UNIT-II

MANAGEMENT PROCESS
BY
Mrs. Manasa Karukonda

PLANNING

Planning may be broadly defined as a
concept of executive action that embodies
the skills of anticipating, influencing and
controlling the nature and direction of
change.

Features of planning

Planning involves selecting mission and objectives,
and actions to achieve them.
It requires decision making.
Planning bridges the gap from where we are to where
we want to go.
There is primary of planning, meaning thereby in all
other functions like organizing, staffing, directing and
controlling planning is the first action in these
functions also.
The pervasiveness of planning: means every manager
at all levels irrespective of the size or type of the
organization this function is essentially evident.

NATURE OF PLANNING

Planning is a mental activity
Planning is goal- oriented
Planning is forward looking
Planning pervades all managerial activity
Planning is the primary function
Planning is based on facts
Planning is flexible
Planning is essential decision making

Significance of planning:-

Minimizes uncertainty
Emphasis on objectives
Promotion coordination
Facilitates control
Economical operation
Encourages innovation
Tackling complexities of modern business

Types of planning

Purpose or mission.
objectives
strategies
Polices.
Procedures.
Rules.
Programs.
Budgets.

1. Purpose or mission

The mission tells about the organization, who
are we? What we do? Who are our
beneficiaries?
The mission tells the people about the
organization and its greater purpose.
Purpose means the greater purpose/use of the
organization,
Ex in hospitals the purpose is to serve the
mankind and make the community diseases free
or more appropriate purpose will be to make
community the healthy community.

2. Objectives
The aim or the goal is one and the same thing
that is the ultimate desired state; it may or may
not be achieved. Even if it is unattainable it will
be our endeavor to achieve it.
Like the goal of health for all. The health for all
can be defined as attainment of a level of
health that will enable every individual to lead a
socially and economically productive life. This
may be achieved or may not be achieved, it is
difficult to make such plans time bound.

3. Strategies

The strategy means deployment of the
resources for achievement of the
environment/ organization goals in terms of
strength and weakness of the organization.
4. Policies:

Policies define an area within which a
decision to be made and ensure that the
decision will be consistent with, and
contribute to.
An objective policies help to decide issues
before they become problems.

5. Procedures:
Procedures are guides to action; procedures
are plans that establish a required method of
handling future activities.

6. Rules:
Rules are simplest type of plan.
Rules allow no discretion on their
application.
Eg: No smoking: is a rule that allows no
deviation from a stated course of action.

7. Programmes:
Program is complex of goals, policies,
procedures, rules.

8. Budgets:
It is expressed in financial terms. It is a
statement of expected results expressed in
numerical terms. It may be called a
numberized programme.

Planning Principles

Comprehensive all significant options and impacts are
considered.
Efficient the process should not waste time or money.
Inclusive people affected by the plan have opportunities
to be involved.
Informative results are understood by stakeholders
(people affected by a decision).
Integrated individual, short-term decisions should
support strategic, long-term goals.
Logical each step leads to the next.
Transparent everybody involved understands how the
process operates.

STEPS IN PLANNING

Being aware of opportunities
Establishing objectives
Developing premises
Determining alternative courses
Selecting a course
Formulating derivative plans
Numbering plans by budgeting.

Limitations of planning

Costly process
Rigidity
Limited scope
Influence of external factors
Non availability of data
Peoples resistance

OBJECTIVES
Objectives are a general declaration of
purpose. They are the ends towards which
the activities of an enterprise are directed.
objectives are goals; they are aims which
management and administration wish
organization to achieve.
Characteristics of objectives

Hierarchy of objectives
Multiple in nature
Long- range and short- range objectives
Objectives are interdependent:
Objectives have priority
Tangible and intangible objectives:

Criteria of effective objectives

Objectives should reflect the fundamental
strategy of an enterprise.
Objectives should be operational.
Objectives should make possible
concentration of resources and efforts.
Objectives are required in all areas on which
the survival of the enterprise depends.
There should be multiple objectives rather
than a single objective.

Benefits of objectives:-

Unity of planning
Stimulates motivation:
Coordination
MISSION STATEMENTS

Mission Statement defines the organization's
purpose and primary objectives. Its prime function
is internal to define the key measure or
measures of the organizations success and its
prime audience is the leadership team and
stockholders. Mission statements are the starting
points of an organisations strategic planning and
goal setting process. They focus attention and
assure that internal and external stakeholders
understand what the organization is attempting to
accomplish.

A mission statement is a formal, short,
written statement of the purpose of a
company or organization. The mission
statement should guide the actions of the
organization, spell out its overall goal,
provide a sense of direction, and guide
decision-making. It provides "the framework
or context within which the company's
strategies are formulated.
Organizations have mission to produce a
product or service
They collectively form a conceptual
description of an organization and display the
frame work for an organizations beliefs,
intent, desired future, planning, and
operations.

Formulation of mission
statements
Using a goal- based strategic planning method;
The mission statement of organization includes its
purpose, function, and reason why it exists.
The mission statement should be simple short concise,
and clear.
In developing a mission statement, factors such as the
organizations products, services, public image, and
activities for survival need to be considered.

The intent of the organizations founders and
its history are useful to review.
Often employees are unaware of historical
back ground
The statement needs to have sufficient
description to clearly identify the purpose
and scope and suggest some order priorities.

