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ORGANIZING in Nursing Management

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Organizing in Nursing Management

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ORGANIZING in Nursing Management Presentation subtitle

The Story of the Donkey Stuck in a Well

One day a farmer’s donkey fell down into a well. The donkey cried piteously for hours as the farmer tried to figure out what to do.

Finally, the farmer decided the animal was old, and the well needed to be covered up anyway; it just wasn’t worth it to retrieve the donkey.
He invited all his neighbors to come over and help him. They all grabbed a shovel and began to shovel dirt into the well. At first, the donkey realized what was happening and cried even more loudly in panic and fear.

Then, to everyone’s amazement the donkey quieted down.

A few shovel loads later, the farmer looked down the well. He was astonished at what he saw. With each shovel of dirt that hit his back, the donkey was doing something amazing.
He would shake off the dirt and take a step up. As the farmer’s neighbors continued to shovel dirt on top of the donkey, he would shake it off and take another step up. Pretty soon, everyone was amazed as the donkey stepped up over the edge of the well and happily trotted off!

Life is going to shovel dirt on you, all kinds of dirt. The trick to getting out of the well is to shake it off and take a step up. Each of our troubles is a steppingstone. We can get out of the deepest wells just by not stopping, never giving up! Shake it off and take a step up.
Remember the five simple rules to be happy: Free your heart from hatred – Forgive. Free your mind from worries – Most never happen. Live simply and appreciate what you have. Give more. Expect less

Organizing the Nursing Service
All but which of the following does not define the process of organizing in nursing management? A. Consist of the structure and process which allows the agency to enact its philosophy and utilize its conceptual framework to achieve a goal. B. It refers to a body of persons, methods, policies and procedures arranged in a systematic process through the delegation of function and responsibilities for the accomplishment of purpose. C. It is the process of establishing formal authority D. It helps the manager look into the future and decide in advance where the agency would like to be and what is to be done.

Organizing is;
• Is the process of determining the activities to be performed, arranging these activities to administrative units, as well as assigning managerial authority and responsibilities to people employed in the organization.

• This is a process of forming a system into an organic whole, giving it an orderly structure, framing and making arrangement for its working order. As an undertaking it involves cooperation. • This is a process where personnel job description, qualifications and functions are distinctly defined and specified for work efficiency in the organization.

What is an ORGANIZATION?
 An organization is defined as a system of interrelated resources, including environment, materials, supplies and behavior of people, that performs a task which has been differentiated into several distinct subsystem.  Planned groupings of people to accomplish a specific purpose  Is an organized body, system or society where members harmoniously work together to achieve organization goals.

GOALS

SUPERVISI ON

PEOPLE

ORGANIZATION

JOB

STRUCTUR E

CULTURE

Types of Organization Classified by Nature of Authority
1) Line Organization- each position has general
authority over the lower positions in the hierarchy. (also known as Bureaucratic/Pyramidal) 2) Informal Organization- refers to horizontal relationship rather than vertical.(Flat or horizontal organization) 3) Staff Organization- purely advisory to the line structure with no authority to put recommendations into action. 4) Functional Organization – each unit is responsible for a given part of the organization’s workload.

TYPES OF ORGANIZATIONAL STRUCTURE
1) Line Organization/

Bureaucratic/ Pyramidal - shows that each position has general authority over the lower position of the hierarchy. - Power are concentrated at the top.

TYPES OF ORGANIZATIONAL STRUCTURE

2.

Flat Organization - refers to an organizational structure with few or no levels of intervention between management and staff.

TYPES OF ORGANIZATIONAL STRUCTURE

3. Staff Organization - purely advisory to the line structure with no authority to place recommendations into action.

TYPES OF ORGANIZATIONAL STRUCTURE

4. Functional Organization

- permits a specialist to aid line position within a limited and clearly defined scope authority.

Is a line drawing which shows how the part of the organization are linked. It depicts the formal organizational relationship, areas of responsibility and person to whom one is accountable;
A. Budgetary Chart B. Hierarchy C. Organizational Chart D. Structural Plant

ORGANIZATIONAL CHART
Organizational chart is a line drawing that shows how the parts of an organization are linked.
The organization chart establishes the following:
■ Formal lines of authority—the official power to act ■ Responsibility—the duty or assignment ■ Accountability—the moral responsibility

ORGANIZATIONAL RELATIONSHIP
1. FORMAL RELATIONS 2. INFORMAL RELATIONS

ORGANIZATIONAL RELATIONSHIP
1. FORMAL RELATIONS

Formal structure, through departmentalization and work division, provides a framework for defining managerial authority, responsibility and accountability..

ORGANIZATIONAL RELATIONSHIP
2. INFORMAL RELATIONS Informal structure is generally social, with blurred or shifting lines of authority and accountability.

1. 2. 3. 4. 5. 6.

