CENTRAL PHILIPPINE UNIVERSITY School of Graduate Studies Lopez Jaena Street, Jaro, Iloilo City Masters of Arts in Nursing

Nursing Education Administration MAN 606a

Lesson Presentation
Unit III Planning: Definitions, Purposes/Reasons, Types and Specific Functions

Submitted by: MARIA REYLAN M. GARCIA, R.N. Submitted to: PROF. MARIA GERALYN D. GOTICO, R.N., M.A.N. NEA Lecturer

I. Objectives At the end of the interactive discussion, the graduate students will be able to: a) Discuss planning as an element of management and of nursing practice b) Explain the different components of the planning hierarchy c) Identify the reasons or purposes of planning d) Differentiate the four modes/orientations of planning and the different types of planning e) Describe the strategic planning process using the 9-method approach f) Discuss the role of budget in fiscal planning g) Differentiate the different budgeting methods h) Criticize a planned expenditure using a decision package of the Zero-based budgeting approach i) Verbalize the importance of the components of planning hierarchy in the entire dynamics of an organization j) Make a personal vision, mission and philosophy II. Introduction He, who fails to plan, plans to fail. Failure is not an option in nursing, whether it be in nursing education, nursing practice or research. As it is vital for a nurse in the clinical setting to formulate efficient and comprehensive plans of care, lesson plans and operational budgets are also the building blocks keeping nursing education together. The concept of planning is a must-know for nursing leaders and managers, for plans may become the best weapons in battling an environment of changing technology, mounting costs and multiple activities in the field of health care. As Chuck Conradt, puts it, in the absence of clearly defined goals, we are forced to concentrate on activity and ultimately become enslaved by it. And nurses, despite how service-oriented their profession is, must never succumb to slavery; they must strive to remain atop and domineering and they must always be in control, for precious lives are at stake. III. Body

a. Definition Planning is deciding in advance what to do; who is to do it; and how, when, and where it is to be done. Thus, planning involves a choice: A necessity to choose from among the alternatives. Planning in the Management Process Henry Fayol defined planning as the first element of management which involves making a plan of action to provide for the foreseeable future. Fayol concurred that with planning, wise use of resources and the selection of the best approaches to achieve the objectives are made easier. With this premise, one can imply that planning is a proactive and deliberate process which reduces risk and uncertainty. It also encourages unity of goals and continuity of energy expenditure in the forms of human and fiscal resources. It also directs the focus to the organizations objectives. It requires moral courage for plans have the potential to fail. Good planning, according to Fayol, is a sign of competence. Urwick further stated that standardization and simplification are basic to sound planning. Aside from the abovementioned characteristics, planning must also use available resources first. For planning to become effective, short and long term plans must be identified. Certain changes must also be considered to ensure that the unit will continue to meet its goals. Leadership skills like vision, creativity, flexibility and energy are necessary in order to formulate plans. Likewise, planning also requires management skills like data gathering, forecasting and transforming ideas into action. Roussel has untangled and provided a much descriptive definition of planning when she defined it as, a continuous process, beginning with the setting of goals and objectives and then laying out a plan of action to accomplish them, put them into play, review the process and the outcomes, provide feedback to personnel, and modify as needed. As planning is then put into action, the management functions of organizing, leading, and evaluating are implemented, making all management functions interdependent.

Planning in Nursing

The forecasting of events and the laying down of a system of activities or actions for accomplishing the work of nursing and of the organization are prerequisites to success. Nurse administrators plan because they do not want to leave events to chance; instead they apply an intellectual process to consciously determine the course of action needed to accomplish the work. The nurse manager plans effectively to create an environment in which nursing personnel will provide nursing care desired and needed by the clients. In such environment, clinical nurses will make decisions about the modality of practice, and nurse managers will work with nursing personnel to establish and meet their personal objectives while meeting the objectives of the organization. Planning Hierarchy Plans of an organization form a hierarchy. It is depicted as a pyramid which broadens at lower levels. This means the planning components at the top of the pyramid are more general and the lower components are more specific. 1. Vision and Mission Statements Vision statements are used to describe future goals of the organization. It is a description in words that conjures up a picture for all group members of what they want to accomplish together. An organization will never be greater than the vision that guides it. Example: CPU College of Nursing - A College of Nursing committed to provide comprehensive education to students to equip them to become responsive to the needs of the individual, family, community and the larger society through exemplary Christian education for life (excel). Mission statements are brief statements identifying the reason why an organization exists. It identifies the organizations constituency and addresses its position regarding ethics, principles and standards of practice. It is the highest priority in the planning hierarchy for it influences the development of an organizations philosophy, goals, objectives, policies, procedures and rules. A organization must truly believe and act upon its mission statement; otherwise, the statement has little value. Example: CPU College of Nursing - Provide holistic nursing education that will assist students to internalize Christian values and equip them with knowledge, attitudes and skills in order to be committed, competent, compassionate and caring in the practice of their profession in various settings.

