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Ms. Arlene Zita B. Brillantes

A basic management function that includes building an effective work climate and creating opportunity

for motivation, supervising, scheduling, and disciplining

Heart of management process

Planning, organizing, staffing have got no importance if direction function does not take place

Directing is the issuance of orders,

assignments and instructions that permit the nursing personnel to understand what are expected of them and the guidance and overseeing them, so that they can an contribute effectively and efficiently in the attainment of the goals of the institution. DOUGLAS

Elements of Directing
1. 2. 3. 4. 5. 6. 7. 8.

Delegation Supervision Leadership Coordination Communication Motivation Decision-Making Conflict Management

is the process by which a manager assigns specific tasks/duties to workers with commensurate AUTHORITY to perform the job without giving ones own responsibility for this duties. .

Principles of Delegation
1. Select the right person to whom the job is to be delegated.

2. Delegate both interesting and uninteresting tasks

3. Provide subordinates with enough time to


4. Delegate gradually.
5. Delegate in advance

6. Consult before delegating.

7. Avoid gaps and overlaps.


Authority Responsibility Accountability


one has the right to act or make decisions w/o approval of higher authorities and it is always associated with responsibility and accountability


has the obligation to complete a task

One is able & willing to assume

responsibility for ones actions and to accept the consequences of ones behavior.

Reasons for Delegating

Saves Time 1. You focus on what you should be doing 2. You are free to take on new challenges
3. You give your staff the chance to develop

What cannot be delegated

Overall responsibility, authority and accountability for satisfactory completion of all activities in the unit
Authority to sign ones name is never delegated. Evaluating the staff and/or taking necessary corrective or disciplinary action. Responsibility for maintaining morale Jobs that are too technical and those that involve trust and confidence.

I can do it better myself Fallacy
Lack of ability to direct Absence of control that warm of

impending difficulties Aversion to taking a risk for fear of being blame for others mistakes

1. 2. 3.


Describe the task / project/ procedures to be done Relay the description of the task Establish check points - policy Standards - Allocate Resources - Time Frame - Rounds Establish Dialogue before, during and after for Feedback on - Clarification - Attitude / Feeling of staff delegated with the task - Judgment of Delegation

Keep yourself informed by requesting simple oral report If something goes wrong, discuss with the person with whom you have delegated responsibility In general, let the individual prepare the correspondence, reports sign his name



It is the process of
INFLUENCING the activities of an organized group in its effort toward goal setting and goal achievement. (Stogdill)


LEADER a person who

enables people to achieve objectives. NATURAL LEADER


Personal Skills required of a leader


MANAGER- MIDDLE - Directs, supervises and coordinate the effort of their subordinates ADMINISTRATOR -TOP - Concerned with the over-all planning and setting up of objective, developing and scheduling of programs, budget proposal, and establishment of policies HEADNURSE- FIRST LEVEL - Responsible for the management and supervision on a particular unit

A leader possesses

striking physical personality and is energetic - sense of purpose and direction - power of ready speech - enthusiastic about the purpose of the group and is devoted to its cause - keen insight into the human nature of people - courage and persistence even in the face of opportunity - decisive - cheerful and even-tempered - technical mastery that inspires to do above average performance in their job - intelligent, versatile and has sense of humor - Moral vision, integrity and idealism

The Evolution of Leadership Theory

Contingency Theory

Transformational Theory Transactional Theory

Behavioral Style Theory

Trait Theory






Approximate Time Line (Years)

Summary of Theories of Leadership Theories


19th century

Title of Author/ Argument / Belief Theory Proponent Great Aristotle . that great Man leaders are born, Theory not made. These

theories often portray great leaders as heroic, mythic and destined to rise to leadership when needed.


Classification Trait Approach (1930- 1940) Title of Theory Trait Theory Author/ Proponent Argument / Belief

Similar in some ways to "GreatMantheories, i t assume that people inherit certain qualities and traits that make them better suited to leadership.

Summary of Theories of Leadership Trait Approach contd

Classification Title of Theory Author/ Proponent Argument / Belief

2. Charismatic Robert House Charismatic leader Theory has 4 personal characteristics: dominance, self confidence, need for influence & power, and conviction of moral righteousness.