All but which of the following activities is not included under Organizing? Budgeting Staffing Scheduling Developing Job description Organizational Structure Forecasting
C. 2,4,5 D. 3,4,5,6

A. 1,2,3 only B. 2,3,4,5

SETTINGN UP THE ORGANIZATIONAL STRUCTURE:

The creation of an organizational system compatible with the philosophy, conceptual framework and goals of the organization. Understanding the organizational structure as a whole facilitates the development of roles and relationships to enables the achievement of goals.

Importance of Organizational Structure
 It enables members what their responsibilities  It frees the manager and the individual workers to concentrate on their respective roles and responsibilities  It Coordinates all organization activities so there is minimal duplication of effort or conflict.  Avoids overlapping of function because it pinpoints responsibilities.  Shows to whom and for whom they are responsible

The successful setting up of the organizational structure enables an organization to achieve; 1. Information of members of their responsibilities 2. Allowing the manager to concentrate on his/her role 3. Avoid overlapping of functions 4. Shows to whom and for whom they are responsible 5. Create an environment that raise friction A. All of these C. 1,2,5,4 B. None of these D. 4,3,2,1

ORGANIZATIONAL TYPE OF AUTHORITIES  Line Authority entitles a supervisor to direct an individuals work. Direct
type of authority over the lower position.

 Staff Authority is the authority created to support, assist recommend
and generally reduce the supervisors' responsibilities. “Purely advisory”

Mrs. Chao has recently been designated as adviser on nursing matters to the Secretary of the DOH. Mrs. Chao’s relationship is indiacted in the organizational chart by; A. Rectangle B. Straight Line C. Box D. Broken Line

A. B. C. D.

One of the things that Nurse Mila noticed when she entered the office of the Chief Nurse is the Hospital’s Organizational Chart. Formal authority in an organizational chart is indicated by a; Box Rectangle Broken Line Straight Line

Characteristics of Organizational Chart
1. Division of Work – each box represents an individual or sub-unit
responsible for a given task of the organization’s workload. 2. Chain of Command – lines indicate who reports to whom & by what authority. 3. Type of work to be Performed - indicated labels or descriptions for the boxes.

4.Grouping of Work Segment- shown by the clusters of work
groups

5.The level of Management, which indicate individual & entire
management hierarchy, regardless of where an individual appears on the chart.

Difference Between Flat and Pyramidal Structure.
CATEGORY No. of Levels Span of Control FLAT PYRAMIDAL

Fewer Broad

More Narrow

Delegation
Authority Control over Subordinates

Greater
Decentralized Lesser

Lesser
Centralized More

Type

Modern

Traditional

Flat or Decentralized Structure
Advantages • Communication patterns are simplified, problems tend to be addressed with ease and efficiency. • Employees have autonomy and increased job satisfaction within this type of structure Disadvantages
• Supervisor spend less time with each worker • Supervisors may lack expertise in the variety of operations and may end up making inappropriate decisions

Authority is the right to act or make decision without the approval of
the higher administrator.

Accountability mean taking full responsibility for the quality of
work and behavior while engaged in the practice of the profession.

Responsibility is the obligation to perform the assigned tasks Power is the ability to influence another to behave in accordance with
one's wishes

Status is the rank bestows on a person in accord with the groups
estimation of the person value, significance to the group.

Communication is the transmission of information between persons

Board Question
Which of the following pertains to the principle of DELEGATION except; a. When responsibility for a particular job is delegated to a subordinate, the latter should have authority over resources needed to accomplish the task b. When a particular task has been delegated to a subordinate the supervisors own authority is diminished to that of the subordinates c. When a person bestowed the authority for action, he is accountable for his actions to the person that bestowed him such. d. If a particular tasked has been delegated to a subordinate the superior’s own responsibility is no way diminished

Board Question
Decentralization or proper delegation of authority is best describe by the following; a. The number of workers that a supervisor can effectively manage should be limited, depending upon the pace and pattern of the working area b. At the top of the structure a ratio of 1:6 ratio of supervisor-worker is common, while at the base of the organization a 1:10 ratio is common c. Workers performing similar assignments are grouped together for a common purpose. d. Conferring specified decision making to the lower levels of organization

Medical Center Chief

MEDICAL DIVISION

NURSING DIVISION

ADMINISTRATIVE DIVISION BUDGET
PERSONNEL

ANXILLARY
LABORATORY

CLINICAL

CLINICAL

SPECIAL AREA

PHARMACY DIETARY
HOUSE KEEPING

SURGERY
EENT ORTHO

RADIOLOGY

OR ER ICU
DR/NICU

SUPPLY AUDIT
MAINTENANCE

DENTAL

LAUNDRY
SOCIAL SERVICE

MEDICINE
OB GYNE PEDIA/OPD

COLLECTING

TRANSPORT

ORGANIZATIONAL STRUCTURE OF A HOSPITAL NURSING DIVISION/SERVICES

Chief of Hospital Chief Nurse
Ass. Chief Nurse Trng & Research
Supervising Nurse Instructor Nurse Instructors

