UNIT - VIII CONTROLLING/IMPLEMENTING NURSING STANDARDS.pptx

NIT – VIII: CONTROLLING
Subject: Nursing Management & Leadership (VI Semester)

Controlling is a vital management function that ensures all organizational activities align with planned objectives. It involves setting performance standards, measuring actual performance, identifying deviations, and implementing corrective actions. It bridges the gap between planning and performance, promoting efficiency, accountability, and goal achievement.

Types of Control

Feedforward Control: Preventive in nature; applied before an activity to anticipate and prevent problems.

Concurrent Control: Applied during the process to ensure smooth and accurate performance.

Feedback Control: Evaluates results after completion to improve future outcomes.

Process of Controlling

Steps include:

Establishing standards,

Measuring performance,

Comparing with standards,

Identifying deviations,

Taking corrective actions, and

Following up for effectiveness.

Advantages: Ensures discipline, detects errors early, improves coordination and resource use.
Disadvantages: Time-consuming, costly, may reduce creativity and cause employee resistance.

Implementing Standards, Policies, Procedures, Protocols, and Practices

These provide uniformity and safety in nursing care.

Standards define quality benchmarks (e.g., hand hygiene).

Policies guide decisions (e.g., infection control).

Procedures detail task steps (e.g., IV insertion).

Protocols direct clinical actions (e.g., CPR).

Practices are actual implementations in daily nursing work.

Process: Communication → Training → Supervision → Auditing → Evaluation.
Benefits: Improves care quality, patient safety, satisfaction, and staff accountability.
Nurse’s Role: Adhere to standards, maintain documentation, report deviations, and participate in audits.

Nursing Performance Audit

A systematic review to assess quality of nursing care and adherence to standards.
Stages: Preparation → Data collection → Analysis → Interpretation → Action → Re-evaluation.
Advantages: Improves quality, accountability, and patient safety.
Disadvantages: Time-consuming, may depend too much on documentation, and requires trained staff.

Patient Satisfaction

An indicator of care quality based on patients’ expectations and experiences.
Determinants: Quality of care, communication, responsiveness, environment, involvement, and support services.
Strategies: Effective communication, empathy, timely care, cleanliness, privacy, education, and follow-up.

Nursing Rounds

Regular, systematic patient visits to assess, plan, and evaluate care.
Types: Information-giving, instructional, problem-solving, and patient-centered.
Advantages: Improves care, teamwork, communication, and professional growth.
Disadvantages: Time-consuming, may disturb patients or increase workload.
Nurse’s Role: Assess needs, monitor progress, educate patients, and document care.

1. CONTROLLING Mr. Pradeep Abothu, PhD Scholar, Dept. of Child Health Nursing ASRAM College of Nursing

2. Implementing Standards, Policies, Procedures, Protocols, and Practices Nursing performance audit and patient satisfaction Nursing rounds and documentation (records and reports) Total quality management – quality assurance, quality, and safety Performance appraisal Program Evaluation Review Technique (PERT) Benchmarking and activity planning (Gantt chart) Critical path analysis CONTENTS

3. Introduction Controlling is the final function of management, where actual employee performance is measured against pre-decided goals. It ensures that organizational objectives are achieved efficiently by identifying deviations and taking corrective actions promptly.

4. Definitions “Controlling is the process of monitoring work, identifying deviations, and ensuring resources are used properly to meet organizational objectives.” “Controlling is the measurement and correction of performance in order to ensure that enterprise objectives and the plans devised to attain them are accomplished.” - O’Donnell “Control consists in verifying whether everything occurs in conformity with the plan adopted, the instructions issued, and principles established.” - Henry Fayol

5. Types of controlling Feedforward Control : This type of control is preventive in nature. It is exercised before the actual activity begins with the aim of anticipating problems and taking corrective measures in advance. It focuses on resources like manpower, materials, and finances to ensure that everything is arranged properly before execution.

6. Concurrent Control : Also called real-time or steering control , this takes place during the actual performance of an activity . It continuously monitors ongoing operations and compares them with the set standards. If any deviation occurs, corrective action is immediately implemented, ensuring smooth and uninterrupted performance. Feedback Control : This control is applied after the completion of an activity . It involves reviewing and analyzing the final output against the predetermined standards. The results of this evaluation are used to make improvements in future plans and performance. Feedback control is essential for long-term efficiency and organizational learning.

7. Process of Controlling The process of controlling involves a series of steps through which managers ensure that activities are carried out as planned and desired results are achieved.

