Academic Courses
FACULTY OF clinical medicine and surgery
Click here to access Unit Three Content..
Topic 1: Human Resource For Health Management
Introduction
The greatest asset of health care organizations is the collective and individual knowledge and intelligence of their employees and nurses/clinical are among the health care providers called “ Knowledge workers” because the services they provide is based on specialized expertise and complex decision making hence the importance of investing in human resource.
HUMAN RESOURCE MANAGEMENT CONCEPTS
Human Resource Management
- Human resource management (HRM) is the strategic and coherent approach to the management of an organization's most valued assets
- The people working there who individually and collectively contribute to the achievement of the objectives
- Human Resource: This is any individual employed by the organization
Performance management
- All that mediates the interactive process between work motivation of the individual the performance rewards and development opportunities provided by the organization (Frank 1998).
Staff development
It’s the process of orientation, in-service education, and continuing education to promote the development of personnel within any employment setting consistent with the goals and responsibility of the employer ( Refers to both professional and non- professional staff
Orientation
Introducing new staff members to the philosophy goals, policies, procedures role expectations, physical facilities, and special services in a work setting
In-service education
Learning of experiences provided in the work setting to assist staff in performing their assigned functions
Continuing education
Educational programmes that consists the concepts, principles, research or theories related to profession that build on previously acquired knowledge, skills and attitudes
Strategic Human Resource Management
This is the linking of HRM strategic goals and objectives in order to improve business strategy. That strategy then provides the framework that guides the design of specific HR activities such as recruiting and training
Click here to access Unit Three Content..
Topic 1: Objectives of Human Resource Management
OBJECTIVES OF HUMAN RESOURCE MANAGEMENT
According to Basavanthappa (2002) the main objectives of human resources management are the following:-
- Effective utilization of human resources to the achievement of organizational goals.
- Establishment and maintenance of an adequate organizational structure and desirable working relationship among staff.
- Securing integration of the individual and informal groups with the organization ad thereby ensuring their commitment, involvement and loyalty.
- Recognition and satisfaction of individual needs and group goals.
- Provision of maximum opportunities for individual development and advancement.
- Maintenance of high morals in organizations
Click here to access Unit Three Content..
Topic 1: Human Resource Management Process
The following are the techniques required for Human Resource Management
- Conducting a Job analysis determining the nature of each employees Job
- Planning labor needs (HR Planning) and recruiting Job candidates
- Selecting Job candidates
- Orienting and training new employees
- Managing wages and salaries ( compensating employees)
- Providing incentive sand benefits
- Appraising performance
- Communicating ( interviewing, counseling, disciplining)
- Training and development
Human Resource planning
- Human resource planning is the process of identifying the member’s skills, occupational categories, and performance and development needs of personnel in an organization.
- This identification has to be linked to the strategic plan of the organization. While the strategic plan of the organization is to identify the future direction
- In the organization, the objective of human resource planning is to ensure that the organization will always have the right people in the right places to do the work required by the organization.
- Forecasting future manpower requirements: Estimating the institutions demand for labor, matching this with what is available and identifying whether there are shortfalls or more than required.
- Such planning is accomplished through analysis of current and expected skill needs, vacancies and department expansions and reductions.
- Formulating and proposing policies: Policy formulation is carried out in Human Resources Department. The policies have to be agreed by the top management team. The key areas of personnel policy include recruitment and selection; terms and conditions of employment, training and development. These personnel policies are guidelines for behavior stating what the organization will do or will not do in relation to employees and employee affairs.
- Recruitment: This involves preparing job descriptions and specifications, drafting job advertisements, interviewing candidates and assessing appropriate salary levels for new employees. As discussed earlier a job description states the principal duties, responsibilities and the scope of authority while A job specification refers to human quality or personnel. Specifications which are necessary to perform a job adequately eg. The knowledge details, skills, ability and behavior Training and Development: Once the employees join the organization, they require training. Induction or orientation of new employees is an integral part of training
- Training and Development of human resources is the most dynamic of all the organization's resources. The process aims at increasing the ability of employees to contribute to organizational effectiveness. Training and development is important in order to maintain the key skills within the organization and motivate the staff. This is to enable them to realize their full potential in their work. The human resource department has the responsibility of assessing the training needs, designing methods of training needs, designing methods of training to be employed and evaluating the training to determine how effective it was.
- In planning, consideration must be given to:
- The type of patient care management used
- The education and knowledge level of staff to be recruited
- Budget constraints
- The historical background of staffing needs
- The diversity of the client population to be served
Principles of Effective Human Resource Plan
- The plan should be as detailed as possible
- Plans should not extend too far into the future, as accurate prediction of the distant future is not always possible
- All alternative courses of action should be considered
- Implications of the actions envisaged should be assessed
- Instructions to individuals and departments must be incorporated into the plans
- Plans should be concise and easy to understand
Click here to access Unit Three Content..
Topic 1: Recruitment Process
Reasons for Training and Development- A change in working methods
- Realization that performance is poor, inadequate and not up to the standards.
- Manpower shortage necessitating the upgrading of some employees to new positions.
- Desire to improve the quality
Recruitment process
1: Defining requirements:
✔Categories and number of people required should be specified in the recruitment programme derived from human resource plan.
✔The department in which the recruit will work must draft or revise a comprehensive job specification and job description (from job analysis) for the vacant position, outlining its major and minor responsibilities; the skills, experience and qualifications needed; grade and level of pay and particulars of any special conditions attached to the job (temporary, permanent, contract, shift duty).
2. Attracting candidates:
After defining requirements then the job is advertised. This involves reviewing and evaluating alternative sources of applicants inside and outside the company. First consideration should be given to internal candidates, then advertising and outsourcing
3. Selection of candidates:
This is the assessment of candidates and choice of the one who best meets the criteria for the available position. It involves matching job requirements with the attributes of the candidates. Normally involves the following steps
a) Short listing: List applications on a control sheet and comparing the applications with the key criterion in the job specification and sort them into three categories.
- Possible
- Marginal
- Unsuitable
Scrutinize the possible again to draw up a short –list for interview. Ideally should be 4-8 candidates per position
b) Interviewing; An interview may be defined as a verbal interaction between individuals for a particular purpose. The goals of the selection interview are;
✔ The interviewer seeks to obtain enough information to determine the applicant’s suitability for the available position
✔The applicant obtains adequate information to make an intelligent decision about accepting the job should it be offered
✔The interviewer seeks to conduct the interview in such a manner that, regardless of the interview’s results, the applicant will continue to have respect for and good will towards the organization.
Types of interviews
•There are many types of interviews and formats for conducting them.
The unstructured interview - The interviewer asks whatever seems appropriate and adapts the discussion to the response. This requires little planning because the goals for hiring may be unclear, questions are not prepared in advance, and often the interviewer does more talking than the applicant.
Semi structured interview - Only the major questions to be asked are prepared in advance and the interviewer may ask other questions that open up areas of discussion during the interview session. They require some planning since the flow is focused and directed at major topic areas although there is flexibility in the approach.
The structured interview - The interviewer uses a prepared list of questions and does not deviate from them. This type of interview requires greater planning time yet because questions must be developed in advance that address the specific job requirements. Information must be offered about the skills and qualities being sought, examples of the applicant’s experience must be received, and the willingness or motivation of the applicant to do the job must be determined. The interviewer who uses a structured format would ask the same essential questions of all applicants
• Other formats of conducting interviews
✔Individual interviews
✔Interviewing panels
✔Selection boards
4. References:
This is to obtain in confidence factual information about a prospective employee and opinions about his or her character and suitability for a job
5. Physical examination:
The examination determines if the applicant can meet the requirements for a specific job and provides a record of the physical condition of the applicants at the time of hire. Also helps to identify applicants who will potentially have unfavorable attendance records or may file excessive future claims against the organization’s health insurance
6. Confirming the offer
Confirm offer of appointment after satisfactory references have been made and applicants have passed medical exam. Contracts of employment should be written. Applicants offered a position should confirm their acceptance in writing. After the employee has been given the appointment and have reported to work they have to understand the work environment and adjust effectively to the job. This is done through the indoctrination process
7. Indoctrination Process
As a management function, this refers to the planned, guided adjustment of an employee to the organization and the work environment. The process includes; induction, orientation and socialization.
