LM

Leadership and Management
Definitions
Leadership is the ability to influence people.
Management is the process of getting work done
through others.
Comparison
LEADER MANAGER
 May not have
delegated authority.
 Obtains power
through influence
 Possess a wide
variety of roles
 May not be a part of
the formal
organization
 Focus on group
process, information
gathering, feedback,
& empowering others.
 Emphasize
interpersonal
relationships
 Direct willing
followers
 Have goals that may
or may not reflect the
formal organization
 Have assigned position
within organizations
 Obtain power through
delegated authority
 Expected to carry out
specific functions
 Always a part of the
formal organization
 Emphasize control,
decision making,
decision analysis &
results.
 Manipulate people and
resources to achieve
goals
 Direct willing and
unwilling subordinates
 Have greater formal
responsibility &
accountability for
control


14 Management Principles
Henri Fayol
1. Division of work: allows specialization. Individuals
build up experience and improve their skills making
them more productive.
2. Authority: right to command balanced with
responsibility and accountability
3. Discipline: employees will only obey orders if
management play their part by providing good
leadership.
4. Unity of command: there should only be one boss
with no conflicting lines of command.
5. Unity of direction: people engaged in the same
kind of activities must have the same objectives in a
single plan.
6. Subordination of individual interest to general
interest: the goals of the firms are always
paramount.
7. Remuneration: payment is an important motivator.
8. Centralization or Decentralization: this depends
on the condition of the business and the quality of its
personnel
9. Scalar chain/line of authority: refers to the number
of levels in the hierarchy. It should not be over
stretched and consist of too many levels
10. Order: both material order (minimizes lost time &
useless handling of materials) and social order
(achieved through organization and selection) are
necessary.
11. Equity: a combination of kindness and justice is
needed. Employees should be treated well to
achieve equity.
12. Stability of tenure of personnel: job security and
career progress are important for employees to work
better. High turnover affects the organization
adversely
13. Initiative: allow personnel to show their initiative, it
may be a source of strength for the organization.
14. Esprit de corps: management should foster the
moral of employees. There is a need to coordinate
effort, encourage keenness, use each person’s
abilities, and reward each one’s merit w/o arousing
jealousies and disturbing harmonious relations.
Theories of Management
 Frederick Taylor: Theory of Scientific
Management states that work should be studied
scientifically to determine the method of task
performance that would yield maximum work output
with minimum work expenditure.
 Henri Fayol: 14 Principles of Management
 Max Weber: Theory of Social and Economic
Organization advocated bureaucracy
 Mary Follett: emphasized training and suggested
that manager and employees should analyze the
situation and take orders from the situation.
 Elton Mayo & Fritz Roethlisberger: much more
than the physical environment affects work
productivity. Factors such as support from fellow
workers, norms established by work group,
opportunity to participate in decision making &
recognition are important.
 Kurt Lewin: Field Theory of Human Behavior
describes the process of attitude and behavior
change which are unfreezing, changing, and
refreezing.
 Douglas McGregor: Theory X and Theory Y.
Theory X assumes that the average individual
dislikes work & will avoid it, prefers to be directed, &
more interested in financial than personal gains
therefore they must be force & threatened. Theory Y
assumes that work is as natural as play, workers
have self control and self direction, and accepts
responsibility.
 Frederick Herzberg: Two-factor Theory identified
two factors which motivate employees. Motivators or
satisfiers include achievements, recognition,
possibility for growth, and status. Hygiene or
maintenance factors or dissatisfiers are salary,
supervision, job security, working conditions, and
interpersonal relations.
 Chris Argyris: The rigid structure and stringent
rules of bureaucracy block normal maturational
changes and encourages passivity & dependency
therefore diminishing job satisfaction.
 Rensis Likert: System 4 Approach to
Organizational Development – superiors and
subordinates demonstrate trust in each other,
information flows freely, group participation,
decisions made at all levels
 Herbert Simon: Two approaches to decision
making – Optimizing approach used by the
economic man where he seeks to achieve the
greatest possible gain from each management
decision. Satisficing approach used by the
administrative man where one looks not at the best
solution to a problem but one that is good enough.
 Alvin Toffler: emphasized the increasing speed of
change and the too rapid arrival of the future leading
to “future shock”, a physical and psychological
distress process. People must design personal and
change regulators to decelerate change by
modifying reactions.
 Henry Mintzberg: identified the manager’s roles as
interpersonal, informational, and decision roles.
 William Ouchi: Theory Z involves lifetime
employment, collective decision making, decision
from within, non-specialized career paths.

