MANAGEMENT PROCESS

PLANNING

Planning is the first step in the management process. It is one of the

fundamental elements of administration. Planning is thinking ahead of time or
well in advance with regards to what needs to be done in an organised way to
minimise the confusions in carrying out future actions.

Meaning

• Planning is deciding in advance what to do, how to do it, when to do it

and who to do it.
• Planning is preparing a blue print
• Planning is the predetermined course of action

Definition

• Planning is defined as pre-determining a course of action in order to

achieve a designed result.

Venson
• Planning is a process of determining the objectives of administrative
efforts and devising the means calculated to achieve them.
Millet
• Planning means determination of what to be done, how and where it is be
done, who is to do it and how results are to be evaluated. Planning
bridges the gap between where we are where we want to go.

James Lundy
• Planning is a continuous process of making present entrepreneurial
decisions systematically and with the best possible knowledge of their
futurity, organising systematically the efforts needed to carry out these
decisions and measuring the results of these decisions against expectation
through organised systematic feedback.
Peter
Drucker

Nature of planning
 i. Goal oriented: Planning must contribute to the achievement of pre-set
goals. Well defined goals are essential for efficient planning.
ii. Primary function: It is the basis or foundation of management process.
All other functions are designed to attain the goals set under planning.
iii. Pervasive: Planning is the function of each and every manger irrespective
of the level and area of his/her operation. Planning is essential at all levels
from top to bottom. But the nature may vary according to the level of
management.
iv. Intellectual or rational process: Planning is a mental exercise involving
imagination, foresight and sound judgement. It is not guesswork or
wishful thinking.
v. Continuous process: It is an ongoing and dynamic exercise. As the
assumptions and events on which plans are based change, old plans have
to be revised or new ones have to be prepared.
vi. Forward looking: All planning is done with an eye on the future. Planning
involves anticipating the future course of events. Therefore forecasting is
the essence of planning. Forecasting involves assessing the uncertain
future and making provisions for it.
vii. Involves choices: Planning is essentially decision making or choosing
among alternative courses of action. A planning problem arises only
when an alternative course of action is discovered.
viii. Integrated process: Planning is a structured process and different plans
constitute a hierarchy. Different plans are interdependent and interrelated.
Every lower level plan serves as a means towards the end of higher plans.
ix. Directed towards efficiency: Planning has no relevance if it does not
facilitate the achievement of objectives economically and efficiently. It is
a deliberate and continuous process. The efficiency of plans is measured
by how much they contribute to the objectives economically and
efficiently.

Principles of planning

1. Contribution to objectives: Every major and derivative plan should

contribute positively towards the accomplishment of enterprise
objectives.
2. Efficiency of plans: The efficiency of plan is measured by the amount it
contributes to the objectives minus the costs and other undesirable
consequences involved in the formulation and operation of plans. This
 principle stress upon economical use of individual effort to achieve group
goals.
3. Primacy of planning: This principle emphasis that a manager can hardly
perform other managerial function without a road map of plans to guide
him.
4. Planning premises: Perhaps the main deficiency of planning arises from
poorly structured plans. A coordinated structure of plans can be
developed only when managers throughout the organisation understand
and agree to utilise a consistent planning premises.
5. Policy framework: A consistent and effective framework of enterprise
plans can be developed if the basic policies that guide thinking in
decisions are expressed clearly and understood by managers who prepare
the plans.
6. Timing: When the plans are structured to provide an appropriately
limited, intermeshed network of derivative and supporting programmes,
the plan can contribute effectively and efficiently toward attainment of
enterprise objectives. Both premises and policies are useless without
proper timing.
7. Alternatives: In choosing from among alternatives the best alternative
will be that which contributes most efficiently to the accomplishment of a
desired goal. This will help in selecting the most favourable alternative.
8. Commitment: Logical planning should cover a time period necessary to
forecast the fulfilment of the commitment involved in a decision. This is
necessary to make reasonably sure that commitments are met.
9. Limiting factor: While choosing from among the alternatives, the planner
should focus on those factors which are critical to the attainment of the
desired goal. This will help in selecting the most favourable alternative.
10.Flexibility: This principle deals with the ability to change what is built
into the plans and reduce the risk of loss due to unexpected events.
However the cost of flexibility should be weighed against the dangers of
future commitments made.
11.Navigational change: The manager should periodically check on events
and expectations and redraw plans to maintain a course towards the
desired goals. Unless plans have inbuilt flexibility, navigational change is
difficult or costly. But in built flexibility should not be an excuse to
refrain from periodic revision of plans, if circumstances so warrant.
12.Competitive strategies: While formulating plans a manager should take
into account the plans of rivals or competitors. The plans should be
chosen in the light of what a competitor will do in the same situation.
Planning Process
Main steps in the planning process are as follows:
 I. Identify goals: Objectives must be stated clearly and in measurable terms.
Objectives should laid down after an analysis of external and internal
environment of the organisation.
II. Developing planning premises: Planning is done for future which is
uncertain. Therefore certain assumptions are made about the future
environment. These assumptions are known as planning premises. In
order to develop good planning premises, it is necessary to collect data on
the current status of the organisation and to forecast future changes.
III. Determining alternative courses of action: Alternative courses of action
should be determined. This requires imaginations, foresight. In
determining alternatives, the critical or limiting factor must be kept in
view.
IV. Evaluate the alternatives: Once alternative courses of action have been
determined, they must be evaluated. Alternative courses of action can be
evaluated against the costs, risks, benefits and organisational facilities.
Strong and weak points of each alternative should be analysed carefully.
V. Select a course of action: This is the point of decision where a plan is
adopted for accomplishing identified goals
VI. Formulate derivative plans: Final step in the planning process is to
develop derivative plans. Once a choice is made and the master plan is
adopted functional and tactical plans and action programmes are decided.
The breakup of the master plan into departmental and sectional plans
provides a realistic picture of the actions to be taken in future.

Identify goals

Developing planning premises

Determining alternative courses of action

Evaluate the alternatives

Select a course of action

Formulate derivative plans

Types of planning
Classified based on

1. Time : Long term and Short term

• Long term- involves more than one year period, usually three to five
years.
• Short term (tactile planning)- usually covers one year. The short term
planning is made with reference to long term plans as short term plans
contribute to long term plans

2. Approach used: Proactive and Reactive planning

• Proactive planning- is planning in anticipation. The suitable course of
action are designed considering the changes expected in the relevant
environment.
• Reactive planning- is the type of planning that is done after the
environment changes have taken place. This approach of planning is
suitable in environment which is fairly stable over a long period of
time.
3. Degree of Formalisation: Formal and Informal Planning
• Formal planning- is based on systematic evaluation of
environmental variables and is in the form of well structured and
systematic process where different steps are taken for planning.
• Informal Planning- is usually based on managers own experiences
or intuitions.

4. Managerial levels: Strategic plans, operational, directional and

administrative plans
• Directional Planning: also called policy planning and is concerned
with the broad general direction of the program.
• Administrative Planning: concerned with the overall implementation
of the policies developed with mobilisation and coordination of the
personnel and material available in the administrative unit.
• Strategic versus operational plan
5. Coverage of activities: Management(corporate) and Functional Planning
• Management (corporate) planning- denotes planning activities at the
top level and it usually covers all the planning activities of the
organisation. The basic focus is to determine the long term
objectives of the organisation as a whole and then generate the
plans.
• Functional Planning- is the segmental and it is taken for each major
function of the organisation, for example for personnel
management, finance etc. It derives from management planning and
should contribute to it.

ORGANIZING

Organising is the basic function of management. It is a process of

determining, grouping and assigning activities of an organisation to achieve
goals.

According to Fayol, to organise is to provide everything for the functioning-

human resources, materials and capital.

Meaning

Term organisation is derived from the word organism which means a

structure of body divided into parts that are held together by a fabric of
relationship as one organic whole.

Organisation is the act of organising or the state of being organised.

The term organisation suggest a functional group working together for

achieving a common purpose/objectives.

Definitions
Organisation involves grouping of activities necessary to accomplish goals
and plans, the assignment of activities appropriate departments and the
provision of authority delegation and coordination.

-Koonts and
O’Donnel

Organizing is the process of defining and grouping the activities of the

enterprise and establishing the authority relationships among them.

-Theo
Haimann

Organizing may be defined as a group of individuals, large or small that is

co-operating under the direction of executive leadership in accomplishment
of certain common object.

-
Keith

A group of people who are cooperating under the direction of leadership for
the accomplishment of a common end.

-R C Davis

An identifiable group of people contributing their efforts towards the

attainment of goal is called an organisation.

-Mc Farland

It is the formal structure of authority through which work subdivisions are

arranged, defined and coordinated for the defined objectives.

-Luther Gullick

Principles of Organisation

Henri Fayol (1947) has defined the principles of organisation as follows:

1. Hierarchy or Scalar chain of command

2. Span of control
3. Delegation of Authority
4. Integration versus Disintegration
5. Centralisation versus Decentralisation
 6. Unity of Command

1. Hierarchy (Scalar chain of command): This principle suggests that there

should be a clear line of authority from top to bottom linking all
managers at all levels. It recognises the necessity of formal authority in
the organisation.
2. Span of control: Means the number of subordinates an officer can
effectively supervise. It is simply the number of subordinates or the units
of work that an administrator can personally direct.
3. Delegation of Authority: Means conferring of specified authority by a
higher authority. Delegation implies transfer of certain specified
functions by the superior to the subordinate authority. The subordinate
authority acts as the agent of superior authority and the superior always
retain the right to issue directions to revise decisions.
4. Integration versus Disintegration: Integration means unification in
administrative language, integration means connecting one or more of
independent organisation with the rest of the organisational structure of
the country by placing them under the executive directly or through some
department.
Disintegration means number of independent establishments and the line
of authority from the executive stops and it is broken
Integrated administration facilitates coordination and disintegrated
administration creates anarchy and conflict.
5. Centralisation versus Decentralisation: Centralisation stands for
concentration of authority at or near the top. An organisation is said to be
centralised if most of the power of decision is vested in the top level so
that the lower ones have to refer most problem to the head of organisation
for decision.
Decentralisation means that the central authority gives certain power to
the local authorities. A decentralised organisation is one in which the
lower levels are allowed the discretion to decide most of the matters
which come up, reserving comparatively a few bigger and more
important problems only for those higher up.
6. Unity of Command: Means that no individual employee should be
subjected to the orders of more than one immediate superior. That is, an
employee should receive orders from one superior only.

Organisation Structure
It includes arrangement of organisational activities and assignment of resources
in those activities to achieve goals of organization. It is the way in which the
activities of each department in the organisation are coordinated and integrated
to achieve the organisational objectives. In a good organisational structure each
employee is assigned a responsibility and the activities of the employees in each
department are coordinated and integrated to achieve the organisational goals.

It refers to the formal configuration between an individual and the group with
respect to the allocation to tasks, responsibilities and authority within an
organisation. The formal structure of an organisation is two dimensional-
horizontal and vertical. The horizontal dimension depicts differentiation of the
total organisational job into different departments. The vertical dimension refers
to the hierarchy of authority/relationship with a number of levels from top to
bottom. Authority flows downward along these levels.

Steps in Organisation Structuring

The organisation needs to be structured in such a manner that human and

physical resources are brought to action to achieve the goals and objectives. The
following are some of the steps to build organisational structure.

• Determination, identification and enumeration of activities: After setting

vision, mission, goals and objectives identify the activities required to
achieve these objectives. These activities are again divided in to sub
activities so that each employee knows his role, responsibilities and
relationship with the others.
• Grouping and assigning of activities: All similar activities are grouped
together and the activities are further divided into sub activities as
purchasing, budgeting etc. These group of activities assigned to various
divisions or departments. The departmental heads delegate and distribute
the job to their subordinates.
• Delegation of authority: The persons who are assigned the particular
activity of job are responsible for performing their work in an optimal
manner. So they must be given corresponding authority also.