Summary of Theories of Leadership contd

Classification Title of Theory II. Behaviora 1940-1950 l Theories Author/ Proponent Argument / Belief


The task orientd beh, relationship oriented beh, participative leadership are 3 types of leadership beh that marked the diff bet effective

Rooted in behaviorism, this leadership theory focuses on the actions of leaders not on mental qualities or internal states.

Summary of Theories of Leadership Behavioral Theories contd

Classifi- Title of Theory cation Blake & Moutons Managerial Grid Author/ Proponent Robert Blake & Jane Mouton Argument / Belief The Team Management Approach, is the most effective leadership style. The grid describe individual leadership as function of 2-variables; concern for people & concern for production

Summary of Theories of Leadership contd

Classification Title of Theory Author/ Proponent Argument / Belief Derived from Expectancy Theory which believed that people act as they do because they expect their behavior to produce satisfactory results.

III. Situationa Path-Goal Robert l Theories Theory House

Summary of Theories of Leadership Situational Theories contd

Classification Title of Theory . Contingency Theory Author/ Proponent Fred Fiedler Argument / Belief That a leadership style will be effective or ineffective depending on the situation & has 3 aspects: leadermember relations, task structure, position power. No leadership style is ideal for every situation.

Summary of Theories of Leadership Situational Theories contd

Classifi Title of Theory Author/ Argument / Belief -cation Proponent Situational Hersey & Predicts the most Leadership Blanchard appropriate leadership Theory style from the level of maturity & readiness of the followers & the demands of the situation.

5 kinds of leader under situational theory

1. Natural leader
2. Charismatic leader

3. Rational leader
4. Consensus leader

5. The leader who dominates by force

Summary of Theories of Leadership contd

Classification VI. Transactional Leadership Title of Theory Author/ Proponent Edward Hollander Argument / Belief Leadership process is best understood as the occurrence of mutually satisfying transactions among leaders & followers


VII. Transformational Leadership

Title of Author/ Theory Propone nt Summary of Theories

Argument / Belief


of Leadership contd

Both leaders & followers have the ability to raise each other to higher level of motivation & morality. The leader is able to transform the follower into one like her/him. Able to cascade his leadership to the followers.
2 kinds of leader; Transactional or traditional Transformational has a vision and committed and has the ability to empower others



TRANSFORMATIONAL LEADER 1. Identifies common values 2. Is committed 3. Inspires other with vision 4. Has long-term vision 5. Looks at effects 6. Empower others

1. Focus: Management task 2. Is a Caretaker 3. Uses Trade-off to meet goals 4. Share Values not identified 5. Examines Causes 6. Use Contingency reward





Managers use of authority

Subordinates area of freedom

Managers makes decisions and announces it

Managers Manager sell present decision ideas and invites questions

Manager presents tentative decision: Subject to change

Manager present problem; gets suggestion then makes decision

Manager defines limit ; ask group to make decision

Manager permits subordinates to function within limits defined by superior

Comparison of Leadership Style and Limiting Conditions

LEADER Holds: Knowledge: Behavior: Position: FOLLOWER Relates: Knowledge: Behavior: Absolute power Unique Dominations Inflexible Dependent Less Submissive

Limited power Shared Participates Flexible

No power Same or less Joins Neutral

Expects Involvement Independent Different More Involve Independent General Goals, controls and time pressure understood No clear, purpose, control or time pressure

Situation Appropriate Crisis, Emergency or great skill required of leader only Inappropriate

Misuse of Employees Cannot Influence Talents

Need Answer

Comparison of Leadership Style and Limiting Conditions

Autocratic Democratic Primarily a Communication downward flow of Communication Primary Strength Stresses prompt, orderly and predictable performance Active two-way flow of upward and downward communication Enhances personal commitment through participation


Primarily horizontal communication among peers Permits selfstarters to do things as they see fit without leader interference Group may drift aimlessly in the absence of direction from leader

Primary Weakness

Approach tends Democratic to stifle individual process is timeinitiative consuming




is providing guidelines, direction & periodic inspection of the actual accomplishment of the task or activity.

