MIDDLE MANAGEMENT

Nursing supervisors

LEADERSHIP AND MANAGEMENT OUTLINE
PLANNING
-defined as pre-determining a course of action in order to arrive at a desired result.
-it is a continuous process of assessing, establishing goals and objectives, implementing
and evaluating them.

PRINCIPLES OF PLANNING

1. Based and focused on the vision, mission, philosophy, and clearly defined objectives of
the organization.
2. A continuous process. (revision/ flexibility to be done to make it more effective)
3. Should be pervasive within the entire organization.
4. Planning utilizes all available resources.
5. Must be precise in its scope and nature. It should be realistic and focused on its
expected outcomes.
6. Planning should be time-bound.
7. Must be documented for proper dissemination to all concerned for implementation and
evaluation.

IMPORTANCE OF PLANNING

1. Planning leads to the achievement of goals and objectives.
2. Planning gives meaning to work.
3. Planning provides for effective use of available resources and facilities.
4. Planning helps in coping with crises. Hospitals should provide for disaster plans.
5. Planning is cost effective.
6. Planning is based on past and future activities.
7. Planning leads to the realization of the need for change.
8. Planning provides the basis for control.
9. Planning is necessary for effective control.

WHY MANAGERS FAIL TO PLAN EFFECTIVELY

1. Lack of knowledge of the philosophy, goals, and objectives of the agency
2. Lack understanding of the significance of the planning process
3. No time management
4. Lack of confidence in formulating plans
5. Fear that planning may bring about unwanted changes

SCOPE PLANNING














MAJOR ASPECTS OF PLANNING
TOP MANAGEMENT
Nursing directors
Chief nurses or
Directors of nursing and
their assistants
LOWER or FIRST LEVEL
MANAGEMENT
Head Nurses
Senior nurses
Charge nurses or team
leader
Set the over-all goals and
policies of an organization
Responsible for the over-all
management of the nursing
service organization
Direct the activities to
implement the broad
operating policies of the
organization
Formulation of policies, rules
and regulations, methods and
procedures for intermediate
level planning for on-going
activities and projects
Coordinate with the top
management and lower level
Do the daily and weekly
plans for the
administration of direct
aeg care and their
respective unit.
The hierarchy
broadens at lower
levels representing an
increase in the
number of planning
components
Planning components
at the top of the
hierarchy are more
general and the lower
components are more
specific.
1. Should contribute to objectives
2. Precedes all other processes of management
3. Pervades all levels
4. Should be efficient

CHARACTERISTICS OF A GOOD PLANNING
1. Be precise with clearly-worded objectives, including desired results and methods for
evaluation;
2. Be guided by policies and/or procedures affecting the planned action;
3. Indicate priorities;
4. Develop actions that are flexible and realistic in terms of available personnel,
equipment facilities, and time;
5. Develop a logical sequence of activities;
6. Include the most practical methods for achieving each objectives &
7. Pervade the whole organization.

All planning involve a choice: a necessity to choose from among alternatives.
Definition of planning











FOUR MODES OF PLANNING:

1. Reactive planning- occurs after a problem exists
2. Inactivism- is another type of conventional planning
3. Preactivism- preactive planners utilize technology to accelerate change and are future
oriented.
4. Interactive or proactive planning- attempt to plan the future of the organization rather
than react to it.

THE PLANNING HIERACHY















- Marquiz deciding in advance
what to do; and how, when, and
where it is to be done.
- Douglas defines planning as
having a specific purpose.
- Minsberg= is one approach to
strategy making
- Porter-oGrady represents
specific objectives that lead to
achievement of objectives
All these
definitions
imply that
planning is
purposeful
and
proactive
MISSION
PHILOSOPHY
GOALS
OBJECTIVES
POLICIES
PROCEDURES
RULES
The plans at the
top influencing
all the plans that
follow
I. PURPOSE OR MISSON STATEMENT:
Outlines what the organization plans to accomplish,
Identifies the purpose or reason why an organization exists

MISSION STATEMENT:
May be short as a single clause or sentence
Identifies the group or (constituency) to whom the services are directed
Indicate its purpose
Guides the planning
Is of highest priority in the planning hierarchy because it influences the development of
an organizational philosophy, goals, objectives and policies/procedures/rules

THE MISSION

The Ateneo de Zamboanga University believes that education is a process of formation that
develops in the person, the knowledge, skills, and orientation needed for a life of dedicated
service. The university also believes that its institutional responsibility includes working for
peace and progress particularly in Western Mindanao.