Management Process
Planning: thinking ahead and making future projections
to achieve desired results. It involves:
1. Forecasting
2. Setting objectives
3. Developing schedules and programs
4. Preparing budgets and allocating resources
5. Establishing policies and procedures

Management Process
Organizing: establishing formal authority. It involves:
1. Setting up the organizational structure
2. Determining the staff needed
3. Developing job descriptions

Directing or leading: actuating efforts to accomplish
goals. It involves:
1. Decision making
2. Developing people
3. Communicating
4. Coordinating
5. Supervising
6. Utilizing, revising, & updating policies
7. Delegating
8. Conflict management

Controlling: assessing and regulating performances. It
involves:
1. Specifying criteria and standards
2. Monitoring and evaluating.
3. Performance appraisal
4. Total quality management



PLANNING
Ma. Irma C. Bustamante, RN, PhD

Planning is deciding in advance what to do; who is to do
it; and how, when, and where it is to be done.

Planning Together

Kinds of planning
Strategic planning or long range planning extends from
3 – 5 years.

Operational planning or short range planning extends
from a few months to a year.
Strategic planning

Purposes – It clarifies the following:
1. Beliefs and values
2. Strengths and weaknesses
3. Opportunities and threats
4. Direction of the organization
EFFICIENCY

Strategic planning process
Situational analysis
Development of:
1. Purpose or mission statement
2. Philosophy
3. Vision
4. Goals
5. Objectives

Organizations exist for a purpose. The mission is a
brief statement identifying the reason why an
organization exists and its future aim or function. This
statement identifies the organization’s constituency and
addresses its position regarding ethics, principles, and
standards of practice.

The philosophy flows from the mission statement and
delineates the set of values and beliefs that guide all
actions of the organization. It is the basic foundation that
directs all further planning towards the mission.

A value is a quality having intrinsic worth for a society or
an individual.

Vision provides a picture of the future. It is an
imagination or a dream.
Healthy visions:
1. Stretch the possible
2. Are grounded in reality
3. Require courage
4. Are based on sound values and ethics

Goals and objectives are the ends toward which the
organization is working. All philosophy must be
translated into goals and objectives if they are to result
into action. Thus, goals and objectives operationalize the
philosophy.

A goal is the desired result toward which effort is
directed.

Objectives motivate people to specific end and are
explicit, measureable, observable,retrievable and
attainable.

Example: BON Mission
MISSION
The BON shall unwaveringly pursue the
advancement of nursing development in the country
by:
1. Providing leadership, information, options,
scenarios and lobby efforts to targeted
decision makers and stakeholders
2. Ensuring adherence to professional, ethical
and legal standards as mandated by existing
regulatory laws
3. Unifying the nursing sector through good
governance
4. Fostering linkages with the domestic and
international stakeholders
Example: BON Core Values
CORE VALUES
1. Love of God
2. Caring as the core of
nursing
Compassion
Competence
Confidence
Conscience
Commitment
Example: BON Core Values
CORE VALUES
3. Love of People
Respect for the dignity of persons regardless of
race, color, or creed
4. Love of Country
Patriotism
Civic duty, social responsibility
and good governance
Preservation and enrichment of our
culture and environment
Example: BON Vision
VISION
The Board of Nursing under the guidance of the
Almighty, with its unquestionable integrity and
commitment, envisions itself to be the ultimate
authority in regulating the nursing profession in the
Philippines and to lead nursing development to its
highest level of excellence.

Forecasting
Forecasting is estimating the future.
It is setting the outline of work to be done.
It is the primary process of selecting and relating facts,
making use of assumptions regarding the future, and
formulating activities necessary to achieve the desired
results.

Policies
Policies are plans reduced to statements or instructions
that direct organizations in their decision making.
They are derived from the organization’s philosophy,
goals, and objectives.
They direct individual behavior towards the
organizational mission and define broad limits.
It provides management with a means of internal control.

Policies
Implied policies are neither written nor expressed
verbally. They are developed over time and follow a
precedent.

Expressed policies are delineated verbally or in writing.
They promote consistency of actions.

Procedures
Procedures are plans that establish customary or
acceptable ways of accomplishing a specific task and
delineate a sequence of steps of required action.
They identify the process needed to implement the
policy.
They are found in manuals of the organization.

Programs
A program is a planned sequence and combination of
activities designed to achieve specified goals.
It normally involve: equipment, materials, money,
personnel, and time.
The term project is often used interchangeably with
program in the academic circle.

Budget
A budget is an itemized summary of probable expenses
and income for an organization over a period of time.
The outcome of budgeting is maximal use of resources
to meet organizational short and long term needs.