Ass. Chief Nurse Clinical Service
Supervising Nurse Spl. Services Senior Nurses Supervising Nurse Clinical Services Senior Nurses

Staff Nurses Nursing Attendants

Staff Nurses Nursing Attendants

Medical Center Chief Chief Nurse Dean of Affiliating Colleges

Ass. Chief Nurse
Supervising Nurses Supervising Nurse Ins Senior Nurses Staff Nurses Nurse Instructors Trainees

Clinical Coordinators
Clinical Instructors

Midwives
Nursing Attendants Institutional Workers

Nsg. & Midwifery Affiliates

Traditional Hierarchical Structure

CHIEF NURSE

SUPERVISING NURSE

STAFF NURSE

NURSING ATTENDANT

Staffing
 Process of determining and providing the acceptable number and mix the nursing personnel to produce desired level of care to meet the patients demand.  To provide each nursing unit with an appropriate and acceptable number of workers in each category to perform the nursing tasks required.

Factors Affecting Staffing
        The type, philosophy and objective of the hospital and the nursing The population serve or the kind of patient served whether pay or charity The number of patients and the severity of their illness-knowledge Administrative policies such as rotation, weekends and holiday off duties Standards (ANSAP, PRC ANSAPS Standards of Safe Nursing Practice) Layout of the various units Budget Expected hours of work per annum of each employee. (40 hours week law)  Pattern of work schedule

The Forty-Hour Week Law, Republic Act 5901, provides that employees working in 100 bed capacity and up will work only 40 hours a week. This also applies to employees working in agencies with at least one million population. Employees working in agencies located in communities with less than one million population, will work 48 hours/week and therefore will get only one off-duty a week.

Nursing Care Hour as per Patient Per Day According to Classification of Patients by Units
Cases/ Patients
General Medicine Medical Surgical Obstetrics Pediatrics Pathologic Nursery ER/ICU/RR CCU

NCH/Pt./Day
3.5 3.4 3.4 3.0 4.6 2.8 6.0 6.0

Prof. to Non Prof. ratio
60:40 60:40 60:40 60:40 70:30 55:45 70:30 80:20

Patient Classification System (PCS)
method of grouping patients according to the amount and complexity of their nursing care requirements, of nursing time & skill they require. serves in determining the amount of nursing care required, generally within 24 hours, as well as the category of nursing personnel who should provide that care.

Purposes for Classifying Patients
1. Staffing. Perceived patient needs can be matched with available nursing resources 2. Program costing & formulation of the nursing budget 3. Tracking changes in patient care needs 4. Determine values for the productivity equation: output divided by input. 5. Determine quality

Classification Categories
 Level I – Self Care or Minimal Care

– Patient can bathe, feed and perform ADL.

 Level II – Moderate Care or Intermediate Care – Patient needs some assistance in ADL,

ambulating up and about for short periods of time,
 Level III – Total, Complete or Intensive Care

– Patients are completely dependent upon the nursing personnel.

 Level IV – Highly Specialized Critical Care -

 Patients maximum nursing care, they need continuous treatment, observation, many medications, IV piggy backs, vital signs q 1530 mins. hourly output;  Significant changes in doctor’s orders more

Levels of Care Level I Self Care or Minimal Care Level II Moderate or Intermediate Care

NCH Needed Per Patient/ Day

Ratio of Prof. to Non-Prof

1.5

55:45

3

60:40

Level III Total or Intensive Care
Level IV Highly Specialized or Critical Care

4.5

65:35

6 7 or higher

70:30 80:20

Percentage of Nursing Care Hours
The percentage of nursing care hours at each level of care also depends on the setting in which the care is being given.

Percentage of Patients in Various Levels of Care
Types of Hospital Minimal Care 70 Moderate Care 25 Intensive Care 5 Highly Specialize Care -

Primary Hospital

Secondary Hospital
Tertiary Hospital

65
30

30
45

5
15

10

Special Tertiary Hospital

10

25

45

20

The Forty-Hour Week Law, Republic Act 5901, provides that employees working in 100 bed capacity and up will work only 40 hours a week. This also applies to employees working in agencies with at least one million population. Employees working in agencies located in communities with less than one million population, will work 48 hours/week and therefore will get only one off-duty a week.