8. Establishing Standards : Standards are set as benchmarks for performance, such as cost, quality, time, or output. These act as criteria to compare actual performance. Measuring Performance : Actual performance is measured through observation, reports, or records. Quantitative and qualitative methods may be used depending on the activity. Comparing Performance with Standards : The measured performance is compared against the set standards to identify any deviations, whether minor or significant. Identifying Deviations : Any gap between expected and actual performance is analyzed . Deviations may occur due to resource issues, errors, or inefficiencies. Taking Corrective Action : Corrective steps are implemented to eliminate the causes of deviations and bring performance back on track. Follow-Up : The effectiveness of corrective measures is monitored to ensure that the same deviations do not occur again.

9. Advantages of Controlling Advantages of Controlling Ensures activities are carried out as per plan. Helps in identifying errors and deviations at an early stage. Improves efficiency and utilization of resources. Facilitates coordination among departments. Enhances accountability and discipline in the organization.

10. Disadvantages of Controlling Can be time-consuming and costly to implement. May create resistance among employees if seen as strict supervision. Overemphasis on control may reduce creativity and innovation. Not always accurate due to limitations in data or measurement tools. Excessive control may lead to stress and lower morale.

11. IMPLEMENTING STANDARDS, POLICIES, PROCEDURES, PROTOCOLS, AND PRACTICES

12. Implementing standards, policies, procedures, protocols, and practices is essential to ensure safe, consistent, and high-quality nursing care. It establishes clear guidelines that help achieve organizational goals and improve patient outcomes.

13. Definitions Standards: Standards are predetermined benchmarks that define the level of quality and performance expected in nursing care. Example: Hand hygiene compliance, frequency of patient vital monitoring, or safe medication administration. Policies: Policies are formal, written guidelines that direct decision-making and actions within the organization. Example: Infection control policy, patient privacy policy, and medication administration policy.

14. Procedures: Procedures are detailed, step-by-step instructions for completing specific tasks. Example: Procedure for IV insertion, wound dressing, or catheterization. Protocols: Protocols are structured plans or instructions that guide nurses in managing specific clinical or administrative situations. Example: CPR protocol, Heimlich maneuver protocol, or emergency response for stroke. Practices: Practices refer to the actual implementation of standards, policies, procedures, and protocols in daily nursing activities. Example: Conducting nursing rounds, adhering to documentation standards, and ensuring infection control practices.

15. Process of Implementation The implementation of standards, policies, procedures, protocols, and practices follows a systematic process to ensure that guidelines are effectively integrated into daily nursing activities. Communication: Clearly communicate the standards, policies, procedures, and protocols to all nursing staff. Effective communication ensures that every team member understands their responsibilities and the expected quality of care. Training & Education: Provide structured training sessions, workshops, and demonstrations to build the necessary skills. Education ensures staff are competent, confident, and able to follow guidelines safely and efficiently.

16. Monitoring & Supervision: Regularly observe nursing activities to ensure adherence to guidelines. Supervisors provide feedback, correct errors, and reinforce good practices, ensuring consistent and high-quality patient care. Auditing: Conduct formal audits such as performance assessments and patient satisfaction surveys. Auditing identifies gaps, tracks compliance, and helps maintain accountability within the nursing team. Evaluation & Feedback: Assess outcomes of implementation and provide constructive feedback. This step involves revising policies if needed, recognizing achievements, and addressing deficiencies to improve overall care quality.

17. Tools and Techniques Used Various tools and techniques assist in implementing standards, policies, procedures, protocols, and practices. Nursing performance audits Patient satisfaction surveys Nursing rounds Documentation Total Quality Management (Quality assurance, quality and safety) Performance appraisal Program Evaluation Review Technique (PERT) Benchmarking and Gantt charts Critical Path Analysis

18. Benefits of Implementing Ensures high-quality, consistent, and safe patient care. Reduces errors, complications, and variation in nursing practices. Improves patient satisfaction and trust in healthcare services. Enhances staff accountability and professional responsibility. Facilitates performance evaluation and quality improvement initiatives. Helps in regulatory compliance and meeting accreditation standards.

19. Role of Nurse in Implementing Adhere to all standards, policies, and procedures consistently. Report deviations or unsafe practices promptly. Maintain accurate and timely documentation of nursing activities. Participate in nursing audits and quality improvement initiatives. Educate patients and families about care standards and safety measures. Collaborate with other healthcare professionals for effective implementation. Provide feedback for updating or improving policies and procedures.