Types of budgets
Personnel budget: expenditure used for the work force

Operating budget: reflects expenses that change in
response to the volume of service. It includes daily
expenses, cost of electricity, repairs, maintenance, and
supplies.

Capital expenditure budget is composed of major
actuations and short term budgeting components.
Examples are purchase of buildings, major equipments
that has long life (5 to 7 years).

Types of budget system
Centralized budgeting: budgets are derived and
imposed by the comptroller and administration of the
organization.

Decentralized budgeting: budgets are prepared by
those who must implement them e.g. middle level
managers.

Approaches to budget development
Open-ended budget: managers are given no explicit
guidelines regarding budget amounts and are allowed to
submit whatever amounts they consider necessary to
run the department.

Fixed-ceiling budget: is constrained by the amount that
is specifically stated for each department

Work measurement and unit costing: requires that a
measuring criterion be established to determine the
number of products or service units to be generated,
based on this, the cost per unit can be determined and
the budget projected.

Performance based budgeting (PBB): use statements
of missions, goals and objectives to explain why the
money is being spent. It is a way to allocate resources to
achieve specific objectives based on program goals and
measured results. The elements are:
1. Result: the final outcome
2. Strategy: ways to achieve the final outcome
3. Activity/outputs: what is actually done to achieve the
final outcome.

Zero based budgeting (ZBB): a method where all
expenses must be justified for each new period. It starts
from a "zero base" and every function within an
organization is analyzed for its needs and costs.
Budgets are then built around what is needed for the
upcoming period, regardless of whether the budget is
higher or lower than the previous one.

Allocation of resources
Allocation of resources involves the minimal use of
money, manpower, materials, machines, space and time
(moment) to get the job done in a specified period.

Cost effectiveness
Cost effectiveness is the result of careful fiscal
planning.
It does not mean inexpensive.
It means getting the most for your money or that the
product is worth the price.
A beautiful quote
Even the most rational approach
is defenseless
if there isn’t the will to do what is right.
Aleksandr Isayevich
Solzhenitsyn
Russian Novelist
Nobel Prize in Literature
(1970)


Organizing
Ma. Irma C. Bustamante, RN, PhD

Organizational structure
An organizational structure refers to the way a group
is formed, its lines of communication, and its means for
channeling authority, and making decisions.
Each organization has a formal and an informal
organizational structure.

The formal structure is generally highly planned and
publicized.
It provides a framework for defining managerial
authority, responsibility, and accountability.
Roles and functions are defined and systematically
arranged, different people have different roles, rank and
hierarchy are evident.

Informal structure is generally social in nature with
blurred or shifting lines of authority and accountability.
People need to be aware that informal authority and
lines of communication exist in every group, even when
they are never formally acknowledged.

Types of organizational structures
Bureaucratic organizational designs are commonly
called line structures or line organizations.
Authority and responsibility are clearly defined which
leads to efficiency and simplicity of relationships.
Bureaucratic structure

Types of organizational structures
The ad hoc design is a modification of the bureaucratic
structure and is sometimes used on a temporary basis to
facilitate completion of a project within a formal line
organization.
It is a means of overcoming the inflexibility of line
structure and serves as a way for professionals to
handle the increasingly large amount of information.

A hierarchical organizational structure is a pyramid
shaped systems that arranges the relations between the
entities within an organization in a top-down way.
Power, responsibility, and authority are concentrated at
the top of the pyramid and decisions flow from the top
downwards.

Hierarchical/Pyramidal

A matrix organization structure is designed to focus on
both product and function.
Function is described as all the tasks required to
produce the product.
The product is the end result of the function.
Typical Matrix Structure
Matrix Organization

Flat organizational designs are an effort to remove
hierarchal layers by flattening the scalar chain and
decentralizing the organization.
More decision making and authority can occur where the
work is being carried out.
Flat Organizational Structure

Shared governance’s aim is the empowerment of
people in the decision-making system.
The organization’s governance is shared among board
members, nurses, physicians, and managers.
Participatory management is the foundation for shared
governance.

Staffing
Staffing is the process of determining and providing the
acceptable number and mix of nursing personnel to
produce a desired level of care to meet the patient’s
demands.

Staffing involves the selection of personnel and
assignment systems and the determination of staffing
schedules.
It involves recruitment, selection, orientation, personnel
development, retention, and retirement. (in lay man’s
terms it is from hiring to firing)

Recruitment is the process of actively seeking out or
attracting applicants for existing positions.
A leadership role in staffing includes identifying,
recruiting, and hiring gifted people.