VISION STATEMENT
-is the future aim or function of the organization

THE VISION
The Ateneo de Zamboanga University, an educational community forming men and women
for others and serving as agent of change in bringing about peace and development in the
city, the region, and the nation.

II. THE ORGANIZATION PHILOSOPHY STATEMENT:
Philosophy flows from the purpose of the mission statement
And provides a statement of beliefs and set of values that are basic to the operation of
the organization, service or unit.

PHILOSOPHY
- It is the basic foundation that directs all further planning toward that mission
- Also include a listing of goals or objectives
- Is the basic foundation that directs all further planning toward that mission.

PHILOSOPHY: Man is a unified dimension, rationale and free, a bio-psycho-socio-cultural and
spiritual being created in the image and likeness of God with individual aspirations, which are
influenced by the stages of development, life experience, society, culture and technological
advances. Man constantly interacts with his family, community as a holistic being.
HEALTH is a dynamic state and a process of being and becoming whole and using ones powers
to the fullest extent. It is not merely the absence of pathologic conditions. It is self
responsibility while it is a basic human right. It is influenced by socio-economic-political-
education and spiritual dimensions. It is socially determined thus it is achieved people
empowerment.







III. GOALS AND OBJECTIVES:

GOAL- may be defined as the desired result toward which effort is directed
It is the aim of the philosophy
are ends towards which the organization is working
GOALS: the college aims to form students into nurses who are compassionate,
competent, committed, confident, caring, conscientious, and a critical-thinking
generalist.

OBJECTIVES

OBJECTIVES can focus either on the desired process or outcome
Objectives are similar to goals in that they motivate people to a specific end and are
explicit, measurable, observable or retrievable and obtainable
Are more specific and measurable than goals because they identify how and when the
goals to be accomplished.
Objectives can focus either on the desired process or he desired result.
Process obj. are written in terms of the method to be used.
Result-focused obj = specific on the desired outcome

The objectives of the College of Nursing are the following:

o Provide students with the necessary skills, knowledge and attitudes for the promotion
restoration of health, prevention of illness, and alleviation of suffering.
o Develop in the students deep awareness and understanding of the legal, social and
moral responsibilities of the profession.
o Develop critical and creative thinking as well as research capabilities through the use of
the nursing process.

POLICIES AND PROCEDURES

POLICIES are plans reduced to statement or instructions that direct the organization in their
decision making
o A designated plan or course of action to be taken in a specific situation.

POLICIES can be:
Implied neither written or expressed
Expressed policies- written policies that are available to all and promote consistency of
action

PROCEDURES
Identify the process or stages needed to implement or stages needed to implement a
policy and are generally found in manuals at the unit level of organization.
Established procedures save staff time, facilitate delegation, reduce cost, increase
productivity and provide a means of control

RULES AND REGULATIONS
Are plans that define specific actions or non-actions.
Generally included as part of policy and procedures statement
RULES describe situations that allow only one choice of action.




POINTS to remember for successful organizational planning:
1) The organization can be more effective if movement within it is directed at
specified goals and objectives.
2) Because a plan is a guide to reach a goal, it must be flexible and allow for
readjustment as unexpected event occur.
3) The manager should include in the planning process people and units that could
be affected by the course of action.
4) Plans should be specific, simple and realistic.
5) Know when to plan and when not to plan
6) Good plans have built in evaluation, checkpoints so there can be a mid-course
correction if unexpected events occur
7) A final evaluation should always occur at the end of the plan

THE PLANNING FORMULA
By KRON
1. WHAT
What has been done?
What should be done?
What equipment and supplies 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?
2. WHEN
When should the job be done?
When was it formerly done?
When could it be done?
3. WHERE-
Where is the job to be done?
Where does an activity occur in relation to those activities immediately
preceding and following it?
Where could supplies be stored, cleaned, and so forth?
4. HOW-
How will the job be done?
What are the steps to be followed in doing the procedure?
How will the time and energy of personnel be used?
How much will it cost?
How much time will it require?
5. WHO-
Who has been doing the job?
Who else could do it?
Is more than one person involved?
6. WHY- to each of the questions, ask why.
Why is this job, this procedure, this step necessary?
Why is it done in this way, in his place, by this person?
7. 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 a machine to help?
Can we get enough money?




