level of arousal, although this level can vary based on the individual or the situation.

5. HUMANISTIC THEORY OF MOTIVATION

·       Humanistic theories of motivation are based on the idea that people also have strong cognitive reasons to perform various actions.

·       This is famously illustrated in Abraham Maslow's hierarchy of needs, which presents different motivations at different levels.

·       First, people are motivated to fulfill basic biological needs for food and shelter, as well as those of safety, love and esteem.

·        Once the lower level needs have been met, the primary motivator becomes the need for self-actualization or the desire to fulfil one's individual potential.

STEPS TO SOLVE THE PROBLEM OF LOW STAFF MOTIVATION (40%)

STEPS IN PROBLEM-SOLVING

• In order to correctly solve a problem, it is important to follow a series of steps.
• This it referred to as the problem-solving cycle, which includes developing strategies and organizing knowledge.
• While this cycle is portrayed sequentially, people rarely follow a rigid series of steps to find a solution.
•  Instead, we often skip steps or even go back through steps multiple times until the desired solution is reached.

1.    Identifying the Problem:

·       While it may seem like an obvious step, identifying the problem is not always as simple as it sounds.

·        In some cases, people might mistakenly identify the wrong source of a

problem, which will make attempts to solve it inefficient or even useless.

2.    Defining the Problem:

·       After the problem has been identified, it is important to fully define the problem so that it can be solved.

3.    Forming a Strategy:

·       The next step is to develop a strategy to solve the problem.

·        The approach used will vary depending upon the situation and the individual's unique preferences.

4.    Organizing Information:

·       Before coming up with a solution, we need to first organize the available information.

·       What do we know about the problem? What do we not know? The more information that is available, the better prepared we will be to come up with an accurate solution.

 

5.    Allocating Resources:

·       Of course, we don't always have unlimited money, time and other resources to solve a problem.

·       Before you begin to solve a problem, you need to determine how high priority it is.

·       If it is an important problem, it is probably worth allocating more resources to solving it.

·       If, however, it is a fairly unimportant problem, then you do not want to spend too much of your available resources into coming up with a solution.

6.    Monitoring Progress: -

·       Effective problem-solvers tend to monitor their progress as they work towards a solution.

·       If they are not making good progress toward reaching their goal, they will re-evaluate their approach or look for new strategies.

7.    Evaluating the Results:

·       After a solution has been reached, it is important to evaluate the results to determine if it is the best possible solution to the problem.

·       This evaluation might be immediate, or it can be delayed.                                          

POLICY DEVELOPMENT AND ANALYSIS

A.   DEFINITION

·       A policy is a general plan of action used to guide the desired outcome. It is a guideline or rule used to make decisions.

·       Policy analysis involves the systematic comparison and analysis of a set of policy alternatives to determine which option is most likely to achieve a set of objectives.

B.   Health Care policies

·       HIV work place policy

·       Malaria Treatment policy

·       Infection prevention policy

·       TB treatment policy

·       HIV  Post Exposure  Treatment policy

C.   THE PURPOSE OF A POLICY.

·       The purpose of a policy (or health care procedure) is to provide standardization in daily operational activities.

·       Policies and procedures provide clarity when dealing with issues and activities that are critical to health and safety, legal liabilities and regulatory requirements that have serious consequences.

·       Policy is also used to communicate to employees the desired outcomes of the organization. They are usually broad, state what has to be achieved and why and answer major operational issues.

·       Policies again can help employees understand their roles and responsibilities within the organization.

 

 

 

 

D.   In our definitions, we said policy development is a process meaning that it has steps that are followed. What are these steps?

PROCESS OF POLICY DEVELOPMENT.

There are four typical and main steps in the  policy process:

1.    Identifying a problem,

2.    Formulating a policy,

3.    Implementing the policy change, and

4.    Evaluating the result.

·       Each step is usually followed in the order listed to make sure that the process is done correctly.

·       In many cases, these "steps" are turned into a cycle, with each step being repeated as changes occur; when a policy is evaluated, for example, it may reveal new problems that need to be addressed.

1.   Identifying the Problem.

• The first step in the policy process is to outline the problem.
• This involves not only recognizing that an issue exists, but also studying the problem and its causes in detail.
• This stage involves determining how aware the public is of the issue, deciding who will participate in fixing it, and considering what means are available to accomplish a solution.

2.   Formulating a Policy to Resolve the Problem

• After identifying and studying the problem, a new policy may be formulated or developed.
• This step is typically marked by discussion and debate to identify potential obstacles, to suggest alternative solutions, and to set clear goals and list the steps that need to be taken to achieve them.
• Once the policy is developed, the authorities must agree to it; a weaker policy may be more likely to pass, whereas a stronger one that deals with the problem more directly might not have enough support to gain approval.