Selection is the process of choosing from among
applicants the best qualified individual (s) for a particular
job or position.
This happens after the applications were completed and
the interviews have been completed.

Introduction provides the employee with general
information about the organization, whereas orientation
activities are more specific for the position.
The purpose of the orientation process is to make the
employee a part of the team thereby increasing the
probability of productivity and retention.

Staff development is the continuing liberal education of
the whole person to develop her potential fully.
It deals with the aesthetic senses as well as spiritual,
technical and professional education.
It includes in-service, courses, conferences, seminars,
journal and book clubs, programmed learning, and
independent studies.

In-service training is the education for employees to help
them develop their skills in a specific discipline or
occupation.
Continuing education refers to the post college
education that individuals engage in to enhance their
professional growth.

Staffing
Some turnover is normal and may be desirable because
it infuses the organization with fresh ideas.
Excessive and unnecessary turnover is expensive and
may reduce the ability of the organization to achieve its
goals.

Retention may be enhanced if there is a close fit
between what the nurse is seeking in employment and
what the organization can offer.

Nursing care delivery
Case method: each patient is assigned to a nurse for
total patient care while that nurse is on duty.
Functional nursing: involves regimentation of tasks or
functions.
Team nursing: utilizes the knowledge and skills of
professional nurses to supervise auxiliary nursing staff at
different levels.

Primary nursing: features a nurse who gives total
patient care to 4 – 6 patients while she is on duty and
remains responsible for the care of those patients 24/7
throughout the patient’s hospitalization.
Private duty nursing: nurses provide total patient care
while on duty to patients who directly pay them for
professional services.

Nurse case manager: works to ensure that quality
health care is being delivered in an efficient, cost-
effective manner to individual patients as they move
from setting to setting within the health care system. A
Nurse Case Manager usually specializes in the delivery
of care to a specific population, such as adults, families,
children, the elderly, AIDS patients, patients with
cardiovascular disease, etc.


The primary role of a case manager is to coordinate the
continuity of care and to ensure that patients get the
proper treatment at the proper time to maximize health
and minimize hospitalization.

Clinical pathways delineate a predetermined written
plan of care for a particular health problem. They specify
desired outcomes and transdisciplinary intervention.
Patient classification system

Category I – Self care: requires 1 – 2 hours of nursing
care/day
Category II – Minimal care: requires 3 – 4 hours of
nursing care/day
Category III – Intermediate care: requires 5 – 6 hours
of nursing care/day
Category IV – Modified intensive care: requires 7 – 8
hours of nursing care/day
Category V – Intensive care: requires 10 – 14 hours of
nursing care/day

Job description
Job descriptions are derived from job analysis and are
affected by job evaluation and design.
They contain specifications that are the requirements for
the job, major duties and responsibilities, and the
organizational relationships of the given position.
The title of the job indicates the major responsibilities
and sets that job apart from others.
Making patient assignments
Assignments are based on:
1. Patient needs
2. Available staff
3. Job descriptions
4. Scope of practice for licensed nurses
5. Scope of functions

National League for Nurses
Formula for Staffing
ABO X NCH = Total # of Nursing
# of working hrs Service Personnel
for 24 hours
Where:
ABO = Average Bed Occupancy
NCH = Nursing Care Hours
# of working hours = 8 Based on RA 5901
The 40 Working Hours per Week Law


Formula for Staffing
Standard values for NCH
Medical = 3.4 OB = 3.0
Surgical = 3.4 Pedia = 4.6
Mixed MS = 3.5 Nursery = 2.8


Formula for Staffing
% of Professionals to Non-professionals

Formula for Staffing
% Distribution per Shift
Morning = 45%
Afternoon = 37%
Night = 18%

Staffing for an OB Ward: 30 Beds
30 X 3.0 = 11 nursing personnel
8 for 24 hours
% of Professionals to Non-professionals
Professionals: 11 X 0.6 = 7
Non-professionals: 11 X 0.4 = 4
Staffing for an OB Ward: 30 Beds
Distribution per Shift
Professionals Non-professionals
AM: 7 X 0.45 = 3 4 X 0.45 = 2
PM: 7 X 0.37 = 3 4 X 0.37 = 1
Night: 7 X 0.18 = 1 4 X 0.18 = 1
Staffing for an OB Ward: 30 Beds
Summary of Staffing: OB Ward 30 Beds

