Elements of Management of Critical Care Unit

8/3/2019 Elements of Management of Critical Care Unit

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ELEMENTS OF MANAGEMENTOF CRITICAL CARE UNIT


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Functions/Elements of management of

critical care unit

Administration may be defined as all the actionsrationally performed by one person or a number of

persons to fulfill a common purpose set by someone

else of their accomplishment

Prof. Luther Gullick(1937)- summed up certain

principles or elements in the word POSDCORB.

It consist of the initials of a number of words under

each of which some administrative activity has been

classified and named


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POSDCORB

Is of course amade up worddesignedto callattentionto the various functional elements ofadministrationand management

P

lanning Organizing

Staffing

Directing

CO-ordinating Reporting

Budgeting


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Planning

Working out a broad outline, the things that

need to be done and the methods for doing

them to accomplish the purpose set for the

enterprises orofthepurpose in hand


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Organizing

This is the establishment of the formal

structure of authority through which work

subdivisions are arranged , defined and co-

ordinated for the defined objectives


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Staffing

The whole personnel function ofbringing in

and training the staff and maintaining

favorable conditions of work


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Directing

It is the continuous taskofmaking decisions

and embodying them, in specific and

general orders and instructions and serving

as leader of the enterprise


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Co- ordinationg

All important duty of interrelating the

various parts of the work and eliminating of

overlapping and conflict


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Reporting

That is keeping those to whom the executive

is responsible informed as to what is going

on, which thus includes keeping himself and

his subordinates informed through records ,

research and inspection


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Budgeting

All that goes with budgeting in the form of

fiscal planning, accounting and control


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Planning


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Planning- introduction

It is the basic of all managerial function because

the future course of action is determined by

proper planning

A managerorganizes, directs and control to ensure

the accomplishment of predetermined goals

according to plan


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Planning- introduction

Itis a blue print for action

Planningis deciding in advance what is to be done

It includes selection of objectives, policies,

procedures, programmes from among alternatives

Planningis predetermined course of action to

achieve specific goals


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Planning- Definition

Planning is a process of determining the

objectives of administrative effort and

devising the means calculated to achieve

them Millet

It is the determination of course of action to

achieve the desired results.It bridges the gap

from where we are to where we want to go.


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Nature of planning Planning is an intellectual activity, since it

involves vision and foresightedness to decide

things to be done in future

It involves selection among alternatives.

Planning process involve finding of allalternative and selection of best alternative

to achieve specified objective

Planning is a forward duty since themanager attempts to handle future events

effectively throughprocess of planning


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Nature of planning

Planning is related to objectives and everyplan specifies objectives to achieve in future

& steps to reach them

Planning is most basic of all managerial

function

Planning is inevitable at all levels of

administration


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Principles of planning1. Planningmustfocus on purpose

2. Planningis acontinuous process whichincludesseries of steps

3. Planning shouldbesimple

4. In planning,there shouldbea good harmony

with organization and environment5. Planningis hierarchical in nature

6. Planningmustbeprecise in its objectives, scopeand nature

7. In planningtheprovision should be made to useall available resources

8. Planningshould always be documented so thatall the concerned are fully committedto the

implementation ofthe programme


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Components/ elements of planning

1. Objectives

2. Policies

3. Procedures

4. Programmes

5. Budget


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Objectives : They are the basic plan which determine the goal

or end result Policies : Are written statement or oral understanding.

Policies are general statement which may be either verbal or

written. Policyprovides standing solution for problem

Procedures : Indicates the specific manner in which certain

activity is to be performed

Programmes : it is defined as a single use comprehensive plan

designed to implement policy and accomplish the objective

Budget : is the statement of expected results in numerical

terms; ie in rupees, man hours etc

Components/ elements of planning


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Levels of planning

Planning function has to beperformed at all 3 levels of

management ie top level , middle level and lower level

Top level: Management has to devote much more time to

planning & policy making. It is concerned with strategic

plans which are long term in nature covering a life span

of1-5

yrs or 10 yrs.


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Levels of planning

Middle level: Has to formulate short term or

intermediate plan & devote less time to planning and

more time for coordination and communication.

Specific plans for different areas of management like

personal, production, marketing are implemented by

middle level managers

Lower level: It is directly concerned with operationalplanning. At this level the first level managers such as

HOD concentrates on daily, weekly and monthly

operations


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Types of planning

1. Directionalplanning

2. Administrativeplanning

3. Operationalplanning


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Directional planning

Is often called as policy planning. It is

concerned with the broad general direction

of programme. Ie. Setting the framework of

intent and philosophy within which the

programme will proceed.