2. Philosophy Statement The philosophy flows from the mission statement and then delineates the set of values and beliefs that guides all actions of the organization. In the hospital setting, the organization philosophy act as guide for developing nursing philosophies for each unit level and for nursing service as a whole. The nursing philosophies must then address fundamental beliefs in nursing care; the quality, quantity and scope of nursing services; and how nursing specifically will meet organizational goals. Example: CPU College of Nursing - Professional Nursing Education is a dynamic, therapeutic, interpersonal process which inculcate holistic caring of people in various settings. As a vital component of the countrys health system, it is responsive to the needs of the society. As health educators, nurses possess an attitude of constant inquiry, research, leadership abilities, communication skills and spiritual ideals through Exemplary Education for Life (EXCEL). Within the context of health and development the College of Nursing continues to involve multisectoral groups in the promotion/ maintenance, restoration of health, prevention of illness, allevation of suffering and preservation of health at all cost. Utilizing the nursing process as framework for practice, nursing education endeavors to develop a globally competitive, competent, caring, confident and compassionate nurse who is conscientious of his/her ethico-moral and legal obligations. 3. Goals and Objectives All philosophies must be translated into specific goals and objectives. Goals and objectives are the ends, towards the organization is working, as they operationalize the philosophy. A goal is the direct result toward which effort is directed; it is the aim of the philosophy. It may change with time and require periodic reevaluation and prioritization. Though goals are global in nature, they should still be measurable and ambitious but realistic. Example: Mercy Hospital All registered nurses will be proficient in the administration of intravenous fluids Objectives are similar to goals; however they are more specified and measurable than goals because they identify how and when the goal is to be accomplished. The more objectives for a goal can be the easier for all involved in goal attainment to understand and carry out specific behaviors. For the objectives to be measurable, they should have a certain criteria.

There should be a specific time frame in which the objectives are to be completed and the objectives should be stated in behavioral terms, be objectively evaluated and identify positive rather than negative outcomes. Example: Mercy Hospital (1) All registered nurses will complete Mercy Hospitals course IV therapy Certification within 1 month of beginning employment. The hospital will bear cost of this program. (2) Registered nurses who score less than 70% on a comprehensive examination on IV therapy Certification must attend the remedial 4-hour course Review of Basic IV Principles not more than 2 weeks after completion of IV Therapy Certification. (3) Registered nurses who achieve a score of 70% or better on the comprehensive examination for IV Therapy Certification after completing the Review of Basic IV Principles will be allowed to perform IV Therapy on patients. 4. Policies and Procedures Policies are plans reduced into statements or instructions that direct organizations in their decision-making. A policy, according to Paige, is a statement of expectations that sets boundaries for action taking and decision-making. Thus, policies direct individual behavior toward the organizations mission and define broad limits and desired outcomes of commonly recurring situations while leaving some discretion and initiative to those who must carry out that policy. Policies can either be implied (neither written or expressed verbally) or expressed (delineated verbally or in writing). The relative value of a policy is often perceived in relation to how it is communicated. Example: Implied: Nurses who limit their maternity leave to three months can return to their former jobs and shifts with no status change. Expressed: Dress code, sick leave or vacation time, disciplinary procedures. Procedures are plans that establish customary or acceptable ways of accomplishing a specific task and delineate a sequence of steps of required action. Procedures save staff time, facilitate delegation, reduce cost, increase productivity and provide a means of control. Procedures identify the steps or process needed to implement policies and are generally found in manuals at the unit level of the organization. Example: Sick leave procedures include how and when to notify sick absence, completion of self-certification forms, sick leave recording and monitoring. 5. Rules

Rules and regulations are plans that define specific action or nonaction. It is generally included as a part of policy and procedure statements, rules describe situations that allow only one choice of action. Rules are fairly inflexible, so the fewer rules, the better. b. Reasons/Purposes of Planning Roussel, laid down nine reasons for planning, and these are: 1. It increases the chances of success by focusing on results and not on activities. 2. It forces analytic thinking and evaluation of alternatives, thereby improving decisions 3. It establishes a framework for decision making that is consistent with top management objectives 4. It orients people to action rather than reaction 5. It includes day-to-day and future-focused managing 6. It helps avoid crisis management and provides decision-making flexibility. 7. It provides a basis for managing organizational and individual performance 8. It increases employee involvement and improves communication 9. It is cost-effective Donovan on the other hand listed the benefits of planning, among them are: 1. 2. 3. 4. Satisfactory outcomes of decisions Improved functions in emergencies Assurance of economy of time, space and materials The highest use of personnel