- Induction: This includes all activities that educate the new employee about the organization and employment and personnel policies and procedures. This takes place before the employee starts performing the job. A handbook can be given and a form signed to verify that it was given. The form should be placed in the employee’s personal file.
- Orientation: Induction provides the employee with general information about the organization whereas orientation activities are more specific to the position. Orientation is the process of assisting new employees to adjust to new roles and responsibilities within the organization. It is the process of introducing new employees to the organization and to their superior, their juniors, colleagues and to their tasks.Recruiting and selecting high potential employees does not guarantee they will perform effectively. People who do not know what to do or how to do it can’t perform effectively
- even if they want to.
- Socialization: Socialization involves inducting new employees to the expectations and behaviors of the organization. This is a sharing of the values and attitudes of the organization by the use of role models, myths and legends. The leader introduces the employees to unit values and culture and molds them to fit in the unit by introducing them to norms of the group. Role models, preceptors and mentors can be used to clarify role expectations.
- Role models are examples of experienced, competent employees. The employee sees the role models are skilled and tries to emulate them.
- A preceptor is an experienced nurse who provides emotional support and is a strong clinical role model to the new nurse. (Preceptors are usually assigned and have a short relationship with the person assigned while a mentor has a long term relationship with the mentee)
- Mentoring is a supportive and nurturing relationship between an expert and a novice. The mentor makes a conscious decision to assist the mentee in his or her career development
Click here to access Unit Three Content..
Topic 1: Approaches to training and development
On The –Job-Training
This is informal training which employees, receive while performing the job.
Off –the –Job Training
This is internal training by other personnel. It is done through coordination of human resources department or a trainer in the organization with expertise in the subject
Internal Training by External Consultants
The Organization may lack expertise and therefore has to source elsewhere. The training is held either inside or outside the organization and facilitated by external consultants. The course(s) are tailored to specific needs of the organization.
Click here to access Unit Three Content..
Topic 1: Further Reading
Reference Material
1. Barton E. et al (1980) On Being InCharge. Geneva: World Health Organization.
2. Basavanthappa, B. P. (2000). Nursing Administration. New Delhi, Jaypee Brothers Medical Publishers Ltd.
3. Bennet, R. (2004) Management. Essex: Pearson Education Ltd.
4. Cole, G. A. (1996) Management - Theory and Practice. London: Martins the Printers.
5. Tappen, R. M. (2001) Nursing Leadership and Management 4th F.A Davis, Philadelphia.
Further Reading Resources
Click here to access Unit Three Content..
Topic 2: Performance management
- Managing performance = improvement of the performance of the organization by getting better result from team and individuals
- The process should encourage dialogue
- Should not be see as an end it self but as one of the process for improving performance
- Performance management should address the needs of the individuals within the organization as well as the needs of an organization
- Performance management should not be a controlling process but ,an enabling process concerning on how to help an individual to realize their potential
- Performance management requires coaching individual hence managers require to invest time in the process
- Performance management should occur as natural process to all managers ,not one imposed by the personnel department or top management
- Managing expectations
- Managing performance is corned about managing expectations
- Organization develops purpose objectives and have strategic plans to meet the expectations
- Organization also defines value as guiding principles in achieving their purposes
- The expectation of an organization determines its functions
- Departmental and team expectations are then translated into what individuals are suppose to do in terms achieving targets and standards of performance
- The organization defines core competency Intergration
- This takes care of corporate ,team and individual objectives, intergration of core values and competency requirement
- Intergration is important in managing performance to ensure that the expectations are shared and understood
- This makes every one move in the same direction of achieving goals
- Cascading
- This corporates objectives to individual objectives often take the form of bottom approach
- But a bottom up approach should be encouraged to ensure that there is ownership of the process and the expectations developed
- Managing performance cycle
- PLAN – agreement of objectives targets and needs for the development of competencies or capabilities and the
- preparation of the plans to achieve the objectives ,improve performance and develop capabilities
- Act – the implementation of the plan in the normal course of work and through special improvement and developmental
- programmes
- •Measure – monitor performance (actions )by reference to performance measures (outcome )with what should have
- been achieved (plans )
- •Review – take stock at regular interviews but not once a year, of achievements in relation to plans as established by
- measuring outcomes
Click here to access Unit Three Content..
Topic 2: Performance Appraisal
Managing the performance of people is a fundamental organizational strategy to gain competitive advantage through mobilization of human resources. An important part of a manager’s job is to define performance in advance and to state desired results
Definition of performance appraisal
- Performance appraisal means evaluating an employee’s current or past performance relative to the person’s performance standards
- Also known as employee appraisal, it is a method by which the job performance of an employee is evaluated (generally in terms of quality, quantity, cost and time).
- Performance appraisal is a part of career development. Performance appraisals are regular reviews of employee performance within organizations and begin when an employee is hired and stops when he/she leaves
Purpose of performance appraisal are
- To identify an individual’s current job performance and give feedback on performance to employees.
- Identify the strength and weaknesses of the employees
- Identify employee training and development needs
- To motivate the employee.
- Document criteria used to allocate organizational rewards.
- Form a basis for personnel decisions: salary increases, promotions, transfers, disciplinary actions, etc.
- Provide the opportunity for organizational diagnosis and development.
- Facilitate communication between employee and administration
- Validate selection techniques and human resource policies
- Provide information for succession planning
Types of appraisal
- Formal – This Involves written documentation according to specific organizational guidelines.
- Informal – It involves e.g. praising the individual for good performance in a job or a compliment from a supervisor, customer /patient. The key is that the praise or corrections be made as close to time to the episode as possible.
Appraisal Process
- The management needs define the appraisal: This involves establishing the performance standards/objectives/expectations and Communicating the expectations to the employee
- Allow the employees some period to work
- Appraisal: Assess and measure the actual performance of the work
- Compare actual with the expected performance
- Complete the appraisal
- Conduct the appraisal interview and provide feedback
Appraisal Methods
1. Rating Scale
A common method which consists of a list of personal characteristics or factors against each of which is a scale. This focuses on attributes and not targets or job. One of the weaknesses is that there is an element of subjectivity. It is usually on a 5- point scale where 1 is the lowest and 5 the highest score. The following is example of assessing Initiative on an employee:
- Requires detailed supervision - 1
- Requires frequent supervision - 2
- Requires occasional supervision - 3
- Rarely requires supervision - 4
- Never requires supervision - 5
Performance Management
This method encompasses objective setting for individuals and departments and performance related pay and training programs. The duties and responsibilities focus on results or targets which are set by individual employees in consultation with their supervisors. The objectives set must be measurable.
Appraisal problems
- Unclear standards: This is where the performance standards have not been clearly defined
- Halo and horns effect: The halo effect occurs when the appraiser lets one or two positive aspects of the assessment or behavior of the employee unduly influence all other aspects of the employee’s performance. The horns effect occurs when the appraiser allows some negative aspects of the employee’s performance to influence the assessment to such an extent that other levels of job performance are not accurately recorded.
- Central tendency: This is where the appraisers stick to the middle when filling rating scales by avoiding high or very low marks and hence cannot be used for promotions or salary increase since everybody is average.