Benefits of Good Organisational Structure

▪ Achievement of objectives: A good organisational structure facilitates

achievement of objectives.
 ▪ Minimum conflicts: Conflicts between employees are found to be less in
good organisational structure as each employee is assigned a particular
job to perform.
▪ Reduction in duplication of work: Since a good organisational structure
requires that the duties be clearly defined and assigned, duplication of
work is less.
▪ Interpersonal relations and communication: A good organisational
structure facilitates effective communication at all levels of
organizational hierarchy and maintains good interpersonal relations
▪ Effective planning: A well organised organisational structure provides a
sound basis for effective planning. Since the goals are clearly established
and resources are clearly defined, planning becomes more focussed and
realistic.
▪ Increase in cooperation and proper coordination: A good organisational
structure results in increased cooperation and a sense of pride among
members of the organisation.

Forms of organisational structure

I. Line organization: It is the simplest and oldest form of organizational

structure. The line of authority flows vertically from top most executive
to the lowest subordinate throughout the organization. The line of
authority is vertical and workers at the same level perform the same
function. The direction flows from top, transmitted through the managers
to the supervisors and then to the workers and staff.

Advantages of line organization:

❖ Simple to establish and easily understood by employees

❖ There is a clear unity of command and all employees are directly
involved in achieving the objectives.
❖ Facilitates prompt decision making
❖ Economically effective
❖ Ensures better discipline and there is unified control
❖ Provides opportunity for the development of managers as every manager
has to perform a variety of functions.

Disadvantages of line organization:

 Cannot be used for large organisations

  It is rigid
 There is lack of expertise to give advice.
 All decisions come from top level.
 There is inadequate communication from bottom to top.
II. Line and Staff organization: Here there are staff specialists who give
expert advice to line managers to perform their duties. The staff
specialists have the right to recommend but have no authority. This type
of organisational structure is most seen in large organisation. The
combination of line organization with expert staff constitute the lines and
staff organization.

Advantages of lines and staff organizational structure

 There is possibility to receive specialised advice from experts.

 The work load is reduced and managers can utilise enough time for
creative thinking.
 The line and staff organizational structure is highly flexible because new
activities may be introduced without disturbing line authority.
 There is chance for better decision making process.
 The principle of unity of command is followed in line and staff
organizational structure.

Disadvantages

 There is possibility for conflicts between line managers and staff

specialists.
 Line managers sometimes depend too much on staff experts.
 Staff specialists have no authority.
 There is chance of role confusion among staff and line officers.
III. Functional organization: Here the organisation is divided into a number
of functional areas.ie, organisation is grouped according to its purpose.
The whole activities of the organisation are divided into various functions
and each functional area is put under the charge of a functional manager.

Advantages

 High specialisation- Every functional head is an expert in his area and all
employees get the benefit of his expertise.
 Better control and coordination
  Duplication of work can be kept minimum and there is clarity in
functioning
 Helps to improve efficiency of employees
 Facilitates adequate supervision

Disadvantages

▪ Complex relationship: Each employee is accountable to several superiors

which results in conflict between workers and specialists.
▪ As there are many cross relationships, an employee may receive
conflicting orders.
▪ Slow decision making: As several specialists may involve in decision
making process, there is delay in decision making.
IV. Project organisation: Here each project is organised under a semi-
autonomous project division. A project team consists of specialists in
different areas. The activities of the project team members are
coordinated by a project manager. Once a particular project is completed,
the project division undertakes a new project.

Advantages

❖ Facilitates more attention to completion of complex projects.

❖ Permits maximum use of knowledge, skill and experience of employees.
❖ Provides better coordination of organisation resources

Disadvantages

❖ Project manager has to deal with specialities from a number of diverse

fields. The specialists have different approaches and interests. It delays
the decision making process.
❖ The job of project manager becomes difficult due to lack of clarity
defined, responsibility and lack of clear communication.
V. Matrix organization: is an organisational form in which there are
multiple lines of authority and is used in large multinational organisation.
It is a combination of functional and project organisation and it is
otherwise called grid organisation. There are several departments under
matrix organisation. The available resources of the organisation can be
used by each department along with the coordination of other department
in an organisation.
 Under matrix organisational structure, the project teams are formed using
personnel from permanent functioning structure. Different project
managers share resources and authority with functional head. The
employees are subjected to dual line of command from project manager
and functional head. When one project is over resources are diverted to
new projects.

Advantages

➢ Better utilisation of resources in the organisation.

➢ Offers operational freedom and flexibility
➢ Here employees learn new skills which help in their development.
➢ Helps to maintain professional identity
➢ Under matrix organisational structure, the motivation and morale of
employees are lightened.

Disadvantages

➢ Double lines of commands: Here working relationships become complex

and there is great confusion among employees due to double line
command.
➢ Problem of adjustment: After completion of one project, people are
assigned to some new project and employees may face problems of
adjustment.
➢ Delayed decisions: There are chances of delay in taking decisions.

Factors influencing Organisational Structure

i. Size of the unit: Size indicates the scale of operation. Size is an important
factor governing cost, efficiency and profitability of an enterprise. Before
any business or non-business enterprise is started, the organisers will
have to decide most profitable and viable size of the unit.
ii. Job Design: The bricks that build up an organisation structure are jobs.
The jobs to be done in an organisation are decided by the top level. Job
design is the first managerial decision of the organisation structure.
iii. Grouping of activities: The designed job have to be formed into groups
according to the nature of activity. Grouping of activities are essential to
achieve coordination. Each group is termed as department.
iv. Span of Control: is the number of persons to be managed by each
manager. Depending upon the nature of the organisation some
departments will be large in size and some will be small.
v. Delegation of authority: If the span is more there will be more authority
levels and the top management has to delegate authority to each level. In
an organisation structure if the span and levels of management are more,
the delegation of authority will be more and there will also be
decentralisation of authority for the smooth functioning of tasks.

ORGANIZATION CHART

Organizational chart and manuals are prepared for the purpose of describing the
organisation structure. They give full information on a particular organisation.
An executive finds out his exact place in the organisation structure from the
charts and manuals. It shows the responsibility and authority of an executive.
He knows his superior for whom he is responsible and his subordinates whom
he has to supervise.

Definition

An organizational chart is a diagrammatic representation of framework or

structure of an organization.

- J Batty.

An organization chart is a diagrammatical form which shows the important

aspects of an organization including the major functions and their respective
relationship, the channels of supervision and the relative authority of each
employee who is in charge of respective function.

-Terry

Contents of organizational chart

• Basic organisational structure and flow of authority

• Authority and responsibility of various executives
• Relationship between the line and staff officers
• Names of components of organization
• Position of various office personnel
• Number of persons working in the organization
 • Present and proposed organisation structure
• Ways of promotion
• Requirements of management development
• Salary particulars

Principles of organisation chart

 Observation of lines of authority by top executives: The executives

should never bypass the lines of authority. The executives should give
orders or obtain information by following the lines of authority.
 Observation of lines of authority: by subordinates
 Defining lines of position: The position of each individual in an
organisation should be clearly stated. The staff should be assured that
there would not be overlapping and two persons would not be appointed
for the same position when their authorities and responsibilities are
different.
 Non assignment of same duty twice: An individual should not be
compelled to work under two masters for same work performance.
 Avoid unique concentration of duty: The work should not be concentrated
in a single point. Instead it should be divided according to the duties and
responsibilities of each worker and the administrative relationship with
others
 Organisational charts should be above personalities: Prime importance
should be given to an organisation than to an individual.
 Simple and flexible: understandable. Size and nature of the organisation
may be changed in course of time. Need may arise for periodical
modification in the organisation chart. Then the existing organisation
chart should permit these modifications.

Types of organizational chart

1. Hierarchial organizational chart: it indicate the formal structure of an

organisation. The number of boxes vertically represents the number of
ranks and depicts the power status, while the horizontal level of boxes
represents the number of departments or people in a particular level. A
top level administrator is represented at the top rectangular box. The level
underneath contains high managers of executives and each succeeding
level includes the subordinates of the line above. An executive position
 may have a larger rectangle than a subordinate position. The same level
generally have boxes of similar size on an organisation chart.

2. Matrix organisational chart: Here the organisation is divided in such a

pattern that the same skilled employees are pooled together in a group
reporting to the respective managers of their group. The matrix structure
has two axes, representing two chains of command. One chain of
command that runs vertically is functional or divisional in nature, while
the chain that runs horizontally represents the group of people from the
various functional departments.

3. Flat or horizontal organizational chart: There are few or no horizontal

layers. It may consist of only managers and the operation level employees
and this type of organisation charts are possible only in small or
individual unit organisation. Due to few layers, communication between
levels is simple and more effective.
 Other types

a. Basic (Vertical): The basic relationship is that between superior

and subordinate and this is shown vertically. The lines of command
flows from top to bottom in vertical lines. The vertical chart is in
the form of a graph. This type is followed in companies.
b. Horizontal Chart: The line of command flows horizontally and has
ales defined chain of command. Employees across lines have
similar input into how the organisation is run. Employees may
perform many different functions and may report to several
supervisors, rather than a single boss.
c. Circular Charts: Top management is shown at the centre of the
circle and other management levels are shown in concentric circles.

d. Departmental chart: This chart is devoted exclusively to particular

department and give details of relationships, authority,
responsibility etc. within the department.

Advantages of organizational charts

 Give a clear picture of the organization

 Shows the levels of authority and relationship prevailing among
employees.
 Instructing work is simplified.
  Newly hired personnel can understand their role in the organization and
behave accordingly.
 Strengths and weaknesses of an organization are evaluated.
 Acts as an authoritative source of information.
 Lines of authority shown are definite and formal.
 Lines of promotion can be understood.
 Helps in planning and improving communication both inward and
outward.
 Degree of contribution to organisation and achievements can be
identified.
 Obstacles to the efficient functioning of the management can be found
while drawing the organisation chart.
 Outsiders can have a quick understanding of each department in the
organisation.

Limitations

 Create more rigidity of relationship prevailing among the employees of

the organisation.
 Difficult to maintain and ensure that the organization charts up to date
 Don’t show informal relationship existing among the organization’s staff
members.
 If the charts are not correctly prepared, they will lead to misleading
inference.
 Organizational charts produce a psychological complex such as superiors,
inferiors etc.
 Relationship shown in an organizational chart does not actually prevail in
the organizations.
 The words and the lines used in an organisational chart give different
meanings to different people.

DELEGATION
Means conferring authority from one person to another to accomplish a work or
activity.

It is assignment of authority and responsibility to another person to carry out

specific activities. The person who delegated the work remains accountable for
the outcome of delegated work.

Definition:

Delegation is defined as the transfer of responsibility for the performance of a

task from one person to another.

“ The act of empowering to act for another”

Delegation refers to a manager’s ability to share his burden with others. It

consists in granting authority or right to decision making in certain defined
areas and charging subordinates with responsibility of carrying through an
assigned task.

Purposes

• Assigning routine task.

• Problem solving
• Capability building.
• Assigning task for which manager does not have time.

Principles

i. Select right person to whom job is to be delegated.

ii. Delegate both interesting and uninteresting task
iii. Provide subordinates with enough time to learn
iv. Delegate gradually
v. Delegate in advance
vi. Consult before delegating
vii. Avoids gaps and overlaps.

Types of delegation

a. Formal delegation: This is found in the exercise of authority

defined by a organisations role.
 b. Fimak delegation: This is downward delegation. It is effective
to the extent of acceptance and responsibility for formal
authority.
c. Informal delegation: It occurs because people want to do
something apart from what they are told to do. It is something
that is formally required to be done.