It involves overseeing the

activities of others and evaluating the adequacy of performance

Qualities of Good Supervision

Good supervision requires:


Good technical, managerial and human relation skills; Ability to communicate well in both spoken and written language; ability to listen;

Qualities of Good Supervision

3. Firmness with flexibility to adjust to the needs of the situation; 4. Fairness in dealing with the employees;

Qualities of Good Supervision

5.Familiarity with hospital &

nursing policies that affect patient care;

Qualities of Good Supervision 6. Good decision-making skills; 7. Willingness to grow and develop;

Qualities of Good Supervision

8. Ability to accept changes & consider them as challenges; 9. Dignified with pleasing personality;

Qualities of Good Supervision

10. Ability to motivate employees & provide opportunities for continuing professional growth and development; 11. Advocacy for nurses and nursing.

Principles of Good Supervision


Good supervision requires adequate planning & organization which facilitates cooperation, coordination and synchronization of services.

Principles of Good Supervision


Good supervision gives autonomy to workers depending in their competency, personality and commitment.

PRINCIPLES OF GOOD SUPERVISION 3. Good supervision stimulates the workers ambition to grow into effectiveness.


4. Good supervision creates an atmosphere of cordiality and trust. It creates a suitable environment for productive work.



Good supervision considers the strengths and weaknesses of employees.


6. Good supervision

strives to make the unit an effective learning situation


7. Good supervision considers equal distribution of work considering age, physical condition and competence.

Techniques in Supervision
Observation of the worker while making the rounds Spot checking of charts through nursing audits Asking the patient about the care they receive Looking into the general condition of the units Getting feedback from co-workers Asking questions discretely to find out the problems they encounter in the wards Drawing out suggestions from the workers for improvement of their work situation.

1. Organizational Chart
2. Communication Device

3. Purposeful rounds
4. Guide to Workmanship /



COORDINATION It unites personnel and services toward a common goal resulting in efficient, smooth and harmonious work flow.

Medical Services, Administrative Service, Ancillary Services, Staff Development We coordinate our work with other departments by conveying to them clearly defined policies,

standard operating procedures,

policies and guidelines using proper channels of communication.




MOTIVATION- is a force

within an individual that influences strength or direction of behavior.


Satisfaction-comes from truly motivating factors such as interesting and challenging work, utilization of ones capabilities , opportunity to do something meaningful. Dissatisfaction occurs when the following factors are not present in the job: - Equitable pay, good working environment, opportunities for selfdevelopment, recreation and congenial


Intrinsic motivation

comes from within the person driving him to be more productive.

Extrinsic motivation is

enhanced by the environment or external rewards.




-An employees work motivation is controlled by conditions in the external environment. The reinforce maybe positive or negative.


2. Expectancy Theory of Vroom
Felt needs of individual in work setting

are increased if a person perceive a positive relationship between effort and performance.

Probability of Getting it

Strength to drive toward action

Strength of desire


3.Equity Theory People believed that they are being treated with equity when the ratio of their efforts to rewards equals those of others.

4.Need Theory

Abraham Maslows Hierarchy of

Needs People are motivated to satisfy needs beginning from basic physiolagical needs to complex psychological needs.

The Two- Factor Theory(Herzberg)

1. Hygiene factors relate to the working conditions such as salary, quality of supervision, job security interpersonal relations policies and supervision . These are called dissatisfiers

2.Motivating factors - satisfiers, these are motivating factors that relate to the job itself and include opportunities for growth and development, advancement and added responsibilities, recognition and achievement.

McClellands Three basic Need 3 Basic Needs Theory -

1.achievement desire to make contribution, to succeed, to excel. To advance 2. power wants to be in control and desire to influence other, more interested in personal prestige 3. affiliation desire in working in a harmonious, seek a meaningful friendship

Ways to increase staff motivation

Help the people understand their values

so that they can achieve their objective simultaneously with the organization Make work interesting, establish understood and accepted plans standards and limits.

Ways to increase staff motivation

Give employees responsibility. Enforce standards

amicably and fairly. Give each person maximum freedom with understood and accepted standards. Help employees achieve more, help them grow in advance. Reward or recognize good work timely and generously. Prevent and relief stress and burn out

The process whereby a message is

passed from sender to receiver with the hope that the information exchange will be understood as sender interpret


transmission of information, opinions, and intentions between and among individuals.