Purpose of mission statement
A mission statement helps the organization to link
its activities to the needs of the society and
legitimize its existence.
Encapsulates the intent and goal of the organization.
It explains, in a short statement, the core reasons
behind the organizations existence and
Primary focus on a single strategic thrust for the
organization.
The mission statement sets standards for the
organization philosophy and its goals and objectives.
The mission statement drives the organizations
existence and is a reflection of the culture.


Dimensions of Mission
statements:According to Bart,


1. Key values and beliefs
2. Distinctive competence
3. Desired competitive position
4. Competitive strategy
5. Compelling goal/vision
6. Specific customers served and products or
services offered
7. Concern for satisfying multiple stakeholders


According to Vern McGinis, a
mission should:
Define what the company is
Define what the company aspires to be
Limited to exclude some ventures
Broad enough to allow for creative growth
Distinguish the company from all others
Serve as framework to evaluate current
activities
Stated clearly so that it is understood by all

Operational planning
An operational planning is a subset of
strategic work plan. It describes short-term
ways of achieving milestones and explains
how, or what portion of, a strategic plan will
be put into operation during a given
operational period, in the case of commercial
application, a fiscal year or another given
budgetary term..
An operational plan is the basis for, and
justification of an annual operating budget
request. Therefore, a five-year strategic plan
would need five operational plans funded by
five operating budgets.
Operational plans should establish the
activities and budgets for each part of the
organisation for the next 1 3 years. They
link the strategic plan with the activities the
organization will deliver and the resources
required to deliver them
An operational plan addresses four
questions:

Where are we now?
Where do we want to be?
How do we get there?
How do we measure our progress?

Operational plans should contain:

clear objectives
activities to be delivered
quality standards
desired outcomes
staffing and resource requirements
implementation timetables
a process for monitoring progress.
PHILOSOPHY

The statement of philosophy is defined as an
explanation of the systems of beliefs that
determine how a mission or a purpose is to
be achieved. An organisations philosophy
states the beliefs, concepts and principles of
an organization.

NURSING SERVICE PHILOSOPHY

The nursing service philosophy is a statement
of beliefs that flows from and is congruent
with the institutions philosophy. The belief
system of the nursing philosophy should
reflect the nursing division members ideas
and ideals for nursing and should be endorsed
by others.

COMPONENTS OF NURSING
SERVICE PHILOSOPHY

1.NURSING/NURSING PRACTICE
Nursing is a health care service mandated by
society; the practice of nursing stems from the
beliefs and ideals of the nursing service
department.
In the first area, nursing theory, the task for
the nurse manager is to decide whether and
how to incorporate theory.



Three different methods may be
considered.


One method is to use an eclectic approach,
selecting ideas and constructs from various nursing
theories and incorporating these into the
philosophy.
A second method is to use one theory throughout
the philosophy.
A third approach is to adopt a theory, then attach
the entire document describing the theory to the
philosophy and refer to the theory at appropriate
places in the philosophy.

A second set of values related to
nursing/nursing practice center around
practice, education and research
Values specific to education are essential
content for most departments of nursing.
The beliefs may focus on the need for
continuing education off staff members.
The third value related to the concept of
nursing practice is research and this include
the departments commitment to applying
research findings or supporting others in their
research efforts.
2.PATIENT/CLIENT

The patient is the main reason for the
institutions existence, examine patients
rights. Beliefs concerning patient's rights will
be influenced in part by institutional policies
and practices .

3.NURSES

Nurses are essential in the day-to day
operations of the hospital organization. They are
the providers of nursing acts which result in
quality, care. To keep the organization
functioning smoothly ,it is necessary to address
values related to and beliefs about nurses.
These values and beliefs center around nurses
rights, advancement criteria and responsibilities
to other health professionals, as well as
professional organizations.

PHILOSOPHY OF NURSING
EDUCATION

Philosophy of nursing education is the
written statement of the believes, values,
attitudes and ideas which the faculty as a
group agreed upon in relation to the nursing
educational programme such as health,
disease, nursing, nurse, nursing profession,
education, learner, society, patient, nursing
education and preparation of nurses.
Philosophy of f nursing education is a perfect
combination of nursing and philosophy of
education, more precisely, philosophy of
nursing and philosophy of education is the
application of the fundamental belief of
nursing and education in the field of nursing.
In the philosophy of education, importance is
given to the students. The objectives
formulated with a philosophical basis of
education focus on the student life and the all
round development.


The beliefs held about the areas of impact of
administration will influence the formation of
philosophy. The last content area related to
nursing/nursing practice is nursing s role in
over all organization.


STAFFING
Staffing is the systematic approach to the
process of selecting, training, motivating and
retaining professional and non professional
personnel in any organization.
It involves manpower planning to have the
right person in the right place .

PURPOSES OF STAFFING

Identifying the type and amount of service
needed by agency client.
Determining the personnel categories that have
the knowledge and skill to perform needed
service measures.
Predicting the number of personnel in each job
category that will be needed to meet anticipated
service demands.
Obtaining, budgeted positions for the expected
types and number of client.

Recruiting personnel to fill available
positions.
Selecting and appointing personnel from
suitable applicants.
Combining personnel into desired
configurations by unit and shift.
Orienting personnel to fulfill assigned
responsibilities.
Assigning responsibilities for client services
to available personnel.

