Theories & Minimum Requirements Of Nursing Care

THEORIES AND MINIMUM REQUIREMENTS FOR ORGANISATION OF NURSING CARE Presented by- PRABU.G, M. Sc Nursing, CN, JIPMER. INTRODUCTION:Nursing profession is considered a caring profession to begin with, it was an art and a vocation. Now it is considered a scientific profession nursing care is defined as the care of the patient with regard to nursing needs, with he ever increasing dimension of medical sciences quantitatively and qualitatively6 nursing care is becoming more and more complex with its management services. ORGANIZATIONDefinition of organization The term organization has been used since time immemorial. It is as old as the existence of human beings. Different writers however hold different views of organizations. According to Allen (1959), an organization is a mechanism or structure that enables living things to work effectively together. Hicks and Gullet (1981) define organization as a structured process in which individuals interact for specific objectives. Denyer (in Kumet and Mittal, 2001) consider organization as the arrangement of work, with the division of activities and responsibilities. Despite variations in definitions, a general perception is that organizations are vehicles used to achieve institutional goals. Therefore, an organization can be considered as a social system which members use to achieve organizational goals. Characteristics of organization Organizations have the following characteristics: a) Organizations consist of a group of individuals. b) Organizations are dynamic. c) Organizations have specific activities which are conducted under the direction of a leader. d) Organizational output is the result of collective effort Types of Organizations There are two types of organizations. a. Formal organizations Formal organizations are characterized by planned structure and represents the patterns of relationship that exist among the components of an organization. 1

Characteristics ❖ ❖ ❖ ❖ ❖ ❖ ❖

Clearly defined structure of activities Permanence/ durable Well defined rules and regulations Determined objectives and policies Status symbol Strict observance of the principles of coordination Messages are communicated through scalar chain.

b. Informal Organizations ⮚ Informal organizations consist of unofficial and unauthorized relationships that occur between individuals or groups within the formal organization. ⮚ Informal organizations occur in order to: ❖ Satisfy a social need ❖ Create a sense o belonging ❖ Perpetuate cultural values of a group ❖ Communicate and pass information. Characteristics of informal organizations ❖ ❖ ❖

Develop Standards of behavior; Informal organizations generally develop its own laws, taboos and beliefs about what is right and wrong behavior or conduct. Pressures to conform; Informal groups tend to exert pressures upon which its members conform to. Informal leadership; Leaders in informal organizations merge from groups through persuasion and influence.

Theory • A Theory is a set of inter related concepts, definitions & propositions that present a systematic view of phenomena • It also specifies the relationship among variables with purpose of explaining and predicting the phenomena. Organization theory • Refers- to the study of the phenomena or occurrences of organizational functioning and performance and of the behavior of Groups and individuals working in them.” • There are several theories which explain the organization and its structure.

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Definition of Nursing Services: WHO expert committee on nursing defines the nursing services as the part of the total health organization which aims to satisfy major objective of the nursing services is to provide prevention of disease and promotion of health. THEORIES FOR ORGANISATION OF NURSING CARE 1) THE ADMINISTRATIVE THEORY Fayol – • Engineer and French industrialist • In France works as a managing director in coalmining organization • Recognizes to the management principles rather than personal traits • While others shared this belief, Fayol was the first to identify management as a continuous process of evaluation. Fayol’s 5 Management Functions Fundamental roles performed by all managers: Planning Organizing Commanding Coordinating Controlling Additionally Fayol recognizes fourteen principles that should guide the management of organizations. Fayol’s 14 Principles: 1. Division of Work —improves efficiency through a reduction of waste, increased output, and simplification of job training 2. Authority and Responsibility—authority: the right to give orders and the power to extract obedience – responsibility: the obligation to carry out assigned duties 3. Discipline—respect for the rules that govern the organization 4. Unity of Command—an employee should receive orders from one superior only 5. Unity of Direction—grouping of similar activities that are directed to a single goal under one manager 6. Subordination of Individual Interests to the General Interest—interests of individuals and groups should not take precedence over the interests of the organization as a whole. 3

7. Remuneration of Personnel—payment should be fair and satisfactory for employees and the organization 8. Centralization—managers retain final responsibility – subordinates maintain enough responsibility to accomplish their tasks. 9. Scalar Chain (Line of Authority)—the chain of command from the ultimate authority to the lowest 10. Order—people and supplies should be in the right place at the right time 11. Equity—managers should treat employees fairly and equally 12. Stability of Tenure of Personnel—managerial practices that encourage long-term commitment from employees create a stable workforce and therefore a successful organization 13. Initiative—employees should be encouraged to develop and carry out improvement plans 14. Esprit de Corps—managers should foster and maintain teamwork, team spirit, and a sense of unity among employees 2) BUREAUCRATIC THEORY OF ORGANIZATIONS • Bureaucratic Theory was developed by a German Sociologist and political economist Max Weber (1864-1920). • According to him, bureaucracy is the most efficient form of organization. • The organization has a well-defined line of authority. It has clear rules and regulations which are strictly followed. Max Weber (1864-1920) • German sociologist • Weber first describes the concept of bureaucracy – an ideal form of organizational structure • He defines bureaucratic administration as the exercise of control on the basis of knowledge • Weber states, “Power is principally exemplified within organizations by the process of control” Weber uses and defines the terms authority and power as: • Power: any relationship within which one person could impose his will, regardless of any resistance from the other. • Authority: existed when there was a belief in the legitimacy of that power. Weber classifies organizations according to the legitimacy of their power and uses three basic classifications:

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❖ ❖ ❖

Charismatic Authority: based on the sacred or outstanding characteristic of the individual. Traditional Authority: essentially a respect for customs. Rational Legal Authority: based on a code or set of rules.

Weber recognizes that rational legal authority is used in the most efficient form of organization because: • A legal code can be established which can claim obedience from members of the organization • The law is a system of abstract rules which are applied to particular cases; and administration looks after the interests of the organization within the limits of that law. • The manager or the authority additionally follows the impersonal order • Membership is key to law obedience • Obedience is derived not from the person administering the law, but rather to the impersonal order that installed the person’s authority Weber outlined his ideal bureaucracy as defined by the following parameters: • A continuous system of authorized jobs maintained by regulations • Specialization: encompasses a defined “sphere of competence,” based on its divisions of labor • A stated chain of command of offices: a consistent organization of supervision based on distinctive levels of authority • Rules: an all encompassing system of directives which govern behavior: rules may require training to comprehend and manage • Impersonality: no partiality, either for or against, clients, workers, or administrators • Free selection of appointed officials: equal opportunity based on education and professional qualification • Full-time paid officials: only or major employment; paid on the basis of position • Career officials: promotion based on seniority and merit; designated by supervisors • Private/Public split: separates business and private life • The finances and interests of the two should be kept firmly apart: the resources of the organization are quite distinct from those of the members as private individuals. (a) A tendency to a leveling of social classes by allowing a wide range of recruits with technical competence to be taken by any organization (b) Elite status because of the time required to achieve the necessary technical training (c) Greater degree of social equality due to the dominance of the spirit of impersonality or objectivity 5

Features of Bureaucratic Organization • The characteristics or features of Bureaucratic Organization are as follows: i) ii) iii) iv) v) vi)