- Leniency or strictness: This is where rating an appraiser rates employees consistently high (leniency) or low (strictness)
- Personal bias: The tendency to allow individual differences such as age, race and sex affect performance appraisal ratings employees receive. How employees performed in the past can affect current appraisal
- Recency and primacy effects: This occurs when the a superior (appraiser) places to much weight on factors that occurred recently (recency) or in the beginning (primacy
- Matthew effect: The Matthew Effect is said to occur when employees receive the same appraisal results, year after year. Those who performed well early in their employment are likely to do well. Those who struggled will continue to struggle.
Click here to access Unit Three Content..
Topic 2: Further Reading
Reference Material
1. Barton E. et al (1980) On Being InCharge. Geneva: World Health Organization.
2. Basavanthappa, B. P. (2000). Nursing Administration. New Delhi, Jaypee Brothers Medical Publishers Ltd.
3. Bennet, R. (2004) Management. Essex: Pearson Education Ltd.
4. Cole, G. A. (1996) Management - Theory and Practice. London: Martins the Printers.
5. Tappen, R. M. (2001) Nursing Leadership and Management 4th F.A Davis, Philadelphia.
Further Reading Material
Click here to access Unit Three Content..
Topic 3: Human resource management functions
1. Staff discipline
- Some of the very challenging problems for managers is what to do when an employee fail to perform as per their expectations
- Discipline is the action taken when a regulation has been violated.
- Discipline can be defined as the process by which an employee brings her or his behavior into agreement with the agency’s official behavior codes. It can also be a managerial action to enforce employee compliance with agency rules and regulations
- The purpose of discipline is to encourage employees to behave sensibly at work or adhere to rules and regulations
- Discipline is called for when rules and regulations are violated.
- The purpose of rules is to inform employees ahead of time what is
Purpose of discipline
- The purpose of discipline is to encourage employees to behave sensibly at work or adhere to rules and regulations.
- Discipline is called for when rules and regulations are violated.
- The purpose of rules is to inform employees ahead of time what is and is not acceptable behavior
- Insubordination e.g. lack of respecting authority and is not acceptable behavior
- Insubordination e.g. lack of respecting authority factors that must be present to foster a climate of self discipline.
- Employee awareness and understanding of rules and regulations that govern behaviour. These must be clearly written and communicated to subordinates.
- There must exist an atmosphere of mutual trust. The managers must believe that employees are capable of and actively seeking self discipline. Conversely, the employees must perceive the manager as honest and trustworthy.
- Employees should identify with the goals of the organization. When this happens, they are more likely to accept the standards of conduct deemed acceptable by the organization.
The disciplinary process
- The purpose of a disciplinary action should be to correct rather than to punish a wayward employee.
- Discipline should be administered promptly, privately thoughtfully and consistently. Discipline should also be progressive and preceded by counseling
- Disciplinary Process
- Preliminary investigation
- A discussion (cordial) with the offender and a brief warning as to why further violations will not be tolerated.
- A stronger verbal warning after a further violation of regulation.
- A formal written warning.
- A written warning accompanied by suspension from the job for a prescribed number of days.
- Suspension from the job for a longer period of time.
- Discharge with opportunity to appeal
Click here to access Unit Three Content..
Topic 3: Staff Coaching
2. STAFF COACHING
This is the day today process of helping employees improve performance. Coaching also should be used when performance meets the standards but improvement can still be obtained. Before entering into a coaching session the coach should prepare for the interaction. The goal of the meeting is to eliminate or improve performance problems
Performance Deficiency Coaching
- Performance deficiency coaching is another strategy that the manager can use to create a disciplined work environment. This type of coaching may be ongoing or problem-centered.
is less spontaneous and requires more managerial planning than ongoing coaching. In performance deficiency coaching, the manager actively brings areas of unacceptable behavior or performance to the attention of the employee and works with him or her to establish a plan to correct deficiencies. Because the role of a coach is less threatening than that of an enforcer, the manager becomes a supporter and helper.
Performance deficiency coaching helps employees, over time, to improve their performance to the highest level of which they are capable. As such, the development, use, and mastery of performance deficiency coaching should result in improved performance for all
3. STAFF MOTIVATION
- Motivation describes the factors that initiate and direct behavior.
- Manager’s most important leadership task is to maximize subordinates work motivation because employees bring to the organization different needs and goals, the type and intensity of motivators vary among employees.
- Therefore the manager must know which needs the employee expects to satisfy through employment and should be able to predict, which needs will be satisfied through the job duties of each employee position.
Definition
- Motivation : Those processes both instinctive and rational by which people seek to satisfy the basic drives, perceived needs and personal goals which trigger human behavior. They are the entire class of wants, drives, desires, needs, wishes which people strive to satisfy
- Motive: Inner state which energizes, activates, moves and directs human behavior toward fulfillment of the desire etc.
- Motivator: Something which influences body’s behavior to perform a task with a certain degree of enthusiasm e.g. rewards or penalties
- Content theories- these focus on the needs that motivate people to behave in certain ways e.g Maslows and McGregors theories
- Process theories- These seek to explain specific actions focusing on the thought process that people experience prior to behaving in a particular manner e.g H. Vroom
Practical Steps in Motivation
i. Make people feel valued by:
- Regularly monitoring and appreciating each employee’s work.
- Showing an interest in whatever they hold important.
- Creating a good working environment by being approachable.
- Ensuring everyone understands the importance of their contribution to the team’s objectives.
- Ensuring everyone understands the objectives of the organization
ii. Provide a challenge and scope for development by:
- Setting targets, after consulting, and review at regular intervals.
- Providing relevant training- where appropriate by using people to train others, in the specialty skills they may have. Restructuring or grouping tasks to use people’s skills to the fullest.
- Rotating jobs to broaden experience.
- Providing scope for individuals to take greater responsibility.
- Training at least one deputy- succession planning
- Encouraging ideas and suggestions and listening.
- Delegating and allowing staff to take decisions and to implement them.
iii. Recognize achievements by:
- Praising and communicating individual successes,
- Reporting regularly to the team on its progress.
- Holding regular meetings with each individual to monitor progress and give feedback
iv. Communicate by:
- Explaining the organisation’s results and achievements.
- Setting and communicating the team’s objectives and regularly appraising them of its progress.
- Ensuring the team knows how the organization is doing and commutating any changes taking place in the organization.
- Explaining decisions made to assist people to accept them
4. SUPPORTIVE SUPERVISION
Supportive Supervision refers to an activity of more experienced or higher positioned personnel whereby they support the work of their juniors so that it meets set standards. It means assisting health, workers in achieving work outcomes, finding out work problems and challenges and together finding solutions to the problems. Supportive supervision should aim at encouraging team members to apply their ability and energy to work. It also means understanding what makes people dissatisfied at work.
Click here to access Unit Three Content..
Topic 3: Conflict and Conflict Resolution
Introduction
Conflicts are generally defined as the internal or external disorder that results from differences in ideas, values, or feelings between or more people. Because managers have interpersonal relationships with people having a variety of different values beliefs and backgrounds and goals conflict is an expected outcome. The Managers role is to create a work environment where conflict may be used as a consult for growth, innovation and productivity
Types of Conflict
- Intrapersonal – within a person. E.g. personal and professional priorities
- Interpersonal – among people e.g. best way to ……., information giving.
- Organizational –e.g. role differentiation, communication, policies and practice, new system or change.
In organizations conflict may be caused by the following:
- Unclear authority structures
- Personal disputes
- Conflicts of interest
- Competition of resources
- Poor coordination of activities
- Incompatibility of group and organizational goals
Conflict resolution methods (strategies)
✔Avoiding/Avoidance: This method/strategy attempts to keep the conflict from surfacing at all e.g. ignore the conflict or impose a solution (especially where concern for people and production is low. Important if in conflict a quick action is needed to prevent the conflict from occurring.
✔Accommodating: This is also known as smoothing or co-operating. It is used when a person ignores his or her own feelings about an issue in order to agree with (accommodate) the other side.