Types of Scheduling
Centralized: one person, usually the DON or a
designate assigns personnel schedule
Decentralized: the supervisor or head nurse do the
scheduling
Cyclical schedule: a cycle of shift is repeated e. g.
Afternoon to Morning to Night to Reliever
Remember
People who have given up are ruled by their darkest
mistakes, worst failures, and deepest regrets. If you
want to be successful, then be governed by your finest
thoughts, your highest enthusiasm, your greatest
optimism, and your most triumphant experiences.
John C. Maxwell


Directing
Ma. Irma C. Bustamante, RN, PhD
Leadership qualities for directing
• Ability to lead
• Ability to guide
• Ability to show the way



Types of Leaders
• Formal leader is a member of organization who has
given authority by virtue of his position to influence
other members of organization to achieve
organizational goals.
• An informal leader has no formal organizational
authority to influence others but possesses special
skills and talent to influence and lead other members
of organization.

Continuum of Leadership Behavior
Leadership theories
• Great man theory: its premise is leaders are born
and not made
• Charismatic theory: a person may be a leader
because of charisma, an inspirational quality
• Trait theory: traits are inherited but may be
improved by learning and experience. Traits are:
energy, drive, enthusiasm, ambition, decisiveness,
self-assurance, self-confidence, friendliness,
honesty, dependability, & mastery.
• Leadership theories
• Later research on trait theory found other traits:
intelligence, initiative, creativity, emotional maturity,
communication skills, persuasion, perceptive, &
sociable
• Situational theories: traits required of a leader
differ according to varying situations.
• Leadership theories
• Contingency theory: Fred Fiedler identified 3
aspects of a situation that structure the leader’s role.
They are:
1. Leader-member relations
2. Task structure
3. Position power
• Leadership theories
• Path-goal theory: (Robert House) the leader
facilitates task accomplishment by minimizing
obstruction to the goals and by rewarding
followers for completing their tasks.
• Life-cycle theory: predicts the most appropriate
leadership style from the level of maturity of the
followers
• Integrative leadership model: leadership
behavior needs to be adaptive.
•
• Transformational leadership: is a leadership
style where one or more persons engage with
others in such a way that leaders and followers
raise one another to higher levels of motivation
and morality. It was described by James
MacGregor Burns in 1978.
• “Selling style”

• Transactional leader: works through creating
clear structures whereby it is clear what is
required of their subordinates, and the rewards
that they get for following orders.
• Allocates work to a subordinate, they are
considered to be fully responsible for it, whether
or not they have the resources or capability to
carry it out. When things go wrong, then the
subordinate is considered to be personally at
fault, and is punished for their failure (just as
they are rewarded for succeeding). “Telling
style”

• Servant leadership: Greenleaf (1977) says that
true leadership "emerges from those whose
primary motivation is a deep desire to help
others." Servant leadership is a very moral
position, putting the well-being of the followers
before other goals.
•
• Principles of servant leadership defined by the
Alliance for Servant Leadership are:
• Transformation as a vehicle for personal and
institutional growth.
• Personal growth as a route to better serve
others.
• Enabling environments that empower and
encourage service.
• Service as a fundamental goals.
• Trusting relationships as a basic platform for
collaboration and service.
• Creating commitment as a way to collaborative
activity.
• Community building as a way to create
environments in which people can trust each
other and work together.
• Nurturing the spirit as a way to provide joy and
fulfillment in meaningful work.
•
• Autocratic: leader has total control
• Democratic: leader shares power with the
people
• Bureaucratic: leader bases leadership on
implementing rules
• Laissez faire: leader is permissive
• Multicratic: leader uses different styles and is
situation based
• Guess the leadership style
• Guess the leadership style
• Guess the leadership style
• Levels of Leadership:
Dr. John C. Maxwell
• Power
• Power
• Power is the ability to impose the will.
• The different forms of power are (French and
Raven, 1959)
1. Legitimate power: given by virtue of position.
Authority is the legitimate right to give commands.
2. Reward power: based on the ability to give rewards
3. Coercive power: based on the ability to give
punishment
• Power
• Forms of power…cont
4. Expert power: based on a special ability,
knowledge, or skill demonstrated by an individual. Ex.
“Knowledge is power.”
5. Referent power: based on the attractiveness or
appeal of one person to another or based on a persons
connections or relationship with another powerful
individual
• Is this true?
• Decision making
• Decision making is the process of selecting
one course of action from alternatives.
• Decision making process
• Identify the problem
• Explore alternatives
• Choose the most desirable alternative
• Implement decision
• Evaluate results
• Decision tree
• A decision tree is a graphic method that can
help visualize the alternatives available,
outcomes, risks, and information needs for a
specific problem.
Nothing is more difficult, and therefore more precious,
than to be able to decide. - Napoleon

Communication
• All management process involve
communication.
• Forms: verbal and non-verbal
• Process: Sender Message
Receiver

• Downward communication: traditional line of
communication from the superior to the
subordinate. It helps coordinate activities at
different levels.
• Upward communication: provides a means of
motivating and satisfying personnel by allowing
employee input.
• Lateral communication or horizontal
communication is between personnel of the
same level.
• Diagonal communication occurs between
individuals or departments that are not of the
same level.
• The grapevine: informal methods of
communication co-existing with formal channels.
It moves fast and is often distorted, fragmentary,
and incomplete.