Rights to delegation

• Right task
• Right circumstance
• Right person
• Right direction/communication
• Right supervision/evaluation

Elements of delegation

1. Assignment of work or duties

2. Grant of authority
3. Creation of accountability

Delegation process

define the
feedback
task

monitor
decide
progress

determination
of task

Strategies for effective delegating

• Plan head
• Identify necessary skills and levels
• Select most capable person
 • Communicate goal clearly
• Empower the delegate
• Set deadlines and monitor progress
• Model the role; provide guidance
• Evaluate performance
• Reward accomplishment

Common delegation errors

❖ Under delegating
❖ Over delegating
❖ Improperly delegating

Barriers of effective delegation

 The belief that ‘that I can do it better myself”

 Lack of confidence and trust in workers
 Low self confidence, in security
 Vague job description
 Inadequate training
 Lack of adequate recruitment and selection
 Time involved in explaining the task
 Reluctance to take the risks involved in depending on others.
 Fear of loss of power
 Subordinate resistance to delegation
 Failure to the delegator to see the subordinates perspectives
 Workload assigned are highly challenging both physically and mentally
 Belief of employees that they are incapable of completing the delegated
task
 Inherent resistance to authority
 Due to over delegation

PARTICIPATORY MANAGEMENT

Definition

Participatory management is the practice of empowering employees to

participate in organizational decision making.

Characteristics of participatory management

 a) Trust
b) Commitments
c) Goals and objectives
d) Autonomy: State of being independent of having responsibility, authority
and accountability for one’s work and personal time.

Process of Participatory management.

1. Training
2. Changing roles of supervisors-decentralised decision making
3. Communication

Advantages

• High trust and mutual support

• Increase accountability of managers and employees
• Reduced ambiguity in work requirements
• Enhanced role for clinical nurses
• Increased dependence of the nursing division
• Legal clarity
• Teamwork
• Improved organisation communication
• Decreased absenteeism
• Increased effectiveness and productivity
• Uplifting morale and motivation
• Increased job satisfaction
• Recognition of contributions of the members of organisation
• Less overtime and lower cost

Disadvantages

 Occasional failures will cover

 Initiation of programs takes time and money
 Policies and procedures must be changed
 Difficult to determine which responsibility are whose
 Lack of knowledge of the process of individual

Activities involved in participatory management.

 i. Job enrichment: Creates job with greater responsibility and more
flexibility and promote personal development.
ii. Personalisation: Strategy that focuses on people and knowledge.
iii. Primary nursing
iv. Shared governance: Allocation of control, power or authority among
mutually interested parties.
v. Entrepreneurship : Forming small companies with the support of
government agencies
vi. Gain sharing
vii. Pay equity: Extrinsic rewards from financial business, stock options and
profit sharing.

HUMAN RESOURCE MANAGEMENT (HRM)

STAFFING

The most distinct and important component of any health organisation is the
staff, neither its physical facilities, building, equipment nor is the sophistication
of computer services, high tech machines or streamlined procedures. If the right
kind of employees is not employed, there will be wastage of equipment, time,
effort and energy, even the software is flawed. The services provided would be
of low quality and organisation goals would have not been achieved. This can
be only be prevented by efficient and effective system of staffing.

Meaning

It is the process that ensures that an organisation has qualified staff available at
various levels of management to meet the short term and long term
requirements.

Definition

Staffing is the function by which managers build an organisation through

recruitment, selection and development of individuals as capable employees.

-Mc Farland

The managerial function of staffing is defined as filling positions in the

organisational structure through identifying workforce, requirements,
inventorying the people available, recruitment, selection, placement, promotion,
appraisal, compensation and training of needed people.
 -Koontz et.al

Staffing pertains to recruitment, selection. development and compensation of

subordinates.

-Theo Haimann

Staffing is the whole personnel function of bringing in and training the staff and
maintaining favourable conditions of work.

-Luther
Gullick

Mission:

 To ensure maximum utilisation of human resources.

 To discover and obtain competent personnel for various job
 To ensure the continuity and growth of the enterprise through adequate
staffing.
 To improve job satisfaction and morale of the employees through
objective assessment
 To be able to meet crisis/emergency situations.
 To deliver good quality of care and attain job satisfaction and patient
satisfaction

Steps of Staffing Process

1. Man power planning: concerned with determining number and type of

personnel required for different type of organisations.
2. Job analysis: finalising the job specification and job description; thereby
help in developing recruiting policies.
3. Recruitment: identification of sources of manpower availability and
making efforts to attract applicants for various job positions.
4. Selection: process of choosing and appointing right candidate for the job.
It includes receiving and screening of applications, tests, interview and
medical exam of candidate.
5. Placement: ensures the right staff is placed or assigned.
6. Induction and orientation: orienting a new employee to organisation and
job
 7. Training and development: various methods of training can be used. On
the job and off the job methods are employed.
8. Remuneration: kind of compensation provided monetarily to the
employees for their work performance.
9. Performance Appraisal
10.Promotion and Transfer: Promotion is said to be an non monetary
incentive in which worker is shifted from a higher job demanding bigger
responsibility as well as shifting and transferring workers to different
units.

HUMAN RESOURCE MANAGEMENT (HRM)

HRM is a subsystem of the total management, primarily concerned with the

management of people, individual or group of workers as also their relationship.

HRM is a function within which an organisation that focus on recruitment of,

management of and providing direction for the people who work in
organisation.

HRM is a process of bringing people and organisation together so that the goals
of each are met.

HRM is planning, organising, directing and controlling of the procurement,

development, compensation, integration, maintenance and separation of human
resources to the end that individual organizational and social objectives are
accomplished. -Edwin B Flippo

Features of HRM

 It is pervasive in nature as present in all organization.

 The focus is on results rather than on rules.
 Its motive is to help employees develop their potential fully.
 It encourages employees to utilise their potentials to give their best to
organisation.
 It is all about people at work both as individuals and groups
 It tries to put people on assigned jobs in order to produce good results.
 It helps an organisation to meet its goals in the future by providing for
competent and well-motivated employees.
 It tries to build and maintain cordial relations between people working at
various levels in the organisation.
Objectives of HRM

→ To develop teamwork among the workers and on organisation culture

that helps the organisation grow and make individuals workers
dynamic.
→ To make the personnel acquire power to perform the different types of
work that come in there at present or in near future.
→ To develop hidden talent of individual workers that may be used for the
development of organisation
→ To provide an opportunity for employees to grow and strengthen the
management and professional team in all the areas of the organisation.
→ To develop employee capabilities according the needs and areas of the
organisation
→ To train new employees to the level required by the organisation to
perform their tasks effectively.
→ To train employee to take up more responsibilities.
→ To adopt problem solving techniques for the problem related to
disciplinary cases and grievance.
→ To increase cooperation and trust and involve employees actively in the
company affairs.
→ To make the organisation dynamic and vibrant, so that it will adjust to
competitive and fast changing environment.

Functions of HRM

• Human resources or man power planning

• Recruitment
• Promotion
• Career planning
• Job and salary administration
• Training counselling, performance feedback etc.

MAN POWER PLANNING

It is the process of developing and determining objectives, policies and

programmes that will develop, utilise and distribute manpower so as to achieve
the goals of the organisation.
WHO Chronicle States:- "Manpower Planning is concerned with organizing, in
systematic fashion, the goals, objectives, priorities and activities of manpower
development in order to ensure that the right number of staff with the
appropriate skills are provided at the right time to meet the requirements of the
work to be done".

Need for man power planning

❖ To fulfil the need of organisation to accomplished its goals

❖ To replace the employees who retire, have physical and mental ailments
etc.
❖ To combat turnover that is unavoidable
❖ To meet the needs of changing and expanding demands
❖ To meet the challenge arises due to socio-economical, political and of a
new and changing technology
❖ To identify the areas of surplus personnel or areas in which there is
shortage of staff

Objectives of man power planning

• Ensure optimum use of HR

• Keeping the organisation work force to cope with the technological
development and modernisation.
• Ensure high labour productivity.
• Fulfilling future needs for managerial and technical skills.
• Directing future recruitments just to suite the appropriate needs of the
organisation
• Ensuring career planning of every employee of the organisation and
making succession programme
• Streamlining uninterrupted supply of work force to the functional needs
of work from time to time.

STAFFING PROCESS

 Recruitment
 Selection
 Placement
 Training
 Development
  Appraisal and remuneration

RECRUITMENT

It is the first step in the process of filling a vacancy. Recruitment is a process of

searching for prospective employee.

MEANING

Recruitment in simple term means as the process of searching for and obtaining
applicants for job from among whom the right person can be selected.

DEFINITION

Recruitment is defined as the process of searching for prospective employee and

stimulating them to apply for job in the organisation.
–B Flippo

Recruitment is the process of locating, identifying an attractive capable

applicant.

-Bergman
and Tylor

Recruitment involves seeking and attracting a pool of people from which

qualified candidates for job vacancies can be chosen

-
Byars and Rue

PURPOSES AND IMPORTANCE:

• Determine the present and future requirements of the organization in

conjunction with the personnel planning and job analysis activities
• Increase the pool of job candidates with minimum cost.
• Help increase the success rate of the selection process reducing the
number of obviously under qualified or over qualified job applicants.
• Help reduce the probability that the job applicants, once recruited and
selected will leave the organization only after short period of time.
• Meet the organization‘s legal and social obligations regarding the
composition of its work force
 • Start identifying and preparing potential job applicants who will be
appropriate candidates
• Increase organizational and individual effectiveness in the short and long
term.
• Evaluate the effectiveness of various recruiting techniques and sources
for all types of job applicants.

OBJECTIVES

• To attract people with multidimensional skills and experiences that suit

the present and future organisational goals.
• To induct outsiders with new perspectives to lead the company.
• To infuse fresh blood at all levels of organisation.
• To develop an organisational culture that attracts competent people to the
company.
• To search or hunt people whose skills fit the company values.
• To devise methodologies for assessing psychological traits.
• To search for talent globally and not just within the company.

PRINCIPLES

i. Recruitment should be done from a central place Eg: Administrative

officer/Nursing Service Administration.
ii. Termination and creation of any post should be done by responsible
officers, eg: regarding nursing staff the Nursing superintendent along
with her officers has to take the decision and not the medical
Superintendent.
iii. Only the vacant positions should be filled and neither less nor more
should be employed.
iv. Job description should be made before recruitment.
v. Procedure for recruitment should be developed by an experienced person
vi. Recruitment of workers should be done from internal and external
sources
vii. Recruitment should be done on the basis of definite qualifications and set
standards.
viii. A recruitment policy should be followed
ix. Chances of promotion should be clearly stated
x. Policy should be clear and changeable according to the need.
FACTORS EFFECTING RECRUITMENT

All organization, whether large or small, do engage in recruiting activity,

though not to the same extent. This differs with:

➢ The size of the organization

➢ The employment conditions in the community where the organization is
located
➢ The effects of past recruiting efforts which show the organization‘s
ability to locate and keep good performing people
➢ Working conditions, salary and benefit packages offered by the
organization- which may influence turnover and necessitate future
recruiting
➢ The rate of growth of organization
➢ The level of seasonality of operations and future expansion and
production programs.
➢ Culture, economical and legal factors etc.

RECRUITMENT PROCESS

It involves a systematic procedure from sourcing the candidate to arranging and

conducting the interviews and requires many resources and time. A general
recruitment process is as follows:

i. Identify vacancy or job requirement

The recruitment process begins with the HRD receiving requisitions for
recruitment from any department of the company. These contain –posts to
be filled, number of persons, duties to be performed, qualification
required etc.
ii. Prepare job description and person specification
iii. Deciding the source of recruitment and selection methods
iv. Advertising the vacancy
v. Managing the response
vi. Short listing of the candidates
vii. Conducting interview and select and appoint successful candidates.

