Post on 27-Nov-2014
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LEADERSHIP AND MANAGEMENT
ROUSSEL FRANCES C. GAJETECHINESE GENERAL HOSPITAL
COLLEGE OF NURSING
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The Setting: THE HOSPITAL
• An integral part of a social and medical organization , the function of which is to provide for the population it serves, complete health care, both curative and preventive, and whose out-patient services reach out to the family in it home environment;
• It is also a center for training and research
Expert Committee on Organization of Medical Care of the World Health Organization
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The HOSPITAL
• A place devoted primarily to the maintenance and operation of facilities for the diagnosis, treatment and care of individuals suffering from illness, disease or deformity, or in need of obstetrical or other medical and nursing care
RA 4226: Hospital Licensure Law
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The Hospital
• Any institution, building or place with beds, cribs or bassinets for use by patients for 24 hours or longer, in the treatment of diseases, diseased conditions, injuries, deformities
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Revised Rules & Regulations Governing the Registration,
Licensure, & Operation of Hospitals & other Health Facilities in the
Philippines AO no. 2005-0029
• Classification:– General
• Service for ALL types of deformity, disease, illness or injury (PGH, QMMC)
– Special• Specific clinical care and management
(NKTI, Heart Center, NCH)
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Classification• As per service capability
– Level I (Primary)• Provides initial care & mgt to patients
requiring immediate treatment, as well as primary care on prevalent diseases in the locality
• Clinical services may include gen med, pedia,OB & non-surgical gynecology, minor surgery.
• Gen admin services & ancillary system (primary clinical laboratory, first level radiology and pharmacy)
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Classification• Level II (Secondary)
– Non-departmentalized hospital that provides clinical care & mgt on prevalent diseases in the locality
– Clinical services include gen medicine, pedia, OB-gyne, surgery & anes
– Nursing care provided in level I hospital as well as intermediate & partial category of supervised care for 24 hrs or longer
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Classification• Level III (Tertiary)
– Departmentalized hospital that provides clinical care & management on the prevalent diseases in the locality as well as particular forms of treatment, surgical procedures & intensive care.
– Clinical services provided in level II as well as speciality clinical care
– With highly specialized critical care provided
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Other health facilities
• Birthing Home- maternity service on pre-natal care, NSD, care of newborn babies
• Psychiatric Care Facility- health facility for mentally ill patients– Acute-Chronic- medical service,
nursing care, psychopharma intervention
– Custodial- long term care with basic human services (food & shelter)
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Ownership & Control• Government- operated and controlled
either partially or wholly by national, provincial, municipal or city govt– National : PGH, NCMH, POC– Regional: Batangas Regional Hospital– Provincial: Bulacan Integrated Provincial
Hospital– City: Ospital ng Maynila– Municipal: Ospital ng Tondo
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Ownership & Control• Private or Non- government - privately
owned, established and operated with funds, raised capital or other means by private individuals, associations, corporations, religious organizations, firms, companies, or joint stock corporations– Missionary: Mary Johnston Hospital– Organization: Urology Center of the Philippines Inc.– Community: Romero Community Hospital– Private: St. Luke’s Medical Center
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Training & Non-Training Hospital
• Training hospital- with an accredited Residency Training Program in one or more specified specialty or discipline.
• Non- training hospital- departmentalized but has no accredited Residency Training Program
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PLANNING
• Defined as pre-determining a course of action in order to arrive at a desired result
• A continuous process of assessing, establishing goals & objectives, implementing & evaluating them.
• Largely conceptual
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Principles in Planning1. Always based and focused on the
vision, mission, philosophy & clearly defined objectives
2. A continuous process
3. Pervasive w/in the entire organization
4. Utilizes all available resources
5. Must be precise in scope and nature. It should be realistic and must focus on outcomes
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Principles in Planning
6. Time-bounded
(short & long range plan)
7. Must be documented for proper dissemination for implementation and evaluation as to the extent of their achievement
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Why is planning important?
1. It leads to achievement of goals
2. It gives meaning to work
3. Provides effective use of available resources
4. Helps in coping with crises (disaster plans)
5. Cost effective
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Why is planning important?
6. Based on past and future activities
7. Leads to realization of the need for change
8. Provides the basis for control (performance eval based on criteria set during planning)
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Major Aspects of Planning
1. It should contribute to objectives
2. It precedes all other processes of management. Planning & control are inseparable!
3. It pervades all levels
4. It should be efficient (peso value, man hours, production as well as individual values and group satisfaction)
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Characteristics of a good plan
• Precise w/ clearly-worded objectives
• Guided by policies, procedures
• Indicate priorities
• Logical sequence of activities
• Flexible & realistic actions
• With most practical methods for achieving objectives
• Pervade the whole organization
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Elements of PLANNING• Forecasting : deciding in advance where the
agency would like to be & what is to be done to get there.The environmentThe clientsThe language/ dialect barriersThe public attitude & behaviourThe severity of condition/ illnessesThe kind of care to be receivedThe # or personnel requiredThe necessary supplies
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Mission, Vision, Philosophy
• Vision- future role and function
• Mission- agency’s reason for existing
• Philosophy- a statement of beliefs and values– The philosophy of the nursing service
dovetails with the philosophy of the organization.
– An intentionally chosen set of values or purposes.
