CONTROLLING

Controlling
It is an on-going function of management
It includes assessing and regulating performance
It offers opportunities for improvement and comparing performance against
standards
Controlling
The means of good performance and management includes
> leadership and commitment
> full employee involvement
> good planning
> sound implementation strategy, measurement and evaluation,
control and improvement,
> the achievement and sustenance of standards of excellence.
Reasons For Conducting Evaluation
1. Evaluation ensures that quality nursing care is provided.
2. It allows for the setting of sensible objectives and ensures compliance with them.
3. It provides standards for establishing comparisons.
4. It promotes visibility and a means for employees to monitor their own
performance.
Reasons For Conducting Evaluation
5. It highlights problems related to quality care and determines the areas that
require priority attention.
6. It provides an indication of the costs of poor quality.
7. It justifies the use of resources.
8. It provides feedback for improvement.
Evaluation Principles
1. The evaluation must be based on the behavioral standards of performance
2. In evaluating performance, there should be enough time to observe employee's
behavior. Usual and consistent behavior should be evaluated
3. The employee should be given a copy of the job description, performance
standards, and evaluation form
4. The employee's performance appraisal should include both satisfactory and
unsatisfactory results
Evaluation Principles
5. Areas needing improvement must be prioritized
6. The evaluation conference should be scheduled
7. The evaluation report and conference should be structured positively as a
means of improving job performance.

Characteristics of an Evaluation Tool

Objectivity
Reliability
Validity
Sensitivity
Basic Components of the Control Process
1. establishment of standards, objectives, and methods for measuring
performance;
2. measurement of actual performance;
3. comparison of results of performance with standards and objectives and
identifying strengths and areas for correction and/ or improvement;
4. action to reinforce strengths or successes; and
5. implementation of corrective action as necessary
Establishment of Standards for Measuring Performance
1. Standards on structure
2. Process standards
3. Outcome standards
Structure Measures
a relationship exists between quality care and appropriate structure.

Structure measures include resource inputs such as the environment in which

health care is delivered.

For example,
staffing ratios, staffing mix,
emergency department waiting times, and
the availability of fire extinguishers in patient care areas
Process Measures
are used to measure the process of care or how the care was carried out.

relationship exists between the process used by the nurse and the quality of care
provided.

They tend to be task-oriented and focus on whether practice standards are being
fulfilled.

Critical pathways and standardized clinical guidelines are examples of efforts to

standardize the process of care

Outcome Measures
Outcome measures are:

The end results of medical care.

The changes in the patient's health status
What happened to the patient in terms of palliation, control of illness, cure, or

rehabilitation.

What results (if any) occurred as a result of specific interventions.

Examples of outcomes are mortality, morbidity, and length of hospital stay.

Establishment of Objectives and Methods for Measuring Performance
It provides clear direction and communication of expected levels of achievement.
There should be full commitment in the form of a performance contract.
Objectives should be challenging but attainable.
Performance expectations must be clearly stated and should lie within the
individual's scope of control.
Commonly used methods for measuring nursing care
Task analysis
Quality control.
Quality Control
Activities that evaluate, monitor, or regulate services rendered to consumers.
Three Steps of the
Quality Control Process

The criterion or standard is determined.

Information is collected to determine if the standard has been met.

Educational or corrective action is taken if the criterion has not been met.

It is an on-going, repetitive process

It may be scheduled in advance

Purpose of measurements should be clarified

It is the easiest steps in the control process

It is the matching of performance to standards and objectives = needs of patients

are met

Reinforcing Strengths or Successes and Taking Corrective Action As Necessary

Positive feedback stimulates motivation, consistently high performance and growth
of the employee.

Corrective actions are applied to improve performance.

Performance Appraisal
Performance Appraisal
It is a control process in which employee's performance is evaluated against
standards.

It is the most valuable tool in controlling human resources and productivity.

It reflects how well the nursing personnel have performed during a specific period
of time.

