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LILIBETH JOY C.

VALLEJO, RN

the

process of working through staff members to be able to provide comprehensive care to the patient includes planning, organizing, directing and controlling The task of the nurse manager is to plan, organize, direct and control available financial, material, and human resources in order to provide effective, economic care to groups of patients

fundamental property of intelligent behaviour; a cognitive process for decisionmaking In organizations and public policy, it is both the organizational process of creating and maintaining a plan. Deciding in advance what to do, how to do a particular task, when to do it, and who is to do it.

management function defining goals for future organizational performance and deciding on the tasks and resources to be used in order to attain those goals. Always has a purpose; may be achievement of certain goals or targets by using available time and resources Must be adaptable and flexible to current realities to ensure that the desired result is achieved.

Good

planning (Douglass, 1986) A continuous process of assessment, establishment of goals and objectives, implementation and evaluation of change as new facts become known.

Poor

Planning (McLarney, 1964) The failure to set goals, make assessments or provide for implementation or to anticipate any possible change in circumstances.

Delivery

dates are not met. Machines are idle. Material is wasted. Some nurses are overworked, others are underworked. Skilled nurses doing unskilled work Nurses fumbling on jobs for which they have not been trained Quarrelling, bickering, buck-passing, and confusion

living document which can be changed based on the prevailing circumstances A predetermined course of action intended to facilitate the accomplishment of a task, work or mission Failing to plan is planning to fail A well-developed plan requires creative thinking and foresight

Involve

the future Involve action Have an organizational identification of the action which will be undertaken either by the planner or someone designated by or for her

Strategic

Plans
Plans or Rolling Plans

Operating

Continuous

Asks, What are the right things to do? Usually 3-5 years Long-term in nature Based on explicit assessments of the competitive strengths and weaknesses of the organization. Usually prepared in the upper levels of management and serve as the basis for operating plans. In a nursing care setting, a strategic plan would be one which calls for increasing diversity in nursing and more aggressive recruitment

How does one do things right? Generally shorter in time frame (e.g. 1 year) Usually pertain to activities in specific departments of an organization. Deals with tactics or techniques

Focuses on timetables, target quantities, and specifies the persons responsible for the tasks usually involve the middle and lower level managers Prepared separately by managers of the functional sub-units of an organization (E.g. Department budget is prepared by the head nurse of the pediatric unit)

Similar

to operating plans Involves mapping out day-to-day activities Task of the staff nurse who has to devise and implement the nursing care plan for the patients, altering or modifying the plan as necessary depending on the needs and problems of the patients and the unit to where the plan is applicable.

(Why is planning essential to nursing?) Leads to success in Brings about behaviour that the achievement of leads to desired actions and goals and outcomes objectives Makes performance of tasks more meaningful Helps nurses relate what they are doing to their professional goals. Provides for the E.g. projecting the number of effective use of nurses needed to care for a available personnel group of patients or ordering and facilities enough supplies for a unit

Helps nurses cope with Predict future activities, anticipate crises and problems future problems, and plan for calmly and efficiently alternatives to prevent or cope with potential problems Reduces element of Study what has been successful or change unsuccessful Discover the need for change Necessary for effective Enables manager to design effective control ways to ensure accomplishment of goals and objectives through coordination and collaboration between and among people in the organization ad effective use of resources

Knowledge

of the philosophy, goals, and operations of the organization Understanding on the significance of planning; that success and failure or work activities relate directly to the quality of a plan Proper appreciation of use of time for planning; wrongly perceive that time spent on planning would be better spent on addressing day-to-day concerns

Confidence

and fear of failure Openness to change that they believe planning may entail Willingness to engage in new activities that planning produces Insights into the exigencies (i.e., pressing/urgent/requiring immediate action) of the situation; prefer to act on problems that give them immediate feedback

1.Forecasting or estimating the future Consider 3 things: The agency The community affected The goals of care Forecasts must be supported by facts, reasonable estimates, and accurate reflection of policies and plans

2.Setting objectives and goals Goals- broad statements of intent derived from the purposes of the organization Objectives- specific behaviour or task set for the accomplishment of a goal

3. Developing strategies and setting the time frame.


Strategy-

techniques, methods, or procedure by which the overall plan of the higher management achieve desired objectives

4. Preparing the budget and allocation of resources 5. Establishing policies, procedures, and standards

Time-

the managers single most important resource Good time management- founded upon intelligent planning and decision-making, and a thorough assessment of the tasks which need to be done; Finding the most efficient way to do things; Smarter use of time

Work

is rushed, becomes substandard, deadlines are missed, bad choices are made, employees suffer from fatigue, and personal lives and relationships are affected by the lack of time or energy to devote to them

Planning

for contingencies Listing of tasks Inventory Sequencing Setting and keeping deadlines Deciding on how time will be spent Delegate

the

apparent simultaneous performance of two or more tasks May have hazardous consequences Nurses must learn to prioritize tasks at hand even if they have to do them one after the other Make sure tasks are done properly

Allow

the manager to set the time frame of the project or activity meant to achieve the goals of the organization
GANNT CHART PERFORMANCE EVALUATION AND REVIEW TECHNIQUE (PERT) CRITICAL PATH METHOD (CPM)

1. 2.