STRATEGIC PLANNING IN THE ORGANIZATION
Planning has several dimensions 2 of these dimensions are:
Time span
Complexity or comprehensiveness
- Complex organizational plans that involve a long period (3-10 yrs) are referred to as long
range or strategic planning.
MARTIN (1998) suggests that all strategic planning forecasts the future success of an
organization by matching and aligning all its capabilities with its external opportunities.

BESSY (1994) suggest that strategic planning as a management process combines 4 basic
features:
i. A clear statement of the organization mission.
ii. The identification of the agencies external constituencies or stakeholders and the
determination of assess of the agencys purpose and operation
iii. The delineation of the agencys strategic goals and objective typically in a 3-5 year
plan.
iv. The development of strategies to achieve the goals.

PLANNED CHANGE

DAVID HIZAR (1996) suggests that the 3 major drive changes in contemporary healthcare are:
Technology
Information
Growing population

CHANGE AGENT- a person skilled in the theory of implementation of planned change.
Occurs because of an intended effort by a change agent to deliberately move the system.
A change agent is the person responsible for moving others who are affected by the change
through its stages.


























LEADERSHIP ROLES & MANAGEMENT
FUNCTIONS IN PLANNED CHANGE


LEADERSHIP ROLE


MANAGEMENT FUNCTIONS
1) Is visionary in identifying areas of change in
the organization and the health care system

Forecasts unit needs with an understanding of the
organizations and units legal, political, economic,
social, and legislative climate
2) Demonstrates risk taking is assuming the role
of change agent

Recognizes the need for planned change and identifies
the options and resources available to implement that
change.
3) Demonstrates flexibility in goal setting in a
rapidly changing healthcare system
Appropriately assesses the driving and restraining
forces when planning for change.
4) Anticipates and creatively problems solves
resistance to change

Identifies and implements appropriate strategies to
minimize or overcome resistance to change
5) Serves as a role model to subordinates during
planned change by viewing change as
challenge and opportunity for growth.

Seeks subordinates input in planned change and
provides them with adequate information during the
change process to give them some feeling of control.
6) Role models high level interpersonal
communication skills in providing support for
followers undergoing rapid or difficult change.

Supports subordinates input in planned change and
provides them with adequate information during the
change process to give them some feeling of control.
7) Demonstrates creativity in identifying
alternatives to problems

Identifies and uses appropriate change strategies to
modify the behavior of subordinates as needed
8) Demonstrates sensitivity to timing in
proposing planned change.

Periodically assesses the unit/ department for signs of
organizational aging and plans renewal strategies
9) Take steps to prevent aging in the organization
and to keep nursing current with the new
realities of nursing practice.



CHANGE THEORIES DEVELOPED BY KURT LEWIN (1990s)
- Identified three phases through which the change agent must proceed before a planned
change becomes part of the system:

STAGES OF PLANNED CHANGE
1. UNFREEZING stage: the change agent unfreezes force that maintains the status quo.
o People becomes discontented and aware of the need to change
o For effective change to occur, the change agent needs to have made a thorough
assessment of the extent of and interest to change/ the nature and depth of
motivation/ the environment in which the change will occur.

2. MOVEMENT: the change agent identifies, plans and implements appropriate
strategies ensuring that driving forces exceed restraining forces.
o Change should be implemented gradually
o Any change must allow enough time for those involved




3. REFREEZING: the change agent assists in stabilizing the system change so it becomes
integrated into the status quo.
o For refreezing to occur, the change must be supportive and reinforce the
individual adaptive efforts of those affected by the change.

MURPHY (1999) contemporary model suggest there are predictable stage that people
pass through when exposed to change:
i. Resistance
ii. Confusion
iii. Exploration
iv. Commitment

PEARLMAN and TAKACS (1990)
Identified 10 emotional phases of the change process.

STAGES OF CHANGE AND RESPONSIBILITIES OF THE CHANGE AGENT:

STAGES & RESPONSIBILITY

TEN EMOTIONAL PHASES OF THE
CHYANGE PROCESS
BY: PERLMAN and TAKACS

1. UNFREEZING STAGE
Gather data
Accurately diagnose the problem
Decide if change is needed
Make others aware of the need for
change
1. EQUILIBRIUM
2. DENIAL
3. ANGER
4. BARGAINING
2. MOVEMENT
Develop a plan
Set goals and objectives
Identify areas of support and
resistance
Include everyone who will be affected
by the change in its planning
Set target dates
Develop appropriate strategies
Implement the change
Be available to support others and
offer encouragement through the
change
Evaluate the change
Modify the change if necessary
5. CHAOS
6. DEPRESSION
7. RESIGNATION
3. REFREEZING
Support others so the change remains
8. OPENNESS
9. READINESS
10. RE-EMERGENCE










DRIVING AND RESTRAINING FORCES

o DRIVING FORCES - are the forces that push the system toward the change.

o RESTRAINING FORCES are the forces that pull the system away from the
changes.

