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Management Is the process of leading and directing all or part of an organization through the deployment and manipulation of resources (salaries, supplies, filing of overtime, etc.) Leadership persuading and influencing others towards a goal and is composed of a wide variety of roles Elements of leadership 1. Vision - foresight 2. Influence - Convince other people to follow your goals/objectives/aims 3. Power - Right to command - Enables one to accomplish goals . Authority - Power to make decisions 5. Responsibility - Obligation to do something 6. Accountability - Nurses are answerable for their actions Sources of Power legitimate, reward, coercive, expert, referent, interm-4formational, charismatic referent power - Refers to the ability of a leader to influence a follower because of the follower's loyalty, respect, friendship, admiration, affection, or a desire to gain approval. Informational person possesses needed or wanted information which puts them in a position of power legitimate Your position is recognized as that of delegated authority, Coercive the capacity to compel others' compliance through the use of force, including punishment Expert person has an elevated level of knowledge or a specific skill set that others in an organization don't have. charismatic leader who uses his or her communication skills, persuasiveness, and charm to influence others Leadership Theories The Great man, Behavioral, situational/contingency, Human and Social Capital Great Man Theory/Trait Theories "Some are born to lead while others are born to be led." Leadership styles by Kurt Lewin, White, and Lippitt Authoritarian - Strong control is maintained over the work group -Others are motivated by coercion. Democratic - Less control is maintained. - Economic and ego awards are used to motivate -Appropriate for an extended period of time working together Laissez-Faire - Is permissive, with little or no control - Motivates by support when requested by the group or individuals Distinguishing Characteristics of a Leader 1. Purpose 2. Values - speaks about our morals in life 3. Heart - compassion 4. Relationships - build network and connections with people, relate to the different kinds of people, talk to people with confidence and sincerity 5. Self-discipline Situational/Contingency Theories Mary Parker Follett, Paul Hersey and Kenneth Blanchard, Blake and Mouton, Tannenbaum and Schmidt Mary Parker Follett: Law of Situation: -conflicts be resolved based on the facts of the situation - To give directives, know the situation first Mary Parker Follet: Participative management theory ideal leadership style is one that takes the input of others into account; leaders encourage participation Paul Hersey and Kenneth Blanchard -Leaders adapt their style to the maturity of the follower -As people mature, leadership style becomes less task focused and more relationship oriented Blake and Mouton's Managerial Grid numerous combinations of leadership styles Tannenbaum and Schmidt - Mixed leadership styles - managers need varying mixtures of autocratic and democratic leadership behavior Contemporary Leadership Theories Transactional Leadership, Transformational Leadership, Servant Leadership Servant Leadership : Robert Greenleaf - Serve others before your own self - To be a leader, he must serve, put serving others as #1 priority which includes the employees/customers and community Transformational Leadership - A leader who has a vision and is able to empower others with the vision - Deep-set internal values and ideas Transactional Leadership - Focused on getting the work done on a day-to-day basis (short-term) Human and Social Capital Theory 5 Components of Emotional Intelligence: 1. Self-awareness- 2. Self-regulation 3.Motivation 4. Empathy 5. Social skills EMOTIONAL INTELLIGENCE - Ability to perceive, understand and control one's emotions (as well as those of others) -Those with high E.I. choose to feel useful emotions and regulate them in strategic ways if they are unpleasant to experience self-awareness (5 components of Emotional intelligence) Awareness of the effects of actions on other people - ability to recognize and understand one's moods, (sensitive in words and your own surroundings) emotions, and drives as well as their effects on others Self-regulation(5 components of Emotional intelligence) - Self-disciplined in emotions, mood, etc. - the ability to control or redirect disruptive impulses or moods as well as the propensity to suspend judgment Motivation (5 components of Emotional intelligence) -energy to do something and achieve your goal -a passion to work for reasons that go beyond money or status; a propensity to pursue goals with energy and commitment Empathy (5 components of Emotional intelligence) - Put yourself in one's shoes - the ability to understand and accept the emotional makeup of other people social skills (5 components of Emotional intelligence) - To communicate and care for constituents - proficiency in handling relationships and building networks; an ability to find common ground Management Theories 1. *Scientific Management 2. *Bureaucratic Management 3. Management functions 4. *Human Relations 5. Participative