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Goals and Objectives• Objectives
– More specific, concrete– Stated in terms of results to be
achieved
• Goals– More general with a broad area
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The PLANNING FORMULA1. WHAT?
– What has been done?– What should be done?– What equipments have been used
or are needed?
– What steps are necessary in the procedure?– What sequence of activities was previously
used?– What other efficient methods may be used?
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THE PLANNING FORMULA
• WHERE?– Where is the job to be done?– Where does an activity occur in relation to those
activities immediately preceding or following it? – Where could supplies be stored, cleaned and so
forth?
• WHEN?– When should the job be done?– When was it formerly done?– When could it be done?
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THE PLANNING FORMULA
• WHO?– Who has been doing the job? – Who else could do it? – Is there more than one person involved?
• HOW?– How will the job be done? – How will the time & energy of the staff
be used? – How MUCH will it cost?– How much TIME will it require?
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THE PLANNING FORMULA
• WHY?– Why is this job, this procedure,
necessary?– Why is this done in this way, in this place,
at this time, by this person?
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THE PLANNING FORMULA
• CAN– Can some steps or equipment be
eliminated?– Can this activity be efficiently
combined with other operations?– Can somebody else do it better? – Can we get enough machine to help?– Can we get enough money?
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The 4 Planning Models
1. Reactive planning– Occurs AFTER a problem exists– (+) dissatisfaction with the current
situation– Done in response to a crisis– May lead to hasty decisions
& mistakes
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The 4 Planning Models2. Inactivism-Inactivists spend a great deal of energy preventing change and maintaining conformity.-Changes occur in the org slowly
3. Preactivism -Preactive planners use technology to accelerate change & are future oriented-They do not value experience & believe that the future is always preferable
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The 4 Planning Models
4. Interactive or proactivism
-These planners consider the past,
present & future
-Adaptation is the key requirement
-Done in anticipation of changing needs
Or to promote growth in an organization
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The Planning Hierarchy
MISSION
GOALS
OBJECTIVES
POLICIES
PROCEDURES
RULES
PHILOSOPHY
The reason an org exists
Set of value & beliefs
Instructions x decision making
Desired result
Ways to accomplish a specific task
Plans that define specific action
SMART how & when
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Policies
• Derived from philosophy, goals & objectives
• Guides general course & scope of organizational activities
• Direct individual behavior towards org mission
• Defines broad limits & desired outcomes
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2 types of POLICIES1. Implied
– Neither written nor verbally– Have developed over time
• E.g. employees are supported in their activity in their professional organizations
2. Expressed– Delineated verbally or in writing– Promotes consistency of action
• E.g. formal dress code, policy for sick leave • & disciplinary procedures
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Procedures• Establishes customary ways or acceptable
ways of accomplishing tasks (how to..)
• Delineates sequence of steps of required action
• Generally found in manuals at the unit level in the org as ready reference
• Manager must review and revise policies and procedures to ensure currency & applicability
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Flowchart for developingpolicies/ procedures
Need IDNeed ID
EVALUATION
EVALUATION
IMPLEMENTATIONIMPLEMENTATION
Nursing EXECOM
authorization
Nursing EXECOM
authorization
FINAL REVIEW
FINAL REVIEW REVISIONREVISION
INITIAL REVIEW (affected grp/indiv)
INITIAL REVIEW (affected grp/indiv)
DRAFTDRAFTProposal
dev & sent to PPRC**
Proposal dev & sent to PPRC**
** PPRC: Policy/ Procedure Review Committee
** PPRC: Policy/ Procedure Review Committee
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Rules
• The least flexible type in planning
• Existing rules must be enforced
• Has only one specific course of action
• Existing rules must be enforced to keep morale from breaking down & to allow organizational structure
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Decision Making
• The process of selecting one course of action from alternatives
• Relies on the decision making process:
1.Identify the problem & analyze situation
2.Explore alternatives
3.Chose MOST desirable alternative
4.Implement decision
5.Evaluate results
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Organizational Models inDecision Making
• Collegial Model– Full participation of community of peers for
decision making– GROUP CONSENSUS
• Rational Model– Based on common goals, technical
competence when INDIVIDUAL goals are = to ORGANIZATION goals
– The best solution to achieve desired outcome
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Organizational Models for Decision Making
• Garbage Can Model– Decisions are unplanned & coincidental– Implementation is incidental w/ no
planning– Outcomes occur by chance & errors
may repeat
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Organizational Models for Decision Making
• Bureaucratic Model – Common in healthcare– Based on history, norms & tradition
(info & action)– The hierarchial bureaucracy dictates key
players
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Organizational Models for Decision Making
• Cybernetic Model– 3 phases
1. Needs Assessment– Determine desired outputs, nature of problem, level of goal
accomplishment expected, strategy, criteria & causal chain of processes & outcomes
2. Program Implementation– Determine that program is in place & progress according
to time plan
3. Results Assessment– Determine that program outcomes are met & outputs
justified the costs
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• 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
The Management Process
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The Management Process• Organizing
– establishing formal authority.
It involves
1. Setting up the organizational structure
2. Determining the staff needed
3. Developing job descriptions
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• Controlling: assessing & regulating performances. It involves:
1. Specifying criteria and standards
2. Monitoring and evaluating
3. Performance appraisal
4. Total quality
management
The Management Process