20. Nursing performance audit is a systematic process of evaluating nursing care provided to patients. It measures quality, identifies deficiencies, and ensures standards are followed to improve patient safety and satisfaction. Definition: Nursing audit is a systematic review and evaluation of the quality of Nursing care. NURSING PERFORMANCE AUDIT

21. To assess the quality of nursing care delivered. To identify strengths and weaknesses in nursing practice. To ensure adherence to established standards and policies. To provide a basis for performance appraisal and staff development. To promote accountability and responsibility among nurses. To improve patient safety, satisfaction, and outcomes. To contribute to quality assurance and accreditation processes. Purposes of Nursing Performance Audit

22. Preparation: Define objectives, select audit type, and develop audit tools. Data Collection: Gather nursing records, reports, and patient feedback. Data Analysis: Compare collected data with standards and identify gaps. Interpretation: Draw conclusions about the quality of nursing care. Action/Implementation: Provide feedback, recommend improvements, and implement corrective measures. Re-evaluation: Conduct follow-up audits to ensure improvement and sustainability. Stages of Nursing Audit

23. Improves quality and consistency of nursing care. Identifies strengths and weaknesses in practice. Encourages accountability and professional responsibility. Provides data for performance appraisal and training needs. Enhances patient safety, satisfaction, and trust. Contributes to accreditation and organizational development. Advantages of Nursing Audit

24. Time-consuming and resource-intensive process. May create resistance or fear among staff. Relies heavily on documentation; incomplete records reduce accuracy. Requires trained personnel for objective evaluation. May focus more on paperwork than actual bedside care. Disadvantages of Nursing Audit

25. Patient satisfaction reflects the extent to which healthcare services meet patients’ expectations and needs. It is an essential indicator of care quality, influencing trust, compliance, and overall health outcomes. Definition: Patient satisfaction is the degree of contentment expressed by patients regarding the healthcare services they receive, based on their expectations, experiences, and outcomes of care. PATIENT SATISFACTION

26. To assess the quality of healthcare services provided. To evaluate the effectiveness of communication and nurse–patient relationships. To identify areas needing improvement in patient care. To enhance patient trust, confidence, and loyalty to healthcare providers. To ensure patient-centred care and safety. To provide feedback for staff appraisal and training. To support accreditation, quality assurance, and hospital reputation. Purposes of Patient Satisfaction

27. Patient satisfaction depends on multiple factors that influence patients’ experiences, perceptions, and overall contentment with care. Quality of Care: Care provided is accurate, safe, effective, and meets clinical standards to achieve optimal health outcomes. Nurse–Patient Communication: Nurses communicate clearly, empathetically, and respectfully, ensuring patients understand treatment and feel emotionally supported. Responsiveness: Patients receive prompt attention, timely interventions, and immediate responses to their needs and concerns consistently. Determinants of Patient Satisfaction

28. Environment: Hospital environment is clean, comfortable, safe, and ensures privacy, promoting patient confidence and satisfaction. Involvement in Care: Patients actively participate in treatment decisions, fostering control, understanding, and engagement in their care. Support Services: Patients have access to counselling, guidance, information, and follow-up services for continuous support.

29. Quality of nursing care – skill, competence, and accuracy of interventions. Communication – clarity, empathy, and respect in nurse–patient interactions. Accessibility of services – ease of reaching and obtaining healthcare. Responsiveness – timeliness in addressing patient needs and concerns. Hospital environment – cleanliness, safety, comfort, and privacy. Interpersonal relationships – courtesy, respect, and trust from healthcare staff. Patient involvement – degree of participation in decision-making. Support services – availability of information, counselling, and follow-up care. Cost of services – affordability and value for money in care. Factors Affecting Patient Satisfaction

30. Nursing strategies to improve patient satisfaction Communicate clearly and respectfully with patients and families. Provide timely responses to patient needs and requests. Maintain a clean, safe, and comfortable environment. Show empathy, kindness, and emotional support during care. Involve patients in decision-making about their treatment. Ensure privacy and confidentiality at all times. Educate patients about their condition, treatment, and self-care. Give continuous feedback, reassurance, and follow-up care.

31. NURSING ROUNDS Introduction: Nursing rounds are systematic visits made by nurses, either individually or in groups, to patients at regular intervals. They aim to observe, assess, discuss, and plan nursing care to improve patient outcomes. Definition: Nursing rounds are a planned approach in which nurses visit patients systematically to assess conditions, review care, provide instructions, and promote professional learning through observation and discussion.

32. Purposes To assess the physical, psychological, and social needs of patients. To evaluate the effectiveness of nursing care provided. To give practical learning experiences to nursing students. To provide guidance and instructions to patients and relatives. To detect problems early and take corrective measures. To promote professional development of nurses through observation and discussion. To encourage effective communication and teamwork among nurses. To ensure quality assurance and maintain standards in patient care.