Total Number of Working and Non Working Days and Hours of a Nursing Personnel Per Year
Rights an d Privilege Given Each Personnel Per Year

Working Hours Per Week
40 HOURS 48 HOURS
15 15 10 2 3 52 3 15 15 10 2 3 104 3

VACATION LEAVE SICK LEAVE LEGAL HOLIDAYS SPECIAL HOLIDAYS SPECIAL PRIVILEDGE OFF DUTIES (RA 5901) CEP

TOTAL NON WORKING DAYS PER YEAR

152

100

Relievers Needed
To determine the relievers needed use the following;  For person working 40 Hours a week =0.15  Foe person working 48 Hours a week=0.12

Distribution of Shift  45 percent for the AM shift  37 percent for the AFTERNOON shift

Activity: Find the Nursing personnel needed for; 250 patients in a tertiary hospital 40 Hours per week

The Formula
 Categories the numbers of patient according to the levels of care needed. Multiply the total number of patient by the percentage of patient at each level of care.  Find the total number of nursing care hour needed by the patient at each category level. Find the number of patients at each level by the average number of nursing care hours per day Get the sum of the nursing care hours needed at the various levels  Find the actual number of nursing care hours needed by the given numbers of patients. Multiply the total nursing care hours needed per day by the total number of days in a year.

The Formula
 Find the actual number of working hours rendered by each nursing personnel per year. Multiply the number of hours on duty per day by the actual working days per year. Divide the total number of nursing care needed per year by the actual number of working hours rendered by an employee per year Find the number of relievers. Multiply the numbers of nursing personnel needed by 0.15 (40 hours), 0.12 (48 hours) Add the number of relievers to the number of nursing personnel needed

The Formula
 Categorize the nursing personnel into professional and nonprofessional. Multiply the number of nursing personnel according to the ratio of professional to non professional.  Distribute by shift.

The Story of the MULE

"God created the mule, and told him, 'You will be Mule, working constantly from dusk to dawn, carrying heavy loads on your back. You will eat grass and you lack intelligence. You will live for 50 years. The mule answered: 'To live like this for 50 years is too much. Please, give me no more than 20.' And it was so.

Then God created the dog, and told him, 'You will be Dog, and hold vigilance over the dwellings of Man, to whom you will be his greatest companion. You will eat his table scraps and live for 25 years. And the dog responded, 'Lord, to live 25 years as a dog is too much. Please, no more than 10 years.' And it was so.

God then created the monkey, and told him, 'You are Monkey, and you shall swing from tree to tree, acting like an idiot. You will be funny, and you shall live for 20 years. And the monkey responded, 'Lord, to live 20 years as the clown of the world is too much. Please, Lord, give me no more than 10 years.' And it was so.

Finally, God created Man and told him, 'You are Man, the only rational being that walks the earth. You will use your intelligence to have mastery over the creatures of the world. You will dominate the earth and live for 20 years.' And the man responded, 'Lord, to be Man for only 20 years is too little. Please, Lord, give me the 20 years the mule refused, the 15 years the dog refused, and the 10 years the monkey rejected.' And it was so.

And so God made Man to live 20 years as a man, then marry and live 20 years like a mule working and carrying heavy loads on his back. Then, he is to have children and live 15 years as a dog, guarding his house and eating the leftovers after they empty the pantry; then, in his old age, to live 10 years as a monkey, acting like a clown to amuse his grandchildren."

Types of Staffing
1. Centralized – done by the nursing director who develops a master plan for nursing personnel; an impersonal approach 2. Decentralized – the managers of individual nursing units have more control over the budget,

NOTE:
It should be noted that the personnel computed are only for those in patients. Therefore, additional personal should be hired for those in supervisory and administrative position and for those in the special units. o Head Nurse should be provided for every nursing unit. o Nursing Supervisors is provided . o Roomed in babies should be provided with additional staff

PLACEMENT
Placement is the assigning employees to a position or area. Proper placement foster personal growth, provides a motivating climate for the employee, maximizes productivity and organizational goals. SCHEDULING o A timetable showing planned work days and shift for nursing personnel. FACTORS CONSIDERED IN MAKING SCHEDULES: Different level of the nursing staff Adequate coverage for 24 hours Staggered vacations and holidays Weekends Long stretches of consecutive working days Evening and night shifts Floating

      

Assessing a Scheduling System: o Ability of the needs of the units o Quality to enhance the nursing personnel’s knowledge, training and experience o Fairness to the staff o Stability o Flexibility Types of Scheduling: Centralized – Chief Nurse or designate do assigns the personnel to the hospital units

Decentralized – Chief Nurse or designate assigns personnel but supervising Nurse/ Head or Senior arranged the shift and off duties Cyclical - Covers designated number of wks. (cycle length)

Advantages of Cyclical Schedule
1. It is fair to all 2. It saves time as the schedule does not have to be redone every week or two 3. It enables the employees to plan ahead for their personal needs preventing frequent changes in the schedule. 4. Scheduled leave coverage such as vacation, holidays and sick leaves are more stable 5. Productivity is improved

Developing the Job Description
Developing Job Description – a statement that sets the duties and responsibilities of a specific job. Contents of Job Description
Identifying Data: Position Title: Department: Supervisor’s Title:
Job Summary-essential features of the job that distinguish it from the others. Qualification Requirements Job Relationship – source of workers Specific and Actual Functions and Activities

WHAT WOULD YOU DO FIRST IF YOU WERE IN A SITUATION WHERE:

INTERPRETATION

FAMILY

SEX

WEALTH
CAREER & JOB

FRIENDS & RELATIVES

Test Your STRESS Levels

DIRECTING
o Directing is getting the work done through others. It is management of people which is the heart of the administrative process to be properly understood and practice by a nurse manager. o Giving orders and directions to others to attain quality patient care. o Directing is the issuance of assignments, orders and instructions that help the nursing personnel to understand what are expected of them.