3.   Implementing the Policy

• A new policy must be put into effect.
• This is the third step of the policy process, and one that can be difficult if the people who are tasked with carrying out the policy are not committed to complying with it.
• During the policy formulation step, compromises may have been made to get the policy passed that those who are ultimately required to help carry it out do not agree with; as such, they are unlikely to enforce it effectively.
• Clear communication and coordination, as well as sufficient funding, are also needed to make this step a success.

6.   Evaluating the Effect of the Policy

·       The final stage in the policy process, known as evaluation, is typically ongoing. This step usually involves a study of how effective the new policy has been in addressing the original problem, which often leads to additional policy changes.

·       It also includes reviewing funds and resources available to ensure that the policy can be maintained. Historically, this step has not always been treated as very important, but policy makers are increasingly finding ways to make sure that the tools needed for evaluation are included in each step of the policy process.

METHODS OF POLICY ANALYSIS

• Policy analysis can explore one policy, compare two or more policies with each other, or model the future implications of a variety of different policy changes (Singer & Manton, 1993).
• Policy analysis can examine one stage in policy development or can look across all stages of policy, from design to implementation and evaluation.

1)   Needs Assessment.

• First, to address problems sensibly a policy analyst identifies the nature, scope, and extent of the problems.
•  He or she accomplishes an assessment of the extent of need in a variety of ways. He or she may document the nature of the problem through analysis of existing information.
• The policy analyst can then use such information to describe the current state of need and to forecast likely needs.

2)   Cost–Benefit Analysis

• Cost–benefit analysis is an approach that attempts to relate the direct and indirect costs of policies to the direct and indirect benefits of those policies.
• Cost–benefit analysis requires that both the costs and the benefits of policies be calculated in monetary form.
• This is frequently difficult to do, because policy analysts are often unable to give a precise dollar figure for saving a life for example.

3)   Cost-Effectiveness Analysis

·       Cost-effectiveness analysis looks at the costs of different policies in achieving the desired policy results.

·       Unlike cost–benefit analysis, this methodology does not require the monetization of the benefits of each policy.

·       Although policy analysts may not know the dollar value of certain benefits, they can compare which policy costs less to achieve the same desired outcome, regardless of monetary value of the expected benefits.

 

4)   Outcome Studies

• One can assess the effectiveness of a policy without knowing the policy's cost or monetizing the benefits.
• Outcome studies can document the comparative effectiveness of different policy alternatives.
• Using conventional quasi-experimental and experimental research designs, policy analysts are able to assess the extent to which some policy intervention has had the intended impact on the problem it was designed to address.

5)   Case Studies

• Case studies involve the systematic and detailed description and analysis of the formation, implementation, and evaluation of specific policies.
• Examples include analysis of the impact of the Zambian health policy on access to health.

6)   Meta-analysis

• Meta-analysis can provide guidance to policymakers in the early phases of policy development by summarizing existing quantitative studies and can assist them after a series of policy outcome studies have been conducted.

 

 

ADVOCACY

A.   Define advocacy 5%

• Advocacy is an activity by an individual or group which aims to influence decisions within political, economic, and social systems and institutions.

B.   List the four areas of Nurse Advocacy in relation to Patient care 10%

• The Model of Advocacy which is used is by Fowler (1989) who described the four areas of Nurse Advocacy in relation to Patient care. These are; 

1. A Nurse is a Guardian of Patient’s Rights
2. A Nurse Preserves Patient Values
3. A Nurse is a Champion of Social Justice in the provision of healthcare
4. A Nurse is a Conservator of the patient’s best interest

 

C.    Outline three (3) Roles of a nurse  as an advocate   15%

·       To up hold the rights of persons/clients without prejudice or discrimination

The nurse serves as a guardian of patients’ rights by protecting the patient’s rights without fear of favour.

·       To act  always in the best interest of the patient

The nurse performs nursing services in the best interest of the patient/client. The client must be the direct beneficiary of the nursing services provided. 

·       To act as an intermediary in patient care

The nurse works as a mediator for the patient. The nurse speaks and where necessary acts on behalf of the patient so that the patient receives the best care possible

D.   State any ten (10) universal human rights 30%

·       We Are All Born Free & Equal. We are all born free. We all have our own thoughts and ideas. We should all be treated in the same way.

·       Don’t Discriminate. These rights belong to everybody, whatever our differences.