It helps promote trust between the health personnel and those of clients;
Provides both client & personnel self satisfaction

of work well done;

It becomes a means of effecting change and serves as lubricant fostering smooth operation of the agency. It provides basis for leadership action

Three types of communication:

Verbal communication - spoken words. INFORMAL TALKS-suitable for day to day liaison, directions, exchanges of information progress

review and disciplinary actions.

PLANNED APPOINTMENT-appropriate for regular

appraisal reviews, joint work session TELEPHONE CALLS

Written communication must be clear, correct, complete and concise

Memoranda or Memos - Information exchanges between individual or groups to keep nursing personnel information of nursing activities.

Directives - Administrative Orders which initiate action or doing, instruction during an emergency situation. - It is used to control policy and operation and conduct hospital services.

Manual of Operation - Written procedures and techniques of each department which are kept on file for references.

. Records - Data of information that maybe used for Decision-making, recommendation or as basis of management or the unit and patients - Basis of legal proof that appropriate care was given or not at all - Patients record is the main source of information in malpractice suits of charges for negligence

Reports - Prepare Account of an important activities in a particular period

of Communication TypesNon - verbal Communication

People oftentimes unconsciously use: 1. Personal appearance 2. Intonation of the voice-soft and gentle 3. Facial expression-smile 4. Posture and gait-indicates physical, wellness, emotions and attitude 5. Touch- conveys caring attitude

Flow of communication in nursing care

Lines of Communication Upward

To Superior

Horizontal To peers & members of the health team


Outward To patient, family & community To workers Family & friends

Downward To Subordinates

Conflict Management

Conflict A clash between two

opposing and oftentimes hostile parties

Conflict is as inevitable as change in

any organization because of the complexity of relationships within the origination, the interaction among its members or their dependence on one another.

Competition is a relatively healthy

struggle among individuals o groups within an organization to excel in striving to meet mutually beneficial goals.

Types of Conflict
Conflict is a dynamic process. It can be overt or covert. Covert conflict is more dangerous because it is not what it appears on the surface. 1. Based on Hierarchical Relationship Vertical conflict- differences in opinions between superiors and subordinates. - caused most often by inadequacy of communication, opposing interest and lack of shared perception and attitudes

Human interactions that relate to conflict are characterized

Source of conflict

by competition, domination and provocation. It arises from differences in knowledge, skills, values, interests; - scarcity of resources; -intergroup rivalry for rewards; -role ambiguity, -unworkable organizational structure and shift in organizational power base and organizational climate - communication Barriers - unacceptable leadership styles.. Cultural Differences may contribute to different attitude, values, belief and behavior

Types of Conflict

Horizontal or line and staff conflict Types of Conflict

- arises as a common struggle or strife between departments or services wherein the degree of inter dependence and collaboration determines the success to achieving shared goals and objectives.

2. Based on Behavioral Standpoint - It is a perceived condition that exists between two or more parties when one or more parties perceive goal incompatibility and some opportunity for interfering with goal achievement of the other.

3. Based on Process Standpoint - conflict can be defined as what occurs when real or perceived conflict exists in goals, values, ideas, attitudes, beliefs, feelings or action of two or more parties. Intrapersonal - occurs within one individual when confronted with two or more incompatible demands or values Ex. Confronted with ethical issues. Interpersonal - Also known as horizontal violence or bullying happens between two or more people with different values, attitudes, and beliefs. Intragroup Conflict - is manifested in feelings of unfairness over distribution of assignment, off-duties and holidays among the staff.

Consequences of Conflict
1. Issues are recognized and brought out in the open.

- recognition of conflict open communication between individuals group members.

2. There is a rise in group cohesion and performance. - during conflict the group follows its chosen

leader. The heightened closeness of the group maybe negative or positive.

3. Poor Performance passive people may repress their feeling of conflict and accept things as they are.

Consequences of Conflict


Constructive or destructive result - moderate conflict may produce resolution of problems but high levels of conflict may produce results destructive to the organization There may be rise of leader- when conflict arises individual in the group may emerge as leader

1. Latent Conflict Implies the existence of antecedents condition which are ripe for conflicts, although no conflict has actually occurred. Participants have developed suspicious and hostile feelings toward one another 2. Perceived conflict or Substantive Conflict It is intellectualized and often involves issues and roles. It is recognize by one or both parties 3. Felt Conflict occurs when the conflict is emotionalized. Tension is begin to build It include anger, hostility, fear, and mistrust Also referred to as Affective Conflict.