management 6. Hawthorne effect 7. Theory X & Theory Y Frederick W. Taylor, Scientific Management 1. [Science, Not] Traditional Rule of Thumb - 2. Scientific personnel system 3. Financial incentives 4. Cooperative and interdependent relationships [Science, Not] Traditional Rule of Thumb : Frederick W. Taylor Organization in work must be replaced with scientific methods Scientific personnel system :Frederick W. Taylor You are placed where your abilities fit best; matching employees' work to appropriate job descriptions Financial incentives : Frederick W. Taylor "Workers are economic animals motivated by money." Cooperative and interdependent relationships:Frederick W. Taylor between workers and managers Max Weber / Father of Bureaucracy "Bureaucracy as an Organizational Design" Bureaucracy o the need for formal authority and consistent rules for personnel in different positions; system of hierarchy Henri Fayol 5 Management Functions 1. Planning 2. Organizing 3. Command 4. Coordination 5. Control Luther Gulick Expanded Fayol's work 7 Activities of Management 1. Planning 2. Organizing 3. Staffing 4. Directing 5. Coordinating 6. Reporting 7. Budgeting The Management Process (Henri Fayol) 1. Planning - determining philosophy, goals, objectives, policies, procedures, and rules 2. Organizing -establishing the structure to carry out plans 3. Staffing-recruiting, interviewing, hiring, and orienting staff. Scheduling, 4. Directing-entail human resource management responsibilities, such as motivating, managing conflict 5. Controlling-performance appraisals, fiscal accountability, quality control, legal and ethical control Human Relations Management Follett, Mayo, McGregor McGregor Theory X: the managers believe that the workers are lazy, thus need constant supervision and direction Theory Y: managers believe that the workers enjoy their work, are self-motivated, and are willing to work hard for their personal and organizational goals Mayo - The Hawthorne Effect - If the people are observed by the managers, there is an increase in efficiency and work outputs Follet - Introduced the participative management - Emphasizes on authority with rather than authority over employees Contemporary Leader-Manager Theories Peter Drucker - Father of Modern Corporate Management Mary Park Follet - management by decision making - Participative management Drucker (Contemporary Leader-Manager Theories) - Father of Modern Corporate Management - Management by Objectives; look back to see if the workers achieve goals (constant evaluation) - Excellent tool to determine an individual employee's progress; incorporates employees, assessment and the organization Motivational Theories Maslow heirarchy of needs Herzberg motivation-hygiene theor McGregor's X and Y Ouchi's Z theory Ferdinand Herzberg - Hygiene factors: are those which can negatively influence people o Salary o Supervision o Job security o Working condition o Personal life o Interpersonal relationships and peers - Company policy status - Motivation factors: results in satisfaction and psychological growth o Achievement o Recognition o Satisfying and Meaningful Work o Responsibility, Professional Growth and Advancement William G. Ouchi - Expansion of McGregor's Theory (X-Y) - Theory Z,: Japanese style of management - Interactional leadership style o Establishment of strong bonds o Quality circles o Fitting employees to their job o Consensus decision Total Quality Management Centered on quality Taking into consideration the entirety of with the participation of all its members Employing the system of management COMPONENTS IN THE MANAGEMENT PROCESS 1. PLANNING 2. ORGANIZING 3.STAFFING 4. DIRECTING 5. PLANNING PLANNING (MANAGEMENT PROCESS) -deciding in advance what to do; who is to do it; and how, when, and where it is to be done. -ENCOURAGES unity of goals and continuity of energy expenditure (human and fiscal resources) Reasons for Planning Achievements of goals Effective control Helps in coping with crisis Reduces element of change REACTIVE Mode of Planning -Occurs after the problem has existed -done in response to a crisis , It leads to hasty decisions and mistakes -dealt with separately INACTIVISM Mode of Planning -seek the status quo, and they spend their energy PREVENTING CHANGE and maintaining CONFORMITY PREACTIVISM Mode of Planning • Uses technology to have change Future oriented INTERACTIVE/PROACTIVE Mode of Planning -anticipation of changing needs -Plans before problem occurs -consider the past, present, and future -promotes growth FORECASTING (Elements in Planning) trying to estimate how a condition will be in the future input from others, gives sequence in activity, and protects an organization against undesirable changes. STRATEGIC PLANNING (type of Planning) - Long range planning; realistic - List strength and weaknesses of the org. - Managers must align managers' capabilities and external opportunities - Examine the readiness for change, identify function critical to achieving goals - Involves top level managers Tools: SWOT analysis, Balanced scoreboard (Robert Kaplan and David Norton) The Planning Hierarchy (under Strategic Planning) 1) Vision 2)Mission 3) Philosophy 4) Goals 5) Objectives 6) Policies 7) Procedures 8) Rules