There is a high degree of Division of Labor and Specialization There is a well defined Hierarchy of Authority. It follows the principle of Rationality, Objectively and Consistency. There are Formal and Impersonal relations among the member of the organization Interpersonal relations are based on positions and not on personalities. There are well defined Rules and Regulations where by rules cover all the duties and rights of the employees. These rules must be strictly followed. There are well defined Methods for all types of work. Selection and Promotion is based on Technical qualifications. Only Bureaucratic or legal power is given importance.

vii) viii) ix)

Criticism of Bureaucratic Organization Although Bureaucratic organization is suitable for organizations where change is very slow and it is also appropriate for static organizations. Bureaucratic organization is criticized because of the following reasons: i)

Too much emphasis on rules and regulations. The rules and regulations are rigid and inflexible.

ii) No importance is given to informal groups. Nowadays, informal groups play an important role in all business organizations. i) ii)

Bureaucracy involves a lot of paper work. This results in lot of wastage of time, effort and money. Bureaucracy is very rigid and does not give importance to human relations

vi) There will be unnecessary delay in decision-making due to formalities and rules. vii)Too much importance is given to the technical qualifications of the employees for promotion and transfers. Dedication and commitment of the employee is not considered Viii)There is difficulty in coordination and communication. 3) SYSTEMS ORGANIZATIONAL THEORY Organizational management systems consist of many internal subsystems that need to be continually aligned with each other. As companies grow, they develop more and more complex subsystems that must coordinate with each other in the process of transforming inputs to outputs (McShane and Von Glinow, 2003). These interdependencies can easily become so complex that a minor event in one subsystem may amplify into serious unintended consequences elsewhere in the organization. Every organized enterprise does not exist in a vacuum. It is rather known to depend on its external environment – which is a part of a larger system, such as the industry to which it belongs, the economic system and the society (Weihrich et al, 2008). 6

According to them, the organization receives inputs, transforms them and exports the outputs to the environment as shown in the basic input-output model below. In their own opinion, the above model requires expansion and development into a model of process, or operational management that indicates how the various inputs are formed through the managerial functions of planning, organizing, staffing, leading and controlling. However, the following sub topics are the basic components of a system. i) Inputs The composition of inputs from the external environment may include people, capital, managerial skills as well as technical knowledge of skills. It also includes the various claimants – groups of people making demands on the organization; such as employees, consumers, suppliers, stockholders, federal, state and local governments. ii) Transformation process – In an organizational system, inputs are transformed in an effective and efficient manner into outputs. This can be viewed from different perspectives. Focus can be on such management functions as finance, production, personnel and marketing. iii) External variable – As a component of the systems model, the external environment plays a key role in the transformation of inputs into outputs. While it is true that organizations have little or no power to change the external environment, they have no alternative but to respond to it. iv) Outputs – Inputs are secured and utilized by transformation through the managerial functions – with due consideration for external variables into outputs. Outputs of different kinds vary with the organization. They usually include many of the following; products, services, profits, satisfaction and integration of the goals of various claimants to the organization. v) Reenergizing the system – It is worthy of note that in the systems model of management process, some of the outputs become inputs again. Apparently, the satisfaction and new knowledge or skills of employees become important human inputs. Similarly, profits are reinvested in cash and capital goods, such as machinery, equipment, buildings and inventory.

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Types of systems 1) Cybernetics and closed systems thinking: The field of cybernetics exemplifies the modern version of closed systems thinking and it is attributed to the work of Norbert Wiener. In 1949, Norbert Wiener, a distinguished mathematician and engineer at MIT (Massachusetts Institute of Technology) discovered this over lunch with a colleague who was a neurosurgeon. The development of the field of Cybernetics allowed diverse disciplines to communicate about their problems in the common language of systems theory. More importantly, it allowed a common set of principles to be applied to problems of control and regulation. It has been seen that the principles of system design that allowed ancient mariners to steer ships with “governors” were the same principles that allowed mechanical engineers to design thermostats for air-conditioning units, industrial engineers to control product quality, astronomers to describe the behaviour of planets, and accountants to design budgetary control systems. These systems can be seen as returning to equilibrium after being disturbed by regulating themselves through feedback information. The cybernetic closed systems model is the intellectual base for traditional cost and quality management approaches. Another key idea in closed systems is the increase in entropy or the tendency to maximum disorder. This is because the system is closed to the environment and has no ability to import energy to counteract the growth in entropy. This view, exemplified by the second law of thermodynamics, means that closed systems will inevitably tend to breakdown from an increase in entropy. 8

2) Biology and open systems thinking: Open systems theory has its foundations in biology, particularly Darwin's work on the evolution of the species. The popular version of open systems theory is attributed to Ludwig Von Bertalanffy who used the term ‘general systems theory’ to describe the main ideas and to distinguish them from closed systems thinking. Bertalannfy maintained that closed systems thinking was not appropriate to study biological phenomena because biological systems interact with their environment, grow and survive. However, the environment of living organisms is less forgiving and often the luxury to learn from errors does not exist. There are four main differences between closed and open systems theory. Each difference is discussed below. 1. Relations with the external environment. Open systems theory focuses on the interchange between a system and its environment. Biological organisms are open systems because they constantly evolve and adapt to the needs of their environment. Their behaviour is a response to the threats and resources available in the environment in which they exist. 2. Variables considered. A second area, which differentiates open and closed systems thinking, is the number of variables included. A closed system has a few variables. An open system typically deals with a more complex set of interrelationships. Cost and quality, viewed from a closed systems perspective, are internal variables that need to be managed within the boundaries of a firm. In an open system, cost and quality are viewed as externally driven variables that must be managed by understanding the environmental influences on these variables. 3. Form of regulation or control, closed systems use error-controlled regulation. This is control after-the-fact. Open systems use anticipatory control. They are regulated by anticipating errors before they occur and taking corrective measures before final output. Like a mouse, open systems anticipate a cat’s next move. Waiting for feedback from errors is usually fatal. This form of regulation is called ‘feed forward’ control. If cost is to be managed as an open system, it should be controlled before a product is produced and not after. 4. Purpose of Regulation. Unlike closed systems, open systems are not interested in returning a system back to some predetermined stable state. They recognize that the purpose of regulation is to adjust and move the system on a dynamic path. Open systems seek continuous improvement and not just stability. They are said to achieve a dynamic equilibrium. Like living systems, most organizations operate in constant interchange with their environment. They have many complex interactions and interrelationships within their boundaries. Systems theory and effectiveness In everyday conversation, the term system is used. A variety of meanings and interpretations are given to describe accounting systems, inventory control system, a car’s ignition system, an ecological system and the Nigerian tax system. Each system consists of elements or characters that interacts (Gibson et al (1997).