·       The Right to Life. We all have the right to life, and to live in freedom and safety.

·        No Slavery. Nobody has any right to make us a slave. We cannot make anyone our slave.

·        No Torture. Nobody has any right to hurt us or to torture us.

·        You Have Rights No Matter Where You Go. I am a person just like you!

·        We’re All Equal Before the Law. The law is the same for everyone. It must treat us all fairly.

·        Your Human Rights Are Protected by Law. We can all ask for the law to help us when we are not treated fairly.

·        No Unfair Detainment. Nobody has the right to put us in prison without good reason and keep us there, or to send us away from our country.

·       The Right to Trial. If we are put on trial this should be in public. The people who try us should not let anyone tell them what to do.

·        We’re Always Innocent Till Proven Guilty. Nobody should be blamed for doing something until it is proven. When people say we did a bad thing we have the right to show it is not true.

·       The Right to Privacy. Nobody should try to harm our good name. Nobody has the right to come into our home, open our letters, or bother us or our family without a good reason.

·       Freedom to Move. We all have the right to go where we want in our own country and to travel as we wish.

·        The Right to Seek a Safe Place to Live. If we are frightened of being badly treated in our own country, we all have the right to run away to another country to be safe.

·       Right to a Nationality. We all have the right to belong to a country.

·       Marriage and Family. Every grown-up has the right to marry and have a family if they want to. Men and women have the same rights when they are married, and when they are separated.

·       The Right to Your Own Things. Everyone has the right to own things or share them. Nobody should take our things from us without a good reason.

·       Freedom of Thought. We all have the right to believe in what we want to believe, to have a religion, or to change it if we want.

·       Freedom of Expression. We all have the right to make up our own minds, to think what we like, to say what we think, and to share our ideas with other people.

·       The Right to Public Assembly. We all have the right to meet our friends and to work together in peace to defend our rights. Nobody can make us join a group if we don’t want to.

·       The Right to Democracy. We all have the right to take part in the government of our country. Every grown-up should be allowed to choose their own leaders.

·        Social Security. We all have the right to affordable housing, medicine, education, and childcare, enough money to live on and medical help if we are ill or old.

·        Workers’ Rights. Every grown-up has the right to do a job, to a fair wage for their work, and to join a trade union.

·       The Right to Play. We all have the right to rest from work and to relax.

·        Food and Shelter for All. We all have the right to a good life. Mothers and children, people who are old, unemployed or disabled, and all people have the right to be cared for.

·       The Right to Education. Education is a right. Primary school should be free. We should learn about the United Nations and how to get on with others. Our parents can choose what we learn.

·       Copyright. Copyright is a special law that protects one’s own artistic creations and writings; others cannot make copies without permission. We all have the right to our own way of life and to enjoy the good things that art, science and learning bring.

·        A Fair and Free World. There must be proper order so we can all enjoy rights and freedoms in our own country and all over the world.

·        Responsibility. We have a duty to other people, and we should protect their rights and freedoms.

·        No One Can Take Away Your Human Rights.

E.   Discuss the bill of rights for patients 40%

·       A bill of rights is a list of the most important rights to the citizens of a country. The purpose of these bills is to protect those rights against infringement. This bill of rights addresses the following  areas:

a)   Information for patients

You have the right to accurate and easily-understood information about your health plan, health care professionals, and health care facilities

b)  Choice of providers and plans

You have the right to choose health care providers who can give you high-quality health care when you need it.

c)   Access to emergency services

If you have severe pain, an injury, or sudden illness that makes you believe your health is in danger, you have the right to be screened and stabilized using emergency services.

d)  Taking part in treatment decisions

You have the right to know your treatment options and take part in decisions about your care. You have the right to ask about the pros and cons of any treatment, including no treatment at all.

 

e)   Respect and non-discrimination

You have a right to considerate, respectful care from your doctors, health plan representatives, and other health care providers that does not discriminate against you based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

f)    Confidentiality (privacy) of health information

You have the right to talk privately with health care providers and have your health care information protected. You also have the right to read and copy your own medical record. You have the right to ask that your doctor change your record if it’s not correct, relevant, or complete.

g)  Complaints and appeals

You have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals, or other health care personnel

 

 

 

CONFLICT MANAGEMENT 3.

A.   DEFINITION OF CONFLICT

·       This is a clash between two opposing parties or ideas. Each side attempts to have their own views accepted than that of the others

B.   CONFLICT MANAGEMENT                                                              

·       Conflict management is a systematic process to find a satisfying outcome between conflicted parties.