GOAL: Return to School













Driving and Restraining Forces

CHANGE STRATEGIES
3 COMMONLY USED STRATEGIES FOR EFFECTIVE CHANGE BY BENNIS, BENNE, and CHINN
(1969)

1) RATIONAL-EMPERICAL STRATEGIES:
The change agent assumes that resistance to change comes from ignorance or
superstition
Human are rational being who will change when given factual information
documenting the need for change.
2) NARRATIVE AND RE-EDUCATIVE STRATEGIES:
Uses group norms to socialize and influence people so change will occur
The change agent assumes human are social animals, more easily influenced by
others than by facts.
Change agent gains power by skill in interpersonal relationship
3) POWER-COERCIVE STRATEGIES:
Based on the application of power by legitimate authority, economic or political
clout of the change agent.

TIME MANAGEMENT
Is making optimal use of available time
Is a technique for allocating ones time through the setting goals, assigning
priorities, identifying and eliminating wasted time and using managerial techniques
to reach goals







3 BASIC STEPS IN TIME MANAGEMENT





Opportunity for advancement
Status-social gratification
Enhanced self-esteem
Family supportive of effort
Forces driving to reach
goal




Low energy level
Limited financial resources
Unreliable transportation
Time with family ready
limited
Forces restraining from
reaching goal
















LEADERSHIP ROLES AND MANAGEMENT
FUNCTIONS IN TIME MANAGEMENT

LEADERSHIP ROLES MANAGEMENT FUNCTIONS
1. Is self-aware regarding personal blocks and
barriers to efficient time management.
1. Appropriately prioritizes day to day
planning to meet short term and long
term unit goals.
2. Functions as a role model, supporter and a
resource person, to subordinates in setting
priorities.
2. Builds time for planning into the work
schedule.
3. Assist followers in working cooperatively to
maximize time use.
3. Analyzes how time is managed on the
unit level using job analysis time and
motion studies.
4. Prevents and/ or filters in working
cooperatively to maximize time use.
4. Eliminates environmental barriers to
effective time mgt. for unit staff.
5. Role models flexibility in working
cooperatively with other people whose
primary time mgt. style is different.
5. Handles paperwork promptly and
efficiently and maintains a neat work
area.

6. Present a calm & reassuring demeanor
during periods of high unit activity.
7. Breaks down large tasks into smaller ones
that can more easily be accomplished by
unit members.


8. Utilizes appropriate technology to
facilitate timely communication &
documentation


9. Discriminates between inadequate
staffing and inefficient use of time when
time resources are inadequate to
complete assigned tasks



1. Time must be set aside for planning
and establishing priorities.

2. Completing the highest-priority task
whenever possible and finishing the
tasks before beginning another.

3. Reprioritizing the tasks to be
accomplished based on new
information received.



TIME MANAGEMENT PRINCIPLES:

1. Planning anticipates the problems that will arise from actions without thought.
2. Tasks to be accomplished should be done in sequence and should be prioritized
according to importance.
3. Setting deadlines in ones work and adhering to them is an excellent exercise in self-
discipline.
4. Deferring, postponing, or putting off decisions, actions or activities can become a habit
which oftentimes cause lost opportunities and productivity, generating personal or
interpersonal crises.
5. Delegation permits a manager to take authority for decision making and to assign tasks
to the lowest level possible consistent with his judgment, facts and experience.

DAVIES (1980) STATES THE FOLLOWING SYMPTOMS OF TIME MISMANANGEMENT:
Rushing
Chronic vacillation between unpleasant alternatives
Fatigue and listlessness with hours of non-productive activity
Constantly missed deadlines
Insufficient time for rest and or personal relationship
Feeling overwhelmed by details and demands, among others

VACARRO (2001) 5 PRIORITY SETTING-TRAPS:

WHATEVER HITS FIRST
An individual simply responds to things as they happen rather than thinking first
and then act.
PATH THE LEAST RESISTANCE
The individual makes an erroneous assumption that it is always easier to do a task
by himself & fails to delegate appropriately.
SQUEEKY WHEEL
The individual falls prey to those who are most vocal about their urgent
needs/requests.
DEFAULT
An individual feels obligated to do the tasks that no one else has come forward to
do.
INSPIRATION
The individual wait until they become inspired to accomplish the tasks
Some tasks are not inspiring and the manager recognizes that the only thing that
will complete these tasks is HARDWORK and appropriate ATTENTION to the
matter.