• Barriers to communication:
1. Personal/emotional
2. Physical/environmental
3. Semantic
• Improving communication
1. Ideas should be clarified
2. Consider the setting
3. Be organized
4. Actions speak louder than words
5. Listen
• Conflict
• A conflict is present when an inner or an outer
struggle occurs regarding ideas, feelings or
actions.
• Conflict
• Kinds of conflict:
1. Intrapersonal – conflict within the individual
2. Interpersonal – between individuals
3. Interdepartmental – between departments
4. Intradepartmental – within departments
5. Extrainstitutional – between organizations

Conflict resolution
• Competition/Power: there is an all out effort to
win regardless of the cost. It reflects a strong
stance to defend important principles or protect
vulnerable parties.
• Smoothing: diplomatic way – relationships are
important
• Avoidance: not taking a position regarding the
conflict
• Compromise: each side makes a concession. It
is used when time pressures require quick
solution or when each party is firmly committed
to different views.
• Collaborative problem solving: a constructive
process in which the parties involved recognize
that conflicts exist, confronts the issue, and
openly try to solve the problem that has arisen
between them. It builds understanding
• Accommodation: is used when the other
person really does have a better idea.
Agreement is reached.
• Controlling
• Ma. Irma C. Bustamante, RN, PhD
• Quality control
• Quality control is a specific type of controlling
that include activities that evaluate, monitor or
regulate services rendered to consumers
• Quality control
• Effective quality control entails:
• 1. Program needs to be supported by top level
administrators.
• 2. Sincere commitment by the institution as
evidenced by fiscal and human resource
support.
• 3. Presence of a developed quality control
criteria
• Quality control process
• Determine criterion or standard
• Collect information if the standard has been met.
• Educational or corrective action is taken if the
standard has not been met.
• Standard
• A standard is a predetermined level of
excellence that serves as a guide for practice.
• Characteristics:
• 1. Predetermined
• 2. Established by authority
• 3. Communicated to and accepted by people
affected by the standard.
• Standards
• Standards of Nursing Practice: Code
• PNA of
• Standards of Safe Nursing Practice: Ethics
• ANSAP
• CMO # 5 s. 2008: CHED – TCNE PNA
• RA 9173: Nursing Law ICN
• Audits
• While standards provide the yardstick for
measuring quality, audits are measurement
tools.
• An audit is a systematic and official examination
of record, process, structure, environment, or
account to evaluate performance.
• Audits
• Retrospective audits are performed after the
client receive the service.
• Concurrent audits are performed while the
client is receiving the service.
• Prospective audits attempt to identify how
future performance will be affected by current
interventions
• Audits
• Outcome audits determine what results
occurred as a result of specific nursing
interventions to clients.
• Process audits are used to measure the
process of care and how the care was carried
out.
• Structure audit monitors the structure or setting
in which patient care occurs.
• Accreditation
• Accreditation is the voluntary process of being
certified as meeting the minimum requirements
as designated by an accrediting agency.
• It engages the organization in meeting high
quality standards, implementing a continuous
improvement process, and engaging in quality
assurance through internal and external review.
• Accreditation
• Joint Commission International, or JCI, is one
of the groups providing international healthcare
accreditation services to hospitals around the
world and brings income into the US-based
parent organisation. This not-for-profit private
company currently accredits hospitals in Asia,
Europe, the Middle East and South America,
and is seeking to expand its business further.
• Accreditation
• ISO (International Organization for
Standardization) is the world's largest
developer and publisher of International
Standards.
• ISO is a network of the national standards
institutes of 157 countries, one member per
country, with a Central Secretariat in Geneva,
Switzerland, that coordinates the system.
• Accreditation
• PACUCOA – Philippine Association of Colleges
and Universities Commission on Accreditation
• PAASCU – Philippine Accrediting Association of
Schools, Colleges, and Universities.
• Performance Appraisal
• Performance appraisal is an assessment of
how well employees perform the duties of their
job as delineated by the job description.
• If done fairly, it increases the employees
motivation because it identifies areas where one
can improve.
• Methods
• Anecdotal notes are objective descriptions of
behaviors recorded on paper.
• Rating scales locates behavior at a point on a
continuum.
• Ranking forces the appraiser to rank staff in
descending order from highest to lowest even if
she does not feel there is a difference.
• Methods
• Management by Objectives (MBO) is a tool for
effective planning and appraisal. It emphasizes
the achievement of objectives instead of
personality characteristics. It focuses attention
on individual achievement, motivates individuals
to accomplish and measures performance in
terms of results. Main
• proponent: Peter
• Drucker
• Pitfalls to avoid in appraisal
• Halo effect occurs when the appraiser lets one
or two positive aspects of the assessment or
behavior of the employee unduly influence all
other aspects of the employee’s performance.
• Pitfalls to avoid in appraisal
• Horn effect occurs when the appraiser allows
negative aspects of the employee’s performance
to influence the assessment to such an extent
that other levels of job performance are not
accurately recorded.
• Pitfalls to avoid in appraisal
• Central tendency is hesitancy on the part of the
appraiser to risk true assessment and therefore
rate all employees as average.
• Pitfalls to avoid in appraisal
• First impression error is making initial positive
or negative judgment and allow that first
impression to color or distort one’s evaluation.
• Pitfalls to avoid in appraisal
• Stereotyping error is the tendency to
generalize across groups and ignore individual
differences.
Delegation
• Delegation is the process of assigning work
from one organizational level to another or from
superior to subordinate.
• It is transferring the responsibility of performing
a nursing activity to another person while
retaining accountability for the outcome.
• Delegation
Purposes
• It is a tool that may be used by the registered
professional nurse to allow unlicensed assistive
personnel (UAP) to provide standardized routine
health services under the supervision of the
nurse when permitted by the Nurse Practice Act
and supported by the nurse’s clinical judgment
to be appropriate.
• Delegation
Purposes
• It maximizes the utilization of every health care
worker and ensure proper delegation of
responsibilities and tasks
• It uses latent abilities of personnel that
contribute to their growth and development.
• Delegation: Definitions
• Accountability: Being responsible and
answerable for actions and inactions of self or
others in the context of delegation.
• Delegator: The person making the delegation.
• Delegatee: The person receiving the delegation.
• Delegation: Definitions
• Supervision: The provision of guidance or
direction, evaluation and follow-up by the
licensed nurse for accomplishment of a nursing
task delegated to unlicensed assistive
personnel.
• Unlicensed Assistive Personnel (UAP): Any
unlicensed personnel, regardless of title, to
whom nursing tasks are delegated
• 5 Rights of Delegation
1. Right Task
One that is delegable for a specific patient.