33. Types of Nursing Rounds Information-Giving Rounds – Provide patients with necessary information regarding their care, treatment, or hospital services. Instructional Rounds – Conducted for educational purposes, especially for nursing students, where the educator explains and demonstrates care procedures. – Identify patient problems and discuss possible solutions with staff and students. Patient-Cantered Rounds – Involve patients and family members in care planning, progress evaluation, and discharge planning.  

34. Advantages Improves quality of patient care through systematic evaluation. Provides clinical teaching and learning opportunities for students. Enhances communication between nurses, patients, and relatives. Promotes patient education, confidence, and satisfaction. Encourages teamwork and collaborative nursing practice. Helps in early detection of patient problems and prevents complications.

35. Disadvantages Time-consuming and may interfere with other nursing duties. May disturb patient’s rest, privacy, or comfort. Creates anxiety in patients when many staff gather around the bedside. Staff shortages can make regular rounds difficult to conduct. Lack of planning and coordination reduces effectiveness. Adds workload pressure for nurses with multiple responsibilities.

36. Role of Nurse in Nursing Rounds Assess the patient’s physical, psychological, and social needs Monitor patient’s condition and progress regularly Identify patient problems and plan interventions Provide instructions and health education to patients and families Communicate patient care information with the healthcare team Supervise and guide junior nurses or students during rounds Ensure continuity and quality of nursing care

37. Document observations and interventions accurately Encourage patient participation in their own care Support professional development through teaching and discussion during rounds

38. DOCUMENTATION (RECORDS AND REPORTS) Records: “Records are a written collection of data and information about a patient’s health status, treatment, and nursing care provided, maintained for communication and legal purposes.” – Kozier & Erb (2004) Reports: “Reports are oral, written, or computer-based statements of patient care, observations, and activities communicated to other members of the health team.” – Potter & Perry (2009)

39. Importance of Records and Reports Provide a legal document in case of disputes, negligence, or malpractice issues. Serve as a means of communication among nurses, doctors, and the entire healthcare team. Ensure continuity of care when different nurses or staff attend to the same patient. Help in assessment, planning, implementation, and evaluation of nursing care.

40. Act as a reference for research and education , supporting evidence-based practice. Provide statistical data useful for hospital administration, planning, and policy-making. Aid in quality assurance and auditing by reviewing nursing performance and patient outcomes. Provide a basis for financial claims like insurance, reimbursement, and medico-legal purposes.

41. Types of Records Clinical Records / Patient Records Admission record Nursing history record Nursing care plan Nurse’s notes / progress notes Medication record Doctor’s orders Vital signs chart Intake and output chart Laboratory and diagnostic reports Operation theatre record Discharge summary

42. Administrative Records Staff duty roster Inventory record (equipment, supplies) Attendance register Leave record Financial records (billing, accounts)

43. Types of Reports Oral Reports Shift report / Change-of-shift report Patient handover report Nursing rounds report Verbal incident report Nurse’s daily report Written Reports Admission report Transfer report Discharge report Operation / procedure report Incident / accident report

44. Role of Nurse in Documentation (Records and Reports) Record patient details clearly and correctly Write everything on time without delay Use hospital-approved formats and abbreviations Maintain confidentiality of patient information Provide complete information for continuity of care

45. Report important changes to doctors and team Keep documents safe for legal and professional use Help in quality checking, audits, and research Use records as a communication tool among staff Support teaching and learning through proper documentation

46. TOTAL QUALITY MANAGEMENT - QUALITY ASSURANCE, QUALITY AND SAFETY

47. Total Quality Management (TQM) is a continuous process of improving products, services, and processes to achieve customer satisfaction and organizational goals. It focuses on teamwork, employee involvement, and a culture of continuous improvement. The concept of TQM originated after World War II in Japan , where quality experts like W. Edwards Deming and Joseph Juran introduced quality control techniques to improve industrial production. Later, in the 1980s , TQM gained popularity in the United States as industries began to adopt Japanese management techniques. It gradually extended to healthcare and nursing , emphasizing patient satisfaction and safety through continuous improvement in nursing care. Introduction

48. “TQM is a management philosophy aimed at continuous improvement of processes, products, and services involving everyone in the organization.” - W. Edwards Deming (1986) “TQM is a system of activities directed at achieving delighted customers, empowered employees, higher revenues, and lower costs.” - M. Juran (1988) Definition

49. OBJECTIVES

50. Elements (Principles) of Total Quality Management

51. TQM has four key components that ensure quality, prevent errors, and promote continuous improvement. Quality Planning: Identifying quality standards and developing processes to meet customer and organizational requirements effectively. Quality Control: Monitoring and measuring processes to detect and correct deviations from quality standards. Quality Assurance: Systematic activities to ensure quality requirements are consistently fulfilled throughout production or service delivery. Quality Improvement: Continuous efforts to enhance processes, reduce defects, and increase efficiency and customer satisfaction. Components