Operational Planning • Revenue - source of income • Budget - a financial plan that includes estimated expenses as well as income for a period of time • Operating expenses - all full-time equivalent personnel and all expenses and revenue for day-in and day-out operations • Direct costs - cost attributed to a specific source • Cost containment - business practice of maintaining expense levels to prevent unnecessary spending • Cost effective - producing good results for money spent • Fiscal planning - Involves all the financial statements that involves the revenue and income within a year Types of Budget 1. Personnel Budget - Forecast long and short-term personnel needs - Vacation leaves - Calculating daily staffing needs - Managers monitor overstaffing and understaffing - Cognizant of staffing mix - Calculating daily staffing needs - To include productive and non-productive time 2. Operating Budget - daily costs - paper supplies, meals, 3. Capital Budget - Equipment - Construction of new buildings - Expensive and big TIME MANAGEMENT - Making optimal use of available time - Common mistakes in planning ▪ underestimating importance of having daily plan ▪ not allowing adequate time for planning 3 Basic Steps in Time Management 1. Allow time for planning and establishing priorities - Do not procrastinate - Making lists - Dealing with interruptions / Time Wasters (technology) - Make use of inventory - Don't make yourself easily accessible 2. Completing the highest priority 3. Reprioritize the remaining tasks and on new information Suggestions/Principles on the Time-efficient Work Environment 1. Gather all the supplies and equipment 2. Group activities that are in the same location 3. Use time estimates 4. Documenting nursing intervention as soon as possible 5. always strive to end the workday on time Time-saving techniques, devices, and methods to better use of time 1. Conduct an inventory of your activities 2. Set goals and objectives and write them down 3. Make use of calendars, executive planners on what you expect to accomplish 4. Break down large projects into smaller parts 5. Devote a few minutes at the beginning of each day in planning 6. Organize your workplace to be functional 7. Close your door when you need to concentrate 8. Learn to delegate 9. Distribute agenda ahead of time for meetings 10. Take or return calls during specified time 11. Do not be afraid to say "No". 12. Take rest breaks and make good use of spare time. Tools in Project Management Gantt Chart, PERT, CPM, Critical Path Method (CPM) (Project management tool) - Calculates time and cost for each activity Performance Evaluation and Review Technique (PERT) (project management tool) Sequencing activities in a flow diagram Gantt Chart (project management tool) Show task and schedule information Decision Making Tools Decision Grid, Pay-off Tables, Decision Tree,PERT Decision Making Tools 1. Decision Grid allows one to visually examine the alternatives and compare each against the same criteria Pay-off Tables - Have a cost-profit-volume relationship - very helpful when some quantitative information is available, such as an item's cost or predicted use Decision Tree decisions are often tied to the outcome of other events Overcoming Barriers to Planning 1. Setting a goal 2. Flexibility 3. Include all people affected by the plan 4. Plan should be specific, simple, and realistic 5. Know when to plan and not to plan 6. Have evaluation process ORGANIZING involves a body of people where relationships are defined, procedures are outlined, equipment is readied, and tasks are assigned. involves establishing a formal structure that provides the best possible coordination or use of resources to accomplish unit objectives. Formal Structure - through departmentalization and work division, provides a framework for defining managerial authority, responsibility, and accountability. - roles and functions are defined and systematically arranged, different people have differing roles, and rank and hierarchy are evident. Informal structure - a naturally forming social network of employees. - Unplanned - fills in the gaps with connections and relationships that illustrate how employees' network with one another to get work done. Max Weber - a German social scientist - father of organizational theory - acknowledged to have developed the most comprehensive classic formulation on the characteristics of bureaucracy - Weber saw the growth of the large-scale organization and correctly predicted that this growth required a more formalized set of procedures for administrators. Reasons for organizing - Having a purpose to achieve - Defines our roles and functions in the organization - Coordinates activities, no duplication - Activities can be defined - Reduces confusion Characteristics of Bureaucracies Max Weber 1. Division of Labor or work - all work must be divided into units that can be undertaken by individuals or groups of individuals competent to perform those tasks 2. Hierarchy of authority - must exist in which superiors are separated from subordinates; based on this hierarchy, remuneration for work is dispensed, authority is recognized, privileges are allotted, and promotions are awarded 3. Rules and impersonality of interpersonal relationships - bureaucrats are not free to act in any way they please. Bureaucratic rules provide superiors systematic control over subordinates, thus limiting the opportunities for arbitrary behavior and personal favoritism 4. System of procedures - for dealing with work situations 5. System of rules - covering the rights and duties of each position must be in place. 