Philosophy of staffing in nursing

Nurse administrators believe that
it is possible to match employees knowledge
and skills to patient care needs in a manner
that optimizes job satisfaction and care
quality.
the technical and humanistic care needs of
critically ill patients are so complex that all
aspects of that care should be provided by
professional nurses.
the health teaching and rehabilitation needs of chronically ill
patients are so complex that direct care for chronically ill
patients should be provided by professional and technical
nurses.
patient assessment, work quantification and job analysis
should be used to determine the number of personnel in
each category to be assigned to care for patients of each type
( such as coronary care, renal failure, chronic arthritis,
paraplegia, cancer, etc.)
a master staffing plan and policies to implement the plan in
all units should be developed centrally by the nursing heads
and staff of the hospital.
the staffing plan should be administered at the unit level by
the head nurse, so that selected plan details, such as shift-
start time, number of staff assigned on holidays, and number
of employees assigned to each shift can be modified to
accommodate the unit workload and workflow.


Objectives of staffing in nursing

Provide an all professional nurse staff in critical
care units, operating rooms, labor and delivery
unit, and emergency room.
Provide sufficient staff to permit a 1:1 nurse-
patient ratio for each shift in every critical care
unit.
Staff the general medical, surgical, obstetrics and
gynecology, pediatric and psychiatric units to
achieve a 2:1 professional-practical nurse ratio.
Provide sufficient nursing staff in general medical,
surgical, obstetric, pediatric and psychiatric units
to permit a 1: 5 nurse-patient ratio on a day and
afternoon shifts and 1:10 nurse- patient ratio on
night shift.
Involve the heads of the nursing staff and all nursing
personnel in designing the departments overall
staffing programmess.
Design a staffing plan that specifies how many
nursing personnel in each classification will be
assigned to each nursing unit for each shift and how
vacation and holiday time will be requested and
scheduled.
Hold each head nurse responsible for translating the
departments master staffing plan to sequential
eight-week time schedules for personnel assigned to
her/his unit.
Post time schedules for all personnel at least eight
weeks in advance.


Empower the head nurse to adjust work
schedules for unit nursing personnel to
remedy any staff excess or deficiency caused
by census fluctuation or employee absence.
Inform each nursing employee that requests
for specific vacation or holiday time will be
honored within the limits imposed by
patients care and labor contract
requirements.
Reward employees for long-term service by
granting individuals special time requests on
the basis of seniority.

Staffing also involves manpower planning.

The objectives of manpower planning
Ensuring maximum utilization of personnel.
Assessing future requirements of the
organization.
Determining the recruitment sources.
Anticipating from past records, i.e. resignations,
simple discharge, dismissal and retirements.
Determining training requirements for
managements development and organizational
development.

3 kinds of staff services and units
The general staff:- it is the staff which helps the chief or other highly
placed executive in his administrative work generally, by advice,
collection of information, research and shifting of the important
from unimportant ones, which is to go up to him, i.e. they acts as
filter and funnel.

Technical staff: - it consists of the technical officers who are qualified in
their own field, like engineers, doctors, nurses and experts, etc...
They advice the chief in technical matters of their field and also
keep functional supervision over the work of the technicians of the
line in their own appropriate fields.

Auxiliary staff: - it consists of officers or units which perform certain
duties and functions common to the various departments but
which are incidental in character, i.e. not directly a part of those
departmental main activities.
Staffing norms

Bajaj committee, 1986:-
This committee reviewed the state of nursing education at the
10+2 level and has predicted the nursing manpower required.
Nursing education: the committee strongly recommends health
related vocational courses for auxiliary nurse midwife (female
health worker).to provide for vertical mobility to the products of
the vocational courses.10% seats to be reserved in higher
technical courses.
Nursing manpower requirements:-
Number of nurses required. Prediction for 1991 on the basis
of 0.73 beds per thousand populations for 1991.
The difference between present bed strength of 0.6 bed per 1000
population and 1 bed for 1000 population required by 2000 Ad
have been split equally between three plan periods, i.e. 1986-
90,1991-95 and 1996-2000 AD.

The Indian Nursing Council

T.N.A.I members felt that they should have some strong
body to guide & protect the nurses in their profession.
I.N.C was founded with this idea.
The Indian Nursing Council, constituted in 1949, was
established for the purpose of providing uniform
standards in nursing education & reciprocity in nursing
registration throughout the country.
Before this time, nurses registered in one State were not
necessarily recognized for registration in other State.
The condition of mutual recognition by the State Nurses
Registration Councils, called reciprocity, was possible only
if uniform standards of nursing education were
maintained.

Therefore, the I.N.C was given authority to
prescribe curricula for nursing education in all
the States.
At the same time, it was given authority to
recognize programmes of nursing education or
refuse recognition to the schools/colleges of
nursing.
I.N.C act was passed in 1947. I.N.C has
prescribed various courses of study for the
Professional nurses.

It also sees whether these educational institutions are functioning
in right manner or not.
I.N.C has a wide range of rights. It can derecognize the institution
if the standards of education are not maintained.
The council is composed of representatives of State Registration
Council, Central & State Health Departments, Military Nursing
Services, Indian Red Cross Society, University Schools of Nursing,
Health Schools & Post Certificate Schools,
T.N.A.I, Medical Council of India, Indian Medical Association &
three members of the Parliament. The Indian Nursing Council
maintains a register of all nurses in the country.