C.   SOURCES OF CONFLICT

·       Poor communication

·       Conditions of service

·       Gender

·       Poor leadership

·       Inadequate allocation of resources

·       Poor relationships

·       Failure in achieving objectives

·       External influence e.g. Politics

·       Difference in perceptions,, goals, values, attitude towards work

·       Emotional cases: anger, resentment, distrust

 

D.   5 MAIN WAYS OF RESOLVING CONFLICTS

1. AVOIDING (WITHDRAWAL)

·       There is low assertiveness and low cooperation.

·        It is in form of denial, under responsiveness, shifting, and postponement.  Ignores the conflict due to non-confidence, avoiding may be used if issues are of low importance, to reduce tensions, to buy some time.

2. ACCOMMODATING (SMOOTHING)

·       Low assertiveness or unassertive but high cooperation

·       . The manager sets aside his own goals in favor of giving the employees what they want, it is used if the manager feels she is wrong. At times it can lead to solutions but in the long run, it may be detrimental.

3.  COMPROMISING (sharing)

·       It involves moderate assertiveness and moderate cooperation.

·        Giving up more than you want.

·       Compromising is appropriate when dealing with issues of moderate importance. When both parties have equal power status, or when there is a strong commitment for resolution

4. COLLABORATING (problem solving)

·       it incorporates both high assertiveness and high cooperation working to find mutual satisfying solution to a conflict not caused by an individual, the collaborating manager works with all sides to find a way to achieve a mutually desired outcome.

·        Everyone is involved.

·       The manager should have collaborating skills e.g active listening, non-threatening confrontation.

5. COMPETING (forcing)

·       Strategy requires employees to be assertive, but don’t have to cooperate with others.

·       An individual’s concerns are satisfied at others expense.

·       It can lead to violence

·       . It should be used in situations where a quick, decisive decision needs to be made.

 

 

 

 

DECISION MAKING

A.   Definition:- Decision making can be regarded as the cognitive process resulting in the selection of a course of action among several alternatives.

B.   STEPS IN DECISION MAKING

1. Identifying and Diagnosing Problems.

·       This is the first step in the decision-making process.

·        It requires clear identification of opportunities or the diagnosis of problems that require a decision. Discrepancies between actual and desired conditions alert a manager to a potential opportunity or problem.

2.  Identifying Objectives.

·       Objectives are often referred to as targets or standards.

·        Objectives can be expressed for long spans of time (years or decades) or for short spans of time (hours, days or months). Regardless of the time frame,

·        objectives will guide the ensuing decision-making process.

·       Objectives reflect the results the organization wants to attain.

3. Generating Alternatives.

·       Once an opportunity has been identified or a problem diagnosed correctly and objectives have been identified, a manager develops various ways to achieve objectives and solve the problem.

·        This step requires creativity and imagination. In generating alternatives, the manager must keep in mind the goals and objectives that he or she is trying to achieve.

·        Ideally several different alternatives will emerge. In this way, the manager increases the likelihood that many good alternative courses of action will be considered and evaluated.

4. Evaluating Alternatives.

·       The fourth step in the process involves determining the value or adequacy of the alternatives generated and selecting the best solution.

·       It includes assessing the value or relative advantages and disadvantages of each alternative under consideration.

5. Choosing the Best Alternative

·       Decision making is commonly associated with making the final choice.

·        Although choosing an alternative would seem to be a straight forward proposition, simply consider all the alternatives and select the one that best solves the problem.

·        Because the best decisions are often based on careful judgments, making a good decision involves carefully examining all the facts, determining whether sufficient information is available, and finally selecting the best alternative.

6. Implementing

·       When decisions involve taking action or making changes, choosing ways to put these actions or changes into effect becomes an essential managerial task. The keys to effective implementation are:

·       Sensitivity to those who will be affected by the decision and

·       Proper planning consideration of the resources necessary to carry out the decision.

·       Those who will be affected by the decision must understand the choice and why it was made, that is, the decision must be accepted and supported by the people who are responsible for its implementation.

·        These needs can be met by involving employees in the early stages of the decision process so that they will be motivated and committed to its successful implementation.

7.  Monitoring and Evaluating

·       No decision-making process is complete until the impact of the decision has been evaluated.

·       Managers must observe the impact of the decision as objectively as possible and take further corrective action if it becomes necessary.

·       Monitoring the decision is useful whether the feedback is positive or negative.

·        Positive feedback indicates that the decision is working and that it should be continued and perhaps applied elsewhere in the organization.

·       Negative feedback indicates either that the implementation requires more time, resources, effort, or planning than originally thought or that the decision was a poor one and needs to be re-examined.