• NB: Parties that consistently ignore feelings and give in can end up feeling frustrated or used and may be less willing to co-operate in future.
• More conflict can ensue if parties disagree about importance of the issues being accommodated
✔Competing: One side wins the conflict and the other side loses. It is also called forcing because the winner forces the loser to accept his or her perspective on the conflict. This can cause anger and resentment to increase withdrawal/avoidance. The method is useful when an issue is critical or time to resolve it is limited. Can also help move a critical but unpopular decision quickly through an origin
Compromising: Each side gives up something as well as gets something. Used when both sides have a reasonable, important goal and losing is not required.
✔Negotiation: This is an extension of compromise with higher stakes and more deliberate techniques to bargain for each side’s give and take. It is useful for high stake issues and solutions are seen as formal and more permanent than Compromise. Conflicts tend not to recur once the negotiations are finished
✔Collaborating: In this method both sides in a conflict work to develop the outcome that is best for both sides. The emphasis is on creative problem solving so that each side meets its key goals.
✔Confronting: This method attempts to block the conflict from the start. The method brings the parties together, clarifies issues and achieves an outcome.
Causes of conflicts
✔ differences in information ,values ,beliefs ,and interest
✔Competition for resources,eg money skilled manpower
✔Inter group rivalry for rewards
✔Take difficulties
✔Skill differences
✔Pressure to avoid failures
✔Unworkable organization structure
Effects of conflict
Advantages
- Prevents intellectual stagnation
- Decreases likelihood of group think
- Stimulates employees curiosity
- Facilities employees change
- Disputes puts others in to conflict
- Unresolved causes violence
- Spread from peripheral to other issues
Managing Conflict
- Communicating to self and others that conflict is a necessary process.
- Determining similarities and differences in facts, goals, methods and values.
- Assessing the degree of conflict – ask questions about quality of decisions.
- Assessing each situation and matching the best approach regardless of which is your favourite.
- Assisting others in assessing conflict and seeing how best they can approach.
The manager may also overcome organizational conflict through the following:
- Improving team spirit
- Enhancing effective communication
- Regular job rotation
- Employee counseling services
Grievances
Grievance Process = When a union member believes that management has failed to meet the terms of the contract or labor agreement and communicates this to management. This process is called grievance!
The grievance process steps
- The employee informs the employer about the nature of the grievance
- The employer arranges for a formal meeting to be held without unreasonable delay after a grievance is received
- The meeting is held and the employee should be accompanied at the meeting. Following the meeting a decision is made on what action if any to take. Decision should be communicated to the employee in writing without unreasonable delay.
- The employee is allowed to take the grievance further (appeal) if not resolved)
- The appeal should be dealt with impartially
- The outcome of the appeal should be communicated to the employee in writing without unreasonable delay
NB: Grievance procedures differ from union to union.
Click here to access Unit Three Content..
Topic 3: Further Reading
Reference Material
1. Barton E. et al (1980) On Being InCharge. Geneva: World Health Organization.
2. Basavanthappa, B. P. (2000). Nursing Administration. New Delhi, Jaypee Brothers Medical Publishers Ltd.
3. Bennet, R. (2004) Management. Essex: Pearson Education Ltd.
4. Cole, G. A. (1996) Management - Theory and Practice. London: Martins the Printers.
5. Tappen, R. M. (2001) Nursing Leadership and Management 4th F.A Davis, Philadelphia.
Further Reading Material
Click here to access Unit Four Content..
Topic 1: Change and Change Management
Objectives
By the end of this topic you should be able to;
- Explain the concept of change
- Analyze the process of managing change.
- Identify reasons for resistance to change and how to overcome it
Click here to access Unit Four Content..
Topic 1: Change and Change Management [Cont'd]
Change is fundamental in order to guarantee long term success in the organization. Some organizations change in response to external circumstances (reactive change) and others change because they have decided to change (proactive change)
a. Definition of change
To change something implies altering it, varying or modifying it in some way. It is also the process of moving from one system to another. It is also the process of making something different from what it was. Also change is any shift in status from an undesirable current status to a desirable future status.
b. Types of change
- Planned change: Results from deliberative, collaborative effort to improve system operations and facilitate acceptance of the improvement by involved parties
- Unplanned /accidental change: Accidental or reactive change is an adaptive response to an outside stimulus that is directed toward re-establishing balance between system and environment
c. The change process (planned change)
Change is a continual unfolding process rather than an event. The process begins with the present state, moves through a transition period then comes to a desired state once the desired state has been reached the process begins again. The change process is very similar to the problem solving process and involves :-
- Assessment: At this stage problem or opportunity for change is identified. Data about change is collected from both internal and external sources and then analyzed. Data analysis should support both the need for change and the potential action selected
- Planning: During planning the change agent determines who will be affected by change and when change will occur. Also all potential actions are examined which should include how change will be implemented. An evaluation component to assess if the change met the organizational goals for the change is also constructed
- Implement the change: The plans are put into motion. Interventions are designed to gain the necessary compliance. The change agent creates a supportive climate, obtains and provides feedback and overcomes resistance to change.
- Evaluation: Determine whether change is effective based on outcomes (goals) identified during assessment and using the evaluation method established during planning. The change agent determines whether presumed benefits were achieved from a financial as well as qualitative perspective
- Stabilization: This is achieved by using policies or procedures to make change the norm rather than the innovation. Should occur as soon as possible to complete the change process
d. Change theories
There are several theories that have been developed concerning the change process. These theories are
- Lewis force field theory
- Lippitt’s phases of change
- Rogers diffusions of innovations
- Bridges’ model of managing transitions
In this session we are going to review the Lewins’ force field model while you can read about the other theories
Overcoming Resistance to Change
- Lewin’s force-field model -Lewin provides a social psychological view of the change process. He sees behavior as a dynamic balance of forces working in opposing directions within a field (e.g. an organization) He suggested that there is need to do an analysis of change situations (which he referred as force field analysis). This includes identifying the following
- Driving forces (behaviors’ that facilitate change because they push participants in the desired direction)
- Restraining forces (behaviors that impede change by discouraging participants from making specified changes
- Therefore for change to be effective driving forces must exceed restraining forces. To plan change one must analyze these forces and shift the balance in the direction of change through the following three step process:-
Steps of change according to Lewin
Unfreezing the existing equilibrium: Refers to the awareness of an opportunity, need or problem for which some action is necessary. To unfreeze a status quo, a change agent must increase driving forces or decreases restraining forces in the situation. According to Lewin it involves motivating the participants by getting them ready for change, building trust and recognition for the need to change To their attitudes, actively involve the participants in identifying problems and generating solutions.
Move the target system to a new level of equilibrium (moving)/change This is done by getting the participants to agree that the status quo is not beneficial to them, encouraging them to view the problem from a new perspective and helping them scan the environment to search for relevant information
Refreeze the system at the new level of equilibrium: This involves reinforcing the new patterns of behavior (e.g. rewarding for desired behavior or research on new system).Reinforcement can also be done through formal and informal mechanism (e.g. formulating policies, establishing communication channels
To implement the above process the following approaches will be necessary:-
- Education and Communication
- This is to make employees fully aware of all aspects of the situation and convince them that change is essential.
- Participation and Involvement
- The employees should actively participate and get involved from the beginning so as to stimulate commitment.
- Patience and Tolerance
- Give support and assistance needed.
Resistance to change
- Response to change varies from ready acceptance to full blown resistance.
- Forces that oppose change are labelled resistance. Resistance is anything that leads to delay or additional costs to a change Programme. This could be an extreme delay (non-starter) or mild (a few months)
Click here to access Unit Four Content..
Topic 1: Change and Change Management [Cont'd]
Reasons why people resist change
There are several reasons why people resist change. Among them are the following
- Fear of unknown: This is where the participants wants the status quo because they are not sure of what will happen when change has occurred.