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According to them, system theorists propose that systems can be categorized in three ways: a. Conceptual systems (a language) Organizations use the notion of a system to view their internal and external world and how the parts relate and interact with each other. By viewing the individuals, groups, structure, and process of organizations in terms of a system, organizations are able to identify common and uncommon themes that help explain the behaviour and effectiveness of people. Identification of themes or patterns is important because it helps to explain how effective an individual, group or entire organization is, in terms of goals (Peterson, 1994). b. Concrete systems (machines) – Systems theory enables us describe an organizations’ internal and external behaviour. Internally, it can be seen how and why people inside the organizations perform their individual and group tasks. Externally, an organization’s transactions with other organizations and institutions can be assessed. All organizations acquire resources from a larger environment of which they are part of, and in turn, provide the goods and services demanded by the larger environment. c. Abstract systems (culture of an organization) The organization is one element of a number of elements interacting interdependently. The flow of inputs is the basic starting point in describing the organization. Every organization is part of an industry (a larger system), a society (a yet larger system), and increasingly, a global economy (perhaps the largest system of all). Systems theory can also describe the behaviour of individuals and groups within an organization. An input (cause) can be processed by an individual mental and psychological process to produce a particular output (outcome). Systems theory and feedback According to Gibson et al (1997), the concept of the organization as a system that is related to a larger system, introduces the importance of feedback. Organizations depend on the environment not only for its inputs, but for the acceptance of outputs. Consequently, they must develop means for adjusting to environmental demands. Simply put, feedback refers to information that reflects the outcomes of an act or series of acts by an individual, group or organization. Qualities of an ideal system According to Harry (1990) the following elements are indicators of a quality system: a) Components: A system consists of more than one part called component elements of a system. A component refers to anything that is part of a system or sub-system. The term element implies the smaller components that one would wish to identify separately. Organization of a system is the specification of relations between its elements. 10

b) Connection: These components of a system are connected together. c) Structure: The form of this connection is fixed in an organized way called structure. The concepts of structure and organization become more interesting in large systems, where more than just one or two possible structures or organizations may be considered. d) Interaction: The components affect each other by their presence in or removal from the system which results from mutual interaction with the systems environment. e) Process: the changes resulting from these interactions are called processes. f) Holism and emergent properties: A system is a whole which exhibits properties which only have meaning in terms of the interactive processes of its components. g) Identity: The properties of a system that enable it to be identified and separated from other things which are not part of the system. h) Environment: There are things which are not part of the system, which significantly affect it, but which the system can only marginally influence, called the environment of the system. i) Conceptualization: a system is a concept whose particular form reflects the aims and values of the individual or group whose concept it is (Harry, 1990). Like living systems, most organizations if not all, operate in constant interchange with their environment. They have many complex interactions and interrelationships within their boundaries. To survive, organizations must grow and achieve a dynamic equilibrium rather than simply return to a steady state. It is for these reasons that general systems theory has come to be applied to the study of organizational phenomena such as design of management planning and control systems.

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4)CONTINGENCY APPROACH THEORY Definition Also sometimes called the situational approach. There is no one universally applicable set of management principles (rules) by which to manage organizations. Organizations are individually different, face different situations (contingency variables), and require different ways of managing. Four important ideas of contingency theory are: 1. There is no universal or one best way to manage 2. The design of an organization and its subsystems must 'fit' with the environment 3. Effective organizations not only have a proper 'fit' with the environment but also between its subsystems 4. The needs of an organization are better satisfied when it is properly designed and the management style is appropriate both to the tasks undertaken and the nature of the work group. Contingency Planning A contingency plan is a plan devised for a specific situation when things could go wrong. Contingency plans are often devised by governments or businesses who want to be prepared for anything that could happen.

The contingency approach to management is based on the idea that there is no single best way to manage. Contingency refers to the immediate contingent circumstances. Effective organizations must tailor their planning, organizing, leading, and controlling to their particular circumstances. In other words, managers should identify the conditions of a task, the requirements of the management job, and people involved as parts of a complete management situation. The leaders must then work to integrate all these facets into a solution that is most appropriate for a specific circumstance. 12

5) INTEGRATED DELIVERY SYSTEM (IDS) Definitions An organized, coordinated and collaborative network that: (1) links various health care providers, via common ownership or contract, across three domains of integration – economic, noneconomic, and clinical – to provide a coordinated, vertical continuum of services to a particular patient population or community and is accountable both clinically and fiscally for the clinical outcomes and health status of the population or community served, and has systems in place to manage and improve them. Types of integration Horizontal and Vertical Integration There are two main types of integration used in integrated delivery systems (IDS) – horizontal and vertical. Horizontal integration This is defined by the Pan American Health Organization as “the coordination of activities across operating units that are at the same stage in the process of delivering services.” Horizontal integration involves grouping organizations that provide a similar level of care under one management umbrella. It usually involves consolidating the organizations’ resources to increase efficiency and utilize economies of scale. Examples of horizontal integration include the following: • multihospital systems • mergers • strategic alliances with neighboring hospitals to form local networks Some systems have demonstrated horizontal success by acquiring and combining prestigious hospitals and then achieving higher reimbursement rates from payers willing to pay more for their services. Examples of these systems include the following: • Partners Health Care • University of Pittsburgh Medical Center • Sutter Health Vertical integration This is defined by the Pan American Health Organization as “the coordination of services among operating units that are at different stages of the process of delivery patient services.” Vertically integrated systems are intended to address the following: • Efficiency goals

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● manage global capitation form large patient and provider pools to diversify risk o reduce cost of payer contracting • Access goals offer a seamless continuum of care and respond to state legislation • Quality goals Unlike horizontal integration, which integrates organizations providing similar levels of care under one management umbrella, vertical integration involves grouping organizations that provide different levels of care under one management umbrella. This type of integration can include acquisitions/alliances with the following: • Physicians (primary care providers, physician-hospital organizations, management service organizations, etc.) • Health plans or health maintenance organizations • Academic medical centers • Long-term care facilities • Home care facilities Kaiser Permanente is the most well-known example of a fully integrated delivery system. • Kaiser Permanente operates in nine states, including Washington, DC, and has almost 9 million members, 14,000 doctors and 160,000 employees. • The system owns and operates more than 420 freestanding ambulatory care facilities and 30 medical centers (hospitals and ambulatory). • The medical centers offer one-stop shopping for most services including hospital, outpatient offices, pharmacy, radiology, laboratory, surgery and other procedures, and health education centers. This set-up encourages patient compliance and enhances opportunities for physicians at the primary care level to communicate and consult with specialists, hospital personnel, pharmacists, etc Integrated Delivery System (IDS) Organizational Models According to Shih, there are four models of integration: • Model 1 is an IDS or multispecialty group practice (MSGP) with a health plan, which is both provider and payer. This model involves physicians in strategic planning. Its advantages include enhanced collection and integration of data, utilization review and cost-control capacity. Duplication of services is greatly minimized. o Kaiser Permanente follows this model by serving only members in its health plan. o Geisinger Health System also follows this model, but serves patients outside of its health plan. • Model 2 is an IDS or MSGP single-entity delivery system that does not own a health plan. o The Mayo Clinic is the world’s oldest and largest integrated MSGP. 14

o HealthCare Partners Medical Group is a nonprofit organized delivery system in greater Boston and eastern Massachusetts. • Model 3 involves private networks of independent providers that share and coordinate services. Similar to the first two models, these networks include infrastructure services (e.g., performance improvement and care management). Other integration structures under Model 3 include the following: ● physician-hospital organizations ● management service organizations ● group practices without walls ● individual practice associations ● California "delegated model" health maintenance organizations • Model 4 includes government-facilitated networks of independent providers on both the state and local levels. Governments take an active role in organizing independent providers, usually to create a delivery system for Medicaid beneficiaries. o Community Care of North Carolina, a public-private partnership, is an example of this model. Characteristics of a Fully Integrated Delivery System After consolidating the literature on integrated care, America’s Essential Hospitals found seven characteristic domains that encompass a fully integrated health care delivery system Components of a Fully Integrated Health System Domain 1: Value-Driven Governance & Leadership: • The board is very focused on integration and reflects all relevant stakeholders. • Administrative leadership is very committed to promoting and implementing integration. • Physician leaders are very committed to promoting and implementing integration. • The organizational structure is very favorable to integrated care. • Strategic, financial and operational planning toward integration is very clear and convincing. • A culture of safety and teamwork is continuously taught and reinforced. • Financial, quality and community benefit data are transparent throughout the organization and to the community. Domain 2: Hospital/Physician Alignment: • The system has a clear and convincing approach to aligning and integrating clinicians with hospital administration. • Physician leaders frequently represent the interests of all system physicians. • Physicians and administrators frequently participate in joint decision making.