52. QUALITY ASSURANCE

53. Quality assurance is a systematic process that ensures health services meet established standards and consistently provide safe and effective care. It focuses on evaluating and improving patient outcomes while supporting healthcare providers in delivering the best care possible. Introduction

54. “Quality Assurance is an ongoing, systematic evaluation of health care services and their impact on patient outcomes.” - Kozier “QA includes all activities to prevent poor quality and maintain standards.” - Neetvert (1992) Definition

55. To ensure that patients receive safe, effective, and timely care. To maintain consistent standards of healthcare services. To identify and correct errors before they affect patient outcomes. To improve patient satisfaction and trust in healthcare services. To enhance the professional performance of healthcare workers. To ensure proper use of hospital resources and reduce wastage. To support accreditation and legal compliance of the hospital. To promote continuous improvement in nursing and medical practices. To reduce hospital-acquired infections and medical errors. To strengthen teamwork, communication, and accountability among staff. Need For Quality Assurance In Hospitals

56. Components of Quality Assurance Components of Quality Assurance help in systematically evaluating different aspects of healthcare services to ensure that patients receive safe, effective, and high-quality care.

57. Establish standards or criteria – Decide what level of quality or performance is expected. Identify relevant information – Choose what data or evidence is needed to measure performance. Determine methods for data collection – Plan how to collect the required information. Collect and analyse information – Gather data and find out how performance compares with standards. Compare with established criteria – Identify gaps between expected and actual performance. Make judgments about quality – Conclude whether quality is satisfactory or not. Take corrective action – Implement changes or improvements where needed. Re-evaluate and monitor results – Ensure the corrective actions were effective and sustained. Quality Assurance Process

58. Different models are used in hospitals and nursing services to evaluate, maintain, and improve the quality of care. These models provide a systematic framework to assess whether patient care meets the expected standards. 1. Donabedian Model (1966) This is the most commonly used model in healthcare for assessing quality. Components: Structure: Refers to the physical and organizational setup such as hospital buildings, equipment, staff, and policies. Process: Refers to the methods or activities involved in providing care, including assessment, planning, implementation, and evaluation. Outcome: Refers to the results of care such as patient satisfaction, recovery, or complications. Example: If a hospital has enough trained nurses (structure), provides timely and safe care (process), and patients recover well (outcome), quality assurance is achieved. Models

59. 2. System Model This model views quality as a continuous flow of activities within a system. Elements: Input: Resources such as manpower, materials, and machines. Throughput: Processes or actions carried out to deliver services. Output: The end results or services provided to patients. Feedback: Information received to identify gaps and improve future performance. Purpose: It helps to identify where errors or delays occur in the system and guides corrective measures.

60. 3. ANA Quality Assurance Model Developed by the American Nurses Association (ANA) to evaluate and maintain quality nursing care. Main Steps: Identify standards of nursing practice. Collect data to measure performance. Compare actual performance with standards. Make judgments and plan improvements. Implement corrective actions and re-evaluate. Focus: Ensures that nursing practice meets professional standards and improves patient outcomes.

61. 4. Plan–Do–Study–Act (PDSA) Cycle Also known as the Deming Cycle , this model is widely used for continuous quality improvement (CQI) . Steps: Plan : Identify a problem and plan a change for improvement. Do : Implement the plan on a small scale. Study : Observe and analyse the results. Act : Adopt the successful change or modify the plan as needed.

62. Several factors influence the successful implementation of quality assurance programs in hospitals. These include internal and external challenges that impact service quality. Lack of adequate resources and modern equipment. Shortage of trained and qualified nursing personnel. Poor maintenance of hospital infrastructure and materials. Unreasonable expectations from patients and attendants. Lack of awareness among the general population regarding quality healthcare. Factors Affecting Quality Assurance in Nursing Practice

63. Absence of strict accreditation and legal regulations. Inefficient hospital information and record systems. Lack of regular patient satisfaction surveys. Limited research and studies on nursing care quality. Failure to review incidents and report errors promptly. Poor motivation and lack of teamwork among healthcare staff.