- When people do not know what is expected of them either during the change process or after change has occurred
- When people do not know what is expected of them either during the change process or after change has occurred
- Parochial self-interests: This is where people resist change because of personal interest is expense of organizational interests. May be they fear that they might loose their position if change occurs.
- Lack of information about what the change entails and the implication of change
- Mistrust: This occurs especially when people don’t trust the leaders.
- They might assume that their leaders could be having a hidden agenda e.g. layoff of employees.
Measures of dealing with resistance to change
- Communication with employees; Speak in person and privately with those who oppose the change. Get to the root of their reasons for the opposition
- Educate the people; emphasize the goals of change and how the individual or groups will benefit. Clarify information and provide accurate feedback
- Facilitation: This can be done by providing the resources required.
- The change agent should also maintain a climate of support and confidence
- Involve people affected by change: The change agent should be open to suggestions but clear about the overall purpose and goals. Do not compromise on the intended outcome
- Negotiation; It is also important to discuss the consequences of resistance e.g. compromised patient care or closure of the organization so that the participants can see the importance of change
- Manipulation: This method can be used by rewarding those who have accepted change so that those who are resisting can see there are some benefits and comply
- Coercion: This by threatening people who resist change and therefore they comply out of fear
Click here to access Unit Four Content..
Topic 1: Team Leadership
a. Differentiating groups from teams
- A group is an aggregate of individual who interact and mutually influence each other. Both formal and informal groups exist in an organization
- Formal Groups: These are clusters of individuals designated by an organization to perform specified organizational tasks. These may include task forces and committees.
- Informal Groups: These evolve naturally from social interactions that are not defined by an organizational structure e.g. People who take lunch together who convene spontaneously to discuss a clinical dilemma.
- Teams: Teams are real groups in which individuals must work cooperatively with each other in order to achieve some goals. They demonstrate healthy interdependence. A team is composed of a small number of people with complementary skills who are committed to a common purpose, set of performance goals and approach for which they hold themselves mutually accountable.
- Teams have command or line of authority to perform tasks and membership is based on the specific skills required to accomplish the task.
Group and team processes
Groups whether formal or informal typically through the following phases
- Forming: This is the initial stage of group development in which individual members assemble into a well-defined cluster ( members get to know each other, and very are cautious..
- Storming: The second stage of group development where members wrestle with roles and relationships. Conflict dissatisfaction and competition arise on important issues related to procedures and behavior. Members often compete for power and status and informal leadership emerges.
- Norming: This is the third phase of Group development. The Group defines its goals and rules of behavior. They also define acceptable and unacceptable behaviors and attitudes. The group structures, roles and relationships become clearer. Cohesiveness also developes.
- Performing: This is the fourth stage. The group members agree on basic purposes and activities and came out the work. Cooperation improves and emotional issues subside. Members communicate effectively and interact in a relaxed atmosphere of sharing.
- Adjourning: This is the final stage of group development, in which a group dissolves after achieving its objectives or reforming with some major changes takes place in the environment
c. Team building/team development
- This is a group development technique that focuses on task and relationship aspects of group functioning in order to build team cohesiveness. Team building involves:
- Gathering data through individual interviews, questioners and or group meetings about the team and its functioning.
- Diagnosing the team strengths and arcsine need of development.
- Holding semi- structured retreat sessions usually directed by an experienced facilitator aimed at addressing priority team problem
Characteristics of effective teams
- Clear objectives and agreed goals
- Openness and confrontation
- Support and trust
- Co-operation and conflict
- Sound procedures
- Appropriate leadership
- Regular review
- Individual development
- Sound intergroup relations
COLLABORATION
Effective teams are characterized by trust, respect and collaboration. Collaboration in health care is defined as health care professional assuming complementary roles and cooperatively working together, sharing responsibility for problem-solving and making decisions to formulate and carry out for patients care
Collaboration between physicians, nurses and other healthcare professionals increases team members awareness of each others type of knowledge and skills, leading to continued improvement in decision making (o’ Daniel and rosentein,2008)
When considering a teamwork model in health care, an interdisciplinary approach should be applied. Unlike a multidisciplinary approach, in which each team member is responsible only for the activities related to his or her own discipline and formulates separate goals for the patient, an interdisciplinary approach coalesces a joint effort on behalf of the patient with a common goal from all discipline involved in the care plan. The plan of care takes into account the multiple assessments and treatment regiments, and it packages these services to create an individualized care program me that best addresses the needs of the patient
COMPONENTS OF SUCCESSFUL TEAMWORK
- Open communication
- Non-punitive environment
- Clear direction ;
- Clear and known roles and tasks for team members
- Respectful atmosphere
- Shared responsibility for team success
- Appropriate balance of member participation for the task at hand
COMMON BARRIERS TO INTER-PROFESSIONAL
COLLABORATION
- Personal values and expectations
- Personality differences
- Hierarchy
- Disruptive behavior
- Culture and ethnicity
- Generation differences
- Gender;
- Historical inter-professional
- Generational differences
- Differences in language and jargon
- Differences in schedules and professional routines
- Varying levels of preparation,qualifications,and status.
- Fear of diluted professional identity
- Differences in accountability,remuneration,and rewards
- Concerns regarding clinical responsibility.
- Emphasis on rapid decision making
- Complexity of care
Click here to access Unit Four Content..
Topic 1: Team Leadership [Cont'd]
LEADERSHIP ACTIVITIES AT DIFFERENT GROUP FORMATION STAGES
Barriers to effective teamwork
changing roles-There are currently considerable change and overlap in the roles played by different health-care professionals. Example include radiographers reading plain film x-rays, nurses performing colonoscopies and nurse practitioners having prescribing rights .These changing roles can present challenges to teams in terms of role allocation and acknowledgement.
changing settings - The of health care is changing including increased delivery of care for chronic conditions into community care and many surgical procedures to day-care centers. These changes require the development of new teams and the modification of existing ones
• 3.medical hierarchies. Medicine is strongly hierarchical in nature and this counter productive in terms of establishing and effectively running teams where all members views are accepted and the team leader is not always a doctor. While these has been a growing acknowledgement that teamwork is important in heath care, this has not necessarily been translated into change practises, especially in environment where cultural norms of communication may mitigate against teamwork
• 4.Individualistic nature of medicine - The practice of medicine is based on the autonomous one-on-one relation between the doctor and patient. While this relationship remains a core value, it is challenged by many concepts of teamwork, and shared care. This can be at many levels including doctors being unwilling to share the care of their patients through to medico-legal implications of teams-based care.
• 5.Instability of teams = As already indicated, health-care teams are often transitory in nature, coming together for a specific task or event(such as cardiac arrest teams).The transitory nature of these teams places great emphasis on the quality of training is often relegated at the expenses of services delivery
TYPES OF MEDICAL TEAMS
• There are many types of teams in health care. They include labour and delivery units, icus,medical wards, primary care teams in the community, teams assembled for specific task such as emergency response team or multi-professional teams such as multidisciplinary cancer care teams that come together to plan and coordinate patient's care.
CORE TEAMS
• Core teams consist of team members who are involved in the direct care of the patient.
• Core team members include direct care providers (from the home base of the operation for each unit) and continuity providers (those who manage the patient from the assessment to disposition, for example, case managers). The core team, such as a unit-based team (physician,nurses,physiotherapist,and pharmacist.
2. COORDINATING TEAMS.
A coordinating team is group responsible for:
- Day-to-day operational management;
- Coordination functions.
- Resource management for core teams.
CONTIGENCY TEAMS.
Contingency teams are:
- Formed for emergent or specific events;
- Time-limited events (e.g.cardiac arrest teams, disaster responsible teams, rapid response teams)
- Composed of teams members drawn from a variety of core teams.
ANCILLARY SERVICES.
