Effective Leadership and Management 1

8/3/2019 Effective Leadership and Management 1

1/43

EffectiveLeadership and

ManagementGroup 7 BSN-4 NA and ND

November 16, 2011


2/43

Healthcare

Organization


3/43


4/43

Organizational Theory Max Weber, a German social scientist, is known as the father

of organizational theory. He developed the most comprehensive classic formulation on

the characteristics of bureaucracy.

Characteristics of bureaucracies (as identified by Weber):

A clear division of labor

A well-defined hierarchy of authority in which superiors areseparated from subordinates

Impersonal rules and impersonality of interpersonal relationships. A system of procedures for dealing with work situations must

exist.

A system of rules covering the rights and duties of each positionmust be in place.

Selection for employment and promotion based on technical


5/43

Organizational Culture

A system of symbols and interactions unique toeach organization.

It is the ways of thinking, behaving, and

believing that members of a unit have incommon.


6/43

Shared Governance

An organizations governance that is shared

among board members, nurses, physicians, andmanagement.

Thus, decision- making and communicationchannels are altered.


7/43

Components of Organizational Structure

Relationships and chain of command The organization chart defines formal relationships

within the institution.

Formal relationships, lines of communication andauthority are depicted on a chart by unbroken (solid)lines.

Unity of command is indicated by the vertical solidline position on the organization chart.

One person/one boss: employees have one managerto whom they report and to whom they areresponsible.


8/43


Span of Control The number of people directly reporting to any one

manager represents that managers span of

control and determines the number of interaction

expected of him or her.

The number of people directly reporting to any onesupervisor must be the number that maximizesproductivity and worker satisfaction.

Too many people reporting to a single managerdelays decision making, whereas too few results inan inefficient, top-heavy organization.


9/43


Managerial Levels

Top-level managers look at the organization as a whole,coordinating internal and external influences and generallymake decisions with few guidelines or structures.

Middle-level manager coordinate the effort of lower levels ofthe hierarchy and are the conduit between lower and top-level managers. Middle-level managers carry out day to dayoperations but are still involved in some long-term planningand in establishing unit policies.

First- level managers are concerned with their specific unitswork flow. They deal with immediate problems in the units

daily operations with organizational needs, and withpersonal needs of employees.


10/43


Centrality Centrality refers to the location of a position on an

organization chart where frequent and various types ofcommunication occur.

Centrality is determined by organizational distance.Employees with relatively small organizational distancecan receive more information than those who are moreperipherally located.

Middle manager often has a broader view of theorganization than other levels of management. A middlemanager has a large degree of centrality because thismanager receives information upward, downward andhorizontally.


11/43

Advantages of the Organization Chart

Maps lines of decision-making authority

Helps people understand their assignments and those of

their coworkers

Reveals to managers and new personnel how they fit into

the organization

Contributes to sound organizational structure


12/43

Limitations of Organizational Chart

Shows only formal relationships

Does not indicate degree of authority

May show things as they are supposed to be or

used to be rather than as they are

Possibility exists of confusing authority with

status


13/43

Although it defines authority, it does not define

responsibility and accountability.

Authorityis defined as the official power to act/person to

which responsibility is given.

Responsibilityis a duty, an assignment or an obligation.

Accountabilitymeans that individuals agree to be morally

responsible for the consequences of their actions/liability or

answerability.


14/43

Types of Organizational Structure

Line Structure


15/43


Ad Hoc Design The ad hoc design is a means of overcoming the inflexibility of line

structure and serves as a way for professionals to handle the

increasingly large amounts of available information.

Ad hoc structures use a project team or task approach and are

usually disbanded after a project is completed.

Disadvantage: decreased strengths in the formal chain of

command and decreased employee loyalty to the parent

organization.


16/43

Matrix Structure



17/43

Service Line Organization

Service lines, sometimes called care-centered

organizations are smaller in scale than a larger

bureaucratic system.

For example, in this organizational design the overall

goals would be determined by the larger organization,

but the service line would decide on the processes to

be used to achieve the goals.



18/43

Flat Design

Chief Nursing Officer

Nurse Manager Nurse Manager Nurse Manager

Staff Staff Staff



19/43

Modes of Organizing Patient Care

Total Patient Care Nursing or Case MethodNursing

Nurses assume total responsibility for meeting all

needs of assigned patients during their time onduty

Advantage: intensity of focus on the patientthroughout that shift.

Disadvantages: lack of communication and lack ofcontinuity over time.


20/43


Functional Method

Functional nursing is done through work assignment by

functions or tasks, such as passing medicine, doing dressing

changes, giving baths, or taking vital signs.

Advantage: no role confusion; method is efficient and cheap;

tasks are completed quickly.

Disadvantage: client could not identify who their caretaker

was, because there were so many caretakers; fragmented

care.


21/43


Team Nursing

Team nursing - a team of RNs, licensed practical

nurses (LPNs), and aides under the supervision of one

nurse, called the team leader

RN assigns work on team members expertise.

Youre accountable for delegating things to people who

are trained to do them.


22/43

Primary Nursing

Primary nursing is an approach in which a nurse

has responsibility and accountability for thecontinuous guidance of specific clients from

hospital admission through discharge

Hallmark to this is that you have

autonomy/accountability 24 hours a day.