Donovan also added that, decision-making, philosophies, and objectives are key elements in planning. There is no purpose to the planning process unless there is knowledge of and skill in applying those processes to the work situation; also necessary is skill in bringing the planning process up to the standard set when deficiencies exist. c. Types of Planning

although there is always some form of cross-over between types of planning within organizations, there is generally an orientation toward one of the four planning modes. Ackoff identified these four modes or orientation. Reactivsim Reactivism looks to the past and considers technology an enemy. It supports the old organizational forms of authoritarian, paternalistic hierarchy. Control operates from the top, with plans submitted from the bottom. Problems are dealt with separately without integration of the whole organization. It may lead to hasty decisions and mistakes. Reactivists do tactical planning (shortterm or operational). Inactivism Inactivism seeks the status quo and much of energy is spent to prevent change and maintain conformity. If changes do occur, they occur slowly and incrementally. Managers are kept busy with red tape and bureaucracy. Inactivists do tactical or operational planning. Preactivism Preactivism utilize technology to accelerate change and is future oriented. Preactivism do not value experience and believe that the future is always better and preferable to the past and present. It is associated with sicence, technology and the future. It is based on long-term forecasting. Proactivism Interactive or proactive planning considers the past, present and future and attempt to plan the future of the organization rather than react to it. Adaptability is the key requirement for proactive planning; it is also the focus together with learning and development. It emphasizes normative planning. Ideals are ends that are not entirely attainable but toward which progress is expected within and after the planning period. The different types of planning have many dimensions and two of these dimensions are time-span and complexity or comprehensiveness. A. Tactical Planning It is otherwise known as short-term planning. It is usually applicable for lower level units in the organization. It is concerned on what the lower levels must do, how they must do it, and who is in charge at each level. Tactics are the means needed to activate a strategy and make it work. Tactical plans

are concerned with shorter time frames and narrower scopes than are strategic plans, thus the term short-term. The plans only span for one year or less because of short-term goals. B. Strategic Planning It is otherwise known as long-term planning. It involves a long period, usually three to ten years. Strategic plans, however, may be done once or twice a year in an organization that changes rapidly. At the unit level, any planning that is at least six months in the future may already be considered as long-term planning. Strategic planning examines an organizations purpose, mission, philosophy and goals in context of its external environment. Strategic planning also forecasts the future success of an organization by matching and aligning an organizations capabilities with its external opportunities. Example: An organization develops a strategic plan for dealing with a nursing shortage, preparing succession managers in the organization, developing a marketing plan, redesigning workload, developing partnerships or simply planning for organizational success. It has generally been understood that top administrators in nursing focus on long-term or strategic planning, whereas operational nurse managers focus on short-term or tactical planning. This process is outmoded. All managers and representative clinical nurses should have input to strategic planning. There should be strategic plans for every unit. There are seven areas of key results, designed to include standards of performance in Strategic planning. These are: 1. 2. 3. 4. 5. 6. 7. Client satisfaction Productivity Innovation Staff development Budget goals Quality Organizational climate

The strategic planning process is used to acquire and develop new healthcare services and product lines including new nursing services and products. It is used also to divest outdated services and products. It can foster better goals, better corporate values and better communication about

corporate direction. The process serves to give planners a sense of direction, involves everyone, and enables unexpected opportunities to be seized and unexpected crises to be dealt with. There are nine phases of the Strategic planning process and these are: 1. Phase 1: The Mission and the Creed Develop statements that define the work, the aims and the character of the division of nursing. These include idea statements of shared values and beliefs. They are called mission and creed statements, and relate to personnel, patients, community and other potential customers. 2. Phase 2: Data Collection and Analysis Collect and analyze data about health care industry and nursing. Data should include both external and internal forces. Simple and complex forecasting techniques must also be used. 3. Phase 3: Assess strengths and weaknesses Define factors from data analysis that influence management of the division of nursing. List them as either strengths or weaknesses. Define the current position and strength of the unit. 4. Phase 4: Goals and Objectives Write realistic and general statements of goals. Breakdown the goals into concrete written statements the division of nursing intends to accomplish in the next 3 to 5 years. 5. Phase 5: Strategies Identify untoward conditions that could develop in achieving each objective. Note the administrative actions to avoid or manage them. Make contingency plans. 6. Phase 6: Timetable Develop a timetable for accomplishing each objective. Identify by geographic units as well. This phase will produce or become part of the plans. 7. Phase 7: Operational and Functional Plans Provide guidelines or general instructions that lead functional and operational nurse managers to develop action plans to implement goals and objectives. These includes detailed actions, policies, practices, communication and feedback, controlling and evaluation plans, budgets, timetables and persons to be held accountable. 8. Phase 8: Implementation Puts the plan to work 9. Phase 9: Evaluation Provide formative evaluation reports before, during and after then implementation of operational plan. Evaluate the strategic mission, and plan frequently. Provide continuous feedback.