3.

illustrates

a project schedule Show task and schedule information. The tasks are numbered and listed vertically. A bar shows the starting date and projected completion of ach task. Color or shading is sometimes used to show ho much of ach task has been completed. Both a management tool and a communications tool.

statistical tool, used in project management, that is designed to analyze and represent the tasks involved in completing a given project. Commonly used in conjunction with the critical path method or CPM

tool to analyze a project and determine the duration, based on identification of a critical path through an activity network. Can calculate time and cost estimates for each activity Method used to create a cost estimate using either normal (least cost) or crash (least available time) operating conditions.

systematic financial translation of a plan, the allocation of scarce resources on the basis of forecast needs for proposed activities over a specified period of time A tool for planning, monitoring, and controlling cost and meeting expenses

allocates

resources for nursing programs and activities to deliver patient care during fiscal year

designed

to meet future service expectations, to provide quality patient care at minimum cost Budget plan for health care institutions- a plan for future activities

Revenue

budget- summarizing the income the management expects to generate during the planning period Expense budget- describing expected activity in operational financial terms for a given period of time

Capital

Budget- outlines the programmed acquisitions, disposals, and improvements in the institutions physical capaacity Cash budget- consists of money received, cash receipts and disbursement expected during the planning period.

CENTRALIZED

BUDGET-developed and imposed by the comptroller, administrator, and/or director of nursing with little to no consultation with lower level managers DECENTRALIZED BUDGET-has middle level manager involved in the planning and budgeting process with ARA placed on the practitioner level

MANPOWER

BUDGET- consists of the wages and salaries of the regular employees and the fees paid to outside registries through which the institution contracts short-term employees
EXPENDITURE BUDGET- Involves the large expense of purchasing of lands, buildings, and major equipment meant for long-term use. BUDGET- Includes the cost of supplies, minor equipment repair and maintenance as well as other overhead expenses

CAPITAL

OPERATING

Open

ended budget- single cost estimatefor each program in the proposed unit ceiling budget- the uppermost spending limit is set by the top executive who then asks managers to develop budget proposals for individual units

Fixed

Flexible

budget- conatins several financial plans for each level of activity or for different operating conditions; Top management can select the budget or shift the spending level upwards or downwards, whichever is best for optimum productivity
budget-based on the functions and activities of personnel involved in the operation budgeted; may refer to direct nursing care activities, supervision of nursing staff, quality control, etc.

Performance

Program

budget- Computed for a program as a whole or the entire program itself e.g. home care program, outreach program, rather than individual activities or functions Zero -based budget- justifies in detail the cost of all programs, both old and new, in every annual budget preparation Sunset budget- designed to self-destruct within a prescribed period to ensure cessation of the funded program at a ppredetermined date.

PLANNING-

Budgeting stimulates thinking in advance COORDINATION- budgeting encourages coordination among different persons; continuous exchange of information COMPREHENSIVE CONTROL- an administrator is able to evaluate quality and initiative in performance

Patient consider

the nature of the patients needs: length of stay in hospital, severity of illness categorize patients Hospital or Health Care Facility Available facilities and resources Size of hospital, bed capacity, occupancy Bed capacity must be enough to accommodate possible number of patients

Personnel Salaries paid to nursing personnel, leave benefits, provisions for staff development programs Standard of Nursing Care and Supervision Cost of training and maintaining of personnel and acquiring equipment that will be needed

There

are a number of tools in the budgeting and management of resources: The budgeting process of the organization. Determine the number of full-time equivalent of nurses necessary to staff the unit.

Compute

the salary and non- salary budget including salary increases and other various factors. Monitor the variances over the budget period and identify negative variances responding promptly and appropriately. Understand the extraneous factors such as changes in technology or direct and indirect cost that may be assigned to their budget. Encourage the staff to monitor resources used including time and supply.

Policies

are defined as standing plans used repeatedly, or guides or basic rules that govern action at all level in the organization. They stem from the goals of the organization. Examples include personnel policy, nursing services policies and the like.

more specific guide to action than policy, while standards indicate the minimal level of achievement acceptable to meet the set of objectives.

Models

of planning vary to the needs and profile of the organization.

basic

model Issue-based (goal-based) model Alignment model Scenario planning Organic planning Functional planning Cross-sectional planning and Operational planning

suited

to small organizations with a high volume work but with limited to no strategic planning. The early operation period of the organization, like the first year, would be a good time to use the model in order to familiarize the organization with the concept and conduct of planning. Subsequent planning may be done with more details, phases and activities.

Planning

is usually carried out by top-level management, who identifies the: Purpose or mission statement. Goals to be accomplish to fulfil the purpose or a mission statement. Specific approaches or strategy for achieving goals. Specific action plans to implement each strategy for achieving goals. Consistent monitoring and updating of plan.

