Roles and Functions in Controlling
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Controlling and evaluating refer to measuring actual performance against planned activities and taking corrective actions. It involves establishing standards, measuring performance, comparing results to standards, and reinforcing strengths or taking corrective actions. The purposes of controlling include establishing trust, clarifying objectives, presenting uniform standards, and promoting growth. Control mechanisms include standards of care, total quality management, quality assurance, quality control, and quality improvement. Quality improvement methods encompass standards of care, credentialing, utilization review, clinical guidelines, clinical pathways, benchmarking, PDCA cycles, and the FOCUS methodology. Nursing audit examines structures, processes, and outcomes through checklists and indicators to determine if nursing standards are met. Control techniques include nursing rounds, operating instructions
Roles and Functions in Controlling
- 2. Definitions • Controlling and evaluating refer to the process by which managers attempt to see the actual activities conform to planned activities. • These are management functions by which performance is measured and corrective action is taken to ensure the accomplishment of organizational goals.
- 3. Basic Components • Establishing standards, objectives and methods for measuring performance. • Measuring actual performance. • Comparing results of performance with standards and objectives and identifying strengths and areas for correction. • Acting to reinforce strengths or successes and taking corrective action as necessary.
- 4. Nature and Purposes • To establish trust and commitment to the system by all personnel through the use of an effective communication system. • To clarify organization and individual objectives. • To present uniform and fair standards with precise definitions of each standard, goal and objective.
- 5. Nature and Purposes • To compare expectancy with performance. • To improve organization development by providing information for decision making on staffing, system for delivery of care and quality of care. • To promote growth and development of personnel.
- 7. Standards of Care • Yardsticks for gauging the quality and quantity of services. • Established criteria of performance, planning goals, strategic plans, physical or quantitative measurement of products, units of service, labour hours, speed, cost, capital, revenue, program and intangible standards. • An acknowledged measure of comparison for quantitative value, criterion or norm, a standard rule or test on which a judgement or decision can be based.
- 8. Total Quality Management (TQM) refers a work ethic involving everyone in the organization. The client is the focus.
- 9. a. Elements • Decentralization • Participatory management: making decisions at lower levels in the organizational hierarchy • Matrix management: free-form organizational structure • by Objectives (MBO): every person or group in a work setting has specific, attainable and measurable objectives that are in a harmony with those of the organization.
- 10. Cont… a. Elements • Statistical analyses • Team building • Quality circles: participatory management technique that uses statistical analysis of activities to maintain quality products. • Theory Z (consensual decision-making): the leadership style is a democratic one which includes decentralization, participatory management, employee involvement and an emphasis on quality of life.
- 11. b. Quality assurance defines performance measures and compares actual processes and outcomes to clinical satisfaction indicators. c. Quality control involves performance management and maintenance and includes systematic methods of ensuring conformity to a desired standard or norm. d. Quality improvement concerned with performance development and is ongoing, involved with fixing now, preventing future costly mistakes and fostering breakthroughs
- 12. e. Quality improvement methods • Standards of care: descriptions of minimum acceptable performance during client care from health acre provider who has specific knowledge and skill; developed by professional organizations, legal sources, regulatory agencies and healthcare agencies. • Credentialing and licensure: review process used by an insurance carrier or healthcare professional may practice or provide care to clients. • Utilization review/management: process of evaluating healthcare services to specific client populations for necessity, appropriateness, and efficiency.
- 13. Cont… e. Quality improvement methods • Clinical guidelines: produced most notably by the Agency for Healthcare Research and Quality (AHRQ) and also by professional organization. They help improve care by identifying outcomes and supporting best practices. • Clinical pathways: tools for use with specific client diagnoses to focus on client outcomes and appropriate use of resources in a timely manner. They promote cost effectiveness as an added benefit. • Benchmarking: tool that identifies best practices and allows the healthcare organization to compare its performance with other units or areas within the organization and also with other organizations.
- 14. Cont… e. Quality improvement methods • Methodologies for quality improvement start with the following three • questions: • What are we trying to accomplish? • How will we know that a change is an improvement? • What changes can we make that will result in improvement?
- 15. Cont… e. Quality improvement methods Plan – Plan a change, test or activity aimed at improvement Do – Carry it out (preferably on a small scale). Study – Study the results. What did you learn? What can you predict? Act – Adopt the change or abandon it or run through cycle again (preferably under different conditions).
- 16. Cont… e. Quality improvement methods The FOCUS Methodology Focus on an Opportunity for Improvement Organize a Team Clarify the Current Process Understand the Degree of Change Needed Select a Solution for Improvement
- 17. Cont… e. Quality improvement methodsOther Improvement Strategies a. Benchmarking is a continual and collaborative discipline of measuring and comparing the results of key work processes with those of the best performers. It fosters learning to adopt best practices to achieve breakthrough process improvement and build healthier communities. b. Regulatory requirements refers to developed standards to guide critical activities performed by a healthcare organization. Example: Joint Commission on Accreditation of Hospital Organization (JCAHO), International Standards Organization (ISO)
- 18. Nursing Audit involves an examination, a verification or an accounting of predetermined indicators.
- 19. Three basic forms of nursing audit:
- 20. Structure audit focuses on the setting in which care takes place, i.e., physical facilities, equipment, caregivers, organization, policies, procedures and medical records. These are measured by means of checklists.
- 21. Process audit implements indicators for measuring nursing care to determine whether nursing standards are met. It is generally task-oriented.
- 22. Outcome audit evaluates nursing performance in terms of establishing client outcome criteria. It may either be concurrent or retrospective.
- 23. Control Techniques – Nursing rounds cover issues like patient care, nursing practice and unit management. – Nursing operating instructions include policies which become standards for evaluation as well as controlling techniques. – Gantt charts depict a series of events essential to the completion of a project or program. – Critical control points and milestones use specific points in a master evaluation plan at which the nurse judges whether the objectives are being met, qualitatively and quantitatively.
- 24. – Program Evaluation and Review Technique (PERT) uses a network of activities, each of which is represented as a step on a chart. It includes time measurement, an estimated budget and calculation of the critical path (the sequence of events that would take the longest time to finish). – Benchmarking is a technique whereby an organization seeks out the best practices in its industry so as to improve its performance. It is a standard, or point of reference, in measuring or judging quality, values and costs.
- 25. Thank You!
- 26. Prepared by: Maria Neze Dalimocon, RN Ric Arthur Estuaria, RN Submitted to: Ms. Rona Alcera, RN, MAN