Elements of Directing
i. ii. iii. iv. v. vi. Delegation Utilization of Policies and Procedures Supervision of Personnel Coordination of Service Communication Staff Development and Making of Decision

Delegation

is the process of by which a manager assigns specific task/duties to workers with commensurate authority to perform the job.

Principle of Delegation
       Select the right person to whom the job is to be delegated Delegate both interesting and uninteresting tasks Provide subordinates with enough time to learn Delegate gradually Delegate in advance Consult before delegating Avoid gaps and overlaps

Do you think that all matters be delegated?
There are matters that cannot be delegated. 1. Overall responsibility, authority and accountability 2. Authority to sign one’s name 3. Evaluating the staff and or taking necessary corrective or disciplinary action 4. Responsibility for maintaining morale or the opportunity to say a few words of encouragement to the staff especially the new ones 5. Jobs that are too technical and those that involve trust and confidence

 These may be due to lack of confidence in their staff  Feeling that only they could do the task better and faster  They may fear loss of control if some of their duties are delegated NURSING CARE ASSIGNMENT (sometimes called.. ) Modalities of Nursing Care Systems of Nursing Care Patterns of Nursing Care

Why Nurse Managers fails to DELEGATE?

Four Basic Methods of Nursing Care
• Functional Nursing

• Total Care or Case Method • Team Nursing
• Primary Nursing

Functional Nursing
 Task oriented in which particular nursing function is assigned to each workers
 This method divides the work to be done with each person being responsible to the Head Nurse or Senior Nurse  The best system to use when there are many patients and professional nurses are few. Advantages' 1. It allows most work to be accomplish in a short possible time 2. Workers learn to work fast 3. They gain skills faster in the particular task

Functional Nursing
Disadvantages:  Holistic care is not achieved  Nurse's accountability are diminished  Patient cannot identify who their “real nurse”  Nurse patient is not fully developed
 It is difficult to find a specific person who can answer the patient’s or relative’s questions

Head / Senior Nurse

R.N. Medication

R.N. Treatment

Nsg. Attendant Hygienic Care

Housekeeper Linen Attendant

Patients

Lines of Authority

Head / Senior Nurse

Staff Nurse Patient Total Care / Case Nursing

Ö In the Total Care or Case Method of nursing care one nurse is assigned to one patient for the delivery of total care. Ö The nurse plans, coordinates, implements, evaluates and documents the nursing care Ö The nurse is accountable for his/her own actions. Ö He/she provides holistic care to the patients

Charge Nurse Team Leader

Staff Nurse Clients

Team Nursing

TEAM NURSING
• • • • Decentralized system giving care through participative effort Assigning patients and task according to job description Leader has the responsibility for coordinating the total care of a group of patient (Team Conference – the heart of team nursing) If not fully implemented, it can lead to fragmentation of care

Physician

Head Nurse

Hospital and Community Resources

Primary Nurse Patient/ Client

Secondary/ Ass. Nurse PM

Secondary/ Ass. Nurse Nite

Secondary/ Ass. Nurse Relief

Lines of Authority in Primary Nursing

 Each registered nurse is responsible for the total care of small group of patients from admission to discharge.  Since primary nurse assumes a 24 hours responsibility for nursing care, secondary or associate nurse executes the nursing care during afternoon, night and on days when primary nurse is off duty.  Authority, autonomy and accountability rest with the primary nurse.  The primary nurse is responsible for in caring for 4 to 6 patients on a 24 hour basis throughout the hospitalization  Patient are provided with continuous care even when the primary nurse is off duty.