An effective appraisal process rewards productive employees and assists the

professional growth and development of inexperienced and unproductive individuals.
Mable H. Smith
What Are the Purposes
of a Performance Appraisal?
A performance appraisal is used to:
1. determine salary standards and merit increases;
2. select qualified individuals for promotion or transfer;
3. identify unsatisfactory employees for demotion or termination;
4. make inventories of talents within the institution;
5. determine training and developmental needs of employees;
A performance appraisal is used to:
6. improve the performance of work groups by examining, improving, correcting
interrelationships between members;
7. improve communication between supervisors and employees and reach an
understanding on the objectives of the job;
8. establish standards of supervisory performance;
A performance appraisal is used to:
9. discover the aspirations of employees and reconcile these with the goals of the
institution;
10. provide "employee recognition" for accomplishments; and
11. inform employees "where they stand."
Factors Contributing to an Effective Performance Appraisal System
1. Compatibility between the criteria for individual evaluation and organization
goals.
2. Direct application of the rated performance to performance standards and
objectives expected of the worker.
3. Development of behavioral expectations which have been mutually agreed upon

by both the rater and the worker.

Factors Contributing to an Effective Performance Appraisal System
3. Development of behavioral expectations which have been mutually agreed upon
by both the rater and the worker.
4. Understanding the process and effective utilization of procedure by the rater.
Factors Contributing to an Effective Performance Appraisal System
5. Rating of each individual by the immediate supervisor.
6. Concentration on the strengths and weaknesses to improve individual
performance.
Factors Contributing to an Effective Performance Appraisal System
7. Encouragement of feedback from the rated employees about their performance
needs and interests.
8. Provision for initiating preventive and corrective action and making adjustments
to improve performance.
1. Essay
The appraiser writes a paragraph or more about the worker's strengths,
weaknesses and potentials.
2. Checklists
A compilation of all nursing performances expected of a worker. The appraiser's
task is to mark the appropriate column whether the worker does or does not show
the desired behavior.
3. Ranking
the evaluator ranks the employees according to how he or she fared with coworkers with respect to certain aspects of performance or qualifications.
4. Rating Scales
includes a series of items representing the different tasks or activities in the nurse's
job description or the absence or presence of desired behaviors and the extent to
which these are possessed.
5. Forced-Choice Comparison
the evaluator is asked to choose the statement that best describes the nurse being
evaluated.

The items are so grouped that the evaluator is forced to choose from favorable as
well as unfavorable statements.

6. Anecdotal Recording
describes the nurse's experience with a group or a person, or in validating
technical skills and interpersonal relationships.
The anecdotal record should include (1) a description of the particular occasion, (2)

a delineation of the behavior noted including answers to the questions who, what,
why, when, where, and how, and (3) the evaluator's opinion or assessment of the
incident or behavior.
Coaching as Part of the Performance Appraisal Process
The effective manager and astute leader are aware that day-to-day feedback
regarding performance is one of the best methods for improving work performance
and building a team approach.
Reflective Practice
or Clinical Coaching
In reflective practice or
clinical coaching, the
manager or mentor
meets with an employee
regularly to discuss
aspects of their work.
Quality Assurance
Assurance means achieving a sense of accomplishment and implies a guarantee
of excellence

Quality is the degree of excellence

Assurance means formal guarantee of a degree of excellence.

is a way to ensure customer satisfaction by involving all employees in the improvement

of the quality of every product or service.
- is a process of continuously improving a system by gathering data or performance
and using multi-disciplinary team to analyze the system, collect measurements,
and propose changes.
The four main principles are
customer focus,
the identification of key processes to improve quality,
the use of quality tools and statistics,
and the involvement of all people in problem solving.
Benchmarking
The process of measuring products, practices, or services against best-performing
organizations.
Organizations can determine how and why their organization differs from these
exemplars and then use the exemplars as role models for standard development
and performance improvement.
Principles Underlying Quality Assurance Efforts
1. All health professionals should collaborate in the effort to measure and improve
care.

2. Coordination is essential in planning a comprehensive quality assurance

program.
3. Resource expenditure for quality assurance activities is appropriate.

4. There should be focus on critical factors such as functions and activities

5. Quality patient care is accurately evaluated through adequate documentation.

6. The ability to achieve nursing objectives depends upon the optimal functioning
of the entire nursing process and its effective monitoring.