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Administrative planning

Is concerned with implementation of the

policies developed and with the mobilization

and coordination of the personnel and

material available in the administrative unit


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Operational planning

It is concerned with the actual delivery

service to the community


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Planning process in health service

Health planning is an orderly process of

defining health problems, identifying correct needs

and surveying the resources to meet them ,

establishing priority goals that are realistic and

feasible and projecting administrative action to

accomplish thepurpose oftheproposedprogramme


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Steps ofPlanning process in health service

1. Analysis ofthehealth situation

2. Establishing objectives andgoals

3. Assessment ofresources

4. Fixingpriorities

5

. Write up the formulated plan

6. Programming and implementation

7. Evaluation


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Benefits of planning

It focuses attention on objectives: Laying down

objectives is the first step in planning. If the

objectives are lay down clearly the execution of

planning also be directed towards this objectives


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Ensures economical operation: Planning involves

lot of mental exercise which is directed towards

achieving efficient operation in the enterprise. It

helps better utilization of resources & thus

minimizing the cost


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It reduces Uncertainty: Planning reduce uncertainty

of future because it involves anticipation of future

events


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It facilitates control: Planning helps the managers

to perform their function of control

Encourages innovation and creativity: It helps for

innovative and creative thinking among managers

because many new ideas come to the mind of

managers while planning


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It improves motivation: A good planning

system ensures participation of all

managers and workers which improves

their motivation


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Disadvantages of planning

1. Itdepends upon facts and information

2. Planningmay leadto internal inflexibilities

and procedural rigidity

3. Itis time consuming and expensive


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Organization


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Introduction Is an essential part ofhuman life. We are born

in organization, educated in organization and

spend most of our time working for

organization

Organization is a process of dividing and

combining efforts of a working group formaking such joint efforts more productive,

effective and fruitful


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Definition

Organization is the form of every human association

for the attainment of common purpose and the process

ofrelating specific duties or functions in a whole

-J.D.Mooney

Organization is a formal structure of authority through

which work subdivisions are arranged, defined and co-

ordinated for the defined objective.

-LutherGullick


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Importance of organizing

1. Focus on objectives andfacilitate the attaining of

objectives.

2. Arrangement of positions and jobs withinthe

hierarchy.

3. Define responsibilities and line of authority ofall

levels.

4. Creating relationships thatwill minimize friction

.


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Basic elements of formal organizations

1. Centralizationanddecentralization.

2. Delegation ofauthority.

3. Span of control (supervision).

4. Division of service.

5. Departmentation.


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Centralization and decentralization:

it refers to the level at which most of the decisions are made

within the organization.

Centralization

Concentration of decision-making and action at high-level

management.

Decentralization

Consistent delegation of authority to the lower levels where

the work is performed


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Centralization

Advantages

1.ProvidePower and

prestige for manager.

2.Promote uniformity of

policies, practicesdecisions.

3.Minimize duplication

of functionis.

4.Extensive controlling

procedures and practices

arenot required.

Disadvantages

1.Neglected functions for

mid. Level,andless

motivated bedside

personnel.2. Nursing supervisor

functions as a link

officerbetweennursing

director and first-line

managementinstead of

acting as a manager .


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Decentralization-Advantages

Raise morale and promote interpersonal

relationships.

Relieve from the daily administration.

Bring decision-making close to action.

Develop Second-line managers.

Promote employees enthusiasm and

coordination.

Facilitate actions by lower-level managers.

Improves coordination, especially forservices.


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Decentralization- Disadvantages:

Top-level administration may feel it woulddecrease their status.

Managers may not permit full and maximumutilization ofhighly qualifiedpersonnel.

Increased costs. It requires more managers andlarge staff.

It may lead to overlapping and duplication ofeffort.

It may lead to lack of uniformity and loweringof standards in decision -making.

Emergency decision may not bepossible.


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2. Delegation of authority.

Delegation:

Process of assigning work from a top

organizational level to a lower one or from

superior to subordinate, and giving that

person the authority to accomplish them.


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The delegation process

Allocation ofduties.

Delegation ofauthority.

Assignment ofresponsibility.

Creation ofaccountability.

Accountability: subordinates must be held

answerable to theircarried out duties.


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Factors determining degree of authority

delegation:

1. Organizations size.

2. Importance ofduty ordecision.

3. Taskcomplexity.

4. Organizational culture

5. Qualities of subordinates.


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Main principles of delegation


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Barriers to successful delegation

Lack of superiors ability to direct the

subordinates.

Lack ofconfidence in subordinate.

Absence ofcontrol.


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Major causes of managers refusal to

delegate

Tendency to do things personally.

Desire to dominate the knowledge,

information, and/orskills.

Unwillingness to accept risks of wrongs

R f b di t id


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Reasons for subordinates avoidance

of accepting delegation

Decision-making is a hard mental work,and

people seekways ofavoidingit.

Fear of criticism formistakes.