C. Operational Planning This is the written blueprint for achieving objectives; it is the organization and direction of the delivery of nursing care. It includes planning to create a budget; to create an effective organizational structure that will encompass a quality monitoring process; and to direct nursing leaders, an administrative staff and new programs. It is otherwise known as the management plan. Operational plans are used to support tactical plans. They can either be a single-use plan or a continuing or ongoing plan. Single use plans apply to activities that do not repeat. A budget is also a single-use plan because it predicts sources and amounts of income and how much they are used for a specific project. Continuing or ongoing plans are usually made once and retain their value over a period of years while undergoing periodic revisions and updates. Examples are policies, procedures and rules. D. Fiscal Planning It is viewed as the most appropriate and helpful way to access an organizations finances and thus plan the best course of action to take for the future. It is forecasting the costs of the organization based on current and projected needs. It requires vision, creativity and a thorough knowledge of the political, social and economic factors that shape healthcare. Budget is a financial plan that estimates expenditures and revenues by an agent for a stated future period. The more accurate the budget blueprint, the better the institution can plan the most efficient use of its resources. Barr in 2005, suggested that budgeting or fiscal planning must be treated as a continuous process rather than an annual exercise because the process is so dynamic. Four most common budgeting methods 1. Incremental Budgeting It is otherwise known as the flat-percentage increase method. It is the simplest method in budgeting. The planner simply multiplies the currentyear expenses with a certain figure, usually the inflation rate or the consumer price index in order to estimate the coming years budget. 2. Zero-based Budgeting

Managers who use zero-based budgeting rejustify their program or needs every budgeting cycle. This type of budgeting method does not automatically assume that since a program has been funded previously, it should continue to be funded. With such premise, ergo, the process becomes labor-intensive for the nurse managers. The use of a decision package is distinctive of zerobased budgeting. Key Components of Decision Packages in Zero-based Budgeting 1. Listing of all current and proposed objectives or activities in the department 2. Alternative plans for carrying out these activities 3. Costs for each alternative 4. Advantages and disadvantages of continuing or discontinuing an activity. Example of a decision package: On implementing a mandatory Hepatitis B vaccination program at a nursing school Objective: All Nursing Students will complete a hepatitis B vaccination series. Driving forces: Hepatitis B is a severely disabling disease that carries significant mortality. The Occupational Safety and Health Association require that Hepatitis B vaccine be offered to health care workers which include student nurses who have a reasonable expectation of being exposed to blood on the job. Vaccination will greatly reduce the risk for contracting the disease. The current vaccination series has proved to have few serious side effects. The nursing school risks liability if it does not follow recommendations to have all high-risk groups vaccinated. Restraining forces: The vaccination series costs $175 per student. Some students do not want to have the vaccinations and believe that requiring them to do so is a violation of free choice. It is unclear whether the school is liable if a student experiences a damaging side effect from the vaccinations. Alternative 1: Require the vaccinations. Because the school of nursing cannot afford to pay for the cost of the series, require that the students pay for it. Advantage: No cost to the school. All students receive the vaccinations Disadvantage: Many students cannot afford the cost of vaccination and believe that requiring it infringes on their right to control choices about their bodies.

Alternative 2: Do not require the vaccination series. Advantage: No cost to anyone. Students have choice regarding whether to have the vaccinations and assume the responsibility of protecting their health themselves. Disadvantage: Some nursing students will be unprotected against hepatitis B while working in high-risk clinical setting. Alternative 3: Require the vaccination series but share the cost between the student and the school. Advantages: Decreased cost to students. All students would be vaccinated. Disadvantage: Costs and limited choice. 3. Flexible Budgeting Flexible budges are budgets that adjust automatically over the course of the year depending on variables such as volume, labor costs and capital expenditures. The flexible budget can be designed to quickly identify such variations occur and create a better picture of current finances as well as a more realistic outlook. 4. New Performance Budgeting This method emphasizes outcomes and results instead of activities or outputs. Thus, the manager would budget as needed to achieve specific outcomes and would evaluate budgetary success accordingly.

IV. References Marquis, B., & Huston, C. (2009). Leadership Roles and Management Functions in Nursing: Theory and Application 6th edition. 530 Walnut Street, Philadelphia, PA: Lippincott Williams & Wilkins Roussel, L. (2006). Nursing Management and Leadership 4th edition. 40 Tall Pine Drive, Sudbury, MA: Jones and Bartlett Publishing, Inc. CliffsNotes. (2012). Detailing Types of Plans. Retrieved January 10, 2012, from http://www.cliffsnotes.com/study_guide/Detailing-Types-ofPlans.topicArticleId-8944,articleId-8871.html