64. Actively participate in quality assurance and improvement committees. Monitor and evaluate nursing care on a continuous basis. Identify problems in patient care and suggest corrective actions. Participate in patient safety and quality improvement initiatives. Maintain accurate, complete, and objective documentation. Engage in continuing education and professional development. Promote evidence-based practice and participate in related research. Ensure adherence to hospital standards and protocols. Encourage teamwork and communication for safe patient care. Report errors or deviations promptly and ethically. Role of Nurse

65. National Agencies (India) NABH (National Accreditation Board for Hospitals and Healthcare Providers) NABL (National Accreditation Board for Testing and Calibration Laboratories) QCI (Quality Council of India) INC (Indian Nursing Council) International Agencies JCI (Joint Commission International) ISO (International Organization for Standardization) WHO (World Health Organization) ISQua (International Society for Quality in Health Care) National and International Agencies for Accreditation and Quality Assurance

66. Quality and safety in healthcare are essential to ensure that patients receive effective, reliable, and risk-free care. These concepts focus on improving outcomes, preventing errors, and maintaining high professional standards. QUALITY AND SAFETY IN HEALTHCARE

67. Quality: “Quality in healthcare refers to the degree to which services increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” – Joint Commission on Accreditation of Healthcare Organizations Patient Safety: “Patient safety is the prevention of errors and adverse effects to patients associated with healthcare.” – WHO Definitions

68. Effectiveness: Providing care based on scientific knowledge to achieve desired outcomes. Efficiency: Minimizing waste of resources while maintaining high-quality care. Equity: Providing care that does not vary in quality because of personal characteristics. Timeliness: Reducing delays in care to improve outcomes. Patient - Centred Care: Respecting patient preferences, needs, and values. Safety: Avoiding harm to patients during healthcare delivery. Key components

69. Improves patient outcomes and satisfaction. Reduces medical errors, complications, and hospital-acquired infections. Enhances trust in healthcare systems. Optimizes use of resources and reduces wastage. Ensures compliance with professional standards and regulations. Encourages continuous improvement and innovation in care delivery. Importance of Quality And Safety

70. Establish clear protocols and guidelines for care. Implement regular training and continuing education for staff. Monitor and report errors or near misses. Conduct audits, inspections, and quality reviews. Use checklists, standard operating procedures (SOPs), and safety tools. Promote teamwork, communication, and a culture of safety. Engage patients in their care and educate them about safety measures. Strategies To Improve Quality And Safety

71. Ensure adherence to hospital policies and evidence-based practices. Identify risks and prevent adverse events. Participate in quality improvement initiatives and safety audits. Maintain accurate and complete documentation. Educate patients and families about safe practices. Report errors or unsafe conditions promptly. Role of Nurse

72. PERFORMANCE APPRAISAL

73. Performance appraisal is a systematic process used in organizations to evaluate an employee’s job performance, identify strengths and weaknesses, and plan for future development. It ensures that employees contribute effectively to organizational goals. Introduction

74. “Performance appraisal is a systematic, periodic and impartial rating of an employee’s excellence in his present job and his potentialities for a better job.” - Edwin B. Flippo “Performance appraisal is a record of progress for employees, serving as a guide in making promotions, transfers, demotions, bonus distribution, and discovering hidden talents.” - Scott, Clothier, and Spriegal Definition

75. Objectives To determine employee effectiveness in their current role. To identify shortcomings and provide necessary guidance or training. To evaluate potential for promotion and career advancement.  

76. Helps management decide salary increases and promotions. Encourages continuous evaluation and improvement of job performance. Identifies training needs and facilitates employee development. Reduces communication gaps between employer and employee. Assists in decisions regarding transfers or discharges. Improves job satisfaction and morale by recognizing achievements Purpose

77. Appraisal should be conducted at least once a year. Results must be shared with employees to ensure transparency. Employees should have the right to respond or appeal against ratings. Each employee should be rated by at least two trained evaluators. Continuous and direct observation of employee performance is essential. Rating should be done by the immediate superior for accuracy. Principles

78. Managers should maintain regular performance notes throughout the year. A separate department or committee may coordinate the appraisal process. Feedback must be clearly communicated to employees. Positive achievements should be recognized; weaknesses discussed constructively. Job standards must be clearly defined and understood by both evaluator and employee. Standardized printed forms should be used for each job according to its nature. Evaluation should focus on employee behaviour and results, not personal traits.

79. Establish Performance Standards: Set clear job-related standards that describe what an employee should achieve in terms of quality, efficiency, and behaviour. Communicate the Standards: Explain these standards to employees clearly so they understand what is expected and how their performance will be judged. Measure Actual Performance: Observe and record the employee’s work regularly to measure how well they are performing according to set standards. Process of Performance Appraisal

80. Establish Performance Standards Communicate the Standards Measure Actual Performance Discuss Results Compare with Desired Decision Making

81. 4. Compare with Desired Performance: Compare the employee’s actual work results with the expected standards to find gaps or differences in performance. 5. Discuss Results: Share feedback with the employee, discuss strengths and weaknesses, and plan ways to improve performance if needed. 6. Decision Making: Use the appraisal results to make decisions about promotion, training, salary, transfer, or other developmental actions.

