CONTROLLING DEFINITION: - Is the use of formal authority to assure the achievement of goals and objectives.

- Here, performance is measured and corrective action is taken to ensure the accomplishment of organizational goals. - It involves assisting, regulating, monitoring, and evaluating individual and group performance. Management control have a negative connotation since it can sound dominating, coercive and heavy-handed. Coordinating is mostly preferred ---- thus coordinating is Controlling The control or coordinating function of management can be a critical determinant of organizational success.

FUNCTIONS of Control - - - It serves as a means and an end. It promotes effective use of resources, provides professional reinforcements, and maintains activity and expectations.

PRINCIPLES: There must be: 1. A critical few, meaning that fewer people involved in control brings about the best results. 2. A defined Point of Control or a centralization and decentralization of authority. 3. Self-control or Discipline, which translate to personal acceptance of responsibility and accountability.

KINDS OF FORMAL CONTTROL: 1. Pre-action Control This is controlling by means of personal supervision and utilizing control checks consisting of procedures for any given task or function. 2. Post-action Control This is controlling as the task or function is being performed or may have been performed and correcting deviations from standards or plans.

TYPES OF CONTROL: 1. Feedforward Controls - Focus on operations before they begin. Their goal is to prevent anticipated problems. - Ex. Preparing all supplies and equipment for a scheduled wound dressing, or bedside lumbar tap, IV insertion, among others, in order to determine what is lacking and other things to be done. o Regular maintenance feeds forward to prevent problems. o Other examples include safety systems, training programs, and budgets. 2. Concurrent Controls - Apply to processes as they are happening. - Enacted while work is being performed include any type of material or supplies for therapeutic care which requires direct supervision or the use of automated systems such as computers programmed to inform the user when they have issued the wrong command, and organizational quality programs and resources. 3. Feedback Controls - Focus on the results of operations. They guide future planning, inputs and process designs. - Examples timely reports so that almost instantaneous adjustments can be made.

CHARACTERISTICS OF EFFECTIVE CONTROLS: 1. Control systems must be designed appropriately to be effective. 2. When control standards are inflexible or unrealistic, employees cannot focus on the organizations goals. 3. Control systems must prevent, not cause, the problems they were designed to detect. Performance variance can also be the result of an unrealistic standard. The natural response of employees whose performance falls short is to blame the standard is appropriate, then it is up to the supervisor to stand his or her ground and take the necessary corrective action. DESIGNING EFFECTIVE CONTROL SYSTEMS Anything that can be planned can be controlled. Controls should primarily serve the need for which they are intended. Here are guidelines for designing effective control systems. 1. Control at all levels in the health care delivery system. All nursing units must have a standard control system. 2. Acceptability of those who will enforce decisions. The nurse managers manner of influence to her staff to comply with the policies or procedures. 3. Flexibility of the enforcers and the implementors to enforce decisions based on practical situations. 4. Accuracy. Steps or mechanisms of control must be clear and vivid with significant implications.

5. Timeliness. Activities are planned with time target set. 6. Cost effectiveness. Resources used are well maintained and enough or adequate to meet the needs of the unit. 7. Understandability. Policies and procedures are simple, easy to understand and can be implemented with less difficulty. 8. Balance between objectivity and subjectivity. Theory and practice-based system. 9. Coordinated with planning, organizing and leading. THE CONTROL PROCESS The control process is a continuous flow between measuring, comparing and action. STEPS: 1. Establish and Specify Criteria and Performance Standards These serve as the criteria against which performance is measured, and give an idea of the level of performance that managers can expect of a person. This consists of the following: A. Standards - Are created when objectives are set during the planning process. - Is a precise, explicit statement of expected results from a product, service, machine, individual, or organizational unit. - Is any guideline established as the basis for measurement.

- Is usually expressed numerically and is set for quality, quantity, and time. - Tolerance is permissible deviation from the standard.
B. Time Controls relate to deadlines and time constraints.

Material controls relate to deadlines and material-yield controls. Equipment controls are built into the machinery, imposed on the operator to protect the equipment or the process. Cost controls help ensure cost standards are met. Employee performance controls focus on actions and behaviors of individuals and groups of employees. Ex. Tardiness, absences - C. Financial controls facilitate achieving the organizations profit motive. One method of financial controls is budgeting. Budgets allocate resources to important activities and provide supervisors with quantitative standards against which to compare resource consumption. They become control tools by pointing out deviations between the standard and actual consumption. D. Operations Control Operations control methods assess how efficiently and effectively an organizations transformation processes create goods and services. Methods of transformation controls include Total Quality

Management (TQM) statistical process control and the inventory management control. E. Statistical Process Control Statistical process control is the use of statistical or mathematical methods and procedures to determine whether production operations are being performed correctly, to detect any deviations, and to find and eliminate their causes. A control chart displays the results of measurements over time and provides a visual means of determining whether a specific process is staying within predefined limits.