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Domain 3: Financial Integration: • The system is well-prepared for assuming risk-based payment and has conducted considerable analysis of the implications. • The system has a very good ability to manage contractual relationships with payers with sufficient staff/resources and compatible information systems. Domain 4: Clinical Integration/Care Coordination: • The system provides or contracts for the full range of services and sites of care needed to meet patient demand for preventive, ambulatory, acute, post-acute and behavioral health care. • Strong evidence exists of accountability, peer review and teamwork among providers. • Care is frequently delivered at the most cost-effective and appropriate setting. • Transitions and handoffs between settings are effectively managed and need little improvement. • Strong collaboration exists between the hospital system and social services. • The system has almost fully integrated behavioral health programs into primary care. Domain 5: Information Continuity: • Electronic Health Records (EHRs) for each patient are accessible to all providers within the system and most community providers outside of the system. • The EHR system can track all patient encounters and combine all data to system wide level for evaluation and benchmarking. • EHRs can track health outcomes of patients with specific conditions within all physicians’ panels. Domain 6: Patient-Centered & Population Health Focused: • The system has very good, complete data on sociodemographic, utilization, cost and health status characteristics of the populations it serves. • The system’s resources and services are well-matched to the needs of the populations served. • The system provides significant social services to assist patients in accessing needed care. • The system provides almost full or full, 24/7 access to care via phone, email or in-person visits. • The system has trained all or nearly all staff in cultural competency skills. • All providers have been trained in encouraging expanded patient/family/caregiver roles in decision making and self-management. Domain 7: Continuous Quality Improvement & Innovation: • The system frequently trains/develops employees to be future leaders. 16

• The system frequently tests strategic activities through pilot projects. • Staff feel very empowered to innovate. • Providers frequently employ evidence-based practices.(2) 6)SCIENTIFIC MANAGEMENT THEORY Taylor dubbed as the “Father of Scientific Management,” is best known for his “one best way approach” in accomplishing task. Classical organization theory evolved from this notion. Frederick Taylor Scientific management – focusing on the management of work and workers Taylor, Generally considered the father of scientific management pioneered the development OF TIME AND MOTION STUDIES. He wrote and published the result of his studies in 1911 on the PRINCIPLES OF SCIENTIFIC MANAGEMENT. Creates systems to gain maximum efficiency from workers and machines in the factory. Focuses on time and motion studies to learn how to complete a task in the least amount of time. The time studies performed by Taylor, which were later classified as time and motion studies, were characterized by timing a worker’s series of motions and determining the optimal way in which to perform their particular job. The goals of the study are as relevant today as they were back then - to increase the efficiency of a business process. Time and motion studies have been successful in various implementations enabling companies to move forward in providing logical frameworks for improving and leaning their operations. “One best Way”

Taylor's scientific management consisted of four principles:

1. Replace rule-of-thumb work methods with methods based on a scientific study of the tasks. 2. Scientifically select, train, and develop each employee rather than passively leaving them to train themselves. 3. Provide "Detailed instruction and supervision of each worker in the performance of that worker's discrete task" (Montgomery 1997: 250). 4. Divide work nearly equally between managers and workers, so that the managers apply scientific management principles to planning the work and the workers actually perform the tasks. PARTS OF ORGANISATIONAL THEORY ⮚ Structure ⮚ Process

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staff in organization find that the organization structure what does the organization look like and the process how things are done become important for example if staff nurse does not understand to whom he or she reports this can be a problem( structure ) or if nurse does not understand the communication process for reporting another process this can lead to problems.Structure an organizational chart is the best placed to find out about an organization structure. an organizational chart is a graphical representation of an organization’s hierarchical structure and the follow the flow of responsibility within the organization it should reflect the chain of command and illustrate the relationship between staff members Elements of organizational structure Vertical structure-establishes hierarchy and uses centralized decision making. this is the type of structure found in bureaucratic organization with staff reporting up the line through the organization.

Horizontal structure-departmentalization related to functions that uses decentralized decision making . typically, a horizontal organization uses a structure organized around customer18

oriented process eliminates functional departments and spreads functional specialist throughout the key process teams. Line of authority / chain of command- It is a traditional approach to authority in organization. Description identifies to whom each staff member reports appropriate through the chain of command. For example, in line staff nurse would report to the nurse manager the nurse manager to the director of the service the director of the service to the nurse executive the executive to the chief executive officer Staff authority-staff who functions in an advisory capacity and cannot force other stuff to do something but must use influence to make an impact. This can be a difficult question but it has become more common. Staff authority is less clear because this relationship is advisory An example is the director of nursing education in a hospital typically has no line authority over the next manager but rather staff relationship. director can suggest and advise nurse manager to initiate set an educational program but cannot direct nurse managers to do this. Key skills for success in this type of position are effective communication, negotiation and building collaborative relationship Span of control-number of people supervised by one person or position. Span of control answer the questions of how many stock report to one manager. Centralized and decentralized organizational structuresCentralized approach focuses toss and authority in one source Decentralized spread task and authority out over components of organization. For example how is staff education organized in hospital , in a centralized approach there is a staff development department that is responsible for staff orientation and education throughout the hospital , where as in a de-centralized approach gives this responsibility to the division of the units Departmentalization-functional departmentalization focuses on grouping related jobs while territorial departmentalization focuses on grouping jobs according to location within the organization. Occurs when divided task are grouped An example of functional departmentalization which is common in healthcare organization is the department of surgery which might include pre-operative area operating rooms and post anesthesia care unit. Another example of Service Department composed of labor and delivery postpartum nurseries and neonatal intensive care unit. Matrix organization- structure attempt to balance functional and service or product organisation.staff belong to a functional department, such as nursing department and to 19

service or product department such as women's health.