Modular Method  Modification of team and primary nursing RN provide direct nursing care with assistance of aides Case Management  The case manager is responsible for assessment of patient and family

Supervis ion

 “Supervide” which means to “Oversee or View Directly”  Providing guidelines for the completion of a task or activity with initial direction and periodic inspection.  It is the active process of directing, guiding and influencing the outcome of a person’s performance of an activity  It “appraises” Techniques in SUPERVISION:  OBSERVATION WHILE MAKING THE ROUNDS  SPOT CHECKING THE CHART  ASKING THE PATIENT ABOUT THE CARE THEY RECEIVE  LOOKING INTO THE GENERAL CONDITION OF THE UNITS  GETTING FEEDBACK FROM CO-WORKERS

What are the Good Qualities if Supervision?
• Good Technical Skills • Ability to communicate • Firmness with flexibility to adjust to the needs of the situation • Fairness in dealing with the situation • Good decision making skills • Willingness to grow and develop • Pleasing personality • Ability the motivate employee • Advocacy for nurses and nursing

Reginald was terribly overweight, so his doctor placed him on a strict diet. "I want you to eat regularly for two days, then skip a day, and repeat this procedure for two weeks. The next time I see you, you'll have lost at least five pounds," his doctor assured him.

When Reginald returned he shocked his doctor by having lost almost twenty pounds. "Why, that's amazing," the doctor said, greatly impressed. "You certainly must have followed my instructions." Reginald nodded, "I'll tell you what though, I thought I was going to drop dead on the third day."
"Why, from hunger?" asked his doctor. "No, from all that skipping. Lesson: A different perspective can yield better results. Therefore, learn to be open to all possibilities. Do not short-change potential results with narrow, limited thinking.

LEADING
Leading ad defined by Webster means “to guide to go before and show the way”. Leadership in nursing is necessary to guide nursing personnel to a specific goal.

What is that GOAL???
To provide quality nursing care to the patient.

Leadership is the act of developing people.

WHAT IS THE DIFFERENCE BETWEEN LEADERS AND MANAGERS????

LEADERS AND MANAGERS
 A manager is a title that can be given that signifies a position – a leader is a title that other people give you.  Managers Demand Respect – Leaders Command Respect  Managers Have Subordinates – Leaders Have Followers  Managers administer - Leaders innovate  Managers demand - Leaders command  Managers maintain - Leaders develop  Managers focus on systems – Leaders focus on people  Managers strive for control – Leaders inspire trust  Managers have short-term view – Leaders have a long-term goal  Managers are focused on the bottom line – Leaders are focused on potential  Managers imitate - Leaders originate  Managers do things right – Leaders do the right thing

“All Managers are Leaders, but all Leaders are not Managers.”
What are the GOOD Qualities of a LEADER?
Leadership style:  Autocratic  Democratic  permissive

AUTOCRATIC LEADERSHIP
• This is all called directive or bureaucratic. In its most extreme form it implies a leader who uses coercion in the exercise of his/her power. • Autocratic leadership style is often considered the classical approach. It is one in which the manager retains as much power and decision-making authority as possible. The manager does not consult employees, nor are they allowed to give any input. Employees are expected to obey orders without receiving any explanations. The motivation environment is produced by creating a structured set of rewards and punishments. • This leadership style has been greatly criticized during the past 30 years. Some studies say that organizations with many autocratic leaders have higher turnover and absenteeism than other organizations.

Studies say that autocratic leaders:
--Rely on threats and punishment to influence employees --Do not trust employees --Do not allow for employee input Yet, autocratic leadership is not all bad. Sometimes it is the most effective style to use.

Autocratic leadership style is effective when:
--New, untrained employees who do not know which tasks to perform or which procedures to follow --Effective supervision can be provided only through detailed orders and instructions --Employees do not respond to any other leadership style --There are high-volume production needs on a daily basis

--There is limited time in which to make a decision
--A manager’s power is challenged by an employee --The area was poorly managed --Work needs to be coordinated with another department or organization

The autocratic leadership style should not be used when: --Employees become tense, fearful, or resentful --Employees expect to have their opinions heard --Employees begin depending on their manager to make all their decisions --There is low employee morale, high turnover and absenteeism and work stoppage

D e m o c r at I c
 Democratic leadership is people oriented. It focuses on human aspects and builds effective teamwork. Interaction between the leader and the subordinate is open, friendly and trusting.  The democratic leadership style is also called the participative style as it encourages employees to be a part of the decision making. The democratic manager keeps his or her employees informed about everything that affects their work and shares decision making and problem solving responsibilities. This style requires the leader to be a coach who has the final say, but gathers information from staff members before making a decision.  Democratic leadership can produce high quality and high quantity work for long periods of time. Many employees like the trust they receive and respond with cooperation, team spirit, and high morale.

Typically the democratic leader:
--Develops plans to help employees evaluate their own performance --Allows employees to establish goals --Encourages employees to grow on the job and be promoted --Recognizes and encourages achievement. Like the other styles, the democratic style is not always appropriate. It is most successful when used with highly skilled or experienced employees or when implementing operational changes or resolving individual or group problems. The democratic leadership style is most effective when: --The leader wants to keep employees informed about matters that affect them. --The leader wants employees to share in decision-making and problem-solving duties. --The leader wants to provide opportunities for employees to develop a high sense of personal growth and job satisfaction. --There is a large or complex problem that requires lots of input to solve. --Changes must be made or problems solved that affect employees or groups of employees. --You want to encourage team building and participation.