F. The Just-in-Time (JIT) System The Just-in-Time System is the timely application of medication for the illness of a patient, and purchased materials just in time to be transformed into parts. Communication, coordination, and cooperation are required from supervisors and employees to deliver the smallest possible quantities at the latest possible date at

all stages of the transformation process in order to minimize inventory costs. 2. Monitor and Measure Performance of Nursing Care Services and Evaluate it against the Standards through Records, Reports and Observations. Different Techniques for Monitoring and Measuring Service: a. Nursing Rounds - pay particular attention to issues of patient care and nursing practice. This will aslo satisfy needs and problems met or unmet. b. Quality Assurance monitors compliance with established standards. c. Nursing Audit consists of documentation of the quality of nursing care in relation to the standards established by the nursing department. Purposes: It prioritizes nursing care by promoting optimum nursing care. It can identify deficiencies in the organization and administration of nursing care, and may be used to correct such deficiencies through education and administrative change. It may also be used to increase performance to assure that improvements have been maintained.

Supervisors collect data to measure actual performance to determine variation from standard. Written data might include time cards, production tallies, inspection reports, and sales tickets. Personal observation, statistical reports, oral reports and written reports can be used to measure performance. employees working, provides unfiltered information, extensive coverage, and the ability to read between the lines. While providing insight, this method might be misinterpreted by employees as mistrust. Oral reports allow for fast and extensive feedback.

Computers give supervisors direct access to real time, unaltered data, and information. On-line systems enable supervisors identify problems as they occur. Database programs allow supervisors to query, spend less time gathering facts, and be less dependent on other people. Supervisors have access to information at their fingertips. Employees can supply progress reports through the use of networks and electronic mail. Statistical reports are easy to visualize and effective at demonstrating relationships. Written reports provide comprehensive feedback that can be easily filed and referenced. Computers are important tools for measuring

performance in fact, many operating processes depend on automatic or computer-driven control systems. Impersonal measurements can count, time, and record employee performance.

3. Compare Performance with Standards, Models or Criteria to Determine Deviations or Differences. Evaluation of the performance is necessary to ensure that tasks are being carried out as planned. Here the actual accomplishment is matched with the acceptance standard to check if there are delays or deviations from the standard. Comparing results with standards determines variation. Some variations can be expected in all activities and the range of variation the acceptable variance has to b established. Management by exception let operations continue as long as they fall within the prescribed control limits. Deviations or differences that exceed this range would alert the supervisor to a problem. Ways or Techniques for Corrections and Improvements of Performance Based on Feedback: a. The Program Evaluation and Review Technique (PERT) employs a matrix that uses network and activities represented in a chart, including the goals or product desired, time management, budget and estimation of critical paths.

b. Benchmarking, seeks out the best so as to improve its performance. It provides a standard or point of reference in measuring or judging such factors as quality, values and cost. 4. Enset Remedial Measures or Steps to Correct Deviations or Errors. a. Corrections of deviations or errors. In the performance of any given function or task, corrections may be made by modifying the plan either by changing the number of personnel, or by better selection and training of personnel, or by better selection and training of subordinates, or by changing the other factors of production or by adding more materials or resources to minimize or eliminate errors or any deviations. b. A Master Control Plan may be used by Managers depicting its functions, goals and objectives to be accomplished and its specific activities to ensure quality of performance and products. c. Take necessary action. The supervisor must find the cause of deviation from standard. Then, he or she takes action to remove or minimize the cause. If the source of variation in work performance is from a deficit in activity, then a supervisor can take immediate corrective action and get performance back on track. Also, the supervisors can opt to take basic corrective action, which would determine how and why performance has deviated and correct the source of the deviation. Immediate corrective action is more effective.

Effective control involves keeping the process continuous for all areas. This includes management of the nursing division and each sub-unit, performance of personnel and the final Product: the Nursing Process. The process that guarantees plans are being implemented properly is the controlling process. Controlling which means it is the final link in the functional chain of management activities and brings the functions of management cycle into full circle. This allows for the performance of subordinates, they may be wise to extend timely feedback of employee accomplishments. CHARACTERISTICS OF THE CONTROL PROCESS: 1. The control process is cyclical which means It is never finished. Controlling leads to identification of new problems that in turn need to be addressed through establishment of performance standards, measuring performance, etc. 2. Controlling often leads to management expecting employee behavior to change. Employees often view controlling negatively, no matter how positive the changes may be for the organization.