4. Manifest Conflict - Also Called overt conflict - Action is taken maybe to

withdraw complete debate or seek resolution

5. Conflict aftermath - It is either positive or negative - If Conflict is managed well, people

involved will be believe they were given fair hearing - If conflict is managed poorly, conflict issue remains and may return later The cycle is completed and hostility are less manifested though parties harbor antagonistic feeling s may provide even more severe hostilities under further provocation


AVOIDANCE If we dont talk about

it, the problem will go away used by groups who do not want to do something that may interfere with their relationships. - participants never acknowledged that a conflict arises LOSE-LOSE SITUATION

CONFLICT RESOLUTION ACCOMMODATION - means self sacrifice - personal needs are neglected to meet the goals of the other party. WIN-LOSE SITUATION

3. COMPROMISE - Setting

differences in which each side makes concern. - Each parties gives up something in order to gain something - Approach is MODERATE ASSERTIVE and COOPERATION. - LOSE-LOSE SITUATION

COMPETITION- the supervisor or nurse

manager exert efforts at the subordinate's expense; enforces the rule of discipline - expressed thru suppression of conflict through authority-obedience approach; - enforces rule of discipline WIN-LOSE SITUATION

3. COMPROMISE - Setting differences in which each side makes concern. - Each parties gives up something in order to gain something - Approach is MODERATE ASSERTIVE and COOPERATION. - Accommodation and adjustment lead to workable situation rather than to the best solution. - A weak resolution has the tendency of the leader to give in and lower her standard LOSE-LOSE SITUATION

Dissagreements are ignored so

harmony is maintained in a state of peaceful co- existence. This method maybe appropriate in solving problems but issues remained unsolved and may later resurface. LOSE LOSE SITUATION


yields to an immediate end to the conflict but leaves the cause of the conflict unresolved. LOSE-LOSE SITUATION

one party is removed to resolve the issue;

-produce the same result as smoothing LOSE-LOSE SITUATION

Conflict means a clash between two opposing and

oftentimes hostile parties.

It is a warning to managers that something is wrong and needs solution


Four general reasons for designing change: To improve the means of satisfying somebodys economic wants b) To increase profitability c) To promote human work for human beings. d) To contribute to individual satisfaction and social well being


1. Effectiveness: doing the right things 2. Efficiency: doing things right 3. Improving: doing the right things better 4. Cutting: doing away things 5. Copying: doing things other people are doing 6. Different: doing things no one else is doing 7. Impossible: doing things that cant be done


2. 3.

Covert Resisters: people who resist the change behind the scenes.

Overt Resisters: those who openly resist the change. Skeptics: people who need to be convinced of the need for the change. 4. Observers: those who watch and withhold judgment about the need of merit of the change. 5. Participants: people who accept the change and go through the necessary options. 6. Committed: Those who embrace the change. 7. Champions: Those who are the initiators of the change.

Things that Can Get in the Way

1. Cultural resistance
Many current operating practices have a long, entrenched bureaucratic history that has developed piecemeal over tune in order to accommodate the needs of different organizations & special interest. The more deeply rooted these systems and attitudes are, the more difficult comprehensive change will be.

2. Unclear goals and performance measures Things that Can Get in the Way

Many agency managers lack clear, hierarchically linked roadmaps that offer straightforward illustration of how their work contributes to attaining strategic goals. This situation can be complicated by poorly integrated accounting information and reporting systems.
3. Lack of incentive for change

For many agencies, performance is measured by the amount of money spent, people employed or tasks completed. Increased attention should be given to rewarding behaviors that meet strategic resultbased goals.

1. Coercive change Types of Change

Non mutual goal setting, imbalanced power ratio & one-sided deliberativeness characterize coercive change

2. Emulative change

Transition is fostered through identification with and imitation of power figures.

3. Indoctrination

Uses mutual goal setting, has an imbalanced power ration and is deliberative. Subordinates are interested in the beliefs of the power source.

4. Interactional change

Types of Change

Mutual goal setting, fairly equal power, but no deliberativeness characterize this. Parties may be unconsciously committed to changing one another
5. Natural change

Include accidents and acts of God. They involve no goal setting or deliberativeness
6. Socialization change

Directly related to interactional change. An individual conforms the needs of the social group. When there is greater deliberativeness on the power ration, change becomes indoctrination.