Laissez-Faire Leadership Style
The laissez-faire leadership style is also known as the “hands-off¨ style. It is one in which the manager provides little or no direction and gives employees as much freedom as possible. All authority or power is given to the employees and they must determine goals, make decisions, and resolve problems on their own. This is an effective style to use when:
--Employees are highly skilled, experienced, and educated. --Employees have pride in their work and the drive to do it successfully on their own. --Outside experts, such as staff specialists or consultants are being used

This style should not be used when:
--It makes employees feel insecure at the unavailability of a manager. --The manager cannot provide regular feedback to let employees know how well they are doing. --Managers are unable to thank employees for their good work. --The manager doesn’t understand his or her responsibilities and is hoping the employees can cover for him or her.

Leadership POWER

An essential part of leadership or management is to influence the people you manage so that they do what you want them to do. The influence of a leader will depend on a variety of factors including their personality and of those around them. For the purposes of this article we will refer to the people that the leader is managing or leading as followers. The influence of a leader over his followers is often referred to as power. Below we will explore the different types of power a leader may have.

Reward Power
• This type of influence is created when the leader is able to offer a reward to his followers for completing tasks/behaving in a certain manner. Rewards in the workplace can take a variety of forms from chocolates, gift vouchers and holidays to promotions, commission and pay rises.
• This type of power needs to be used carefully to prevent followers becoming accustomed to rewards and refusing to complete routine tasks without a reward. Generally rewards should not be offered, to follower employees to complete duties which are a normal part of their role. This is because as an employee they are under a contractual obligation to complete these tasks and they are already rewarded for this through their salary.

Coercive Power
• This is the opposite of reward power because this power is based on the leader having control over what happens if followers do not act as required. If followers do not undertake the action required, the leader will impose a penalty. Penalties take a variety of forms including withdrawal of privileges, job losses, verbal abuse, and delayed or loss of promotion. In all cases the leader will need to choose the penalty carefully to prevent breaking the law or being the subject of an employment tribunal.
Coercive powers should be used carefully; overuse can lead to unhappy employee followers. Unhappy followers can be negative or unmotivated, they may resign or adopt a “work to rule” attitude. Work to rule is where employees refuse to undertake any duties (or adopt working practices) that are not stated in their contract.



Legitimate Power This is the power that a leader has when the followers believe that the leader has “a right” to instruct them and that they have an obligation to follow instructions. Sometimes legitimacy power is created by the leader’s job title (such as captain, doctor, or area manager), combined with the follower’s belief that the job title gives the leader the right to give them orders. Referent Power This is created when the followers believe that the leader possess qualities that they admire and would like to possess. The followers identify with their leader and attempt to copy their leader. As referent power is dependant on how the follower views the personality of their leader, a leader will not have referent power over every follower they lead. Some leaders will have referent power over just a few, whilst others such as Ghandi have lead millions through their personality and charisma.

Expert Power As the title suggests a leader has expert power when the followers believe that the leader has “expert” knowledge or skills that are relevant to the job or tasks they have to complete. Often an experienced member of the team or staff in an organisation, can have expert power even though they are not a supervisor or manager.

• Reward power needs follower to believe leader will reward them. • Coercive power needs follower to believe leader will punish them. • Legitimate power needs follower to believe leader has right to instruct them. • Referent power need follower to believe leader has desirable qualities. • Expert power need follower to believe leader is an expert.

“Trust men and they will be true to you; treat them greatly and they will show themselves to be great.”

MOST LIKELY OUTCOMES OF LEADER POWER & INFLUENCE • RESISTANCE
COERCIVE

• COMPLIANCE
LEGITIMATE REWARD

• COMMITMENT
EXPERT REFERENT

EXPERT POWER
– – – – ACT CONFIDENT AND DECISIVE KEEP INFORMED DON’T THREATEN SUBORDINATES’ SELF-ESTEEM – BE APPROACHABLE WILLING TO SHARE YOUR KNOWLEDGE WITH OTHERS

REFERENT POWER
– TREAT SUBORDINATES FAIRLY – DEFEND SUBORDINATES’ INTERESTS – BE SENSITIVE TO SUBORDINATES’ NEEDS & FEELINGS

LEGITIMATE POWER
– – – – BE CORDIAL, POLITE, AND CONFIDENT MAKE APPROPRIATE REQUESTS FOLLOW PROPER CHANNELS EXERCISE POWER REGULARLY AND ENFORCE COMPLIANCE

REWARD POWER
– VERIFY COMPLIANCE AND ACCOMPLISHMENTS – OFFER REWARDS FOR DESIRED ACTIONS AND BEHAVIORS – OFFER CREDIBLE REWARDS THAT ARE DESIRED BY SUBORDINATES

COERCIVE POWER
– INFORM SUBORDINATES OF RULES AND PENALTIES – UNDERSTAND THE SITUATION BEFORE ACTING & WARN BEFORE PUNISHING – ADMINISTER PUNISHMENT CONSISTENTLY & PUNISH IN PRIVATE

Theories of Leadership
• Situational Leadership in this approach the leader behaves according to a given situation which may vary from one setting to the other. The theory considers a person’s qualities and motivation, the role expectations of the group, and the social forces at work such as the external factors that bring forth the leadership potentials. • “Contingency” leadership style is one in which the leader’s style matches the situation and its needs.