SCHEDULING

The manager has both a fiscal and ethical duty to plan
for adequate staffing to meet patient care needs.
Innovative and creative methods of staffing and
scheduling should be explored to avoid understanding
and overstaffing policies must not violet labour laws,
state or national laws, or union contracts.
Workload measurement tools include NCH/PPD,PCS,
and workload measurement systems. All workload
measurement tools should be periodically reviewed
to determine if they are a valid and reliable tool for
measuring staffing needs in a given organization.

Mandatory overtime should be a last resort, not
standard operating procedure because an
institution does not have enough staff.
Managers should attempt to have a diverse staff
that will meet the cultural and language needs
of the patient population.
Fair and uniform staffing policies must be
examined periodically to determine if they still
meet the needs of the staff and the
organization.

HUMAN RESOURCE
MANAGEMENT
I. Terminology

Recruitment- is the process used by
organization to seek out or identify
applicants for potential employment.
Retention- it is the act of retaining. it is
defined as the ability to continue the
employment of qualified individuals, that is,
nurses and/or other health care
providers/associates who might otherwise
leave the organization.
Selection- is defined as the job of determining the
most qualified candidate for a job this process
includes reviewing, sorting, ranking, and offering of
candidate recruit for a job.
Termination- it is the movement of an employee
who is performing at a less than satisfactory level or
is not a good match fort.
Turn over loss of an employee due to transfer,
termination or resignation

RECRUITMENT
Definitions of Recruitment
The recruitment is the process of attracting
the candidates with the right characteristics
and skills to fit a job in the organization. The
purpose of recruitment and selection is to find
out the employees, who are fit for a
particular job in the organization.
- D. Joshi

The recruitment is the process of securing
applicants to fill vacant positions. It covers
both the filling of new and replacement of
previously established posts which fall vacant.
- Basavantappa
Aims of Recruitment

The recruitment process aims at developing
and maintaining adequate manpower
resources upon whom the organization can
depend when it needs additional employees.
The recruitment and selection process should
look to the human adjustment to
organizational objectives.
Purpose of recruitment

To seek out, evaluate and obtain
commitment from an employee,
To place and orient to fill positions
required for the successful conduct of
conduct of work in an organization.
Steps of recruitment
1. Identifying the different sources of labor
supply
2. Assessing the validity of different sources
3. Choosing the most suitable source or
sources
4. Inviting applications from the prospective
candidates for the vacant jobs.


RECRUITMENT PROCESS

2. SELECTION

Selection process is the sorting out the
elimination of those judged unqualified to
meet the job and organizational requirement.

Selection process is somewhat negative
because it rejects a good portion of those
who apply. The Selection process
necessities the match of a person with the
job in a particular organization and social
environment.
Steps In Selection Process

1. Receipt of applications
2. Scrutiny of applications
3. Reception
4. Preliminary Interview
5. Selection test-


Selection tests are broadly classified into

Proficiency tests skill
Trade test- business skills
Dexterity test- handliness
Achievement test- Measure the applicants
knowledge and skills. They require applicants
to demonstrate their competence. Ex-typing
Aptitude tests- abilities
Personality tests-
Vocational tests
Integrity tests
Interest rated tests

6. Reference verification-
7. Employment Interview
8. Medical examination
9. Issue of appointment letter
10.Placement and Orientation
3.DEPLOYMENT
an arrangement or classification of things
an implementation, or putting into use, of
something

Definition
Use of staff in a effective way to improve the
product by giving training

Need

It is important because this planning step
directly affects immediate and sustaining
success.
Ease of deployment is a function of matching
the needs and expectations with a
deployment strategy that achieves goals.
The key to successful deployment is flexibility

Training and deployment

PROMOTION
Definition

A promotion is a reassignment of the
individual to a job of higher rank. In other
words it can be described as advancement
involving a change from one job to another
that is better in terms of status and
responsibility.
Principles of promotion
Seniority vs Ability

The promotion policy may be based either on
seniority or ability, or a combination of both.
Where seniority indicates the length of service, the
ability of an employee is judged by tests, personnel
interviews and their records of performance.
If seniority is considered as the basis, the
promotion is made
On the other hand, if ability is considered to be the
criterion for future promotions, it encourages the
employees to improve their performance. But the
ability criterion fully ignores the value of
experience.
Thus a sound promotion policy should be based on
the consideration of both seniority and ability.

Transfer vs. Promotion

Transfer refers to changes in which the pay, status
and the job conditions of new positions are almost
the same as those of the old.
In the case of promotion, the new position has a
higher pay scale, higher status, and the job
conditions are different from those of the old.
Promotion in Nursing Service
Administration
1.Policy
Among policy issue, the nursing administration
must decide whether to fill vacancy from within
hospital organization or state, or to select through
employment exchange (without). (The advantages
and disadvantages have already been explained
under the heading sources of recruitment.)
2.Promotional channels

Promotion channels must be clearly defined and
recorded in personnel policy hand book and the
nurses should be made aware of these channels
during their orientation program on first
appointment.
It serves as a guide to the nurse administrator and
protects her from legal matters and help the
nurses to work hard for next position.
3. Selection and appraisal