2. Right Circumstances
Appropriate patient setting, available resources, and
other relevant factors considered.
• 5 Rights of Delegation
 3. Right Person
Right person is delegating the right task to the
right person to be performed on the right person.
4. Right Direction/Communication
Clear, concise description of the task, including its
objective, limits and expectations.
• 5 Rights of Delegation
 5. Right Supervision
Appropriate monitoring, evaluation, intervention,
as needed, and feedback.


Controlling
Ma. Irma C. Bustamante, RN, PhD
Quality control
Quality control is a specific type of controlling that
include activities that evaluate, monitor or regulate
services rendered to consumers

Quality control
Effective quality control entails:
1. Program needs to be supported by top level
administrators.
2. Sincere commitment by the institution as evidenced
by fiscal and human resource support.
3. Presence of a developed quality control criteria

Quality control process
Determine criterion or standard
Collect information if the standard has been met.
Educational or corrective action is taken if the standard
has not been met.

Standard
A standard is a predetermined level of excellence that
serves as a guide for practice.
Characteristics:
1. Predetermined
2. Established by authority
3. Communicated to and accepted by people affected
by the standard.
Standards
Standards of Nursing Practice: Code
PNA of
Standards of Safe Nursing Practice: Ethics
ANSAP
CMO # 5 s. 2008: CHED – TCNE PNA
RA 9173: Nursing Law ICN
Audits
While standards provide the yardstick for measuring
quality, audits are measurement tools.
An audit is a systematic and official examination of
record, process, structure, environment, or account to
evaluate performance.
Audits

Retrospective audits are performed after the client
receive the service.

Concurrent audits are performed while the client is
receiving the service.

Prospective audits attempt to identify how future
performance will be affected by current interventions
Audits

Outcome audits determine what results occurred as a
result of specific nursing interventions to clients.

Process audits are used to measure the process of
care and how the care was carried out.