Lack of necessary information and

resources to do agoodjob.

Overload of work.

Positive incentives maybeinadequate.


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Authority

The right to take final decisions, to act or to

command action of others

It moves in a downward direction.


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Types of authority

1. Ultimateauthority.

2. Legal authority.

3. Technical authority.

4. Operational authority.


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Ultimate authority:

It deals with the original source from which

one derives the right to take actions.

Thus, in the health sector, the ministry of

health has ultimate authority


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Legal authority

Means that an individual is legally permitted

by the virtue of the position to take an action;

a hospital director delegates to director of

nursing service to act on behalf of the

department


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Technical authority

It refers to a person who is a recognized

expert in some particular field.

This does not necessarily mean that it is

derived from position.


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Operational authority

Is giving someone permission to assure

certain responsibilities through delegation of

authority.


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Responsibility:

The obligation involved when one accepts an

assignment.


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Types of organizational relationshipsThe line relation

Presents levels of hierarchy, superior-subordinate

relationships, and provides the framework for the

organization.

The superior has the right to give orders and

demand accountability. Each member knows from

whom he/she receives orders and to whom he/she

reports

It is showed by a solid line in the organizational

chart


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Types of organizational relationships

Staff relation

Has no command, personnel have only the

right to advise, assist, support those in the

line authority in the performance of their

duties, it is line showed by a dotted line inthe organizational chart.


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Line & Staff Relationships


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Number of subordinates that can be

adequately supervised by one supervisor.


Span ofControl:


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Dimensions of span of control

1. Narrow span of control.

2. Wide span of control.


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Narrow span of control

Themanagersupervises a small numberofworkers

Narrow span of control


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Narrow span of control.

Advantages:

Close supervision.

Close control.

Fast communicationbetween subordinates and

superiors.Disadvantages:

Superiors tendto gettoo much involved in

subordinates work.

Many levels of management.

High costs dueto many levels.

Wid f t l


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Wide span of control

The manager supervises a large number of workers


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Wide span of controlAdvantages:

Superiors are forced to delegate.

Clear policies must be made.

Subordinates must be carefully selected.

Disadvantages:

Tendency of overload superiors to take most

or all decisions. Dangerofsuperiors loss of control.


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T ll Fl t O i ti


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Tall versus Flat Organizations


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Factors determining the span of control

The competence of both the supervisor and the

subordinate.

The degree of interaction between the units orpersonnel

being supervised.

Other duties of the top manager. Lower-level managers

have a wider range of span than top-level manager.

The similarity or dissimilarity of activities being

supervised.

The nature of work(stability, complexity, etc complexity,

etc).



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g

4. Division of service

Dividing large activities to be distributed among severalpeople.

Advantage:

Allow an employee to master a taskwith a maximum

skill, a minimum time and effort.

Disadvantages:

Creates many different, narrow jobs, which need

effective managerial coordination.


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Itis theprocess of grouping activities into

administrative units.


5) Departmentation


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Types ofDepartmentation

1. Departmentation by services: activities are grouped

according to similarities of skills needed to

accomplish the goal, i.e. medical, surgical and

pediatric units. It is simple and commonly used.

2. Departmentation by time: activities that need

coverage twenty four hours a day, seven days a

week (e.g. acute care settings), or activities

coverage for eight to twelve hours a day for five orsix days a week (e.g. preventive services) at the

most.


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3.D

epartmentation by degree of acuteness of illnessof the patients: fiveprogressivepatientcare (PPC),

i.e. Intensive Care Unit, Intermediate Care Unit,

Self-Care Unit, Long-TermCare Unit, and Home

Care Unit.

4. Departmentation by function: This method places

all the resources and authority under one

manager, e.g. laundry, pharmacy, dietary services.

Types of Departmentation


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5. Departmentation by location: activities that are used

with wide geographic activities in a given locationthat are grouped and assigned to a manager, i.e.

inpatient department, outpatient department, and

administrative department.

6. Departmentation by patient: making sense when

service is important and the welfare of the patient

is of primary interest, i.e. sex: male, female, age:

geriatric, pediatric, economic status: paying, freeunit.


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I t d ti


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Introduction

Once the plan is decided and organization

structure is created then next step in the

managementprocess is to fill the various post

created in the organization. This is

managerial function of staffing.

I t d ti


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Introduction

Staffing is the management activity that provides

for appropriate and adequate personnel to

fulfill the organizations objectives.

The nurse manager decides how many and what

type of personnel are required to provide care

forpatients.

St ffi d fi iti


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Staffing- definition

Selecting the personnel to carry out these

actions and placing them in positions

appropriate to their knowledge and skills

P f t ffi


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Purpose of staffing

To ensure the right number, right type ofpeople are working on the right job at right

time and right place.