Ancillary services consist of individual such as catering, cleaners, and other support staff who:
✔Provide direct, task-specific, time-limited care to patients;
✔Support services that facilitate care of patients;
✔Are often not located where patients receive routine care.
• Ancillary services are primarily a service delivery team whose mission is to support the core team. This does not mean that they should not share the same goals. The successful outcome of a patient undergoing surgery requires accurate information on catering and instructions
SUPPORT SERVICES
- Support services consist of individuals who:
- Provide indirect, task-specific services in a health-care facility;
- Are services-focused on integral members of the team, helping to facilitate the optimal health care experience for patients and their families
Click here to access Unit Four Content..
Topic 1: Problem Solving
ADMINISTRATION.
Administration includes the executive leadership of a unit or facility, and has 24-hour accountability for the overall function and management of organization. Administration shapes the climate and culture for a teamwork system to flourish by
- Establishing and communicating vision;
- Developing and enforcing policies;
- Setting expectation for staff;
- Providing necessary resources for successful implementation
- Defining the culture of the organization.
Problem solving
a. Definition of problem solving
- Problem solving is a systematic process that focuses on analyzing a difficult situation. Problem solving is also an active process that starts with a problem and ends with a solution.
- Problem solving always includes a decision-making step. Managers are constantly faced with problems to solve in an organization.
b. Scientific Problem Solving
- Most problems are solved using step by step problem solving process.
- Problem solving uses critical thinking to gather and analyze data/information, creative thinking to come up with solutions and decision making at key steps on the process.
c. Steps of the scientific problem solving process
Problem solving process has the following seven steps
- Define the problem, Issue or Situation: The most common cause of failure in problem solving is improper identification of the problem. In work settings problems fall under certain categories e.g. Manpower, methods, machines and material The definition of the problem should be a descriptive statement of the state of affairs but not a judgmental or a conclusion.
- Gather information/Data: Collect the facts that can provide the clues to the scope and solution of the problem. Obtain relevant, valid accurate and detailed descriptions from appropriate people or sources and put the information in writing
- Analyze the information/data: Categorize information in order of reliability. List information from most important to least important and set information into a time sequence Information can also be categorized in terms of cause and effect e.g. is A causing B. The information can also Classified into categories e.g. human factors, technical factors rules/procedures, legal and ethical issues.
- Develop Solutions: As the information is being analyzed numerous solutions will come up and should be written down and plans made to immediately start developing the best of them. Develop alternative solutions, in case the first order solution proves impossible.
- Make a Decision: Select one solution that is most feasible and satisfactory and has the fewest consequences.
- Implement the decision: The manager implements the decision after selecting the best cause of action.
- Evaluate the solution: Review the plan instituted and compare the actual results and benefits to those of the idealized solutions. The Manager should ask herself or himself: Is the solution being implemented?, are the results better or worse than expected and how can he/she ensure that the solution continues to be used and to work?
- Separate large problems from small ones, and rely on policy for small problems while conserving managerial time for solving major problems.
- Delegate smaller problems to subordinates trained to handle them.
- Seek information for problem solving from internal and external experts so that the solution will be based on current knowledge
- Approach problems in relaxed fashion and avoid solving problems under stress.
- After appropriate consideration, select and implement the best solutions without rumination. (do not agonize over selecting a solution)
- it is impossible to expect 100% accuracy in diagnosing and resolving problems
Click here to access Unit Four Content..
Topic 1: Further Reading
Reference Material
1. Barton E. et al (1980) On Being InCharge. Geneva: World Health Organization.
2. Basavanthappa, B. P. (2000). Nursing Administration. New Delhi, Jaypee Brothers Medical Publishers Ltd.
3. Bennet, R. (2004) Management. Essex: Pearson Education Ltd.
4. Cole, G. A. (1996) Management - Theory and Practice. London: Martins the Printers.
5. Tappen, R. M. (2001) Nursing Leadership and Management 4th F.A Davis, Philadelphia.
Further Reading Resources
Click here to access Unit Four Content..
Topic 2: Delegating and Decision Making
- OBJECTIVES
- By the end of this lecture, you should be able to:
- 1. Define delegation and decision making.
- 2. Explain delegating and the process of delegating
- 3. Describe the difficulties of delegating and how to overcome them
- 4. Discuss decision making process
Click here to access Unit Four Content..
Topic 2: Decision Making
Definition:
- Decision making is a complex, cognitive process often defined as choosing a particular course of action.
- “the process of making choices or reaching conclusions
- Choice made from at least two alternatives
Types of Decisions
- Strategic Decisions – Long term decisions based on principal goals and objectives eg. Major policy statements
- Operating Decisions – Short term decisions routine and repetitive – e.g schedules or inventory levels.
- Administrative Decisions – Concerned with organization structure eg. Communication.
Rational decision making process
The primary steps of decision making process are similar to those of problem solving.
- Define the problem/issue and diagnose the problem.
- Collect relevant data
- Develop alternative solutions
- Assess consequences
- Select optimum solution
- Implement solution
- Measure and monitor
1. Gather information
- Identify signs and symptoms of dissatisfaction – there must be a problem.
- Gather data – what contributed to the problem.
- Isolate facts, ideas, information clues in terms of what is relevant, valid, accurate.
- Put down in writing
2. Analyze data
- Categorize in order of reliability.
- Compile and rank order information.
- Identify pointers to problem.
- Set in time sequence.
3. Select the cause and define the problem
- Select the most probable cause of the problem.
- Clearly state the problem based on available data.
- Use all available resources.
- Classify the problem in terms of e.g personal, educational or technical skills
4. Develop alternatives or solutions
- Brainstorm
- Explore and list alternative ways.
- Discuss advantages and disadvantages of each of the alternatives
5. Choose or decide
- Actual deciding
- Choose the best alternative – most cost effective or advantageous, feasible or satisfactory. If it involves change – involve those to be affected.
- It should have few undesirable consequences.
6. Implement
- Draw a plan of action for the choice made and objectives to be met.
- Identify tasks to the goal or objectives stating :
- What is to be done.
- Who is to do it.
- When it should be done
- Monitoring process – by who - Set timelines
7. Evaluate
- Finding out if goals/objectives were met and to what extent.
- Evaluation will be ongoing (formative ) and the end (summative)
- Are the results as expected
Click here to access Unit Four Content..
Topic 2: Delegation
DEFINITION
Delegation is defined as the purpose by which responsibility and authority for performing a task (function, activity or decision) is transferred to another individual who accepts that authority and responsibility (Sullivan and Decker, 1992, pg 216).
Although the delegator remains accountable for the task, the delegate is also accountable to the delegator for responsibilities assumed.
Delegation is a dynamic process which involves 3 factors:-
- Responsibility for work delegated - willingness to do the assigned work or an obligation to accomplish a task.
- Accountability - obligation to carry out the responsibility or authority or act of accepting ownership for the results or lack thereof.
- Authority - the right to act or empower.
To clearly understand who is responsible, the manager must consider the following;
- Practice acts – These determine the scope of nursing practice.
- Policy statements regarding the quality of care and the standards of care
- Job descriptions for various positions- This is to enable delegate specific responsibilities
Principles for effective delegation:
- Grant proper amount of authority: Responsibility should not be less than authority delegated.
- Define the results expected: Delegation must define results expected (don’t give ambiguous instructions).
- Consider the capabilities of the subordinates: While delegating consider the background, experience, intelligence, training and the limitations of the delegate
- Make sure authority is clearly stated: Authority relationships should be clearly defined not only to the subordinate but also to others concerned as well. Everyone must know who is in charge and where authority rests.
- Modify authority whenever necessary: Authority is always revocable or subject to modification and can be increased or decreased or even withdrawn altogether (depending on situations and also environment).
- Follow unit of command/chain of command: Authority should flow from the highest manager to all subordinates (each individual reports to one superior except in matrix organizations (according to functional areas).