The recruitment process is immediately followed by the selection process ie,

the final interviews and the decision making, conveying the decision and the
appointment follows.

TYPES OF RECRUITMENT
 → Planned: arise from changes in the organisation decisions
and retirement policy.
→ Anticipated: arises due to change in the environment.
Organisation can predict by studying trends in internal and
external organisation.
→ Unexpected: arises due to accidents, transfers, death, illness,
retirement etc.

RECRUITMENT SOURCES

Internal sources

Internal sources include present employees, employee referrals, former

employee and former applicants.

❖ Present employees: promotion and transfers from among the present

employees can be good source of recruitment. Promotions to higher
positions have several advantages. They are:
• It is good public relations
• It builds morale
• It encourages competent individuals who are ambitious
• It improves the probability of a good selection, since information of the
candidate is readily available
• It is less costly
• Those chosen internally are familiar with the organization.

However promotions can be dysfunctional to the organization as the advantage

of hiring outsiders who may be better qualified and skill is denied. Promotions
also results in breeding which is not good for the organization.

Another way to recruit from among present employees is the transfer without
promotion. Transfers are often important in providing employees with a broad
based view of the organization, necessary for the future.

❖ Employee referrals: this is the good source of internal recruitment.

Employees can develop good prospects for their families and friends by
acquainting with the advantages of a job with the company, furnishing
cards introduction and even encouraging them to apply. This is very
effective because many qualified are reached at very low cost.
 ❖ Former employees: some retired employees may be willing to come
back to work on a part time basis or may recommend someone who
would be interested in working for the company. An advantage with
these sources is that the performance of these people is already known.
❖ Previous applicants: although not truly an internal source, those who
have previously applied for jobs can be contacted by mail, a quick and
inexpensive way to fill an unexpected opening.

External sources

Sources external to an organization are professional or trade associations,

advertisements, employment exchanges, college/university/institute placement
services, walk-ins and writer-ins, consultants, contractors.

 Professional or trade associations: many associations provide

placement services for their members. These services may consist of
compiling seekers‘ lists and providing access to members during regional
or national conventions.
 Advertisements: these constitute a popular method of seeking recruits as
many recruiters; prefer advertisements because of their wide reach. For
highly specialized recruits, advertisements may be placed in professional/
business journals. Newspaper is the most common medium.
 Employment exchange: Employment exchanges have been set up all
over the country in deference to the provisions of the Employment
exchanges (Compulsory Notification of Vaccination) Act, 1959. The Act
applies to all industrial establishments having 25 workers or more. The
Act requires all the industrial establishments to notify the vacancies
before they are filled. The major functions of the exchanges are to
increase the pool of possible applicants and to do preliminary screening.
Thus, employment exchanges act as a link between the employers and the
prospective employees.
 Campus recruitment: colleges, universities and institutes are fertile
ground for recruitment, particularly the institutes.
 Walk-ins, write-ins and Talk-ins: write-ins those who send written
enquire. These job-seekers are asked to complete applications forms for
further processing. Talk-in is becoming popular now-in days. Job
aspirants are required to meet the recruiter (on an appropriated date) for
 detailed talks. No applications are required to be submitted to the
recruiter.
 Consultants: ABC consultants, Ferguson Association, Human Resources
Consultants Head Hunters, Bathiboi and Co, Consultancy Bureau, Aims
Management Consultants and The Search House are some among the
numerous recruiting agents.
 Contractors: Contractors are used to recruit casual workers. The names
of the workers are not entered in the company records and to this extent,
difficulties experienced in maintaining permanent workers are avoided.
 Radio Television:
 International Recruiting: Recruitment in foreign countries presents
unique challenges recruiters. In advanced industrial nations more or less
similar channels of recruitment are available for recruiters.

Advantages Disadvantages
Internal recruitment • Cheaper and • Limits the number
quicker of potential
• People already applicants
familiar with the • No new ideas can
business be introduced from
• Provides outside the
opportunities for business.
promotion within • May cause
the business- can resentment among
be motivating. the candidates not
• Business already appointed.
knows the • Creates another
strengths and vacancy which
weaknesses of needs to be filled.
candidates.

External recruitment • Outside people • Longer process

bring in new ideas. • More expensive
• Larger pool of due to
workers from advertisements and
which to find the interviews required
best candidate. • Selection process
• People have wider may not be
range of effective enough to
experiences. reveal the best
 candidate.

RECENT TRENDS IN RECRUITMENT

1. Outsourcing: The outsourcing firms help the organisation by the initial

screening of the candidates according to the needs of the organisation and
creating a suitable pool of talent for the final selection by the
organisation. Outsourcing firms develop their HR pool by employing
people for them and make available personnel to various companies as
per their needs. In turn the outsourcing firms charge the organisation for
their service.
2. Poaching/Raiding: ‘Buying talent’ is the latest mantra being followed by
the organisation today. Poaching means employing a competent and
experienced person already working with another reputed company in the
same or different industry. A company can attract talent from another
firm by offering attractive pay packages and other terms and conditions
better than the current employer of the candidate. But it is seen as an
unethical practice and not openly talking about it.
3. E-Recruitment: It is the use of technology to assist the recruitment
process. They advertise job vacancies through World Wide Web. The job
seekers send their applications or CV through e-mail using the internet.
Alternately job seekers place their CV in World Wide Web which can be
drawn by prospective employees depending upon their requirements.

Selection

Selection is an integral part of staffing, where in one person is chosen in

preference to other for the announced job position. It leads to employment of
personnel. It involves a series of steps by which candidates are screened for
choosing the most suitable person for vacant post in the organisation.

Definition:

Selection is a process of differentiating between applicants in order to

identify those with a greater likelihood of success in the job.
It is a process of choosing the fit candidates or rejecting the unfit
candidates or combination of both.
 -Thomas
S Stone.
It refers to negative process of eliminating of all those who appear
uncompromising from all candidates considered for possible
employment.
-
Yodar

Selection process:

There is no standard process that can be followed by all institutions in all area.
Institutions may follow different selection techniques or methods depending
upon the size of the organisation, nature of the duty, kind and number of person
to be employed, government regulations to be followed etc.

Steps of selection procedures

i. Receipt of Application: Everyone who applies for job is an enterprise

may not be qualified for the job. Those who do not possess adequate
experience and qualifications should not be included in the list of
candidates to be called for a preliminary interview. A proper scrutiny of
applications is made to select the candidate to be called for a preliminary
interview.
ii. Preliminary interview: Here the employers try to find out whether the
candidate is physically and mentally fit for the job. In general candidates
are asked about the qualifications, experiences, interests, residence etc.
Employers should not take much time for conducting preliminary
interview.
iii. Selection test: Those candidates who have passed preliminary interview
will be asked to appear for the selection tests. Tests serve as an important
device in the process of selection. Tests aims at discovering and
measuring selected qualities, abilities and skills of candidate in terms of
job specification.
iv. Employment interview: Interview is a face to face observational and
personal appraisal method to evaluate a candidate fitness for the job.
Every person who is selected by a company for interview is interviewed
by one or more persons.
v. Medical examination: It reveals whether or not a candidate possesses the
required stamina, strength and tolerance of hard working conditions.
 vi. Reference checks: Reference are sought after selection is finalised. These
may be either in a written form or checked over the telephone.
vii. Employment: After the final decision, the institution has to intimate this
decision to the successful as well as unsuccessful candidates. The
organisation sends the appointment orders to the successful candidates
either immediately or after some time, depending upon the schedule.
viii. Appointment: the selected candidate is given an appointment letter with
all the details such as terms and condition of the appointment and the
period of probation, job description, salary scale, hospital policy etc. The
candidate should inform the management about the job acceptance and
the date of joining.
ix. Placement: A proper placement of the worker reduces employee turn
over, absenteeism and improve morale. After selection, the employee is
generally from one or two years and after this employment may be
regularised provided that during this period, his work has been found to
be satisfactory.
x. Induction: Final step in the selection process is the induction of new
employees into the setting of his/her work. The main objective of
induction is familiarising the new employee with the new surroundings
and company rules and regulations. And also integrating the personal
goals with the organisational goals.

Placement

It is defined as the appointment of right employees at the right place that arouse
the will to work in the mind of the operators.
Effective placement can be made in the following ways:

• Job rotation
• Teamwork
• Training and development
• Job enrichment
• Empowerment

Orientation of New Staff

Components of orientation programme

 Aims and principles

 Organizational policies
 Clinical policies
 Administrative policies
 Relationship between various departments and personnel
 Standards of nursing practice
 Physical facilities
 Records
 Educational opportunities
 Legal and ethical responsibilities
 Infection control practices
 Emergency response procedures
 Evaluation procedures

Training

It is the act of increasing the knowledge and skills of an employee for doing a
particular job.

It is an activity which involves the development of hidden talent of an

individual and using it for the benefit of the organisation. It is directed towards
maintaining and improving current job and developing skills in employees for
future job. After the candidates are selected for various jobs, there is a need for
management to provide for their training and development which is essential
for the efficiency of an organisation.

Reasons for training

 ▪ Increased use of technology in production
▪ To minimise labour turnover arising from normal separation
▪ To increase the productivity of employees
▪ To enable employees to keep abreast of the changing methods, techniques
and use of sophisticated tools and equipment.
▪ To manage time effectively
▪ To raise the morale of employees

Objectives

 To provide basic knowledge and skill to new employees to perform the

tasks designed by the organisation
 To develop the capabilities of existing employees by exposing them to
latest concepts, information techniques and thereby strengthen their skills.
 To develop 2nd and 3rd line executives to strengthen the working links and
levels so that they can occupy higher positions.
 To improve the outlook of senior managers and other policy makers
enabling them to look to future prospects for the organisation.
 To make employees more effective and productive thereby increasing
their earning power and ensuring job security.
 To mould employee attitude with the purpose of achieving their better
cooperation with the company and develop loyalty to the organisation

Characteristics

i. Allowance for individual difference: There are difference in ability,

learning capacity and interest of trainees and the management should
consider this factor while designing programmes.
ii. Relevance of job requirements: Training programmes must relate to the
requirements of the job for which they are intended.
iii. Determination of training needs: Management should determine the
training needs of the employees and should select a method of training
that is most effective.
iv. Training programme should be result oriented: Management should avoid
training for the sake of training and show greater interest in the benefits
of the training programme

Steps of training

 Identifying training needs

  Getting ready for the job
 Preparation of the learner
 Presentation of operations and knowledge
 Performance tryout
 Follow-up

Advantages of training

❖ Reduces wastage and spoilage.

❖ Improves efficiency and brings confidence in employees.
❖ Improves quality of work
❖ Helps the employee to discharge their social obligation along with
departmental duties.
❖ Training enables the employees to adjust according to changed situations.
❖ Reduces the supervisory burden

Staff deployment

Meaning

“The use of some thing or someone in an effective way”. Deployment means

arrange manage or give positions to their employees.

It is a systematic and organised way of introducing the staff members into an

activity process or into a particular working area in an organisation.

Advantages of Staff deployment

• Area of deployment should be selected based on the competency of the

staff.
• No duplication of work is possible
• There will be no interruption in work mode by the staff in any case.
• Staff has a sense of belongingness and a right mind to work with team
spirit.
• Unnecessary expenditure is avoided.

Retaining staff

Employee retention involves measures to encourage employees to remain in the

organisation for the maximum period of time. Organisations are facing a lot of
problems in retaining employees these days. They may leave for personal and
professional reasons. Organisation are becoming aware of these concerns and
adopting many strategies for employee retention. The various strategies include:

• Salary increment
• Appreciation for their outstanding work
• Contests and incentives
• Motivating conversation and good communication
• Promoting from within
• Fostering employee and management relationship
• Participative leadership
• Employee ownership
• Compelling corporate purposes and mission statement

Advantages

• Saves man, money, material and time.