Structure audit monitors the structure or setting in
which patient care occurs.

Accreditation
Accreditation is the voluntary process of being certified
as meeting the minimum requirements as designated by
an accrediting agency.
It engages the organization in meeting high quality
standards, implementing a continuous improvement
process, and engaging in quality assurance through
internal and external review.
Accreditation

Joint Commission International, or JCI, is one of the
groups providing international healthcare accreditation
services to hospitals around the world and brings income
into the US-based parent organisation. This not-for-profit
private company currently accredits hospitals in Asia,
Europe, the Middle East and South America, and is
seeking to expand its business further.

Accreditation
ISO (International Organization for Standardization) is
the world's largest developer and publisher of
International Standards.
ISO is a network of the national standards institutes of
157 countries, one member per country, with a Central
Secretariat in Geneva, Switzerland, that coordinates the
system.

PACUCOA – Philippine Association of Colleges and
Universities Commission on Accreditation

PAASCU – Philippine Accrediting Association of
Schools, Colleges, and Universities.

Performance Appraisal
Performance appraisal is an assessment of how well
employees perform the duties of their job as delineated
by the job description.
If done fairly, it increases the employees motivation
because it identifies areas where one can improve.

Methods
Anecdotal notes are objective descriptions of behaviors
recorded on paper.
Rating scales locates behavior at a point on a
continuum.
Ranking forces the appraiser to rank staff in descending
order from highest to lowest even if she does not feel
there is a difference.
Management by Objectives (MBO) is a tool for
effective planning and appraisal. It emphasizes the
achievement of objectives instead of personality
characteristics. It focuses attention on individual
achievement, motivates individuals to accomplish and
measures performance in terms of results. Main
proponent: Peter Drucker
Pitfalls to avoid in appraisal

Halo effect occurs when the appraiser lets one or two
positive aspects of the assessment or behavior of the
employee unduly influence all other aspects of the
employee’s performance.
Pitfalls to avoid in appraisal
Horn effect occurs when the appraiser allows negative
aspects of the employee’s performance to influence the
assessment to such an extent that other levels of job
performance are not accurately recorded.
Pitfalls to avoid in appraisal
Central tendency is hesitancy on the part of the
appraiser to risk true assessment and therefore rate all
employees as average.
Pitfalls to avoid in appraisal
First impression error is making initial positive or
negative judgment and allow that first impression to color
or distort one’s evaluation.
Pitfalls to avoid in appraisal
Stereotyping error is the tendency to generalize across
groups and ignore individual differences.

Quick Checks
Leadership and Management
Ma. Irma C. Bustamante, RN, PhD
Mrs. Agusto has just been appointed as Chief Nurse of a
150 bed hospital because she is the only one from
among the nursing service personnel with an MAN. As
such, she is a:
A. Leader
B. Manager
C. Both
D. Neither
After 6 months of service, with good performance, Miss
Rosario has been classified as permanent employee.
This is in line with which management principle?
A. Scalar chain
B. Remuneration
C. Equity
D. Stability of tenure
The process of attitude and behavior change described
as unfreezing, change, and refreezing was developed
by:
A. Kurt Lewin
B. Frederick Taylor
C. Douglas McGregor
D. Alvin Toffler
When Mrs. Agusto engages in setting objectives and
preparing the budget for the nursing service department,
she is doing:
A. Planning
B. Organizing
C. Directing
D. Controlling
Mrs. Agusto called for a meeting with the supervisors to
discuss understaffing and the need to hire new nurses.
They are engaging in:
A. Planning
B. Organizing
C. Directing
D. Controlling
To be able to provide a temporary remedy to
understaffing, Mrs. Agusto delegated her supervisors to
have the nurses on the floors divide the tasks to finish
the work. What nursing care delivery has been utilized?
A. Case method
B. Functional method
C. team Nursing
D. Primary nursing
What style of leadership is being utilized by Mrs.
Agusto?
A. Autocratic
B. Bureaucratic
C. Democratic
D. Laissez faire
Miss Manuel, one of the supervisors, decided to hold a
journal club in her units once a week. Which aspect of
directing is involved?
A. Coordinating
B. Developing people
C. Communicating
D. Supervising
How can Miss Manuel identify the weaknesses and
strengths of the nurses under her supervision?
A. Through performance appraisal
B. Through interviews with doctors
C. Through interviews with patients
D. Through a course audit
Mrs Agusto has been hearing unfavorable stories about
one of her head nurses. These came from the staff and
some nursing aids. This communication is:
A. Downward communication
B. Lateral communication
C. Diagonal Communication
D. Grapevine