7. Feedback to practitioners is essential to improve practice.

8. Peer pressure provides the impetus to effect prescribed changes based on the
results of assessment and needed improvements on the quality of care.
9. Reorganization in the formal organizational structure may be required if
assessment reveals the need for a different pattern of health care.
10. Collection and analysis of data should be utilized to motivate remedial action.

Quality Assurance Methods

Nursing Audit Committee
A nursing audit committee is composed of a represent ative from all levels of the
nursing staff: a member of the Training Staff, Supervising Nurse,
Head/Senior Nurse, and a Staff Nurse.
Patient Care Audits

A concurrent audit
1) a review of the patients' charts while the patients are still confined in the hospital;
2) observation of the staff as patient care is given; and
3) inspection of patients and/or observation of the effects of patient care where the
focus is on the patient.
A retrospective audit
1) a review of discharged patients' charts; and
2) questionnaires sent to or interviews conducted on discharged patients.

Peer Review
Patient care audits may be done by peers (employees of the same profession,
rank and setting) evaluating another's job performance against accepted
standards.

Peer review has the potential for increased professionalism, performance, and
professional accountability among practicing staff and is gaining popularity in the
United States and internationally.
(Vuorinenet et al., 2000)

Quality Circles
>introduced by the Japanese.
> a group of workers doing similar work who meet regularly, voluntarily, on normal
working time, under the leadership of their supervisor, to identify, analyze, and
solve work-related problems and to recommend solutions to management.

the periodic review of the utilization of materials and supplies in the various nursing
units

Consumption of supplies and materials should be proportionate to the number of

patient served

A high turnover rate is desired

Preventive maintenance is important

Self-Discipline
The process by which rules are internalized and become part of the persons
personality.
Highest and most effective form of discipline.
Factors that influence self-discipline

A strong commitment to the vision, philosophy, goals and objectives of the

institution

Laws that govern the practice of all professionals and their respective Codes of
Conduct

Understanding the rules and regulations of the agency

Factors that influence self-discipline

4. A atmosphere of mutual trust and confidence
5. Pressure from peers and organizations
Strategies to Create an Environment
of Self-Discipline
1.Clearly written and communicated rules and regulations.
2.Atmosphere of mutual trust.

3.Judicious use of formal authority.

4.Employee identification with organizational goals.
Rule Breaking
Most common reason for discipline.
If rule is consistently broken, need to ask:
1) Whose rule is it?
2) Do we still need the rule?
Think back to rule breakers you have known
Were they a majority or minority in the group?

How great was their impact on group behavior?

What characteristics did they have in common?

Did the group modify the rule breakers behavior or did the the rule breaker modify
the groups behavior?
Destructive Discipline
Use of threats and fear to control behavior.

Employee always alert to impending penalty or termination.

Arbitrarily administered and either unfair in the application of rules or the resulting
punishment.
Constructive Discipline
Helps the employee to grow.
Is carried out in a supportive, corrective manner.
Employee is reassured that punishment is given because of actions and not
because of who he or she is as a person.
Primary focus is to assist the employee to behave in a manner that allows
him or her to be self-directed in meeting organizational goals.

McGregors (1967) Hot Stove Rule

Four elements must
be present to make discipline as fair and growth-producing as possible:
1. Forewarning
2. Immediate
consequences
3. Consistency
4. Impartiality
Four Common Steps in Progressive Discipline
1. Counseling/Informal reprimand or verbal admonishment.
2. Formal reprimand
or written admonishment.
3. Suspension from work without pay.

4. Termination.
The Disciplinary Conference

State problem clearly.

Ask employee why there has been no improvement.
Explain disciplinary action to be taken.
Describe expected behavioral change.

Get agreement and acceptance of the plan.

Performance Deficiency Coaching
May be ongoing or problem-centered.
Manager actively brings areas of unacceptable behavior or performance to the
attention of the employee and works with him or her to establish a plan to correct
deficiencies.
The Termination Conference

State the facts of the case and the reason for termination.
Explain the termination process.
Ask for employee input and respond calmly and openly.

End the meeting on a positive note, if possible.

Termination
Should always be the last resort when dealing with poor performance, but is
necessary for employees who continue to break rules despite repeated warnings.
Is always difficult for the employee, manager, and unit; however, the cost in
terms of managerial/employee time and unit morale of keeping such an
employee is enormous.