Selection of nursing staff for promotion is closely
related to their performance appraisal and to
centralized records maintenance.
The education, experiences, skill and abilities and
evaluation of nurses are maintained in their
personnel, file and are kept under the custody of
nursing superintendent/HRD department.
4.Training and development:

In many institutions, it is a practice policy that in
order to get next promotion, the nursing
personnel must undergo special training e.g. in
order to get the promotion to ward
administration for three months.
In the same way to get promotion of Theater
supervisor, the nurse must take training of
Theater techniques and management.
In some state, on order to get promotion, nurses
need to appear for departmental examination
after every five years.
5.Communication

If the policy favors promotion for the nurses from within
the department, job vacancies, job title, duties and
responsibilities pay, qualification and special training are
communicated to the nurses through hospital bulletin
board.
It helps the interested nurses to apply for the job. Final
decision is still with the selection committee.
If the confidential report (performance appraisal) is not
satisfactory of a particular nurse, should also be
communicated to her so that she will try to improve her
work.
6. Centralized record and co-
ordination

Service record file for each nurse is
manufactured and is keeping in nurse
administrators office/HRD office.
It contains all reports of the particular nurse
(good and bad).
The selection committee goes through the
file to study all the positive and negative
reports of nurses on that basis like:
educational qualification
Experience
Seniority
Integrity certificate
Performance appraisal
Special training
Satisfactory work records and other desired criteria is
made before selecting the nurse for promotion

RETENTION


Retention Meaning and Definition

The act of withholding; retrain; reserve.
Place of custody or confinement.
the act of keeping in your possession .
The act of retaining, or the state of being
retained.
Importance of retention;


Staff retention keeps the organizations going
and meeting its mission and goals.
Staff is needed to meet these goals. The
nursing philosophy, standards, rules that
determine the working conditions,
perception of peer cohesion, administrative
support, autonomy, task orientation and
innovation all help to develop the
organization culture and maintain it.
The purpose of recruitment is to hire the staff
necessary for agency to provide quality care.
Retention is the tool that will allow
recruitment programs to meet these goals.
If you cannot retain your staff you will never
be able to recruit the sufficient staff

Reasons for Retention

I High quality care
Hospitals commitment to providing high
quality patient
Hospitals reputation as outstanding setting
for clinical care ongoi
II Strong nurse leadership
Quality of direct manager
Quality of overall nursing leadership
III Meeting the baseline
Salary
Scheduling options
Benefits package
Hospital reputation for assigning nurses
lower numbers of patients
Location/convenience

Reasons for the Shortage of Nurses



Smaller number of nurses in the workforce
Nurse workforce growing older
Weak leadership, poor management styles,
and resistance to changing culture
Increased pressures on nurses in the
workforce
Explosion of career opportunities for women
failing to attract men
Growing demand for nurses in alternative
health care settings
Frustration with the work environment

Retention strategies used to retain new
graduates and expensed nurses

Flexible hours /schedules
Bonus pay
Fixed shifts
Creation of autonomous self managed
units
Part time pay with bonus hour
Scholarships for graduate studies
Professional development support for
ongoing
Professional development
opportunities
Leadership and clinical support for
ongoing
Professional development and decision
making


Finance support associated with
credentialing
Mentoring/ preempting program
opportunities
Provision for sabbatical
Initializing of new technology into
practice
Realignment of salary
structure/compression
Management
Bonus pay for recruitment of employees
Profit/ gains sharing program
Shared governance/ leadership models
Career advancement program
Clinical ladder/career ladder
Free parking
Culture of safety
Child/elder care



FIVE KEY STRATEGIES
FOR
STAFF RETENTION
Organizational Commitment
Administrative ownership and champion
Visibility management by walking around
Human resources as part of the strategic
plan
Utilize the triad working group to
develop and maintain the recruitment
and retention plan
Utilize an interactive planning process
(IPP)

1. Ends planning
Shared vision
describing the future
4.Resource
planning- how,
who, where
5.I mplementation/f
ollowup;
responsibility,
authority
accountability
2. Assessing current
reality- identify strengths
and weakness/barriers
3.Means planning-
inventing ways to close the
gap;reality to vision
2. Promote the HR department
Be visible to staff
Be involved with staff
Focus meetings what are they and how
does human resources conduct them
Develop credentiability by employing
valuing measurable outcomes

3 Recruit effectively
Short term recruitment initiatives
1. Newspaper advertising
2. Signature events
3. Other short term initiatives
Long term recruitment initiatives
Redesigning the patient care delivery
system to be a multidisciplinary model in a
barrier free environment with staff
members working together as a team
Fore in recruitment
Scholarships
Organizations staff
Tuition forgiveness

4 Understand your target market
Generational differences
Emerging workforce expectations
Keys to empowerment
Understanding current staffs career
expectations
5. become the facility or organization
of choice for staff
Caring is a great business advantage
PENSION OR RETIREMENT
PLAN OR SUPERANNUATION
A pension is an arrangement to provide
people with an income when they are no
longer earning a regular income from
employment
The payments a person receives upon
retirement, usually under pre-determined
legal and/or contractual terms. A recipient of
a retirement pension is known as
a pensioner or retiree.