The quatity of human resources to achieve

their goal depends upon the quality of human

workforce

El t / f ti f t ffi


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Elements/ functions of staffing

Manpower planning: involves estimation of size and

make up of personnel required

Recruitment : concerned with finding out of

applicants for job vacancies

Selection: involving the choice of best qualified fromamong the job seekers to fill the job vacancies

Placement: of selected people in appropriate

position

Training and development of employees: to enablethem to do their jobs more efficiently

Appraisal of performance: to design rewards,

promotion, transfer etc

1 Steps in manpower planning


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1.Steps in manpower planning

1. Strategic plans

2. Humanresource planning

a. Forecasting human resource needs

b. Forecastingpersonnel availability

c. Designing and implementing personnel selection

policies andprocedures

Strategic plans


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Strategic plans

After developing the policies the

administrators design health resource

planning requirement and budget to fit withotherplans

Human resource planning


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Human resource planning

Itincludeforecasting thedemand for andsupply for required personnel.

This planninghave 3 majorsteps

a. Forecasting human resource needs

b. Forecastingpersonnel availability

c. Designing and implementing personnel selection

policies andprocedures

Forecasting human resource needs


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Forecasting human resource needs

This include forecasting of retirement ,

transfer, termination, resignation etc

Also include analysis of turnover to maintain

the existingpersonnel

Forecasting personnel availability


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Forecasting personnel availability

The human resource inventory provide informationabout the organizations present personnel

After completing the inventory, the organization

prepares a catalogue indicating the detailed skills,

abilities and needs of the work force

Thus personnel inventory permits managers to matchthe organizations present strength and weakness

against future needs and requirements

2 Recruitment


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2.Recruitment

Involves seeking and retracting a pool of

people from which required candidates for

job vacancies can be chosen

Recruitment is a process of searching for

prospective employees & stimulating and

encouraging them to apply for a job in the

organization

Sources of Recruitment


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Sources ofRecruitment

Internal: Whenever new vacancies arises

people from within the organization will be

promoted or will be transfered

External : When the organization has

exhausted internal sources or find it unsuitable

external sources can be used

Process of recruitment


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Process of recruitment Job analysis- it is the systematic and scientific study

of a job in order to determine the nature andcharacteristic of job and the knowledge, experience

and skills requiredfor the successful performance of

the job

Job description- it follows jo b analysis. It is anorganized, written and factual statement of the job

contents in the form of duties.

Job specification- Is the formal statement of the

minimum acceptable human qualities required for

the successful performance ofthe job

3 Selection


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3.Selection

It is theprocess ofchoosing a candidate from

the pool of applicants created by recruiting

The selection is done after the candidate

proceed through a series of step that

compose selection process

It is a negative process

Steps in staffing procedure


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Steps in staffing procedure1. Preliminaryinterview

2. Applicationblank

3. Employmenttest

4. Employmentinterview

5. Physical examination

6. References

7. Final Approval

REJECTIO

N

Steps in staffing procedure


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Preliminary interview- done in reception counters

Application blank- briefwritten resume . Itprovide

data about the candidate

Employment test- designed to measure selected

aspect ofthe candidate

Employment interview- personal or face to faceinterview

Physical examination

References- before final selection; the prospective

employer likes to investigate into the details of the

candidate from the reference provided by the

applicant

Final Approval

4 Placement


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4. Placement

Selected candidates are posted in appropriate

job.

It involve assigning specific job and work

places to the selected candidate

5 Training and development of employees


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5. Training and development of employees

The selection of the best person for the job isthe first step in staffing

The selected persons must be trained to

build up an effective work force

Training is the process of increasing

knowledge and skills of an employ for doing

particular job


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Directing

Directing


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Directing

The function oftelling people what to do and

seeing that they do it to the best of their

ability

Definition


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Definition

The heart of administration is directing

function which involves determining the

course giving orders and instruction and

providing the dynamic leadership

M.E. Dinok

Directing


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Directing Once theplans are formulated the organization

structure is designed and competent persons

are placed at various positions and the

organization is ready to go into action. The

actual actions begins when orders and

instructions are given to the employees andsteps are taken to get them executed.

This is the managerial function ofdirecting

Directing


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Directing

It is the managerial function of instructing,

guiding, supervising, inspiring and influencing

people towards the achievement of

predetermined objective

Directing is basically human resource

management

Importance of direction


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Importance of direction Direction initiates action-

It bridges the gap between the managerial decisionand actual execution bypeople.

It is the integrated team function ofmanagement

Direction made itpossible to achieve the mission orthe objective ofthe organization

Direction facilitates the introduction of change

in an organization

People have a tendency to change in an

organization. They need direction to accept and

implement changes in the right direction for the

betterment ofan organization

Principles of direction


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Principles of direction


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Elements of Management of Critical Care Unit

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