Types of Change

7. Technocratic change

Collecting and interpreting data bring about change. A technocrat merely reports the findings of the analysis to bring about change.
8. Planned changes

Involves mutual goal setting and equal power ratio and deliberativeness.


A team is two or more employees who are organizationally empowered:
to establish their objectives to make decisions about how to achieve those objectives to undertake the tasks required to meet them, and to be individually and mutually accountable for their results.

Empowerment is the delegation of authority to an individual or team and includes autonomy trust and encouragement to make the decisions necessary to accomplish the job.
Teambuilding is a method designed to help teams operate more effectively by improving internal communication and problem-solving skills.

Chris Development Team Argyris describes an effective team as:

Contributions made within the group are additive. The group moves forward as a unit; there is a

team spirit, high involvement. Decisions are made by consensus. Commitment to decisions by most members is strong. The group continually evaluates itself.

sense of

Four Phases of Development

1.Forming Each person in the process of getting acquainted with the other members, seeks his or her place in the group. - members must reach a common understanding of their objective, as well as agreement on basic operational ground rules, such as when to meet, attendance requirements, how decisions will be made and so on. 2. Storming individual begin to compete for attention and influences -divergent interest surface a members begin asserting their ideas and viewpoint of the task and their feeling about other members

Four Phases of Development

3. Norming a sense of identity or team spirit" is developed - individuals become more sensitive to each others need and are more willing to share ideas, information, and opinions - task considerations start to override personal goals and concern

Four Phases of Development

4.Performing group emerges as a team - members work well together and have a high degree of productive problem solving - structural and inter personal issues have been resolved - High creativity and intense loyalty of members to each other

Pitfalls of decision making
Managers are resistant to change involving risk and new

ideas; often lack in trust in others who will test the new areas Inadequate fact finding - decision must be based on accurate information Time constraints collection of facts ,opinion and assumptions must be completed in a timely manner Poor Communication communicating the decision to the appropriate individual Failing to systematically follow the steps in decision making process

Decision Making Process

1.Definition of a Problem

- problem must be identified; - extent of the problem, - how often does it occur, question all sources for opinion - differentiating symptoms from real problem - prioritize the problem (deal with the problem in order in which they appear, solve easiest problem first, solve crisis problem before all others )

Decision Making Process

2. Analysis of the Problem
- involves gathering of relevant data first, thorough information search - diagnosing the root cause of the problem - Factors contributing to the existence of the problem

3. Development of Alternative Solutions

- search for and analysis of alternatives and possible consequences - if we do this, the result will be - factors to be considered are the foll. * time ,resources available ,labor ,cost, * tools and equipment to be used * capabilities of those who will be involved in implementing the decision

Decision Making Process

4. Selection of the solution for implementation - factors have been weighed and alternative solutions are explored - Ranking of preferences is to be done considering the positive and negative consequences -Is the solution practical, efficient or cost effective?,

Decision Making Process

5. Implementation and follow-up - Implementation of the selected alternative - involves setting up of the budget - defining responsibilities to ensure project completion -effectively communicating the process with all involved Monitor implementation and evaluate outcomes - need for a system of checking and control to ensure that decision is implemented correctly - compares actual results with anticipated outcomes and makes modifications as needed

TYPES OF DECISION 1. Considered Decisions

- are usually those great magnitude, they tend to be complicated and call for considerable reflection. 2. Operational Decisions - are those we make practically everyday. 3. Swallow-Hard Decision - are those that are often personally uncomfortable to make because they may result in discomfort or uneasiness for subordinates or others. 4. Ten- second Decision
- are those we make during daily operation

The Problem Solving Process

STEPS 1. Assess

and analyze-systematic collection, organization, and analysis of data into related information

2. Plan break problem into components,

- establish priorities, - develop alternative courses of actions , - determine probable outcomes - decide which course is best - decide on a plan of action with timetable for implementation

The Problem Solving Process



Implementation of the plan - a process that can be delegated to the subordinates. -requires knowledge and skills appropriate to specific selected alternatives Evaluate - how closely goals and objectives are met; determine if plan should be terminated because the problem is resolved or continued with or without modification