• Save the advertisement, recruitment, orientation and training expenses.
• Increase productivity of an organisation
• Motivates the staff to work efficiently in the organisation.
• Maintains smooth functioning in the working environment.

Staff Promotion

Promotion is the upward movement of the employee in the hierarchy level of

the organization, associated with higher accountabilities, status and pay.

Definition

• Promotion is the advancement of an employee to a better job , better in

terms of greater responsibility more prestige or status, greater skill and
especially increased rate of pay and salary.
• According to Scott & Clothier, A promotion is the transfer of an
employee to a job that pays more money or one that carries some
preferred status.

Purposes

i. Improve the workers and the institutions efficiency and effectiveness

ii. Builds morale and belongingness on the part of the employee
iii. Promotes job satisfaction on the part of the employee
iv. Increases interest in training and self-development as a necessary
preparation for promotion.

Types of promotion

• Horizontal promotion: In this case position of the employee and pay may
be increased but there is no change in the nature of jobs.
• Vertical promotion: In this case there is a change in the status,
responsibilities, job classification and pay.
• Dry promotion: In this case responsibilities and status group increase but
not financial benefits.

Basis of Promotion

❖ Seniority
❖ Merit
❖ Seniority cum merit system

Seniority as the basis of promotion

Provides an objective criterion

Prevents arbitrary selection or favouritism
Develop a sense of loyalty to the organisation
Reduce employee turnover and minimise dispute on promotion
It tends to demoralise competent persons and leads to higher turnover and
mobility
Organisation may not be able to attract capable and talented personnel
Strongest argument against such a policy is that experience which goes
with longer service does not make anyone more competent.

Merit as the basis of promotion

Provides due incentives to employees for continuous improvement in

work performance
Adds positively to overall organisation effectiveness and success.
Limitation is that it is difficult to assess merit objectively and leaves a
wide scope for arbitrariness and favouritism.

Seniority cum merit system

 Most widely used basis for promotion combines both seniority and merit
which provides for ability or merit being the deciding factor in
promotional selection, when two employees are of equal seniority.
Similarly when two employees who are almost equally competent, one
who is senior in service should be preferred for promotion.

Demotion

Demotion is the shift to a position in which responsibilities are decreased. It is

the lowering of rank, reduction in salary, reducing of status and responsibilities.
It may be defined as “the assignment of an individual to job of lower rank and
pay usually involving lower level of responsibility”.

Causes

• Inadequacy on the part of the employees.

• Organisational staff reductions
• Disciplinary tool to regulate and control the staff behaviour.
• Employee is unable to adjust to the new technology, employee encounters
ill health or for some personal reasons an employee cannot do his job.

Superannuation

It is a retirement fund or pension given to the employees at the time of

retirement. It is also a basic right of the employees to be paid for by the
employer for their sincere hard work or service rendered to the institution.

Benefits

▪ Helps the employee to plan for their future life.

▪ Motivates the current working employees to work efficiently.
▪ It reflects the institutional or organisational image
▪ It helps to increase the productivity and quality directly and indirectly.

Separation

It occurs when an employee leaves the organisation

Types

➢ Voluntary-Quits, resignation
➢ Involuntary- Discharge,resignation
JOB ANALYSIS

➢ It is a process to identify and determine in detail the particular job duties

and requirements and the relative importance of these duties for a given
job.
➢ It is a formal and detailed examination of job.
➢ It is a process where judgements are made about data collected on a job.
➢ The process results in collecting and recording two data sets including job
description and job specification.
➢ Both job description and job specification are essential parts of job
analysis information.
➢ Writing them clearly and accurately helps organisation and workers cope
with many challenges.

Purposes

• To establish and document the job relatedness of employment procedures

such as training, selection, compensation and performance appraisal.
• Determining training needs
• To identify or develop skill levels, compensable job factors, work
environment (eg. Hazards, attention and physical effort) and
responsibilities (eg.fiscal or supervisory)
• To identify the required level of education
• To identify duties that should be included in the advertisements of vacant
positions, appropriate salary level for the position to help determine what
salary should be offered to a candidate.

Methods of Job Analysis

• Structured inventory/questionnaire
• Direct observation
• Log books/ work diaries
• interviews

JOB DESCRIPTION

▪ A job description is a clear, concisely and clearly communicating written

statement of duties and responsibilities and organisational relationships
that constitute a given job or position.
 ▪ Is defined as a broad statement of the basic purpose of the job, significant
tasks, extent of authority and relationship necessary for a good
performance of the job.
▪ A job description is written statement explaining why a job exists, what
the job holder actually does, how they do it and under what conditions the
job is performed.

JOB SPECIFICATION

▪ It is a written statement of qualifications, traits, physical and mental

characteristics that an individual must possess as a minimum
requirements to perform the job duties and discharge responsibilities
effectively and satisfactorily.
▪ Refers to the definition of the job and employees in the organisation.

Job description Versus Job Specification

Basis of Job description Job Specification

difference
Meaning Describes the job Describes job requirement
Contents Duties and Responsibilities Qualification experience
Origin From job analysis Fromm job description
Application Solving argument in Promotion, rewards and
overlapping duties transfers
Motive Explaining the job Explaining the perfect fit for
the job holder
DIRECTING

Direction represents one of the essential function of management because it

deals with human relations. Direction is the managerial function of guiding,
motivating, leading, supervising the subordinates to accomplish the desires
objectives. In order to maintain healthy working environment proper direction
plays an important role.

Definition

Direction consists of the process and techniques utilised in issuing

instructions and making certain that operations are carried out as
originally planned. It is the process around which all performance
revolves. It is the essence of operations and coordination is necessary by
product of good managerial direction

Theo
Haimann

Directing is a complex function that include all those activities which are
designed to encourage subordinates to work effectively and efficiently in
both the short and long run.

Koontz and
O’Donnel.

Directing is what has to be done and in what manner through dictating the
procedures and policies for accomplishing performance standards.
Earnest Dale

Importance of direction

• Direction initiates action

• Direction integrates employee effort
• Direction attempts to get maximum out of the individual.
• Direction facilitates change in the organization
• Direction provides stability and balance in the organisation.

Principles of Direction
 i. Harmony of objectives: means the employee should go side by side with
the organisational goals. There should be harmony between these goals,
their objectives, then only the organisation will progress.
ii. Unity of command: Employee should receive orders and instructions only
from one superior.
iii. Appropriate technique: Use of correct techniques to ensure efficiency of
direction. These techniques used should be suitable to the superior, the
subordinate and the situation.
iv. Direct supervision: Effective supervisor makes direct personal contact
with her subordinates for giving any direction. Such direct contact
improves morale and commitment of the employees. Therefore wherever
possible direct supervision should be used.
v. Effective leadership: Supervisors should be effective leaders instead of
doing the same things as subordinates are doing to secure maximum
output from them.
vi. Understanding and Comprehension: Direction conveyed by the
supervisor should be clear and comprehensive for the subordinates to
understand.
vii. Effective communication: Success of the direction depends on the
effective communication between the superior and subordinates.
viii. Use of informal communication: Organisation should have informal
groups because the information passes very quickly and management can
take appropriate steps in time.
ix. Utilisation of maximum individual efforts: Supervisors should use the
effective directional techniques to maximise the individual efforts to
accomplish organisational goals.
x. Clear orders: The instructions or the orders given by the superiors should
be very clear, logical, concise and acceptable by the subordinates.
xi. Follow up: Directing is a continuous process. It should have the means of
evaluating the performance of employee and provide the feedback to
them. After providing the directions, subordinates should follow them.

Elements of directing

There are five elements of effective directing- Supervision, Leadership,

Communication, Motivation and Order giving.

LEADERSHIP
Leadership is the process of influencing the thoughts and actions of other people
to attain the desired objectives. The leaders job is to get work done by other
people and make people willingly want to accomplish something.

DEFINITIONS

• Leadership is the ability to influence other people.

- Landsdale
• Leadership is the ability of a manager to induce subordinate to work with
zeal confidence.
-Koontz &O’Donnel
• Leadership is the art of motivating a group of people to act towards
achieving a common goal.
• Leadership is shifting of own vision to higher sights, raising of man’s
performance to higher standards, building of man’s personality beyond its
normal limitations
- Peter Drucker
• Leadership is interpersonal influence exercise in a situation and directed
through common process, towards the attainment of a specific goal or
goals.

CHARACTERISTICS OF LEADERSHIP

• Leadership is a continuous process of behaviour and it is not oneshot

activity
• Leader tries to influence the behaviour of individuals around him/her to
achieve common goals.
• Leadership gives an experience to help to followers to attain common
goals.
• Leadership is exercised in a particular situation at a given point of time
and under a specific set of circumstances.
• Leadership may be seen in terms of relationship between a leader and his
followers, which arises out of their working for common goals.

IMPORTANCE OF LEADERSHIP

• Motivating employees: a good leader motivates the employees for high

performance by exercising his leadership.
 • Creating confidence: a good leader creates confidence among his
followers by directing them, giving suggestions and getting good results.
• Building morale: high morale leads to high productivity and
organisational stability.

QUALITIES OF GOOD LEADER

Managerial abilities

• Plans organises makes decisions effectively, encourages cooperation and

participation.
• Assists the subordinates in solving the problems and provides constant
feedback.
• Guide subordinates to develop new skills
• Provides the subordinates with adequate facilities

Interpersonal skills

• Supportive and caring behaviour towards subordinates.

• Good listener and sensitive to others needs
• Guides and motivates workers.
• Establish harmonious relationship

Temperament(nature of person)

• Reliable, open, honest and sincere

• Sense of humour, tactful, friendly and loyal
• Positive, energetic, hardworker, happy and enthusiastic

Credibility and forward thinking

• Acts as a role model and influence others

• Acts as an activist
• Challenger and creative thinker
• Change and agent innovator
• Risk taker and courageous
• Acts as a facilitator and solution seeker

Professionalism

• Committed to the profession

 • Maintains confidentiality
• Instils hope and pride in the profession
• Stands for rights while considering others rights.

Advocacy

• Acts as an advocate for the rights and standards of workers.

TYPES OF LEADERSHIP/STYLES OF LEADERSHIP

1. Autocratic/authoritarian leadership
2. Democratic/participative leadership
3. Laissez Faire /free rein/delegative leadership

Autocratic/authoritarian leadership:

• Here leader alone establishes policies and makes plans.

• Leader assumes complete control over the decisions and activities of the
group

Characteristics

• Firm personality, insistent, self-assured, highly directive, dominating.

• Has high concern for the work than for the people who performs task
• Shows no regards to the interests of the employees
• Set rigid standards and method of performance and expects the
sudordinates to obey the rules and follow the same
• Makes all decision by himself or herself
• Minimal group participation or none from the workers

Merits and Demerits

Merits Demerits
Efficient in time of crisis, easy to make Does not encourage the individuals
decision by one group and less time growth and does not recognize the
consuming potentials, imitativeness and creates
less cooperation among members
It is useful when there is only leader Leader lacks supportive power that
who is experienced having new and results in decision made with
essential information, while consultation although he may be
subordinates are in experienced and correct
new
It is useful when the workers are Less job satisfaction leads to less
unsure of taking decision and expect commitment to goals of the
the leader to tell what to do organization

Democratic/Participative leadership:

Here the whole team is involved and accepts responsibility for achieving the
desired goal. Subordinates have considerable freedom of action.

Characteristics

• Sense of equality among leader and followers

• Open system of communication prevails
• Interaction between the leader and group is friendly and trusting
• Leader works through people not by domination but by suggestions and
persuasions

Merits and Demerits

Merits Demerits
Encourages all employee in decision It takes more time for taking decision
making by the group than the leader alone
Promotes personnel involvement, This style can be used as a way of
greater commitment to work and avoiding responsibility
enhance job satisfaction
Increase the employee productivity
Reduces the number of greivances of
people

Laissez Fairre/Free rein/Delegative leadership:

Here leader has absolutely no control. He only gives information, materials and
facilities to his/her employees to enable them to accomplish desired goals.