- Develop a willingness to delegate: Managers lack confidence in their staff, fear to loose control. Let go and let others make mistakes if delegation is to work.
- Create a supportive climate. Give moral and material support.
- Provide advice and encouragement continuously
- Develop effective communication system. There should be free flow of communication between superior and subordinates for subordinates to seek clarification and guidance from superior.
- Establish an effective control system: Controls consent that authority delegated is used properly. Superior should set performance standards and evaluate subordinate periodically and help them improve.
- Appropriate incentives: Suitable financial and non-financial incentives should be provided to reward subordinates for successful assumption of authority and completion of responsibility
Delegation process
1. Defining the task – The manager should first determine what can and should be delegated eg.
- Routine tasks
- Tasks for which you do not have time
- Tasks that have moved down in priority
- Problem solving issues
- Staff development
2. Decide on the delegate: Match tasks to the individual. Analyze the person’s abilities to perform various tasks to be delegated and determine . Delegate to the person next in the hierarchy who has the requisite capabilities and who is legally allowed to do the task and also by organizational policy.
3. Define the task : Clearly define your expectations to the delegate. Plan your meeting with the delegate .Provide enough time to describe the task and your expectations and to entertain questions.
4. Providing clear communication about expectations regarding the task. It is important to communicate effectively with the delegate. To do this the manager must:
- Plan a meeting with the delegate
- Describe the task
- Give reasons for the task
- Inform the delegate by what standard the task will be evaluated
- Identify any constraints for completing the tasks
5. Reach agreement: After outline your expectation you must be sure that the delegate agrees to accept responsibility and authority for the task.
6. Monitor performance and provide feedback: monitoring performance provides mechanism for feedback and control that ensures that delegated tasks are carried out as agreed
Benefits of Delegation:
To the delegator
✔devote more time to these tasks that cannot be delegated. With more time,
✔develop more skills and abilities facilitating the opportunity for career advancement.
✔Improve interpersonal relationship with subordinates,
✔Provides continuity of work in the delegator’s absence and offers ready replacement.
To the delegatee,
✔gains new skills and abilities that can facilitate upward mobility.
✔Delegation also brings trust and support thereby building self-esteem and confidence.
✔ Job satisfaction and motivation are also enhanced as individuals feel stimulated by new challenges.
✔Morale improves a sense of pride, develops greater awareness of responsibility and individuals feel more appreciated and learn to appreciate the roles and responsibilities of others
To the Organization:
✔ organization is able to achieve its goals more efficiently due to team work,
✔overtime and absences decrease and productivity increases and at the same time organization’s financial position may improve.
✔As delegation increases efficiency, the quality of care improves and hence patient’s satisfaction
Some Problems That Hinder Delegation
- Manager is reluctant to delegate adequately to his/her subordinates. In some cases some will delegate responsibility and not authority.
- A manager will fail to delegate because she can do a better job.
- A manager may lack the ability to communicate to people what is to be done. On the other hand, the subordinate or delegate may:
- Not accept delegated tasks because it is easier to ask the manager than to decide for themselves how to deal with a problem.
- Fear criticism for mistakes made. This keeps subordinates from accepting responsibility.
- Lack necessary information and resources or non-supportive environment which creates an attitude that might make a person reject further assignments).
- Lack self confidence.
- Fear liability - some individuals do not like to take risks
Centralization and decentralization
• Centralization is the degree to which authority is retained by higher level managers with an organization rather than being delegated. If a limited amount of authority is delegated , the organization is usually characterized as being centralized. If significant amount of authority is delegated to lower managers, the organization is described as being decentralized.
Click here to access Unit Four Content..
Topic 2: Further Reading
Reference Material
1. Barton E. et al (1980) On Being InCharge. Geneva: World Health Organization.
2. Basavanthappa, B. P. (2000). Nursing Administration. New Delhi, Jaypee Brothers Medical Publishers Ltd.
3. Bennet, R. (2004) Management. Essex: Pearson Education Ltd.
4. Cole, G. A. (1996) Management - Theory and Practice. London: Martins the Printers.
5. Tappen, R. M. (2001) Nursing Leadership and Management 4th F.A Davis, Philadelphia.
Further Reading Material
Click here to access Unit Four Content..
Topic 3: Managing Material And Time
OBJECTIVES
By the end of this topic you should be able to:-
1. Explain demand estimation and procurement.
2. Describe the role of the nurse manager in inventory control
3. Identify time wasters
4. Describe the principles of time management
Click here to access Unit Four Content..
Topic 3: Managing Materials
Materials are essential resources to achieve the objectives of the health care institution. For quality and efficient services, the materials must be in the right place, at the right time when needed and in right quantity
Activities Which Pertain to Materials
Management
i. Demand estimation
Since a large quantity of materials are used in hospitals and in specific units/wards, you need to identify your requirements or needs.
ii. Procurement
Having come up with your list the next step is procurement or ordering. Some institutions have laid rules and regulations regarding procurement. This is aimed at reducing wastage and maximizing the value of money
iii. Receipt and Inspection
• The materials received should be subjected to either physical or chemical inspection. This ensures that you receive the right quality of material supplied to the organization.
iv. Storage
The materials should be in a store within or near the institution. The store should be of adequate size to accommodate the materials required for different types of usages eg. Fridges, shelves, cupboards
v. Inventory Control (Issue and use)
This means stocking adequate numbers so that materials are available whenever required. Close supervision of movement of materials or consumption rate is a good tool for proper control
Time management
Def. :- act or process of exercising conscious control over amount of time spent on specific activities in order to increase efficiency and effectiveness
Time management skills
✔Set goals – realistic and achievable
✔Prioritize work – make a list of task
✔Delegate task – to your subordinates as per their skills
✔Avoid distractors - i.e. email face book politics
✔Organize your time - identify when you waste time and reduce
✔Break down tasks – so as to accomplish one step at a time
✔Set deadlines – set realistic deadlines for task and stick to it challenge your self and meet the deadline ,reward your self for meeting difficult tasks
✔Avoid stress – stress occurs when we accept more than our abilities resulting into tiredness and loss of productivity ,delegate tasks and leave time for relaxation
1. Tasks which have to be done. These relate to key responsibilities eg. Clinical or administrative duties.
2. Tasks into which you are pressurized by other people.
Some of these are important and must be done while others you do because you do not want to say no.
3. Tasks which you do because you want to.
These are usually your own choices and include tasks which someone else could do well eg. attending a association meeting
Time Wasters
- Interruptions such as telephone calls and drop-in visitors.
- Lack of clear cut goals, objectives and priorities.
- Meetings both scheduled and unscheduled.
- Lack of daily and/or weekly plans.
- Lack of self discipline.
- Failure to delegate.
- Ineffective communication.
- Inability to say no.
Principles of Time Management
1. Goal Setting
The nurse manager sets both organizational and personal goals. The goals are either short or long term and provide direction and vision for actions as well as time frames in which activities will be accomplished.
2. Time Analysis
The manager should conduct a survey of how she/he spends a day. Reviewing the daily schedule and keeping it accurate may demonstrate how time is used.
3. Priority Setting
Time frames for achievement of goals are identified by the nurse manager. The "to do" list should be prioritized by classifying activities as e.g. "1" for urgent or "2" not urgent but important and "3" less important.
4. Delegation
A number of activities may be delegated by the nurse manager
5. Controlling Interruptions
Identify causes of interruptions and plan to reduce them. Some could become a planned and scheduled activity.
Click here to access Unit Four Content..
Topic 3: Human Resource Development
Training
Training is the planned process of modifying employee behavior, attitude, and skill through learning in order to increase the probability of goal achievement.