Types Of Pensions

1. Employment-based pensions (retirement
plans)
2. Social / state pensions
3. Disability pensions

Benefits


BUDGET
Definitions of budget:

1. A Budget is a plan that outlines an
organization's financial and operational
goals. So a budget may be thought of as an
action plan; planning a budget helps a
business allocate resources, evaluate
performance, and formulate plans.
2. A budget is a detailed plan of operations
that is predetermined for a particular period.
Budgets are quantitative or financial
statements prepared for the purpose of
attaining a particular objective.

Basic Concepts in Budgeting

Budget is a plan, which states anticipated
expenditure in terms of rupees and paise.
The budget serves as a guide for the fiscal
year, for which it is prepared, specifying a
framework within which the nursing
department functions.
A nurse need not make a budget separately
every time during every fiscal year for her
department. But she has to be the member of
the budget committee, where she voices our
regarding her need in her department for
standard patient care.

It is a nurse only who will understand the
prerequisites for standard care.
It is again the nurse who is the provider of
nursing care and hence she is the best person
to select the standard items for the nursing
care.
Besides the salary budget, the nurse should
be aware of much fund is being allocate for
the development of nursing and in turn how
much will be benefited by the patients.

Objectives of budget

Plan about the future properly
It ensure the co-ordination with different
department
To eliminate the waste
To anticipate expenditure
To centralize the expenditure
To correct the deviation
To fix up the responsibility


Objectives of budgeting in health
care

To allocate scares resources
To decrease the cost of health care
To make cost Containment control

Budget Principles

1. Core Value
2. 2. Budget Clarity
3. Budget Flexibility
4. Authorized Budgets
5. Baseline Budgeting Principles
6. Budget Expansion, Reallocation and
Reduction Principles

Budget characteristics-

Budget should provide sound financial
management by focusing on requirement of
the organization
Budget should focus o objectives and policies
of the organization
Budget should ensure the most effective use
of scarce financial and non- financial
resources.
Budget requires that a programme activities
planned in advance

Budget requires proper delegation
Budget include co-ordination
setting budget target, requires an adequate
checks and balance against the adoption of
too high or low estimate
Budget is prepared under the direction and
supervision
Budget are to be prepared and interpreted
constistently through out the organization
Budget necessitates a review of the
performance of the previous year and an
evaluation of its adequacy both in quality and
quantity
While developing a budjet, the provision
should be made for its flexibility


Types of Budgets

According to time:
1. Long Term Budget- budget prepared for
long term i.e. more than 5 years
2. Short Term Budget- budget prepared for
long term i.e.less than 5 years
3. Current Budget- budget for every year

According To Function:

1. Sales Budget- it gives the comprehensive
sales program and plans for a specific period
2. Production Budget-it is based on sales
budget. It indicates the quantity of units to be
produced, during the budget period
3. Cost of Production Budget- it is based on
the production budget, lays own estimated
cost of carrying out the plans relation to
production.

4. Purchase Budget- for purchage the things
5. Personnel budget- A personal budget is
prepared by individuals and families to
allocate income for various expenses, savings,
investments and other financial obligations,
such as debts

6. Selling and distribution budjet- it gives the
cost of selling and distributionof products
during the budjet periodit includes cost of
selling and distribution such as cost of
insurance, paking, storing, transport,
advertisements etc.
7. Capital Expenditure Budget- it gives the
estimates in respect of the capital resources of
the business concern
8. Cash Budget- it gives the estimated receipts
and payments for the budget period and
indicates the position of cash arising from it.

9. Material Budget- it is prepared by the store
division gives an eatimated requirement of
materials and other supples of different types
for carrying out the work of organization.
10. Master budget- it is prepared by the
budget officer. It includes all types of budget.

According To Flexibility
1. Fixed Budget
2. Flexible Budget

Budgeting Process

Identifying expenses
Determining different sources of income
Preparing the budget
Establishing the budget period
Laying down the budget procedure
Allocating income for expenses
Monitoring the efficiency of the budget
Re-assessing the budget

Requisites for budgeting control
system

Objectives should be clear
Proper delegation of authority and responsibility
It should have proper communication
Budget education should be provided to the
employees
Participation of all employees in budget planning
It should be flexible
Motivate the employees

Essential conditions to implement
budgeting

Organization should be proper
Budget center should be available
Budget officer should be appointed
Budget manual should be prepared
Budgetary period should be specified
Key or limiting factor should be set

COST-BENEFIT ANALYSIS

This is an economic technique in health
planning and evaluation.
The resources or the inputs are measured in
monitory terms and the out put of the
program is also measured in minatory terms.
An informal approach to making economic
decisions of any kind
The process involves, whether explicitly or
implicitly, weighing the total expected costs
against the total expected benefits of one or
more actions in order to choose the best or
most profitable option. The formal process is
often referred to as either CBA (Cost-Benefit
Analysis) or BCA (Benefit-Cost Analysis).
Benefits and costs are often expressed in
money terms, and are adjusted for the time
value of money

Cost-Benefit Analysis in Health
Care


MATERIAL MANAGEMENT
DEFINITION:
Material management is defined as a system of
planning, organizing, directing, coordinating,
controlling and maintaining adequate
equipment and supplies whereby there will be
right quantity and quality of stock of items
properly stored, easily retrievable and
distributed for the use whenever required at a
given time.