Features

• Group members are free to set their own goals and determine their own
activities.
• This style is effective in highly motivated professional groups.
 • Not useful in a highly structured organisation
• When there is no appointed leader, the group collectively assumes
leadership.

Merits and Demerits

Merits Demerits
In limited situations creativity may be May lead to instability,
encouraged for specific purposes disorganization, inefficiency, no unity
of action
To try new method of action Lack of feeling responsible to solve
the problem that may arise. Individual
will lose interest, initiative and desire
for achievement

FUNCTIONS OF A LEADER

14 functions performed by leaders in general. By Krech and Crutchfield

• Executive: Leader is responsible for seeing that the appropriate activities

of the organisation are carried out.
• Goal setter: A leader either establishes organisational goals and
objectives himself or he may participate with his superiors or
subordinates in establishing them.
• Planner: Leader makes decision concerning the ways and means with
which the organising goals can be achieved.
• Mediator or Arbitrator: The leader tries to maintain harmony among the
members of the organisation.
• Expert: The technical information and skills the supervisor possess are
useful in aiding and instructing their subordinates in an effective work
procedure.
• Symbol of group: Leader provides a kind of continuity and stability to the
group standing for it despite changes in circumstances and membership.
• Exemplar: A leader serves as an exemplar, a model for others to emulate.
• Controller of internal relationship in the organization
• External group representative: Leader acts as a representative of an
organisation to deal with outside and groups.
 • Surrogate for individual responsibility: Leader relieves other members of
the group of certain responsibilities and they in turn place their trust in his
decisions.
• Ideologist: By presenting his ideas concerning the group, he is a source of
moral strength to them.
• Father figure: Fulfils an emotional role for the members of the group. By
identifying themselves with their leaders, the members of a group drew
strength and a feeling of security.
• Scapegoat: Leader provides a ready target for the dissatisfaction of the
group. Failure can be attributed to him.
• Administrator of rewards and punishment: Encourages upgrade and
promote workers who deserve and remove, transfer or dismiss workers
who violate rules or regulations of the organisation.

THEORIES OF LEADERSHIP

1. Trait theory/Great man Theory

This theory suggests that leaders have some inborn traits. They have
certain set of characteristics that are crucial for inspiring others towards a
common goal. A successful leader is supposed to have the following
traits- good personality, tirelessness, capacity to read other’s mind, ability
to make quick decision, courage, persuasion, intelligence, reliability,
imagination
2. Behaviour theory
Behavioural theories of leadership are based upon the belief that great
leaders are made, not born. This leadership theory focuses on the actions
of leaders not on mental qualities or internal states. According to this
theory, people can learn to become leaders through teaching and
observation.
Assumptions of Behavioural Theories
• Leaders can be made, rather than born.
• Successful leadership is based in definable, learnable behaviour.
3. Situational theory
This theory believes that leadership effectiveness depended on the
relationship among the leader’s task at hand, their interpersonal skills and
the favorableness the work situation. This theory considers the challenge
of situation and encourages an adaptive leadership style to complement
the issue being faced.
4. Contingency Theories
According to contingency theory, leader’s success depends upon a
number of variables, including the leadership style, qualities of the
followers and aspects of the situation. Different styles of leadership may
be more appropriate for certain types of decision-making. For example,
an authoritarian style might be most appropriate in a situation where the
leader is the most knowledgeable and experienced member of a group. In
other instances where group members are skilled experts, a democratic
style would be more effective.

APPLICATION OF LEADERSHIP IN NURSING

1. Patient care coordination : Even new graduate nurses have
leadership responsibilities when they begin in nursing. Nursing
leadership begins with nursing care of the individual patient. The
students are guide to organize nursing care.
o Establish good and priorities for each day.
o Establish time
o Establish success and failure
2. Employee responsibilities : Nurses have specific tasks or duties to
perform. These tasks are determined by the plan and objective of the
health care agency. It is important to read your job description
carefully and to continue to evaluate how institutional factor s
influences your own practice of nursing. Factors that compromise
quality care should be noted and addressed in construction with
experience nurses.
3. Guidelines for delegating nursing care : New graduate nurses use
leadership techniques when they direct the work of nonprofessional
staff and volunteers and consider delegating tasks to nonprofessional
staff.
4. Mentorship: It is a relationship in which an experienced individual
advise and assist a less experienced individual. This is an effective
way of easing a new nurse into leadership responsibilities
5. Preceptor ship: An alternative model is preceptor ship. The
preceptor is selected to introduce an employee to new responsibilities
through teaching and guidance. The relationship is limited by the new
employee s needs.
 6. Continuing education : leadership , managerial and administrative
skills are needed

Difference between management and leadership

Assertiveness

• Assertiveness means being firm to stand up for your own rights and that
of others in a calm, direct and positive way without being overly
aggressive.
• Assertiveness is defined as, “it is the quality of being self-assured and
confident without being aggressive.”

Benefits of Assertiveness

• Increased self-confidence
• Stress reduction
• Prevents or reduces strife
Techniques of being assertive
• Identify your personal rights, wants and needs.
• Identify how you feel about particular situation.
• Be direct: Deliver your message to the person for whom it is intended.
• Own your message: In describing your feeling use ‘I’ statement to
express your feeling instead of evaluating or blaming others.
• Avoid assumptions about others thinking or feeling or about how they
may react.
• Avoid statement that begins with ‘why’ and ‘you’.
• Ask for feedback: It can encourage others to correct any misperception;
you may have as well as helps others to realize that you expressing an
opinion, feeling of desire rather than a demand.
• Stop apologizing all the time
• Learn to take compliment
• Act confident
• Feel free to say no, I don’t know and I don’t understand etc.
• Evaluate your expectations: Are they reasonable! Be willing to
compromise.

MOTIVATION

• Derived from a Latin word ‘movere’ which means to move or to energize

or to activate.
• Motivation is the core of management
• Success of any organisation depends on the ability of managers to
provide a motivating environment for its employees.
Definitions

➢ Motivation is the process of stimulating people to action to

accomplish desired goals. It refers to the way which urges, drives,
desires, aspires, stirs or needs direct control or explain the behaviour
of human beings. W.G Scott.
➢ Motivation refers to the way in which urges, drives, desires,
aspirations, striving or needs direct, control or explain the behavior of
human beings. -Dalton E. McFurland,
➢ Motivation is the act of stimulating someone or oneself to get a
desired course of action to push the right button to get a desired
action. Michael. J.Jucious.
 ➢ Motivation is an inspirational process that impels the members of a
team to pull their weight effectively to give their loyalty to the group,
to carry out properly the tasks that they have accepted and generally to
play an effective part in the job, that the group has undertaken.
E.F.L Brech

Concept of Motivation

• Psychological concept: as it is concerned with the intrinsic forces

operating within a person that forces him/her to act or not to act in a
specificway.
• Dynamic and continuous process: as it deals with human beings, an
everchanging entity modifying itself every moment.
• Complex and difficult function: People adopt different approaches to
satisfy their needs and one specific need may cause different
behavioural response on the part of different people.
• Circular process: An unsatisfied need causes tension in people and
they take action to overcome this tension
• Stimulating individual: It is the process of encouraging an individual
or a group of people to take desired action.
• Product of anticipated value: It is the product of anticipated value
from given course of action and the perceived probability that the
action will lead to these values.

Types of Motivation

i. Extrinsic motivation: motivation that is received from external

environment. Comes from outside of the performer.
ii. Intrinsic motivation: Actual self motivation. Originates from within the
heart of the person. It is the inner gratification and feeling of fulfilment
rather than just achieving a goal.
iii. Achievement motivation: It is the drive to pursue and attain goals. An
individual with achievement motivation wishes to achieve objectives and
advance up the ladder of success.
iv. Affiliation motivation It is a drive to relate to people on a social basis.
Individuals with affiliation motivation perform work better when they are
complimented for their favourable attitude and co-operation.
 v. Competence motivation: It is the drive to be good at something,
allowing the individual to perform high quality work. Competence/skill
motivated individuals seek job mastery, take pride in developing and in
using their problem solving skills and strive to be creative when
confronted with obstacles. They learn from their experiences.
vi. Power motivation: It is the drive to influence people and change
situations. Power motivated people wish to create an impact on their
organisation and are willing to take risks.
vii. Attitude motivation: Attitude motivation is how people think and feel. It
is their self-confidence, their belief in themselves and their attitude to life.
It is how they feel about the future and how they react to the past.
viii. Fear motivation: Motivation by known or unknown fear and act contrary
to her original tension.
ix. Incentive motivation: Motivation that arises due to incentives, rewards
to do the particular work.

Theories of Motivation

1. Abraham Maslow’s Need Heirarchy theory: Maslow‘s theory included

5 basic needs in his theory, namely the- The physiological needs, Safety
and security needs, Love needs, self-esteem needs and self-actualization
needs. Maslow suggested that human needs are ordered in a hierarchy
from simplex to complex. Higher level needs do not emerge as motivators
until lower needs are satisfied and a satisfied need no longer motivates
behaviour.
2. Fredrick Herzberg Two Factor theory: Herzberg felt that job
satisfaction and dissatisfaction exists on dual scales. Workers are
motivated by two types of needs/factors-
• Needs relating to the work itself called intrinsic/motivation factors
(satisfiers): challenging aspects of the work, achievement, added
responsibility, opportunities for growth and opportunities for
advancement
• Needs relating to working conditions called extrinsic/hygiene
factors (dissatisfiers): salary, status, working conditions, quality of
supervision, job security and agency policies.
According to Herzberg, the hygiene factors must be maintained in
quantity and quality to prevent dissatisfaction. They become
 dissatisfiers when not equitably administered, causing low
performance and negative attitudes.
3. Clayton Alderfer’s ERG Theory: ERG theory is similar to Maslow‘s
hierarchy of needs. The existence (E) needs are equivalent to
physiological and safety needs; relatedness (R) needs to belongingness,
social and love needs. The growth (G) needs to self-esteem and self
actualization- personal achievement and self-actualization.
4. McClelland’s Theory of needs: David McClelland has developed a
theory on three types of motivating needs:
• Need for Power
• Need for Affiliation
• Need for Achievement
McClelland observed that with the advancement in hierarchy the need for
power and achievement increased rather than Affiliation. He also
observed that people who were at the top, later ceased to be motivated by
this drives.
5. ‘Theory X and Theory Y’ of Douglas McGregor: Douglas McGregor
proposed two different motivational theories- theory X and theory Y. He
states that people inside the organization can be managed in two ways.
The first is basically negative, which falls under the category X and the
other is positive, which falls under the category Y.

Assumptions of theory X:

• Employees inherently do not like work and whenever possible, will

attempt to avoid it.
• Because employees dislike work, they have to be forced, coerced
or threatened with punishment to achieve goals.
• Employees avoid responsibilities and do not work until formal
directions are issued.
• Most workers place a greater importance on security over all other
factors and display little ambition.

Assumptions of theory Y:

• Physical and mental effort at work is as natural as rest or play.

• People do exercise self-control and self-direction and if they are
committed to those goals.
 • Average human beings are willing to take responsibility and exercise
imagination, ingenuity and creativity in solving the problems of the
organization.
• That the way the things are organized, the average human beings
brainpower is only partly used.

Role of Manager

 Should understand the dynamics of employee motivation theories.

 Consider employees as individuals and be available for them
 Initiate communication and be a good listener.
 Involve them and set challenging but realistic goals for the welfare of
employees
 Create clear work objectives for workers
 Include all workers in planning process
 Initiate team work and cooperation
 Be fair and consistent
 Provide opportunities for professional development.
 Provide workers with resources, freedom and authority to meet
expectations.
 Provide opportunities for social interaction with employees
 Give workers lots of feedback about the way they are performing.