Organizations

which follow this approach may adjust their strategies to identify additional goals to develop operations or administration of the organization.

Issue-based

or Goal-based Strategic Planning consists of the following activities: External/ Internal Assessment to identify SWOT Strategic analysis to identify and prioritize major issues or goals. Designing major strategies or programs to address these issues or goals. Designing or updating the organizations vision, mission and values. Establishment of action plans based on the organizations objectives, resource needs, roles and responsibilities for implementation.

Documentation

of issues, goals, strategies or programs, and whenever applicable, an updated mission and vision, action plans in a strategic Plan Document, and SWOT. Development of the yearly Operating Plan document from one year of the multi-year strategic plan. Development and implementation of the budget for year one and allocation of funds needed to fund year two and onward. The conduct of the operations year-one operations. Monitoring/reviewing/evaluating and update the Strategic Plan document.

geared

towards ensuring that the organizations resources are aligned with its mission in order to ensure effective operation. a useful strategy for organizations that needs to fine tune their operating strategies or which may need to rework their current approach. An organization with internal issues may also find benefit in this model.

involves

identifying possible scenarios or situations that the organization may face. This model is useful in identifying strategic issues and goals and may be used to ensure truly concrete solutions to problems.

Organic

strategic planning is self-organizing, and naturalistic in orientation, requiring repeated reference to common cultural values within the organization.

deals

with both the actual activities of the organization and the administrative or the internal matters thereof as well, such as work, costs and resources. usually works in the context of the overall plan and as such to be weighed against competing priorities from other programs and internal initiatives for organizational advancement like process improvements and training.

defines

tasks which may be assigned to individuals; produces clear final outputs to other similarly oriented organizations; tracks internal operations; allows for additional program requirements; and allows for managing competing priorities from multiple programs. may be affected by non-project related work which includes change and work includes a process for assessing plan status.

focuses

on managing the external effects of outputs of a function. It brings together the activities of various functional groups in support of a single project like a team working together. Unlike functional planning, which is oriented towards moving work within a single organization, cross-functional planning is geared towards moving work from one functional organization to another.

requires

one to look at the development of the decision being made as they relate to the overall effectiveness of work on the health care facility. defines how one will implement the action agreed upon and monitoring these plans, what the needs are, how one will use available resources, how one will deal with the risks, and how one will ensure sustainability of the projects achievements.

incorporates

all other plans, past and present, to come up with a wholistic implementation of the plan. The key components are integrated with the other parts of the overall Strategic Plan.

Nurses

make decisions of varying importance every day, so the idea that decision making can be a rather sophisticated art may at first seem strange studies have shown that most people are much poorer at decision making than they think. understanding of what decision making involves, will help produce better decisions at work.

the

process of identifying and choosing particular course of action from among several possible choices. This process is influenced by the values and preferences of the decision maker.

Whether

Decisions-refer to the decision made before the selection of one several alternatives, where selection is made after weighing pros and cons.

E.g. before figuring out alternatives of what car to buy, the decision is to be made whether or not to buy a car.

Which

Decisions-process of choosing from among several alternatives, which are measured based on a set of predefined criteria.

decisions

that have been made but put on hold until some conditions are met like time, energy, price, availability, opportunity and encouragement.
I have decided to buy that car if I can get it for the right price and/or I have decided to write that article if I can work the necessary time for it to fit into my schedule.

E.g.,

Win-win mutual willingness in the group to come up with solutions that are acceptable to all.

Win-Lose. some interests are advanced at the expense of others.

Disagreement and Collaboration. Decisions resulting in the following elements are made when conflicts and disagreements are openly explored, using collaboration and cooperation.
High quality decisions Creative decisions Decisions that are understood Decisions that are accepted and owned

focused

on how to modify or armed an unpopular proposed solution rather than attempt to pressure people into changing their minds about the solution. holding the planned solution in abeyance for further study and analysis until justifiable is reached.

devised

to address the presence of risk or uncertainty in decisionmaking situation by looking for predictable patterns based on historical date, thereby reducing the uncertainty. When there is limited historical precedent, it becomes hard to apply the theory and the risk remains unchecked.

more

graphic in nature, enables the planner to visualize alternatives courses of action taking into account all factors involved like risks, information needs and outcomes for a problem over time. a tree-shaped diagram which starts with a primary decision that branches out into increasing numbers of alternatives, each of which further branches out until all alternative outcomes are laid out on the diagram. gives the manager a forecast of the possible results of his choices and enables him to make a cost-benefit analysis on each alternative.

problems

are addressed one after another and after having determined the best balance of factors related to service. the mathematical study of waiting lines (or queues). a powerful tool that helps hospitals and clinics to uncork chronic bottlenecks in the flow of patients in the emergency department (ER), the out-patient department(OPD), and elsewhere.

First

in first out (FIFO)-service according to order of arrival Last in first Out (LIFO) Last to arrive First to be served Processor Sharing (PS)- equally served

Finally,

the Linear Programming method uses matrix algebra or linear mathematical equations to determine the best way to use limited resources to achieve maximal results.

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