PURPOSES :-

Material management is very important in All the
nursing procedures
starting from simple to complex, non-invasive to
invasive techniques require
materials. In other words no nursing procedures can
be done in a scientific
way without adequate and appropriate materials.
To make materials available in safe and viable
condition at all times.
To increase efficiency of the organization.
To increase effectiveness of the workers.
To provide job satisfaction.
To provide material at and optimal cost.
To cut down material cost through standardization.
To ensure appropriate and safe waste disposal, that
arises out of the use of materials and supplies.
To ensure recycling of materials wherever feasible.


ELEMENTS OF MATERIAL MANAGEMENT
SYSTEM:

i) Demand estimation
ii) Procurement
iii) Receipt and inspection
iv) Storage
v) Issue, use and record maintenance
vi) Maintenance and repair
vii) Condemnation and disposal
viii) Accounting and information
system\inventory

Procurement;

Based on preparation of the total requirement
need for the PHC the medical officer submits the
list to the district medical officer after thorough
verification and then received at PHC.
Lead-time is the time lag between the placement
of an order and getting supply of the same order.
Hence the time lag between submission of
annual action plan along with estimation of
material requirement and supply of these will be
referred as lead time. The supplies may be
received in 4 installments on quarterly basis.

Receipt and inspection

Storage
materials often being inspected received are
stored in the store room till its distribution and
consumption.
The store should be located near the other
stores of the hospital.
It should be accessible to the suppliers and
indents.
Location should be as per activity of the stores.
Size should be adequate to accommodate all
materials
such as instruments, appliances steel racks with
shelves.
Refrigeration should be available for storing
thermolablile items.
Many stores maintain two bins or boxes. One bin
contains main stock and the second bin contains
enough stock to satisfy the demand during the lead
time.
Lead time is time between placement of order or
receipt of the same order.
As soon as the first bin exhausted, demand for the
order is placed and 2
nd
bins are issued.
Part of new stock received if placed in the second
bin as reserved.


Issue, use and record maintenance
arrangement of materials can be done
alphabetically or group wise.
Both are easy for identification and retrieval.
Materials should be stored on both sides of open
rack.
These racks are always filled from backside and
issued from the front side.
Materials received later from the suppliers should
be stored behind by this you maintain the principle
of first in first out FIFO means issuing items
first which are received.

Maintenance and repair
Storage of equipment;
Equipment is stored in two places;
A main or reserve stock (stock of usable but
idle items that means the items waiting to be
used)
At place of use
The new items of equipment are received and
stored in main store.

Condemnation and disposal
Accounting and information
system\inventory
inventory control means stocking adequate
number and kind of material that are made
available whenever required this has to be
done according to the financial resources and
objectives of the organizations.
High inventory level leads cost of inventories by:
Blocking the finance.
Large storage space.
Large handling and administrative charges.
obsolence
Spoilage etc.

Purposes of an inventory are as follows:-
To make an account of materials held in the
ward to check against the recommended
standards and take remedial measures.
To dispose excess and obsolete materials.
To recommend changes in standard.
To determine the serviceability of all materials
and equipments.

To request for repair or replacement if necessary.
To return equipment to its proper place if barrowed.
E.g: central supply department, OT or another ward.
To maintain and trace materials for their adequacy.
To identify dispensaries such as loss and damage.
To put the defective items for condemnation
accordingly as per the policies of the organization.


Techniques in Inventory Control

ABC Analysis (Always Better Control)
VED Analysis (Vital, Essential, Desirable)
HML Analysis (High, Medium, Low)
FSN Analysis (Fast, Slow moving and Non-
moving)
SDE Analysis (Scarce, Difficult, Easy)

CRITERIA FOR ANALYSIS OF
EQUIPMENT:-

ABC ANALYSIS: ABC analyses are the analysis
of stored items and are based on cost criteria.
A Items represent high cost materials.
B Items of intermediate cost materials.
C Items are of low cost materials.

Guidelines to keep inventory
control in the optimum level:-

A-ITEMS:
tight control.
Rigid estimate.
Strict and close watch.
Safety stocks should be low.
Management of items should be done at top
management level.
B- ITEMS:
moderate controls.
Purchase based on rigid requirements.
Safety stocks moderate.
Management is done at middle level.
C- ITEMS:
ordinary control measure.
Purchase based on usage by storekeeper.
Safety stocks high.
Management be done at lower level.



Rate of consumption (FSN)
close study of each item of the store its
movement or consumption is a strong tool for
proper inventory control. The items can be
classified into:
fast moving.
slow moving.
non moving.
obsolete.
VED ANALYSIS
Vital: items without which treatment comes to
standstill: i.e. non- availability can not be tolerated.
Essential: items whose non availability can be
tolerated for 2-3 days, because similar or
alternative items are available.
Desirable: items whose non availability can be
tolerated for a long period.
on an average vital items are 10%, essential items
are 40% and desirable items make 50% of total
items available
SDE Analysis

Unit value is the basis of this analysis and not
the annual consumption value.
H - Unit value > 1000 (Sanctioned by higher
officials)
M - Unit value 100 to 1000
L - Unit value < 100

ABC & VED Analysis (Matrix module: criticality Vs cost)
Coupling matrix model
Cat I Cat II Cat III

V E D

A Av Ae Ad

B Bv Be Bd

C Cv Ce Cd
V E D
H Defibrillator
1
X-ray machine
2
Air- curtains
3
M Ventilator
4
Electric cautery
5
Ultrasonic wash
machine
6
L Oxygen regulator
7
Patient trolley
8
Electronic BP
machine
9
Points to be remembered in material
management:
Ensure regular and adequate flow of materials.
Standard and quality materials should be
procured.
Monitor quality and safety of materials.
Prevent and control wastage \misuse of
materials.
Follow policies, procedures and routine for
indents, which are developed, by the hospital.
Receive store and check timely to replenish all
necessary materials.