6. Selection for employment and promotion is based on technical competence 1. Division of Labor or work - all work must be divided into units that can be undertaken by individuals or groups of individuals competent to perform those tasks 2. Hierarchy of authority - must exist in which superiors are separated from subordinates; based on this hierarchy, remuneration for work is dispensed, authority is recognized, privileges are allotted, and promotions are awarded 3. Rules and impersonality of interpersonal relationships - bureaucrats are not free to act in any way they please. Bureaucratic rules provide superiors systematic control over subordinates, thus limiting the opportunities for arbitrary behavior and personal favoritism 4. System of procedures - for dealing with work situations 5. System of rules - covering the rights and duties of each position must be in place Components of Organizational Structure Organizational chart - defines formal relationships within the institution Unbroken lines (solid lines) - Formal relationships, lines of communication, and authority are depicted - Coordinating communication - Solid horizontal lines represent communication between people with similar spheres of responsibility and power but different functions. - Solid vertical lines between positions denote the official chain of command, the formal paths of communication and authority Dotted or broken lines - represent staff positions - advisory, a staff member provides information and assistance to the manager but has limited organizational authority - Advisory (staff) positions do not have inherent legitimate authority. 1. chain of command - the formal paths of communication and authority - one person/one boss in which employees have one manager to whom they report and to whom they are responsible 2. Span of control - number of people directly reporting to any one manager represents that manager's span of control and determines the number of interactions expected of him or her. - 3 to 50 people reporting to one manager - the ideal span of control in an organization depends on various factors: o nature of the job o the manager's abilities o the employees' maturity o the task complexity o the level in the organization at which the work occurs o geographic location 3. Managerial levels a. Top-level managers b. Middle-level managers c. First-level managers 4. Centrality - or where a position falls on the organizational chart, is determined by organizational distance - refers to the location of a position on an organization chart where frequent and various types of communication occur - the middle manager often has a broader view of the organization than other levels of management. - A middle manager has a large degree of centrality because this manager receives information upward, downward, and horizontally 5. Scalar Chain - Chain of command - Decision making hierarchy Types of Organizational Design 1. Line organization/ bureaucratic - Each position has general authority over the lower position in the hierarchy - often produce monotony, alienate workers, and make adjusting rapidly to altered circumstances difficult. 2. Matrix Structure - designed to focus on both product and function. - Less formal rules; decision making is slow - Can produce confusion and frustration 3. Flat designs - Flat scalar chain - effort to remove hierarchical layers by flattening the chain of command and decentralizing the organization organizational culture - a system of symbols and interactions unique to each organization. It is the ways of thinking, behaving, and believing that members of a unit have in common - the total of an organization's values, language, traditions, customs - "Sacred cows" —those few things present in an institution that are not open to discussion or change - the values and behaviors that contribute to the unique social and psychological environment of an organization - includes an organization's expectations, experiences, philosophy, and values that hold it together and is expressed in its self-image, inner workings, interactions with the outside world, and future expectations. Organizational Climate - how employees perceive an organization - an employee might perceive an organization as fair, friendly, and informal or as formal and very structured - is the view of the organization by individuals, the organization's climate and its culture may differ Authority Power Gap - bridging the gap - build a personal power base, and minimize the negative politics of the organization Suggestions to Bridge Authority-Power Gap 1. provide information to the organizational and unit goals 2. genuine effort to know and care for the workers 3. consider perceptions of the subordinates 4. credibility of the manager 5. empowering subordinates empowerment: decentralization of power creates and sustains a work