Dual authority is a part of this type of structure as staff report to to managerial system.it facilitates efficient use of resources and allows for more flexibility during times of change with more timely response and interchange of information vertically and horizontally and it encourages greater interdisciplinary interaction and innovation and improve motivation and commitment as staff have no responsibility for decision making and eat freeze managers for greater opportunity to enhance planning. PROCESS Organizational process the second critical descriptor of an organization. focuses on how the organization operates? Organization’s vision, mission statement and goals and objectives should be included in a review of an organization’s process A vision is important in describing the organizations belief and values in organizational philosophy answer the question of ‘’why’’ for an organization. Goals and Objectives identify how the organization plans to meet its Vision and mission an organization’s mission statement is a brief concise expression of a company's organizations fundamental purpose and goals The other important elements of the process include Decision making-Decisions on made frequently in all healthcare organization decision about patient care how they will be done how the organization will run and about the future of the organization. Decision making is a critical element of the organization process Delegation - Decisions should be made close to the task or activity as possible which has made delegation even more important in today's healthcare organization.it is important to remember

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that delegation does not relinquish the person who is delegating from the responsibility over the task. Coordination - This needs to be a clear framework of responsibility the reporting relationship groups of common production functions and mechanism to link and co-ordinate all the elements. Coordination is the process by which the parts of a process of synchronized to work together Communication - Without communication nothing will get done in an organization in fact no one would know what to do without communication Evaluation - Evaluation of the organization’s performance and that of the individual staff performance assist organization intimating its needs in the planning process so that goals and objectives can be met. All processes are evaluated in some form whether it be a formal revelation of staff concluding that some action was successful on an informal basis an informal basis MINIMUM REQUIREMENTS FOR ORGANISATION OF NURSING CARE The basic requirements for organization of nursing care includes 1) Integration of Vision and mission into organizational structure The Vision and mission statements are the driving force behind alteration or should be provide critical information about the organization’s values and philosophy.it is also important to remember that many organizations have beautifully written Vision and mission statements and yet never really make them come alive. When an organization is an list the important issue is whether or not the Vision and mission match what the organization and its staffs actually do 2) Description of corporate culture and historical determinants The culture of health care organization and its history have a major impact on the way that staff in track communicate work as teams and field awarded and organized or feel neglected. It also affects organization outcomes. Community in which the organization must survive also affects the organizations culture 3) Structural design of the organization (hierarchy or scalar Principle) Nursing organization has any other organization is like a pyramid broad at the base and tapering towards the top Hierarchy consists in the universal application of superior subordinate relationship through a number of level of responsibility reaching from top to the bottom of the structure.It is also known as scalar process.it means that rule or control of higher is over the lower. It also means graded organization of several successive steps in which each of lower level is immediately subordinate to the next higher one and show right up to the top hence authority command and control design from top to bottom. The person has to go from up to down or down to up without skipping the intermediate level through proper channel 21

It was also illustrated as Fayaz gave the concept of gang plank, it shows that if F wants to communicate with K Usually the message will flow from F to A via E ,D, C ,B and from A it will come down to K through G H I J, but if it is essential to communicate immediately a gangplank ( dotted line ) may be created between F and K without weakening the chain

Organization structure where is and structure effects how organization communicates work together solve problems or do not solve problems which represents the organizations process. The structure of healthcare organization is changing and some of the efforts of resulting in positive outcomes An organizational structure is defined as “a system used to define a hierarchy within an organization. It identifies each job, its function and where it reports to within the organization.” A structure is then developed to establish how the organization operates to execute its goals. There are many types of organizational structures. There’s the more traditional functional structure, the divisional structure, the matrix structure and the flatarchy structure. Each organizational structure comes with different advantages and disadvantages and may only work for companies or organizations in certain situations or at certain points in their life cycles. Types of Organizational Structures Functional structure The functional structure is based on an organization being divided up into smaller groups with specific tasks or roles. For example, a company could have a group working in information technology, another in marketing and another in finance. An advantage of this structure is employees are grouped by skill set and function, allowing them to focus their collective energies on executing their roles as a department.

One of the challenges this structure presents is a lack of inter-departmental communication, with most issues and discussions taking place at the managerial level among 22

individual departments. For example, one department working with another on a project may have different expectations or details for its specific job, which could lead to issues down the road. In addition, with groups paired by job function, there’s the possibility employees can develop “tunnel vision” — seeing the company solely through the lens of the employee’s job function. Service line structures in service line structures sometimes called as product lines the functions necessary to produce a specific service or product or brought together into an integrated organization unit under the control of a single manager or executive for example, a cardiology service line at an acute care Hospital might include all professional technical and support personnel providing services to the cardiac patient population

the benefits of service line approach to organizational structure include coordination of service, expected decision making process and the clarity of purpose.

23

the limitations of this model can include increase expense associated with the location of service , loss of professional or technical affiliation and lack of standardization. Matrix structures Matrix structures are complex and design to reflect both function and service in an integrated organizational structure. in matrix organization the manager of a unit responsible for service reports to both the functional manager and service or product line manager for example, a director of pediatric nursing could report to both our vice president off periodic services service line manager and vice President of nursing the functional manager. Geometric structure combines both about bureaucratic section under flag structure teams are used to carry out specific program for projects

Matrix structure superimposes horizontal program management over the traditional vertical hierarchy, this creates an interdisciplinary team. Service line manager and product manager must function collaboratively in a matrix organization. for example, in asking that may be a chief nursing executive and ask manager and staff nurses in the line of authority to accomplish nursing care 24

Flat structure the primary organizational characteristics of a flat sector is the delegation of decision making to the professionals doing the work. The term flat signifies the removal of hierarchical layers thereby granting authority to act and placing authorities act at the action level.

In flat organizational structure of decentralization making replaces the centralization making typical of functional structures. Providing staff with authority to make decisions at the place of interaction with patient is the hallmark of a flat organizational structure. Hybrid structure is a one that has characteristics of several different types of structure Shared governance In its simplest form, shared governance is shared decision-making based on the principles of partnership, equity, accountability, and ownership at the point of service. This management process model empowers all members of the healthcare workforce to have a voice in decision-making, thus encouraging diverse and creative input that will help advance the business and healthcare missions of the organization. This feeling leads to • longevity of employment • increased employee satisfaction • better safety and healthcare • greater patient satisfaction • shorter lengths of stay Characteristics of shared governance-

25

Four principles of shared governance • Partnership——links healthcare providers and patients along all points in the system; a collaborative relationship among all stakeholders and nursing required for professional empowerment. Partnership is essential to building relationships, involves all staff members in decisions and processes, implies that each member has a key role in fulfilling the mission and purpose of the organization, and is critical to the healthcare system’s effectiveness (Porter-O’Grady and Hinshaw 2005; Batson 2004). • Equity——the best method for integrating staff roles and relationships into structures and processes to achieve positive patient outcomes. Equity maintains a focus on services, patients, and staff; is the foundation and measure of value; and says that no one role is more important than any other. Although equity does not equal equality in terms of scope of practice, knowledge, authority, or responsibility, it does mean that each team member is essential to providing safe and effective care (Porter-O’Grady and Hinshaw 2005; Batson 2004; Porter-O’Grady, Hawkins, and Parker 1997). • Accountability——a willingness to invest in decision-making and express ownership in those decisions. Accountability is the core of shared governance. It is often used interchangeably with responsibility and allows for evaluation of role performance. It supports partnerships and is secured as staff produce positive outcomes (PorterO’Grady and Hinshaw 2005; Batson 2004). • Ownership——recognition and acceptance of the importance of everyone’s work and of the fact that an organization’s success is bound to how well individual staff members perform their jobs. To enable all team members to participate, ownership designates where work is done and by whom. It requires all staff members to commit to contributing something, to own what they contribute, and to participate in devising purposes for the work (Porter-O’Grady and Hinshaw 2005; Batson 2004; Koloroutis 2004; Page 2004). Shared governance activities may include participatory scheduling, joint staffing decisions, and/or shared unit responsibilities (e.g., every RN is trained to be “in charge” of his or her unit or area and shares that role with other professional team members, perhaps on a rotating schedule) to achieve the best patient care outcomes. 4) Unity of command ( Decision making patterns) It means that the employee should get the orders from one superior only as mentioned above various diversity of command leads to conflict, confusion and blurring.  The nursing administrator receive orders from Medical personnel in charge of their Hospital.  The supervisor receives from nursing administrator and also their receive instructions related to patient care from Medical personnel of their respective departments.  The operation level nurses report and receive orders from nursing administrator as well as from nursing supervisor and medical personnel regarding patient care. 26