MORALE

Morale is a way of describing how people feel about their jobs, employers and
companies, and those feelings are tied to the behaviours and attitudes that
employees exhibit in the workplace. When employees have good morale, they
feel committed to their employers, loyal to their jobs and motivated to be
productive.

Importance of morale

 Better productivity
 More focused on customers or outcomes
 Less employee turnover
 Increased communication between co-workers and management
 Better work attendance and timeliness
 Enhanced care about work product
  Fewer workplace-related injuries or accidents
 Increased attention to detail

COMMUNICATION

Meaning of Communication:

Communication is a process of change. In order to achieve the desired

result, the communication necessarily is effective and purposive.

Definition of Communication:

Communication is a process in which a message is transferred from

one person to other person through a suitable media and the intended message is
received and understood by the receiver.

It is defined as an exchange ideas, facts, feelings, opinions or emotions between

two or more persons.

Newman and
Summer

Importance of Communication:

Promotes motivation:

Communication promotes motivation by informing and clarifying the

employees about the task to be done, the manner they are performing the task,
and how to improve their performance if it is not up to the mark.

Source of information:

Communication is a source of information to the organizational members

for decision making process as it helps identifying and assessing alternative
course of actions.

Altering individual‟s attitudes:

Communication also plays a crucial role in altering individual‘s attitudes,

i.e., a well informed individual will have better attitude than a less-informed
individual. Organizational magazines, journals, meetings and various other
forms of oral and written communication help in moulding employee‘s
attitudes.
Helps in socializing:

Communication also helps in socializing. In today‘s life the only presence

of another individual fosters communication. It is also said that one cannot
survive without communication.

Controlling process:

Communication also assists in controlling process. It helps controlling

organizational member‘s behavior in various ways. There are various levels of
hierarchy and certain principles and guidelines that employees must follow in
an organization

Techniques To Improve The Communication:

• Listening
• Broad openings
• Restating
• Clarification
• Reflection
• Focusing
• Sharing perceptions
• Silence
• Humor
• Informing
• Suggesting

Listening:
An active process of receiving information. The complete attention of the
nurse is required and there should be no preoccupation with oneself. Listening
is a sign of respect for the person who is talking and a powerful reinforce of
relationships. It allows the patients to talk more, without which the relationship
cannot progress.

Broad openings:

These encourage the patient to select topics for discussion, and indicate
that nurse is there, listening to him and following him. For e.g. questions such
as what shall we discuss today? ―can you tell me more about that‖? ―And then
what happened?‖ from the part of the nurse encourages the patient to talk.
Restating:

The nurse repeats to the patient the main thought he has expressed. it
indicates that the nurses is listening. It also brings attention to something
important.

Clarification:

The person‘s verbalization, especially when he is disturbed or feeling

deeply, is not always clear. The patients remarks may be confused, incomplete
or disordered due to their illness. So, the nurses need to clarify the feelings and
ideas expressed by the patients.

Reflection:

This means directing back to the patient his ideas, feeling questions and
content. Reflection of content is also called validation. Reflection of feeling
consists of responses to the patient‘s feeling about the content.

Focusing:

It means expanding the discussion on a topic of importance. It helps the

patient to become more specific, move from vagueness to clarity and focus on
reality.

Sharing perceptions:

These are the techniques of asking the patient to verify the nurse
understands of what he is thinking or feeling. For e.g. the nurse could ask the
patient, as ―you are smiling, but I sense that you are really very angry with
me‖.

Theme identification:

This involves identifying the underlying issues or problem experienced

by the patient that emerges repeatedly during the course of the nurse-patient
interaction. Once we identify the basis themes, it becomes easy to decide which
of the patient‘s feeling and thoughts to respond to and pursue.

Silence:
 This is lack of verbal communication for a therapeutic reason. Then the
nurse‘s silence prompts patient to talk. For e.g. just sitting with a patient without
talking, non verbally communicates our interest in the patient better.

Humor:

This is the discharge of energy through the comic enjoyment of the

imperfect. It is a socially acceptable form of sublimation. It is a part of nurse
client relationship. It is constructive coping behavior, and by learning to express
humor, a patient learns to express how others feel.

Informing:

This is the skill of giving information. The nurse shares simple facts
with the patient.

Suggesting:

This is the presentation of alternative ideas related to problem solving.

It is the most useful communication technique when the patient has analyzed his
problem area, and is ready to explore alternative coping mechanisms. At that
time suggesting technique increase the patient‘s choices.

Types of Communication:

One-way v/s two way communication:

One-way communication:

The flow of communication is one way from the communicator to the

audience. Example receive method.

Drawbacks are:
 • Knowledge is imposed.
• Learning is authoritative.
• Little audience participation.
• No feedback.
• Does not influence human behavior.

Two way communication:

In this both the communicators and the audience take place. The process of
communication is active and democratic. It is more likely to influence behavior
than one way communication.

Formal v/s informal communication:

Communication has been classified into formal (follows lines of authority)

and informal (group line) communication.

Formal communication:

It is officially organized channels of communication and it is delayed

communication. It is generally used for all practices purposes. This
authoritative, specific, accurate and reaches everybody. The medium of formal
communication may be department meeting, conferences, telephone calls,
interviews, circular etc.

Informal network:

Gossip circles such as friends internet group, like minded people and casual
groups. Communication is very faster here. The informal channels may be more
active. It follows grapewine route. It may be a fact but more in native of rumor.
It does not reach every one informal communications are quite fast and
spontaneous.

Verbal v/s nonverbal communication:

The traditional way of communication has been by word of mouth

language is the chief vehicle of communication. Through it, one can interact
with other can be passes through. Direct verbal communication by word of
mouth may be loaded with hidden meanings. The important aspects if verbal
communications are as follows.

Vocabulary:
 Communication is unsuccessful if senders and receivers cannot translate
each others word and phrases when a nurses cases for a client who speaks
another language an interpret may be necessary.

Denotative and connotative meaning:

A single word has several meaning. Individuals who use a common

language share the denotative meaning, baseball has the same meaning for
everyone who speaks English, but code denotes cardiac arrest primarily to
health care providers.

The connotative meaning is the shade or interpretation of a word‘s

meaning influences by the thoughts, feelings or ideas people have about the
word.

Pacing:

Conversation is more successful at an appropriate speed or pace nurse

should speak slowly enough to enunciate clearly. Pacing is improved by
thinking before.

Adoptability:

Spoken messages need to be altered a according with behavioural due

from the receiver.

Intonation:

Tone of voice dramatically affects a meaning. The nurse must be aware

of voice line to avoid sending unintended messages.

Clarity and brevity:

Effective communication is simple, brief and direct. Clarity is achieved

by speaking slowly, enunciating clearly and using, repeating important parts of
a message also clarifies communication.

Brevity is achieved by using short sentences and words that expresses

an idea simply and directly.

Credibility:

Credibility means worthiness of belief, trustworthiness and reliability.

Time and relevance:

Timing is critical in communication. Even though message is clear,

poor timing can prevent it from being effective. Often the best time for
interaction is when a client express an interest in communication. If message are
relevant of important to the situation at hand, they are more effective.

Oral communication:

Oral communication is a transmitting message orally either by meeting the

person through artificial media of communication such as telephone and
intercom systems.

Written communication:

It is transmitting message in writing. Written communication can be

followed when a record of communication is necessary.

Non verbal communication:

Communication can occur even without word. Non-verbal communication

is message transmission through body language without using words. It includes
bodily movements, positive, facial expression. Silence is non verbal
communication. It can speak louder than words.

Personal appearance:

Nurse learn to develop a general impression of clients health and emotion

status through appearance and clients develop a general expression of the
nurse‘s professionalism and caring in the same way personal appearance
includes physical characteristics, facial expression, manner of dress and
grooming first impressions are largely based on appearance.

Poster and gait:

Poster and gait are forms of self expressions. The way people sit, stand
and more reflect attitudes, emotion and self concept and health status.

Facial expression:

The face is the most expressive part of the body. Facial expression
convey emotion such as surprise, fear, anger, happiness and sadness. People can
be unaware of the messages their expression convey doing procedure and the
client may interpret. This is anger or disapproval.

Eye contact:

Maintaining eye contact during conversation shows respect and

willingness to listen, lack of eye contact may indicate anxiety, discomfort or
lack of confidence in communicating.

Hand movements and gestures:

Hands also communicate by touch, slapping or caring another‘s head

communicates obvious feelings.

Channels of communication

i. Based on the number of people to which the message has to be conveyed

 Intrapersonal communication: Person communicates himself.
 Interpersonal communication: Interaction between 2 or more
persons. It involves listening, speaking, watching, observing and
responding between 2 people.
 Group communication: Message is conveyed to a large number of
people called audience. Group can be small or large.
 Mass communication: Kind of communication delivered with the
help of mass media.
ii. Based on the medium used to transmit the message
 Verbal communication
 Non -verbal communication
iii. Based on the flow of communication
 One- way communication
 Two-way/cyclic/socratic communication
 Vertical/formal communication
 Horizontal/informal communication

ADVANTAGES OF COMMUNICATION:

Oral communication:

• It is face to face system and hence can be clarified.

• There is an opportunity to ask questions, exchange ideas and clarify
meaning.
 • It can develop a friendly and co-operative spirit.
• It is easy and quick.
• It is flexible and hence effective.

Written communication:

• It has permanent record for future reference.

• It is less likely to be misunderstood.
• It will have adequate coverage and accuracy.
• Suitable for communicating lengthy messages.
• It is an authoritative communication.

DISADVANTAGES OF COMMUNICATION:

Oral communication:

• The spoken words may be misunderstood.

• The facial expression and tone of voice of the communicator may misled
the receiver.
• Not suitable for lengthy communication.
• It requires the art of effective specificity
• It has no record for future reference.

Written communication:

• It requires skill and education for understanding.

• It is also one way communication and hence may not be effective.
• There is no opportunity for the subordinates to ask questions and
exchange ideas.
• It may not communicate all aspects.

INTERPERSONAL RELATIONSHIP (IPR)

Means interaction or relations between two or more individuals.

Purposes:

IPR for an individual

• Personal growth and development

• Sense of security
• Interpersonal needs
IPR for Nurses

• Improved decision making

• Improved problem solving
• Building mutual understanding and cooperation

IPR for Patients

• Developing a sense of security and comfort

• Facilitating communication
• Improve socialisation

Phases

1. Orientation phase- problem defining phase

➢ Initial encounter between nurse and a patient having problems.
➢ Nurse clarifies his/her responsibilities.
➢ Identify the patient problems, define the problems and settles on
type of service needed.
2. Identification phase:
➢ Nurse approaches the patient with empathetic understanding to
understand accurately the problem.
➢ Nurse helps the patient to identify his problems in their own
context and uses the available resources to solve them.
3. Exploitation phase:
➢ Patient understands his problems and explores all possible
alternative solution to his problems.
➢ Nurse helps the patient to learn how to explore and use the
available resources to solve the problem.
4. Resolution phase:
➢ Termination of professional relationship that begins with the
convalescence and rehabilitation stage of the hospitalisation and
ends with discharge of patient.

Barriers of IPR

▪ Personal barriers-gender, lack of honesty, trust, fear of rejection

▪ Situational barriers.
 ▪ Sociocultural barriers-cultural diversity, ethnic diversity, social diversity
and language diversity.

SUPERVISION

▪ Very important element and essential component of staffing.

▪ Involves the management, planning and leadership of employees.
▪ Operates in all functions of administration

Meaning:

▪ Derived from two Latin words- ‘Super’ means above and ‘video’ means
see
▪ Means overseeing or superintending the work of others.