environment that speaks to values, such as facilitating the employee's choice to invest in and own personal actions and behaviors that result in positive contributions to the organization's mission - Components o Professional traits o Continuing education o Effective leadership style Building a Personal Base a. Maintain personal energy b. Present a powerful picture to others c. Pay the entry fee d. Determine the powerful in the organization e. Learn the language and symbols of the organization f. Learn to know the organization's priorities g. Increase professional skills and knowledge h. Maintain broad vision i. Use experts and seek counsel j. Be flexible k. Develop visibility and voice in the organization l. Learn to toot your horn m. Maintain a sense of humor Modes of Organizing Patient Care/ Modalities of Nursing Care 1. Total Patient Care/ Case Method 2. Functional Method 3. Team Nursing 4. Modular Nursing 5. Primary Nursing/Relationship Based Nursing 6. Case Management Total Patient Care/ Case Method - nurses assume total responsibility during their time on duty for meeting all the needs of assigned patients - referred to as the case method of assignment because patients may be assigned as cases, much like the way p duty nursing was historically carried out - provides nurses with high autonomy and responsibility - Assigning patientrivates is simple and direct and does not require the planning that other methods of patient care delivery require. - The lines of responsibility and accountability are clear. - Advantage: The patient theoretically receives holistic and unfragmented care during the nurse's time on duty. - To maintain quality care, this method requires highly skilled personnel and thus may cost more than some other forms of patient care. - Disadvantage occurs when the nurse is inadequately prepared or too inexperienced to provide total care to the patient 2. Functional Method - evolved primarily because of World War II - Because nurses were in great demand overseas and at home, a nursing shortage developed, and ancillary personnel were needed to assist in patient care. - Examples of functional nursing tasks were checking blood pressures, administering medication, changing linens, and bathing patients. - RNs became managers of care rather than direct care providers, and "care through others" became the phrase used to refer to this method of nursing care. - employment of personnel with various levels of skill and education proliferated as new categories of health-care workers were created - an economical and efficient means of providing care - A major advantage is its efficiency; tasks are completed quickly, with little confusion regarding responsibilities. - does allow care to be provided with a minimal number of RNs - disadvantage: may lead to fragmented care and the possibility of overlooking patient priority needs - may result in low job satisfaction, e some workers feel unchallenged and under stimulated in their roles - may also not be cost-effective due to the need for many coordinators - Employees often focus only on their own efforts, with less interest in overall results 3. Team Nursing - ancillary personnel collaborate in providing care to a group of patients under the direction of a professional nurse - As the team leader, the nurse is responsible for knowing the condition and needs of all the patients assigned to the team and for planning individual care. - The team leader's duties vary depending on the patient's needs and the workload. - These duties may include assisting team members, giving direct personal care to patients, teaching, and coordinating patient activities. - Through extensive team communication, comprehensive care can be provided for patients despite a relatively high proportion of ancillary staff. - A team should consist of not more than five people or it will revert to more functional lines of organization. - usually associated with democratic leadership - Group members are given as much autonomy as possible when performing assigned tasks, although the team shares responsibility and accountability collectively. - allows members to contribute their own special expertise or skills - Recognizing the individual worth of all employees and giving team members autonomy results in high job satisfaction. - Disadvantages are associated primarily with improper implementation rather than with the philosophy itself - can lead to blurred lines of responsibility, errors, and fragmented patient care - the team leader must be an excellent practitioner and have good communication, organizational, management, and leadership skills 4. Modular Nursing - was never practiced in its purest form but was instead a combination of team and functional structure. - uses a mini team (two or three members with at least one member being an RN), with members of the modular nursing team sometimes being called care pairs - patient care units are typically divided into modules or districts, and assignments are based on the geographical location of patients. - allow the professional nurse more time for planning and coordinating team members - a small team requires less communication, allowing members better use of their time for direct patient care activities