How does the organization handle decision making? this can be highly variable from one organization to another and even within an organization. Each organizational leader has greater skill in this area than other leaders. All organization’s need improvement in decision making.  Do staff feel that decision are handled well is there staff input?  Is shared governance used and how effective is it?  What is the response of accountability? How empowered are the staffs? 5) Span of control The span of management and of control of span of supervision or used to denote the same concert that the number of subordinates and officer or superior can effectively supervise. It is span of attention applied to the work of supervision It can be direct single relationship( contacts of Suprior with subordinates) , direct group relationship(between supervisor and subordinates in all possible combinations) , gross relationship ( mutual interaction of subordinates working under common supervisor) Factors affecting span of control     

capacity of supervisor characteristics of subordinates natural work number of assistants degree of decentralization

The Nurse-patient Ratio as per the norms of TNAI and INC (The Indian Nursing Council, 1985) The norms are based on Hospital Beds.      

Chief Nursing Officer :1 per 500 beds Nursing Superintendent :1 per 400 beds or above D.NS. :1 per 300 beds and 1 additional for evcry 200 beds A.N.S. :1 for 100-150 beds or 3-4 wards Ward Sister :1 for 25-30 beds or one ward. 30% leave reserve Staff Nurse :1 for 3 beds in Teaching Hospital in general ward& 1 for 5 beds in Non-teaching Hospital +30% Leave reserve  Extra Nursing staff to be provided for departmental research function.  For OPD and Emergency :1 staff nurse for 100 patients (1 : 100 ) + 30% leave reserve  For Intensive Care unit: (I.C.U.)- 1:l or (1:3 for each shift ) +30% leave reserve. It is suggested that for 250 beded hospital there should be One Infection Control Nurse (ICN). 6) Division of labor and specialization Division of labor and specialization means that rather than an entire job being done by online digital it is broken down into a number of steps. Each step being completed by a separate 27

individual or breaking down the total work into simpler and repetitive tasks.the groups and individual should be allowed to specialise in their specific field so that one can become more efficient and confident in their work. For managerial functions in nursing management     

The nursing personal management Material management Equipment and supply management For supervisor activities For nursing care

7) Authority Authority defined as the power to make decisions which guide the action of another.it is a relationship between two individual one superior and another subordinate. The superior frame and transmits the decision with the expectation that this will be accepted by the subordinates. The subordinate executes the function and his or her contact is determined by them. Features of authority  authority is denoted as right vested due to position.  Gives right of decision making.  the right of giving order is legitimate Types of authority- Formal authority - this type of authority is held by the administrator due to his or her question in the organization and that is achieved by delegation from higher position Informal authority type of authority is either due to accidents by the subordinates maybe for his or her personal quality are due to technical competence or leadership qualities of a person 8) Delegation of authority It is one of the most important factors in the process of organizing as well as in formal organization. It refers to the authorization of a person to make certain decision Delegation refers to a manager's ability to share his board and with others. it consists in granting authority for right to decision making in certain defined areas and charging subordinates with responsibility of carrying through in the assigned task. Elements of delegation assignment of work  

Grand of authority Creation of accountability

9) Responsibility Responsibility is the duty to which a person is bound by reason office status for task. It is an obligation of an individual to carry out assigned activities to the best of his ability. 28

It refers to execution of duties associated with a particular role. Delegation of responsibility in nursing services responsibilities in hospital nursing services are categorised into two broad headings administrative and supervisory The activities related to administration or carried out by nursing administrator and supervisory activities by middle level nursing administrator designated as nursing sisters or ward sisters. JOB DESCRIPTION OF VARIOUS CADRES IN NURSING SERVISES IN AIIMS, NEW DELHICNO (CHIEF NURSING OFFICER) 1. She/he will be responsible for efficient running of Nursing Services of the Main hospital and various centres of AIIMS. 2. Services.

She will assist the Director in formulating broad policies concerning Nursing

3. She will disseminate the AIM, objectives and policies regarding patient care to all cadres of nursing services. 4. services.

She will implement policies and procedures of Institute regarding nursing

5. She/he will plan future requirements of nurses and carry out recruitment of nurses from time to time. 6. She/he will plan and disseminate programmes for continuing education reorientation programmes for nurses. 7. patient care.

She/he will closely interact with other hospitals regarding improvement of

8.

She/he will encourage research by nurses in their work areas.

9.

She/he will guide and conunsel the sub-ordinate nursing staff.

10. She/he will keep herself abreast of latest happenings in nursing care by attending National / International conferences. 11. She will strive to implement standard nursing practices and maintain highest quality of care. 12. She will critically analyse the budgets for nursing services from Main hospital and various centers before being forwarded to Director. 13. Evaluate confidential reports of higher level nursing officers and recommend for promotion. 29

14. the centres.

She will be assisted in her duties by nursing Supdt.’s, of Main Hospital and from

15. hospital.

She will keep the Director informed about the happening concerning the

Nursing Superintendent is responsible to the C.N.O. for planning organisation and development of nursing services in the hospital in consultation with Medical Supdt./Chief of centres. 1. She will be responsible and overall In-charge of Nursing Services in a hospital or specialized centres irrespective of the number of beds. 2. She will be responsible to the Medical Supdt. or Addl. MS or chief of Centres of the hospital or centre as the case may be. 3. She will be responsible for implementing hospital/centre policies amongst various nursing units. 4. She will assist the CNO in formulation of hospital policy, particularly concerning nursing services. 5. She will officiate as CNO in the absence of CNO (The senior most amongst the NS will do so). 6. She will recommend personnel and material requirement for nursing various nursing service departments of the hospital. 7.

She will assist MS/Addl. MS or Chief of Centres in recruiting nursing staff.

8.

She will carry out regular rounds of the hospital.

9.

She will accompany MS/Addl. MS while making hospital rounds.

10.

She will ensure safe and efficient care rendered to patients in various wards etc.

11.

She will prepare budgets for nursing services.

12. She will be a member of various condemnation boards for linen and other hospital stores. 13.

She will be responsible for counselling and guidance of sub-ordinate staff.

14.

She will attend hospital/intra hospital meetings and conferences.

15. She will investigate all complaints regarding nursing care and personnel, and take suitable corrective action. 16.

She will initiate and encourage research in nursing services.

17. She will evaluate confidential reports of her sub-ordinate staff and recommend for promotion, higher studies etc. 18.

She will maintain cordial relations with patients and Medical Social workers. 30

19.

She will periodically interact with clinical heads to discuss problems in patient

care. 20. She will educate nursing staff of all categories by conducting awareness programme on universal Precautions. DEPUTY NURSING SUPERINTENDENT Deputy Nursing Superintendent is responsible to the Nursing Supdt. and assist her in the administration of nursing services in the hospital. A.

NURSING ADMINISTRATION:

1. Supervise the nursing care given to the patients in various departments by taking regular round of her area. 2. hospital.