Maintain emergency and buffer stock.
Arrange for preventive maintenance wherever
needed.
Maintain proper inventory and stock of all
materials and update it periodically.
Arrange for condemnation of broken and
worn out equipment as per the policy and
procedures of the organization.
Assist in the audit of materials as and when
required, time to time informs lose
misplacement and shortage.
Orient all the nursing personnel to the policies
of material management.
Participate in developing policies for material
management.
Participate in the purchase of materials and
advise to purchase materials as per
specifications.
Evaluate me system of material management.


And provision must for consultation with and
consideration of recommendations of nurses
responsible for the planning and administration
of nursing services and programmer for nursing
education and training.
All planning includes a standard setting
component in the service models and of the
staffing pattern used to determine total
programmed requirements, concluding our
discussion on nursing standards here, we shall
next proceed to discuss assessment of quality in
nursing.
Assessment of quality in nursing:
in order to maintain the quality of nursing
services you must understand what is quality in
nursing care and how it may be assessed?
Quality, you know, denotes the degree of
excellence. To ascertain this, in the first place it is
important to consider what will help the patient,
for speedy recover..
In the last few decades with technological
changes in medicine and nursing the
patients situation has changed markedly. A
widening rang of professional and technical
people are concerned with patient care
now. However, their services are helpful
only to the extent that they are coordinated
and the the patient, if possible, his family
participate in the planning of care
The basic assumptions in this
regard are:
This implies that all health professionals particularly
doctors and nurses should observe and
communicate with each other in assessing his
health problems.
The nurse rules on information from doctor for
medical diagnosis and the plan of medical care is
responsible for making own assessment of patients
problem.
The nurse is responsible for much more than
specific treatment procedure. Nurses will have to
use their judgment in assessing which patient have.
The greatest and immediate need for the most
skilled nursing care.
It is important to remember that outcome of high
quality nursing should be that patients are their
families, are better able to cope with problems of
health and disease and to turn their attention to
cure and recover to make adjustment in life, if
necessary.
Conditions conductive to
achievement of quality:
1) There are certain factors that influence quality and indeed
are essential for the achievement of high quality in the
nursing care of patients. Perhaps most important
among these, is contact with nurses whose work
exemplifies good patient care. it is important that as
rapidly as possible more such role models are available
in the hospital and in the community as nurses
specialized in clinical nursing care as well as more
familiar position of supervisors and instructors. Lack of
practicing nurses whose work exemplifies a high
standard may delay the recruitment of better-educated
young people.
2) An earlier WHO publication in describing a survey of need
within a community included the questions to what
extent do nurses who are recognized as qualified give
personal care to patients and to what extent do they
teach, administer and supervise care given by the
nursing personnel or families there seems to e
agreement among nurses that the qualified nurses
carry some responsible for teaching and supervising
other nursing personnel, there is also a growing feeling
that she must continue to nurse if she is to retains and
improve her own skills. Social recognition and
economic reward should therefore be given to nurse
whom chooses to remain in patient care services.
3) Another factor influencing the quality of
nursing is the condition of work not only
the environment, itself, including adequate
supplies and equipment, hierarchal system
patterns and communication system as
availability of essential equipment and
supplies. Maintenance of a high standard of
medical proactive also has a beneficial
influence.
4) A third factor id the opportunity for developing a
career the chance for the nurses to grow
professional, to develop her skills, and to move
to increasingly responsible, with adequate
remunerations A well organized plan for staff
development and in service education under
the leadership of skilled nurses can be vital in
helping nurses to maintain a high standard of
patient care.
NURSING AUDITS:
Nursing service audit is an official examination
of nursing records for the purpose of
evaluation. Verification ad betterment of
nursing care. It is a systematic formal in depth
evaluation of nursing care gone in order to
assess the quality of clinical nursing from the
nurses record of the discharged patients. A
committee is formed to do the nursing audits.
Senior nurses are the members of the
committee by rotations.
Advantages:
It provides good nursing care services to patients.
It is used as a method of measurement in all areas
of nursing care.
It highlights the strong and the weak points, it
assess the all areas of patient care.
Helps in better planning and helps tin reallocation
of resources.
It has a medical legal value in the court of law.
Contributes to researches.
Disadvantages:
Nursing audits is to so useful in those areas where
elements of nursing process are not implemented.
Analysis is difficult if there is overlapping of
components.
Consumer is lots of time.
Requirement of trained nursing auditors are
required.
It is considered as a source of punishment as it has
a medical legal value.
Methods of audits:
There are two methods:
Retrospective view
The current view
Today we think of audit in the term listed
below:-
Structure audit: - concerned with the setting
in which care is given ( e.g: physical facilities,
equipment and supplies, the personnel).
Process audit: - focused on the order in which
events occur i.e procedure of giving care.
Outcome audit: - looks at the status of the
patient as a result of care provided.