L & M CGH 2010 2011

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LEADERSHIP AND MANAGEMENT

ROUSSEL FRANCES C. GAJETECHINESE GENERAL HOSPITAL

COLLEGE OF NURSING


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


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


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


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)


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)


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


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


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)


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


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


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


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


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


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


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


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)


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)


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


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


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.


Goals and Objectives• Objectives

– More specific, concrete– Stated in terms of results to be

achieved

• Goals– More general with a broad area


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?


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?



• 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?



• WHY?– Why is this job, this procedure,

necessary?– Why is this done in this way, in this place,

at this time, by this person?



• 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?


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


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


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


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


Policies

• Derived from philosophy, goals & objectives

• Guides general course & scope of organizational activities

• Direct individual behavior towards org mission

• Defines broad limits & desired outcomes


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


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


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


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


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


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


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



• Bureaucratic Model – Common in healthcare– Based on history, norms & tradition

(info & action)– The hierarchial bureaucracy dictates key

players



• 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


• 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


The Management Process• Organizing

– establishing formal authority.

It involves

1. Setting up the organizational structure

2. Determining the staff needed

3. Developing job descriptions


• 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

L & M CGH 2010 2011

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Transcript of L & M CGH 2010 2011