Act as a liasion officer between Nursing Supdt. and the nursing staff of the

3. Interpret the policies and procedures of the Nursing service department to suboradinate staff and others. 4.

Attend the emergency calls concerning nursing services or hostel problems.

5. Receive Supdt./Supervisors.

evening

and

night

reports

from

the

Assistant

Nursing

6.

Keep records and reports of Nursing Services.

7.

Maintain the records of attendance of nursing staff and leave of any kind.

8.

Conduct regular physical verification of hospital stocks, i.e. drugs, equipment

etc. 9. Initiate equipment/linen etc.

procedure

for

condemnation

and

procurement

of

hospital

10.

Maintain the confidential report and records of nursing personnel.

11.

Assist the nursing supdt. in making master duty roster of nursing personnel.

12.

Assist the nursing superintendent in Recruitment of nursing staff.

13. hospital.

Assist the nursing supdt. on planning and organising nursing services in the

14.

Officiate in the absence of nursing supdt.

15.

Attend the official meetings.

16. the wards.

Keep the senior nursing Officials (CNO & NS) informed of the happenings in

31

ASSISTANT NURSING SUPERINTENDENT Asstt. Nursing Supdt, is responsible to Deputy Nursing Supdt. for the total nursing care of patients, management and development of the unit assigned to her: A.

NURSING CARE:-

1.

Assist the total needs of patients in the unit and prepare planned nursing care.

2.

Demonstrate and Supervise the nursing care of patients in the unit.

3.

Attend regular round in the unit with the medical and nursing personnel.

4.

Reviewing reports from Sr. Gr. I regarding the nursing care of patients in each

5.

Give counseling and health education to the patients and their attendants.

B.

WARD MANAGEMENT:-

1.

Plan and arrange duty for nursing personnel posted under her.

2.

To ensure availability of adequate nursing staff in all shifts.

3.

Maintain cleanliness of unit its annexes and environment.

4.

Interact with the engineering service department for proper up keep of the unit.

shifts.

5. Keeping Deputy Nursing Supdt., Nursing Supdt. informed of the needs of the patient care areas and bring it to their notice any special problems. 6. Guide the Sister Grade-I to ensure supplies and equipment of different stores, and re-checking their use and care. 7. Daily check of emergency and dangerous drugs, life saving equipment i.e. monitors, ventilators, defibrillators, suction machines and O2 points etc., to ensure their proper functioning. 8.

Periodical check of all stocks and supplies.

9. Maintain good inter-personnel relationship with all categories of staff, patients and their relatives. 10. Maintain good public relation with patients relatives and the public, and project positive image of the hospital. 11.

Maintain disciple of nursing and domestic staff.

12.

Interpretation of Hospital policies, rules and regulations.

13.

Daily check of attendance and reporting the lapses.

14.

Investigate complaints if any.

15.

Work evaluation and confidential reports. 32

16.

Guidance and counselling of nursing staff in the unit.

17.

Project the annual requirements of drugs supplies and equipment’s for the units.

18.

Take care of legal aspects and report about the medico legal cases in the ward.

C.

TEACHING AND SUPERVISION:

1. Plan and implement a proper orientation programme for new nursing staff, student nurse and domestic staff. 2. meetings.

Participate in In-service education of nursing personnel and attend the

3. Give incidental and planned teaching to nursing personnel in the unit, as well as domestic staff. 4. Participate in clinical teaching for student nurses in Co-operation with the nursing tutor. 5.

Perform any other duties assigned to her for time to time.

SENIOR NURSING OFFCIER (NURSING SISTER GRADE-I) The Nursing Sister Grade-I is responsible to the Assistant Nursing Superintendent or the total care of patients in the wards and supervision of the Nursing Sister Grade-II, student nurses and Domestic staff. She would also be assisted by Nursing Sister Grade-II, Clinical and Domestic staff. The main aim of the sister Grade-I should be to foster team spirit in her area of works as a team leader. A.

NURSING CARE OF PATIENTS:

1.

Assess the total needs of patients and prepare plan of nursing care.

2.

Admission and discharge of patients.

3. Demonstrate and carry out efficient nursing care, taking care of personal comfort and toilet of patients, administration of drugs and treatment, observation and recording of vital parameters. 4.

Supervise patients diet.

5.

Attending rounds with Medical/Nursing personnel.

6.

Assist Medical staff in examination of patients and treatment.

7.

Participate and help with clinical investigations/procedures.

8.

Demonstrate and carry out preoperative and post-operative care of patients.

9.

Maintenance of patient’s records.

10.

Care of patient’s personal effects in accordance with hospital rules.

11.

Giving and receiving reports. 33

12.

Follow prescribed rules in case of accident or death of a patient.

13.

Give information and health education to patients and their attendants.

14. the ward.

Intimation to nursing supervisors of any emergency or unusual occurrence in

B.

WARD MANAGEMENT:

1.

Handing over and takeover charge of patients at the end of the shift.

2.

Assignment of work to nursing sister grade-II and domestic staff.

3. Co-ordinate and facilitate work of other staff, e.g. physical therapist, social worker, dietitian, voluntary worker etc. 4. Maintaining good inter personal relationship among all categories of staff and with patients and their relatives. 5. Maintain cleanliness of ward, its annexes and environments. Proper upkeep and repairs of linen and ward equipment. 6.

Make indents for drugs, surgical supplies, stores and issue.

7.

Keep custody of dangerous drugs and record of their administration.

8.

Daily check of emergency drugs and life savings equipment’s.

9.

Maintenance of stock registers, inventories.

10.

Investigate complaints if any.

NURSING OFFCIER (NURSING SISTER GRADE-II) Nursing sister grade-II is directly responsible to Nursing Sister Grade-I (Ward InCharge) for total nursing care of the patient assigned to him/her. A.

DIRECT PATIENT’S CARE:

1.

Admission and discharge of the patients.

2. To maintain the personal hygiene of the patients, including bathing, care of mouth, back, nails, hair etc. 3. 4. Urinals.

Care of pressures points as needed. To assist the patient in elimination, offering and removing the bed pans and

5.

Bed making.

6.

Assist in feeding the weak and debilitated patients.

7.

Writing of diet sheet, Supervision and distribution of diets.

8.

Assist in physiotherapy, ambulation and rehabilitation. 34

9.

Carry-out patient’s teaching and demonstration according to the need.

10.

Counselling the patients, and relatives.

11.

Care of the dying and dead.

12.

Administration of Medicines and Injections to the patients.

13.

Assist in administration of intravenous injections, infusion and Transfusion.

14. pressure.

Observing, recording and reporting of vital signs e.g. T.P.R. and Blood

15. Carry out technical procedures, such as Naso-gastric intubation, Gastric Gavage and Lavage, Oxygen Therapy, Dressing and Irrigation, Enema, Catheterization hot and cold applications, suction etc. 16.

Collecting, labelling and dispatch of specimens.

17.

Preparation for and assistance in clinical tests and medical/surgical procedures.

18.

Urine testing for sugar, and albumin.

19.

Observation, recording and reporting of all procedures and tests.

20.

Escorting serious patients to and from the department/wards for investigations.

B.

WARD MANAGEMENT:

1.

Handing over and taking over charge of patients, and ward inventory in each

2.

Maintenance of therapeutic environment in the ward.

3.