3. Control is both anticipatory and retrospective. The process anticipates problems and takes preventive action. With corrective action, the process also follows up on problems. 4. Ideally, each person in the health care delivery views control as his or her responsibility. The organizational culture should prevent a person walking away from a small, easily solvable problem because that isnt my responsibility. In a service driven profession, each employee cares about each client. 5. Controlling builds on planning, organizing and leading. Controlling is related to each of the other functions of management. MANAGEMENT CONTROL STRATEGIES Managers can use one or a combination of four (4) control strategies or styles: 1. Market control, which first relies primarily on budgets and rules. 2. Bureaucratic control 3. Clan control

4. Self-control PERFORMANCE APPRAISAL TOOLS - Is a method of acquiring and processing information needed to improve the individuals performance and accomplishments. - It consists of setting standards and objectives against determined standards and objectives; reviewing progress; having on-going feedback between the appraiser and the one who is being appraised; planning for reinforcement, deletion or correction of identified behavior as necessary. - The purpose of the evaluation is to assess the appropriateness, adequacy, effectiveness and efficiency of services. The methods used may be anecdotal records, checklist, rating scale, ranking among others. - Some of the tools used to evaluate performance are trait rating scale, job dimension scales, behaviorally anchored rating scale (BARS), checklist, peer review, and self-appraisal. 1. Trait Rating Scale This is a method of rating a person against a set of standard which may be the job description, desired behavior and personal trait.

2. Job Dimension Scales It focuses job requirements and the quality work performance.

3. Behaviorally Anchored Rating Scale (BARS) This focuses on job requirements and the quality work performance.

4. Checklist It is composed of behavioral statements that represent desirable behavior.

5. Peer Review It is a collegial evaluation of the performance done to promote excellence to practice and offer information, support, guidance, criticism and direction to one another.

6. Self-Appraisal This tool allows the employee to evaluate his own performance.

COMMON ERRORS IN APPRAISAL

It is not unusual to encounter errors during the appraisal. Some of these common errors are: 1. Halo Effect This has a tendency to overrate staff based on the raters first impression of the rate. The evaluation is based on the good traits or good things one sees in a person.

2. Logical error It is often based on first impressions of the rater to the ratee.

3. Central Tendency Error This rates the staff as average. This is used by

the rater when feedback tools are inadequate. 4. Leniency Error There is the propensity to overlook the weaknesses and mistakes of the person being evaluated leading to an inaccurate picture of the job performance.

5. Hawthorne Effect The behavior of the rate changes simply because he is observed by the rater.

5. Horns Effect This occurs when rating an employee very low because of an error committed.

DEVELOPMENT OF STANDARDS

Standards are not arbitrary measures of performance. It is a pre-determined level of excellence that serves as a guide to practice. It is established by an authority communicated and accepted by the standard. In developing a performance standard, it is mandatory that a criterion is established and specified. Organizational standards outline the level of acceptable practice within the institution while nursing audit is a measurement tool used to provide the yard stick for measuring quality care.

TYPES OF STANDARDS

Standards are used to monitor and measure performance of nursing care services and evaluate it against the standards through records, reports and observations.

Types:

1. Structure Standards Standards that focus on the structure or management system used by an agency to organize and deliver nursing care, including the number and categories of nursing personnel who provide that care. (Ex. A team leader is responsible for no more than 20 patients, with no fewer than 3 team members to provide care).

2. Process Standards Standards that refer to actual nursing care procedures or those activities engaged in by nurses to administer care.

3. Outcome Standards These are standards that are designed for measuring the results of nursing care. Other means of monitoring and measuring include Conflict

Management, Budgeting and Discipline. DYSFUNTIONAL CONSEQUENCES OF CONTROL Managers expect people in an organization to change their behavior in response to control. However, employee resistance can easily make control efforts dysfunctional. The following behaviors demonstrate means by which the managers control efforts can be frustrated. 1. Game Playing Control is something to be beaten, a game between the boss and me and I want to win. 2. Resisting Control A passive aggression or negative reaction to too much control. 3. Providing Inaccurate Information A lack of understanding of why the information is needed and important leading to you want numbers, we will give you numbers. 4. Following Rules to the Letter People following dumb and unprofitable rules in reaction to do as I say.

5. Sabotaging 6. Playing One Manager Off Against Another Exploiting lack of communication among managers, asking a second manager if dont like the answer from the first manager.