23/43


Case Management

Case management in acute care hospital nursing

has been defined as a system of client care

delivery that focuses on the achievement of client

outcomes within effective and appropriate time

frames and resources.

Focus is on individual patients, not populations of

patients


24/43

Factors to consider when organizing committees and making appointments

composed of people who want to contribute in terms of

commitment, energy, and time

variety of work experience and educational backgrounds

should have enough members to accomplish assigned tasks

task and responsibilities should be clearly outlined

assignments should be given ahead of time


25/43

Delivery of

Nursing Care


26/43

Staffing

Recruitment is the process of actively seeking out or attractingapplicants for existing positions.

Selection is the process of choosing from among applicants the best-

qualified individual or individuals for a particular job or position.

Placement is the process when the astute leader is able to assign a

new employee to a position within his or her sphere of authority where

the employee will have a reasonable chance for success.

Indoctrination refers to planned, guided adjustment of an employee to

the organization and the work environment through induction and

orientation.


27/43

Factors AffectingStaffing-External

Nature of Competition for Human

Resources

Legal factors

Socio-culture Factors

External influences


28/43

Factors AffectingStaffing-Internal

Size of Organization

Organizational Image

Technology Used


29/43

Staffing Computation

Step 1: Determine the type of hospital (primary,secondary, or tertiary).

Step 2: Categorize patients according to levels ofcare.


30/43


Step 3: Find the total number of NCH needed by

patients at each level of care.


31/43


Step 4: Find the total NCH per year(x 365 days)

Step 5:Find the actual working hours rendered by

each Nursing Personnel per year.

40 h/week- 1,728 work hours/year

(locality of > 1 million populations)

48 h/week- 2, 144 work hours/year

(locality of < 1 million populations)


32/43


Step 6: Find the total number of nursingpersonnel needed.

a. (NCH/year) Actual working hours/year

b. # of relievers needed (nursing personnel needed *

0.095)

c. Total nursing personnel needed: (sum of A & B)


33/43


Step 7: Categorize into professional and non-professional.

Primary 55:45

Secondary 60:40

Tertiary 65:35

Step 8: Distribute by shifts.

AM 45%

PM 37%

Night 18%


34/43

Evaluation of Staff

Performance


35/43

Using the Performance Appraisal to Motivate Employees

Performance appraisal implies an appraisal of how well employees

perform the duties of their job as delineated by the job description.

Factors influencing effective performance appraisal

Appraisal should be based on a standard.

Employee should have input into development of the standard.

Employee must know the standard in advance.

Employee must know the sources of data gathered for the

appraisal. Appraiser should be someone who has observed employees

work.

Appraiser should be someone who the employee trusts andrespects.


36/43

Strategies to Ensure Accuracy and Fairness inthe Performance Appraisal

Develop self-awareness regarding own biases and prejudices.

Use appropriate consultation.

Gather data adequately over a period of time.

Keep accurate anecdotal records for the length of appraisal period.

Collect positive data and areas where improvement is needed.

Include employees own appraisal of his or her performance.

Guard against the halo effect, horns effect, central tendency trap

and Matthew effect.


37/43

Strategies to Ensure Accuracy and Fairness in thePerformance Appraisal

The halo effect occurs when the appraiser lets one or twopositive aspects of the assessment or behavior of the employeeunduly influence all other aspects of the employees

performance.

The horns effect occurs when the appraiser allows somenegative aspects of the employees performance to influence theassessment to such an extent that other levels of jobperformance are not accurately recorded.

The manager who falls into the central tendency trap is

hesitant to risk true assessment and therefore rates allemployees as average.

The Matthew effectis said to occur when employees receivethe same appraisal results, year in and year out.


38/43

Performance Appraisal Tools

Trait Rating Scales

Rates an individual against some standard

Job Dimension Scales

Rates the performance on job requirements

Behaviorally Anchored Rating Scales (BARS)

Rates desired job expectations on a scale of

importance to the position Checklists

Rates the performance against a set list of desirablejob behaviors


39/43

Performance Appraisal Tools

Essays

A narrative appraisal of job performance

Self-Appraisals

An appraisal of performance by the employee

Management by Objectives

Employee and management agree upon goals ofperformance to be reached

Peer Review

Assessment of work performance carried out by peers


40/43

Overcoming Appraisal Interview Difficulties

Be calm, courteousand

prepared.


41/43

Performance Management

Experts believe that annual performance

appraisals should be replaced by ongoing

performance management.

In performance management, appraisals are

eliminated and the manager places his or her

efforts into ongoing coaching, mutual goal setting

and the leadership training of subordinates.


42/43

Coaching

Coaching is a mechanism for informal performance appraisal that promotes improvedwork performance and team building.

To become an effective coach, one must be:

Be specific, not general.

Be descriptive, not evaluative.

Be certain that the feedback is not self-serving but meets the needs of the employee.

Direct the feedback toward behavior that can be changed.

Use sensitivity in timing the feedback.

Make sure that the employee has clearly understood the feedback and that the

employees communication also has been clearly heard.


43/43

Thank You for

Listening.

Documents

Effective Leadership and Management 1