Development
This usually suggests a broader view of knowledge and skills acquisition than training. It is less job oriented than career oriented. It is concerned more with employee potential than with immediate skills. It sees the employees as adaptable resources
Training and development cycle
• The primary objective of training is to reduce the gap between what employees know and what they should know. Systematic training is initiated by the organization’s policy and sustained by its training organization
Training involves five steps
- Needs analysis/identifying training needs: The first priority is to establish what the training and development needs of the organization are. A training need is any shortfall terms of employee knowledge, understanding, skill, and attitudes against what is required by the job or the demands of organizational change. This will involve use of job descriptions, employee’s appraisal records and any other data that may indicate such needs.
- Plan training required; The next step is to plan the training required to the needs identified. This involves such matters as setting budgets and timetables, and deciding on the objectives, content and methods of training to be employed
- Implementation/carry out the training: This is training the targeted employee/ group. The implementation of plan is a joint affair between the training specialist and their line and functional colleagues.
- Evaluation and follow up: Management assesses the programme success. This is by evaluating the results so that subsequent changes can be made if necessary. Then the cycle starts again.
- NB: Read and draw the systematic training basic cycle
Methods of training
- On the job training
- Apprenticeship training ( combination of classroom ,institutions and on the job training
- Vestibule training: This is an internal off the job training method in which the environment of the actual work place is simulated. Used by organizations where specific skills are needed before actual job performance
- Job Rotation; In this training method the employee is moved from one job to another. It gives the employee a chance to use a variety of skills and abilities.
- In coaching/mentoring: A senior experienced manager takes charge of training and development of a new incumbent. The mentor/trainer helps the employee to adjust both to the organizational culture and work setting
- JOB ANALYSIS
- Job analysis is the procedure through which you determine the duties of positions to be staffed in an organization and the characteristics of the people to hire for them.
- Job analysis produces information used for writing Job descriptions (a list of what the Job entails) and Job specification ( what kind of people to hire for the Job). The following types of information is gathered during Job analysis
- Work activities: identifying the tasks involved in the Job e.g giving medications, monitoring vital sign etc.
- Human behavior: Included here is information regarding Job demands such as lifting weights or walking long distances
- Machines, tool equipment's and work aids:
- Performance standards: This is the Jobs performance standards in terms of quality or quantity level of each Job duty. (The standards will be used to appraise the employees
- Job context: This includes physical working conditions, work schedule number of people with whom the employee wound normally interact, information about incentives etc.
- Human requirements: This is the job related knowledge or skills (education, training, work experience) and the required personal attribute (attitudes, physical characteristics personality interest)
Job description
- This is a written statement of what the worker actually does, how he or she does it, and what the jobs working conditions are.
- A job description set out the purpose of the job, where it fits in the organization structure, the context within which the job holder functions and the principal accountabilities of job holder(s) or the main tasks they have to carry out.
Sections of job description
A job description mainly contains the following sections.
- Job identification; This contains the job title e.g. manager, etc. It also contains the date that the job description was written, who prepared it, who approval the job description and the location of the job e.g. hospital in charge
- Job summary: This describes the general nature of the job and includes only it major functions or activities e.g. plan, directs, co-ordinates hospital activities.
- Relationships: This shows the job holders relationship with others inside and outside the organization e.g. reports to, supervises who? Works with etc.
- Responsibilities and duties: This section presents the jobs main responsibilities and duties. e.g. conducting performance appraisal, giving medication to patients etc.
- Standards of performance and working conditions: This lists the standards the employee is expected to achieve under each of the job description duties and responsibilities.
- Job specifications: It shows what kind of a person to and for what qualities that person should be tested e.g. the skills, knowledge, experience, attitudes etc.
Click here to access Unit Four Content..
Topic 3: Commodity and Supplies Management
Commodity management is a set of activities and procedures that ensure that health commodities are available, accessible and of high quality.
Importance of commodity management
This is to ensure consistent availability of and access to medicines, laboratory reagents and other medical supplies. Some of the supplies also have a short shelf-life and are costly and hence needs to management effectively. The other importance is to improve quality of life patients and to increase the consumer confidence in the healthcare system
Commodity management cycle
Commodity management can be described as a cycle made up of various components. These components are product selection, procurement, inventory management (with storage & distribution) and use
Product Selection: Selection is the process of identifying which commodity should be made available as per the national guidelines. Appropriate selection ensures that the effective medicines and related commodities for are selected. It also ensures that right dose, dosage form, preparation are selected and the most affordable commodities are made available
Procurement: This is the process of obtaining the required medicines and supplies through purchase, donations or manufacturing. Key components of procurement includes quantification which is the need to know how much to buy. It also includes supplier selection where who to buy from and how to buy is identified. In procurement also quality assurance in order to ensure quality of the products you buy
Distribution: This is transferring commodities from a storage facility/supplier to a point of use or from one point of use to another, including appropriate storage and inventory control. It involves moving stocks from national stores, to district stores or central sites. It also includes distribution from District stores or central sites to facilities and finally from the facility store to user points.
Use: Refers to practices that include dispensing the prescribed medicines to patients, patient adherence and follow up and also issuing other commodities to points of use.
Types of Records used in commodity management
- Stock keeping cards: These keep information about commodities in storage at the facility
- Transaction records: Keep information about commodities being moved from one facility to another or within a facility.
- Consumption records: Keep information about quantities of each commodity dispensed on daily basis to patients
The Procurement
Procurement means the purchasing, hiring or obtaining by any other contractual goods, construction and services. Public Procurement means procuring by public funds. Procurement also means acquiring affordable commodities of good quality, either by purchase or from donations
Procurement cycle
Procurement follows a series of steps
- Select the commodity / Review the selection
- Forecast & quantify the quantities needed
- Reconcile the needs and the funds available
- Choose the procurement method
- Locate and select suppliers
- Specify terms of supply
- Monitor supply order progress
- Receive and check supplies
- Make payment to suppliers
- Distribute the commodities
- Collect consumption data
Procurement Methods
In Kenya, procurement in the public sector is governed by the Public Procurement Act. Let us briefly look at the methods used in procuring health commodities:
Open tender: This is a formal procurement process in which local or international suppliers (or their representatives) are invited to submit bids for the supply of commodities under the terms and conditions stipulated in the tender. This method allows for the widest selection of potential suppliers. However it is a time-consuming and bureaucratic method
Closed or Restricted tender: Similar to open tender but here the bidding is limited to suppliers meeting certain conditions, e.g. suppliers of a certain financial capacity, suppliers producing drugs of a certified quality. These suppliers are short-listed using a pre-qualification procedure. It assists by reducing the potentially large number of suppliers who may bid, as compared to the open tender.
Competitive negotiation: Here, the buyer selects a small number of suppliers and negotiates prices with them directly. It is useful for bulk procurements or for emergency supplies.
Direct purchase: The product is purchased directly from one supplier. This is the simplest method but usually very expensive since the buyer does not seek better value by checking out other suppliers. It’s useful for small procurements or for emergency supplies
Ethical and legal implications in commodity and supplies management
Public procurement in Kenya should be based on core principles and pillars. Some of these principles include:
- Transparency and Accountability: Procuring entities should ensure there is openness and clarity on procurement policy and its delivery.
- Efficiency: This encompasses the performance of the procurement process as cost effectively as possible and in a timely manner.
- Consistency: The application of the procurement process should be the same across all procuring entities.
- Open and Effective Competition: Provision of ample and equal opportunities for participation by interested and qualified suppliers of goods, works or services.
- Ethics and Fair Dealing: Under the Public Officers and Ethics Act (2003), it is an offence for those employed by contracting authorities in their official capacity to accept any gift or consideration as an incentive or reward for acting in a manner showing favor or disfavor for any person or entity
- Legal Framework: The legal framework for public procurement includes:
- Public Procurement and Disposal Act, 2005
- Public Procurement and Disposal Regulations 2006 and 2009
- Public Procurement and Disposal Regulations (Public Private Partnerships) 2009
- Supplies Practitioners Management Act, 2007.