82. Tools / Methods of Performance Appraisal Ranking Method Paired Comparison Method Forced Distribution Method Grading Method Checklist Method Forced Choice Method Critical Incident Method Graphic Rating Scale Method Field Review Method Essay Evaluation Method Peer Review  

83. 1. Ranking Method Employees are ranked against each other. Advantages: Simple, suitable for small organizations. Disadvantages: Lacks objectivity, unsuitable for large setups. 2. Paired Comparison Method Each employee is compared with every other employee one at a time. Advantages: Suitable for large organizations, evaluates traits. Disadvantages: Time-consuming and complex.

84. 3. Forced Distribution Method Employees are grouped into categories like superior, average, or poor. Example: Ratings distributed among categories. Limitation: Does not assess individual traits. 4. Grading Method Predefined grades (e.g., very good, good, average, poor). Helps identify specific characteristics and abilities.

85. 5. Checklist Method Evaluation through yes/no questions about employee behaviour. Example: Is the employee satisfied with the job? Does he finish work accurately? Does he respect superiors?

86. 6. Forced Choice Method Evaluator chooses between sets of positive or negative statements describing an employee. Reduces bias but limits evaluator’s freedom of expression. 7. Critical Incident Method Evaluation based on real incidents, e.g., Suggested improvements, refused cooperation, or showed leadership. 8. Graphic Rating Scale Method Uses printed forms listing traits like quality, reliability, and rated on a scale (e.g., 1–5).

87. 9. Field Review Method Personnel department interviews supervisors about employee performance and prepares reports. 10. Essay Evaluation Method Supervisor writes a narrative describing employee’s strengths and weaknesses. 11. Peer Review Employee is evaluated by peers, usually 2–4 colleagues. Involves self-evaluation portfolio and group discussion.

88. Use of Nursing Process Professionalism Maintaining Safety Continuing Education Initiative and Character Interpersonal Relationships Technical and Organizational Ability Flexibility and Communication Skills Components to be evaluated in nurse performance appraisal

89. Leniency Error: Rating everyone too favourably. Recency Error: Focusing only on recent events. Halo Effect: One positive trait influences overall rating. Horn Effect: One negative trait affects entire appraisal. Ambiguous Evaluation: Unclear standards and criteria. Potential Appraisal Problems

90. Role of Nurse in Performance Appraisal Participate actively and honestly in the appraisal process. Maintain accurate records of daily nursing activities and achievements. Engage in self-evaluation to identify strengths and areas for improvement. Cooperate with supervisors and provide necessary data for evaluation. Accept constructive feedback positively and use it for personal growth. Set professional goals based on appraisal outcomes. Support a fair and transparent appraisal process for all team members. Encourage peers through feedback and teamwork for better performance.

91. Program Evaluation and Review Technique (PERT)

92. The Program Evaluation and Review Technique (PERT) is a project management tool developed by the U.S. Navy in the late 1950s for its submarine missile program and was first applied in 1958 . PERT is designed to analyze , plan, and represent tasks involved in completing a project and to illustrate the flow of events in a network form. Introduction

93. PERT is a statistical tool used in project management that helps in analyzing , representing, and monitoring the tasks and events involved in completing a given project within a specified time. Definition

94. Prediction of deliverables Planning of resource requirements Controlling resource allocation Internal program review Performance evaluation Reduction in cost and saving time Achieving uniform and wide acceptance Objectives

95. Shows the time required for each component of a project and the total completion time . Breaks down the project into events and activities , showing their sequence, relationships, and duration . Represents the project plan in a network diagram . Provides a graphical representation of the project schedule. Features

96. Types of Network Diagrams

97. Identify Activities and Events: Activities are tasks required to complete the project. Events mark the beginning and end of activities. It is helpful to list all tasks in a table to include their sequence and duration. Determine the Proper Sequence of Activities: Establish the order in which tasks should be performed. Some sequences are obvious, while others may require analysis to determine the exact order. Construct a Network Diagram: Using the sequence information, draw a network diagram showing serial and parallel activities. Steps In Pert Planning

98. Estimate the Time Required for Each Activity: A key feature of PERT is its ability to handle uncertainty in activity completion times . Three estimates are used for each activity: Optimistic Time (O) – shortest possible duration Most Likely Time (M) – most probable duration Pessimistic Time (P) – longest possible duration Determine the Critical Path: Add the times for activities in each sequence to find the longest path through the network. The critical path determines the total project duration and identifies activities that cannot be delayed without delaying the project.