SIMPLE MEANS OF PRIORITIZING IS TO DIVIDE REQUEST INTO 3 CATEGORIES:


1. DONT DO
Taken cared of by themselves or
Problems that are already outdated or
Problems/tasks that can be accomplished by someone else




2. DO LATER
Items which reflect trivial problems
Those that dont have immediate deadlines or
Those that may be PROCRASTINATED (procrastination means to
put off something else until a future time, to postpone or delay
needlessly)
Major causes of Procrastination:
Performance anxiety
Low frustration tolerance
Resentment of working conditions
Escapisms, over-preparation, over-working
Poor working conditions
Over-commitment & rationalizing

3. DO NOW

Reflect a units day to day operational needs

MANAGING TIME AT WORK:
o Daily Planning Actions to help manager identify and utilize time as a resource:
i. At start of each workday:
Identify key priorities to be accomplished.
Identify what specific actions to be taken.

ii. Determine the level of achievement you expect for each prioritized tasks.

iii. Assess the staff assigned to work with you.
Assign work that must be delegated to staff members
Clearly expect expectations you may have about HOW and WHAT a delegated tasks
must be completed.

iv. Review the short term and long term plans of the unit regularly.

v. Allow time at several points throughout the day and at the end of the day to
assess progress in meeting established daily goals.


Important as
they allow
workers to
REFRESH both
physically and
mentally



























TAKING BREAKS:
STRONGMAN AND BURTS (2000)
STUDIES OF STUDENTS SAYS:
















HUNGER/ THIRST
BOREDOM
FEELING TIRED
LACK OF
CONCENTRATION
MENTAL
EXHAUSTION
KRIEGEL (2002) says that when
individuals are:
Overworked longer hours on
the job do not necessarily
produced the desired
outcomes.
Working longer at a rushed
pace not only increases the
potential for stress and
burnout but also results in
more mistakes.
A 15 minute
daily time out
to think
creatively
about how to
achieve work
objectives is
recommended

ORGANIZATIONS TECHNOLOGY













MANAGEMENT



INFORMATION
SYSTEMS

DEALING WITH INTERRUPTIONS:
o LOWER LEVEL MANAGER- experience more interruptions that higher level-manager.
o FIRST AND MIDDLE MANAGER- are more involve in daily planning than higher-
levelmanagers and interact with the subordinates.

TIME WASTERS (External)

Telephone interruptions
Socializing
Meetings
Lack of information
Lack of feedback
Lack of adequately described policies
and procedures
Incompetent co-workers
Poor filing system
Paper work and readings

INTERNAL TIME WASTERS:

Procrastination
Poor planning
Failure to establish goals/
objectives
Inability to delegate
Inability to say NO
Management by crisis
Haste
Indecisiveness
Open door policy


3 TIME WASTERS THAT WARRANT SPECIAL ATTENTION:
i. SOCIALIZING

Dont make self overly accessible
Interrupt
Avoid promoting socialization
Be brief
Use coffee breaks and lunch hours for scheduling

ii. PAPERWORK OVERLOAD

iii. POOR FILING SYSTEM
Keeping correspondence organized in easily retrievable files

PERSONAL TIME MANAGEMENT:
refers to the knowing of self


HANSTEN and WASHBURN (1998) suggest the three (3) primary areas of practice that
consume the time of RNs:
1. Professional practice
2. Technical practice
3. Amenity care








MONOCHRONIC AND POLYCHRONIC TIME MANAGEMENT STYLES
GIGER and TURNER (1994)suggest that most people have tendencies towards either:

MONOCHRONIC POLYCHRONIC
People prefer to do one thing at a time
Monochromic people tend to begin and
finish projects on time
Have clean and organized desks as a
result of handling each piece of
paperwork only once
Are highly structured

They do TWO or MORE things
simultaneously
They tend to change plans
Borrow and lend things frequently
Emphasize relationship rather than
tasks
Builds linger term relationships


















SOURCE : NCM 107 LECTURE 2013-2014

THE STANDARD FOR
HEADSHIP IN
SCOTLAND

SELECTION
NEEDS
IDENTIFICATION

QUALITY
ASSURANCE

PROGRAMME
DESIGN

ASSESSMENT

LEARNING
SUPPORT