Keeping the ward clean and tidy.

4.

Routine care and cleaning of dressing trolleys, cupboards apparatus, mackintosh

5.

Care of clean and soiled linen.

6.

Disinfection of linen, beds, floor and bed pans, and fumigation of rooms etc.

7.

Preparation of room, trolleys, and sets for procedures.

8.

Preparation of surgical supplies.

shift.

etc.

9. members.

Maintaining interpersonal relationship with patients, relatives and health team

10.

Orientation of new staff/students.

11.

Demonstration and guidance to student nurses.

12.

Participation in staff education and staff meetings. 35

13.

Participation in professional activities.

14.

Demonstration and supervision of domestic staff.

15. Report about the medico-legal cases if any admitted in the ward. To keep the senior nursing officials informed of the happenings / in the ward like fire, absconding patients, theft etc. 16.

Any other duty that may be assigned by sister grade-I from time to time.

10) accountability Accountability is a liability of of reckoning of responsibilities received by delegation of authority authorities right to hack responsibilities application to carry out delegated authority accountability establishes reliability for proper discharge of the duties delegated to the subordinate Features of accountability   

Accountability cannot be delegated accountability of supervisors for the acts of their subordinates is absolute Account accountability always moves upwards in the hierarchy

Accountability of nursing personnel in hospital 

For material accountability of the use of Lenin drugs and loss or breakage of equipments in hospital is wasted on supervisors and operational level nurses and about 39-100 % of nursing supervisors affirmed of this accountability for nursing care in most of the hospitals on nursing sisters and operational level nurses aur accountable for rendering patient care



Accountability      

Responsibility      

Defined by outcomes Self-described Embedded in roles Dependent on partnerships Shares evaluation Contributions-driven value

Defined by functions Delegated Specific tasks/routines dictated Isolative Supervisor evaluation Tasks-driven value

11) Centralization In management centralization refers to concentration of authority for consolidating decision making in one coordinating head . This term is used to do various connotations. It is to be a process where the concentration of decision making is in few hands.

36

Advantages  It helps in reducing wastage of efforts by avoiding duplication ,  It provides opportunity to exercise power and leadership skills to manage the organisation by the top management.  quick decisions can be taken  the emergency situation can be handled within no time and easily  Business communication and control easy Limitation of centralization    

Highly centralized organization or slow in adapting to change lack of initiative by lower-level nurses Lack of motivation Model on top-level nurse administration

12) Decentralization Decentralization refers to delegation of decision making to subordinate units. It refers to dispersion of authority. It is the tendency to discuss decision making authorities in an organization structure, to know whether it should be contracted or dispersed in the organization It is a systematic effort to delegate to the lowest level of authority except that which can be control and exercise at Central points.it is concerned with the placement of authority with reference to responsibility Implications of decentralization    

There is less burden on top administrator Subordinate get a chance to decide and act independently Diversification of activities can place effectively Operations can be coordinated at divisional level

37

5) Planning process— Skills for planning are needed, and planning should address a time frame, responsibility for conducting the activities, the availability and use of human resources, management of workflow, and financial resources. 6) Implementation— Implementation requires that a number of issues must be addressed by the management staff. These include management of projects and activities, directing resources to accomplish plans, and assuring that timelines are met and goals achieved. 7) Monitoring— As components of the quality management system are put in place, processes for monitoring will be needed to assure that the system is working, that benchmarks and standards are being met. This element is essential to the primary goal of a quality system, which is continuous improvement. 8) Communication pattern Communication runs an organisation. ❖ ❖ ❖ ❖ ❖ ❖ ❖

How is communication conducted ? who communicates with whom? What are the formal and informal aspects? How successful is communication? How to how is technology is used? Do staff feel they are listened , do when they speak up? How can it be improved? How are interdisciplinary, inter departmental, inter departmental communication described? ❖ How have the communication patterns affected the change process? ❖ how does the healthcare organization communicate with the community and with other healthcare organization? 9) Alignment of goals across subsystem Integrative systems and multi organizations are more common organization success today subsystems whether they be subsystems of a multi organization with multiple entities for the subsystem of an organization must be aligned? If goals of a subsystem or not in alignment with overall organizational goals , there will be conflict and it will be difficult to determine organizations outcome. All the subsystem must convince the overall organization that this change is appropriate. 10) Incorporation of quality and safety as a value There is no doubt that quality and safety or critical issues today in healthcare. All health care organization or involved in quality improvement however some are much more successful than others. 38

In analyzing an organization ,in quality improvement of what need to be assessed.When and organizations quality and safety assessed , we can be learn about the organizations vision, mission, goals and objectives, structure and process communication, decision making ,utilization of resources and what is really important to the organization. ❖ Is the organization using evidence-based practice? ❖ The key questions is what are its outcome? 11) Utilization of human resources Clearly utilization of human resources critical. today some organization or just sitting around worrying about the number of empty questions but others are quite active in trying to find creative Solutions. understanding human resources needs and planning to meet them is a daily organizational concern. 12) Effective financial and information infrastructure planning Nice organization for analyst consideration must be given to their financial status and effective financial planning. Outcomes are always tied to financial issues and cannot be ignored. All healthcare organizations and the providers of cycling which is a reimbursement issues and how those issues affect practice. 13) Information management Information within the organization is also a critical component. ❖ what information is available? who has it collected? is it reliable or valid? ❖ how is the information used? how has the technology impacted the collection and use of the information? ❖ is the organization in compliance with legal requirement? 14) Organizational responsiveness to change Organization that cannot change effectively will struggle and many will disappear. change cannot be avoided. show the best approach is to learn, how to effectively adopt, making sound decisions based on sound evidence and data. Healthcare organization are at different stages of development in how they respond to change? Analyzing an organization should include and assessment of the organization’s response to change. Leaders have a major impact on the organizations ability to change effectively 15) Organizational readiness for the multicultural world Providers are caring for the patients from many different cultures and this affects their care.Staff who come from many different cultures or more common on this impacts the organizational communication staff relationship problem solving and decision making and moral.

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16) Effective leadership Effective leadership is critical to the success of any organization. Master of organization or analyst it's leader should be identified and assessed. What is the leadership style? Does the leadership provide what is needed to help the organization succeed? 17) Assessment of future organizational challenges and opportunities Future should be considered for an organization. ❖ Is the organization preparing for the future? ❖ Does it have a strategic plan? What is included in the plan? ❖ is the plan reasonable? what is the process of the organization uses to cope with the future organizational challenges and opportunities? ❖ Are the challenges or opportunities identified? CONCLUSION The Nursing Services Delivery through above organization gives a relational structure for reconciling disparate streams of research related to nursing work, staffing, and work environments. The organization theory can guide future research and the management of nursing services in large-scale healthcare organizations. Bibliography❖ Davar. R.S. Personal management and industrial relations, Vikas publishing home, New Delhi 2007. ❖ Fisher,M.(1996).redesigning the nursing organization.Albany,NY:Delmar Publishers ❖ Grohar- Murray, M.,&dICroce,H.(2003).Leadership and mangement in nursing(3rd edtion).Upper saddle River:Prentice Hall ❖ Patricia. S Yoder Wise, Leading and managing in nursing, Fifth edition, Elsevier LLC WA publications ,2010 ❖ TNAI, Nursing Administration and Management, TNAI, New Delhi, 2000 .

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