FIVE KINDS OF LEADERS
1. 2. 3. 4. 5. The natural leader who become a leader in spite of himself or herself The charismatic leader who is an authentic hero in the eyes of his followers The rational leader who is consistent and persistent in what he/she thinks is right The consensus leader who is perceived to be acceptable to all The leader by force who dominate by force and fear.

• The Trait Theory of Leadership describe the
personal and mental characteristics which are associated with successful leaders. Trait theory is based on the belief that leaders are born with certain qualities. • Leaders are gifted with certain qualities that are developed and show in their ability to get along with people, persuade them to course of action. • Similar in some ways to "Great Man" theories, trait theories assume that people inherit certain qualities and traits that make them better suited to leadership.

The GREAT MAN Theory
• assume that the capacity for leadership is inherent – that great leaders are born, not made.
• These theories often portray great leaders as heroic, mythic and destined to rise to leadership when needed. • The term "Great Man" was used because, at the time, leadership was thought of primarily as a male quality, especially in terms of military leadership. Learn more about the great man theory of leadership.

Servant Leadership
• Robert Greenleaf • Servant Leadership is a recent theory of leadership that argues that the most effective leaders are “servants of their people” • Servant leaders get results for their organization through whole-hearted attention to their followers and followers’ needs. Unlike many approaches to leadership, which offer suggestions on how top-level leaders can influence and motivate those further down the hierarchy, servant leaders puts its emphasis on collaboration, trust, empathy and ethics. • The leader should be a servant first, leading from a desire to better serve others and not to attain more power. The assumption is that if leaders focus on the needs and desires of followers, follower will reciprocate through increased teamwork, deeper engagement and better performance. • Ten Characteristics of SERVANT Leader: listening, empathy, healing, awareness, persuasion, conceptualization, foresight, stewardship,

Charismatic Leader
• Charismatic leadership is leadership based on the leader's ability to communicate and behave in ways that reach followers on a basic, emotional way, to inspire and motivate • It's difficult to identify the characteristics that make a leader "charismatic", but they certainly include the ability to communicate on a very powerful emotional level, and probably include some personality traits. • Developing "charisma" is difficult, if not impossible for many people, but luckily charismatic leadership is not essential to be an effective leader. Many other characteristics are involved in leading effectively, and there is significant evidence to indicate that it simply is not necessary to have this elusive charisma to lead others well.

Co mmu ni c atI on
• Communication is the transmission of information, opinions and interactions between and among individuals.
• Communication facilitates work, increases motivation, effect change, optimizes patient care, increase workers satisfaction and facilitates coordination. • It helps promote trust between the health personnel

Principles of Effective Communication
• Clear lines of communication serve as the linking process by which parts of the organization is unified towards achievement. • Simple, concise and exact messages ensures understanding of the message to be conveyed. • Feedback is essential to effective communication. • A managers communication thrives best in a supportive environment which encourage positive value among its personnel. • A managers communication skills is vital to the attainment of the goal of the organization. • Adequate and timely communication of work related issues or

UPWARD To Supervisor

HORIZONTAL
Peers and the Members of the Healthcare Team

NURSE

OUTWARD
Patient, Family, Community

DOWNWARD Subordinates

Downward Communication The traditional line of communication is from superior to subordinates which may pass through level of management. Upward Communication Upwards communication emanates from the subordinates and goes upward. Upward communication does not flow as easy as the downward communication. Horizontal Communication Flows between peers, personnel or departments on the same level. Outward Communication Deals with information that flows from the caregiver to the patients, their families, relatives, visitors and the community. Outward communication also involves how employee value their work.

Coordination
• Unites personnel and services towards a common objective. Synchronization of activities among the various services or departments enhances collaborative efforts resulting in efficient, smooth and harmonious flow of work. • Promotes overlapping of functions, promotes good working relationship and work schedule are accomplished as targeted.

Coordination
• • • • • • • • • Coordination with the Medical service Coordination with the Administrative Service Coordination with the Laboratory Services Coordination with the Radiology Service Coordination with the Pharmacy Service Coordination with the Dietary Service Coordination with the Medical Social Services Coordination with the Medical Records Servives Coordination with the Community Agency, Other Institution and Civic Organization

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