99. Update the PERT Chart as the Project Progresses: Replace estimated times with actual times . Modify and improve the chart to reflect the current project status . Use updates for better control and decision-making .

100. Research and development projects Tooling and introducing new products Planning and installation of electronic systems Development and administration of training programs Management development and organizational planning Uses of Pert

101. Simple to understand and use Shows whether the project is on, behind, or ahead of schedule Identifies activities that need attention Determines flexibility available in activities Highlights potential risks Provides documentation of all activities Helps set priorities and allocate resources effectively Advantages

102. Emphasis mainly on time , not on cost High setup and maintenance costs Difficulty in estimating accurate time and cost Errors in estimation make the chart unreliable as a control aid Does not solve all managerial problems Limitations

103. BENCHMARKING

104. Benchmarking is a systematic process of comparing an organization's processes, practices, and performance metrics with those of the best in the industry. It helps identify areas for improvement, efficiency, and quality enhancement . INTRODUCTION

105. “Benchmarking is the continuous process of measuring products, services, and practices against competitors or industry leaders to identify opportunities for improvement.” - Camp (1989) In simple terms, benchmarking helps organizations learn from the best practices of others and improve their own performance. DEFINITION

106. Internal Benchmarking: Compares processes within different departments or units of the same organization. Example: Comparing medication administration procedures between the ICU and general ward to standardize best practices hospital-wide. Competitive Benchmarking: Compares performance with direct competitors to identify gaps and improve. Example: A hospital comparing average patient discharge time with another leading hospital to reduce delays. Types of Benchmarking

107. Types of Benchmarking Generic Benchmarking Functional Benchmarking Competitive Benchmarking Internal Benchmarking

108. 3. Functional Benchmarking: Compares similar functions or processes with organizations in different industries to learn innovative practices. Example: Adopting inventory management techniques from a large retail chain to improve hospital supply tracking. 4.Generic Benchmarking: Focuses on broad processes that are common across industries , regardless of sector. Example: Improving staff scheduling by studying hotels or airlines to make nursing shifts more efficient.

109. Benchmarking Wheel 1. Plan: Decide what area or process needs to be benchmarked, such as patient care, documentation, or infection control. Establish clear objectives and performance indicators. 2. Find: Identify other departments, hospitals, or organizations that perform exceptionally well in the selected area to serve as benchmarks. 3. Collect: Gather relevant data and information about current practices and the benchmarked organizations through reports, records, or direct observation. 4. Analyze: Compare the data to identify performance gaps and reasons for differences. This step helps to understand which practices can be adapted or improved. 5. Improve: Develop and implement an action plan to enhance performance based on the findings. Monitor progress and make continuous adjustments to sustain improvement.

110. Benefits

111. Resistance to change within the organization. Difficulty in accessing accurate data from external sources. Misalignment between benchmarking goals and organizational goals . Cultural differences that make adoption of practices difficult. High cost and time investment . Barriers to Benchmarking

112. Comparing patient care practices across hospitals to improve safety and quality. Improving nursing processes , such as medication administration or patient documentation. Enhancing staff training and development programs . Evaluating hospital performance metrics like patient satisfaction, infection control, and discharge procedures. Applications of Benchmarking in Nursing/Healthcare

113. CRITICAL PATH ANALYSIS

114. Critical Path Analysis (CPA) is a project management tool used to plan, schedule, and control complex projects. It helps identify the longest sequence of dependent tasks , ensuring the project is completed in the shortest possible time . Introduction

115. “Critical Path Analysis is a method used to identify all essential tasks in a project, their dependencies, and the sequence that determines the minimum project duration.” - Kerzner (2017) In simple terms, CPA highlights tasks that cannot be delayed without affecting overall project completion. Definition

116. Identifies the critical path , which determines project duration. Shows task dependencies and their sequence. Helps in resource allocation and scheduling . Useful for monitoring project progress and anticipating delays. Provides a visual representation through network diagrams. Key Features of CPA

117. List all activities: Identify every task required to complete the project. Determine dependencies: Find out which tasks depend on others. Estimate duration: Assign expected time for each task. Draw a network diagram: Represent activities as nodes or arrows showing dependencies. Identify the critical path: Find the longest sequence of dependent tasks —delays here will delay the project. Calculate float/slack: Determine tasks that can be delayed without affecting the project. Monitor progress: Update durations and paths as the project moves forward. Steps in Critical Path Analysis

118. Benefits of CPA Ensures timely project completion . Highlights tasks requiring close attention . Helps optimize resources . Provides a clear project overview . Assists in decision-making and prioritization .

119. Limitations/ Barriers Complex for very large projects . Requires accurate duration estimates . Does not consider costs or resource limitations directly. Changes in project scope can affect the critical path .