Definition

• Supervision is an act of a superior person to see the work of the personnel

working under him or her.
• Supervision is observing the subordinates at work to ensure that they are
working according to places and policies of the organisation and to help
them in solving the problems.
-
Terry
• Supervision can be defined as a process by which the subordinates are
guided according to their needs by the immediate superiors so that they
can make the best use of their knowledge and skill and improve their so
as to do their job efficiently and effectively to fulfil the objectives of the
organisation.
-
Williamson

Objectives of supervision:

• Meeting predetermining work objectives.

• Promotion of motivation and morale
• Bridging the gap between the workers personal goals and the
organisational goals
 • Ensuring that the subordinate staff or supervisor does what she is
supposed to do.
• Promotion of team work
• To assist and to help in the development of the staff of their highest
potential
• To interpret policies, objectives, need of the organisation.
• To develop coordination and to avoid overlapping
• To develop standards of service.
• To plan the services cooperatively.
• To develop the method of evaluation
• To assist in problem solving of the matters concerning personnel
• To evaluate the service given in wards and in community setting

Principles of supervision

▪ Good supervision do not overburden a staff

▪ Good supervision do not exert undue pressure
▪ Coordinates and unifies efforts of staff
▪ It is based on the needs of the individuals
▪ Give autonomy to staff depending upon personalities, expertise,
capabilities, knowledge, competence, experience and characteristics.
▪ Provide necessary counselling, guidance and training to staff.
▪ Encourage staff in decision making
▪ It is well planned.
▪ Good supervision generates and guarantees quality of nursing care.
▪ Good supervision foster the ability of each staff member to think and act
for himself/herself.
▪ Communicate with workers freely.
▪ Encourage innovation allowing free flowing of ideas, share positive
experiences specially.
▪ Adopt and positive attitude rather than an attitude for inspection.
▪ Focus on continued and sustained staff growth.
▪ Ensure good planning, organising and coordination
▪ Provide good leadership
▪ Create suitable climate for productive work
▪ Good supervision helps the individual nurses set up objectives which are
for her dynamic, reasonable and worthwhile and helps her to attain her
objectives.
 ▪ Good supervision strives to make the ward a good learning situation.

Tips for effective supervision

• Don’t overburden a staff.

• Don’t exert undue pressure
• Give autonomy to staff.
• Be professional and technically competent.
• Encourage staff in decision making
• Provide good leadership.
• Ensure good planning, organising and coordination
• Create suitable climate for productive work.
• Be flexible.
• Communicate
• Motivate
• Be fair
• Decide on facts
• Be acceptable

Methods of supervision

▪ Direct method- direct supervision on staff. This is done at the time of

performing the activities by the staff to assess their skills and expertise
▪ Indirect method- through records and reports. Retrospectively observed to
compare work performance against performance indicators.(work diary,
performance report, copies of monthly report, other reports)
▪ Other methods- staff meetings, individual and group conferences

Tools of supervision:

i. Observational checklist- it comprises of a list of skills and knowledge,

attitude and other variables to be assessed and a space to put tick mark
whether or not that particular behaviour has occurred.
ii. Rating scale- is a device for obtaining judgement of degree to which a
particular characteristic or attitude is expressed or performed which is
readily detectable simple observation. It consists of a straight line to
represent a range of behaviour provided with units on scale or divisions.
iii. Nursing rounds
iv. Observation
 v. Written policies, printed materials
vi. Reports
vii. Staff meeting
viii. Inservice education
ix. Follow up visits and evaluation

Techniques of Supervision

• Group conference: Is a small group teaching method. The students are

allowed to participate actively in the discussion, explaining their own
experiences in the clinical area.
This helps the students to develop problem solving skills, team building
skills and the ability to express themselves assertively.
• Individual conference: Focuses on the overall development of the
individual student. • The focus is more directed towards the development
of clinical skills.It mainly deals with the student nursing care ability, level
of performance achievements and assignments related to the clinical
experiences.
▪ Anecdotal records: An anecdotal record is an observation that is written
like a short story. They are descriptions of incidents or events that are
important to the person observing. Anecdotal records are short, objective
and as accurate as possible.
▪ Incidental teaching: A naturalistic teaching method. A procedure where
new behaviors are taught within the context of natural environments,
during the course of typical events

Methods of supervision

1. Technical versus creative supervision

2. Cooperative versus authoritarian supervision
3. Scientific versus intuitive supervision
4. Task oriented versus employee oriented supervision

Technical versus creative supervision

❖ Technical – These are basic supervisory skills and which need to be

trained – group discussion and conference
❖ Creative – provides maximum adaptation to the situ

Cooperative versus authoritarian supervision

 ❖ Cooperative – full participation of each member of the group in
planning, action and decision.
❖ Authoritarian: supervision responsibility centers entirely on the
supervisor, with the staff following his / her orders.

Scientific versus intuitive supervision

❖ Scientific supervision – Relies on objective study and measurement than

personal judgment / opinion.
❖ Intitutive supervision: It needs to maintain IPR

Task oriented versus employee oriented supervision

❖ Task oriented supervision emphasize the task more than performer.

❖ Employee oriented: Supervisors are more concerned about worker staff
their needs and welfare than assigned tasks

Steps in Supervision:

When supervision is needed the superior has to make plan for supervision by
using certain steps to follow.

1. Defining of the job to be done

2. Selection and organization of supervisor activities based on available
resources.
3. Anticipation of difficulties
4. Establishment of criterion for evaluation determining what extent the
programme has met problem / objectives according to plan.

Functions of Supervision

Administrative:

 Assignment of the work loads of individual and groups according to the

level of physical and mental competence (or) preparing the duty roaster.
 Identify the needs for supplies and equipment and providing materials
and supplies to facilitate the staff performance.
 Identify the problem and helps to solve.

Educative:

 Orientation
 Teaching subordinates
  Plan and conduct in service education program
 Ensuring staff developments

Communicative

 The supervision act as a communicator between the staff and authorities

and other health team members.
 She facilitates communication
 She should encourage free communication among persons between
worker and community representatives and members of health team.

Evaluative:

 Supervisor is supposed to carryout performance appraisal of all the staff

this include identify the cause of difficulty.
 Providing Continuing Education and guidance.

Functions of Supervisor

Administrative- Assigning duties, preparing duty roster, providing

material.
Teaching- providing technical guidance
Helping-help by solving problems
Linking- acts as a communicator between superior and subordinates
Evaluation- carrying out performance appraisal

Qualities of a Supervisor:

 IPR and Professional Skills

 Professional and technical knowledge
 Thoroughness
 Fairness
 Initiative
 Tactful
 Enthusiastic
 Emotionally mature
 Teaching abilities
 Positive attitude
ORGANISATIONAL BEHAVIOR AND HUMAN RELATIONS-
CONCEPT, PRINCIPLES AND THEORIES

Organizational behaviour

It refers to the behaviour of individuals and groups within organisation and the
interaction between its members and their external environment.

Definition

• Organizational behaviour is the study and application of knowledge of

how people act or behave within an organisation.
– Keith Davis and John
Newstorm
• Organizational behaviour is a field of study that investigates the impact
that individuals, groups and structure have on behaviour within
organisation for the purpose of applying such knowledge towards
improving an organizations effectiveness.
–
Stephen P Robins

Concepts of organisational behaviour

• Individual difference- Each person is different in several ways. Whether

intelligence,physique, personality and any other trait. Individual
difference means that management can cause the greatest motivation
among employees by treating them differently.
• A whole person- When an individual is appointed her skill alone is not
hired,his or her social background,likes and dislikes,pride and prejudices
are also hired. A persons family life cannot be separated from his or her
work life. So managers should endeavour to make work place a home
away from home. Management not only strive to develop a better
 employee not of a worker but a better person in terms of growth and
fulfilment.
• Caused behaviour- The behaviour of the employee is caused and not
random behaviour. It is directed towards someone that the employee
believes, right or wrong in his or her interest.
• Human dignity- It recognizes that people want to be treated with dignity
and respect and should be so treated.
• Organisation as a social system- Organisation is a social system, the
actions there in are governed by social as well as psychological laws. Just
as people have psychological needs they also have social roles and status.
Their behaviour is influenced by their group as well as their individual
drives.
• Mutuality of interest-Organistion need people and people also need
organisation. Organisation have a human purpose. They are formed and
mentioned on the basis of some mutuality of interest among their
participants.
• Holistic concepts- this concepts interprets people and organisation
relationship in terms of whole person, whole group, whole organisation as
a whole social system.

Elements of organisational behaviour

a. People- In an organisation people exist both as individual and in

group. As individual differences exist with respect to perception,
personality, motivation and individual learning etc.It is necessary
to understand the individual traits and characteristics. This helps
each individual understand another’s behaviour.
b. Structure- Organisation is a social system. It has its own structure
and that could be either formal or informal. Company is a formal
organisation. Informal organization are formed by individuals. As
the saying goes men may come and go but company goes on
forever. The organisation structure may change due to technology
and environment.
c. Environment- Two types of environment in which organisation
operate: internal and external. Internal environment include: for
instance, the working environment, individual attitude etc. External
environment –Govt. rules, procedures, customers of company etc.
Both internal and external environment affects the organisation.
 d. Technology- This means the materials, equipment, machines and
systems with which the individual works. The company purchases
technological tools for purpose of production and service.

Theories

➢ Classical doctrine theory

• Oldest theory in the study of organisation. It emphasises rigid,
centralised control of workers to promote high production.
▪ Fredrick Taylor- Father of Classical theory & the Father of Scientific
Management
High production was his primary concern in developing this theory. He
believed that high production could be achieved by paying high wages.
Taylor’s scientific management approach involves timing various work
activities with a stop watch. The purpose is to determine the exact time in
which a worker should be able to accomplish task.
Further, in the classical approach, strict obedience to authority is
expected. Workers must do the handwork exactly as told by their
superiors. Only top level managers may do brain work and workers job is
to keep production going.
▪ Henry Fayol theory of management: Fayol identified 14 principles of
management. His principles made it clear that production, efficiency and
profit were of prime importance, while individuals/workers were of
comparatively less importance.
➢ Humanistic School (Behavioural or Neoclassical theory):It was
demonstrated lack of concern for workers that led to the formation of a
new theory of organisation in 1930. It identifies two major functions of
organization: one maintaining the external balance, that is the economics
and other maintaining the internal balance, that is the social organisation
of the workers through which they satisfy their own desires and needs.
Together these functions have equal importance in the humanistic theory.
The theory also recognises that an individual goal may differ from
organisational goals.an institution organised according to humanistic
theory therefore allows and encourages participation of workers in
planning and decision making. The institution tries to promote general
job satisfaction for workers because according to this theory concern for
workers needs as well as for profit and production will lead to improved
production and economic cost effectiveness.
 ➢ Modern organisation theory:
Began in the late 1950s, as researchers recognised that in the humanistic
as well as in the classical approach something is missing. The modern
organization theory consists of two approaches: system and contingency.
The theory comes from the field of sociology, economics, mathematics,
engineering and administration, but its unifying strand is human systems
in their totality. However the modern organization theory is still evolving.
Its basic assumption lies in a system framework- that the organisation is
an open system- consisting of input, throughput, output and feedback.

GROUP DYNAMICS:

• It is a social process by which people interact in a group environment.

The influence of personality and power of behaviour on the group
process can influence the dynamics of any group.
• A branch of social psychology which studies problems involving the
structure of a group.
• The interactions that influence the attitudes and behaviour of people
when they are grouped with others through either choice or accidental
circumstances.
• A field of social psychology concerned with the nature of human
groups, their development, and their interactions with individuals,
other groups, and larger organizations.

OBJECTIVES OF GROUP DYNAMICS

• To identify and analyze the social processes that impact on group

development and performance.
• To acquire the skills necessary to intervene and improve individual and
group performance in an organizational context.
• To build more successful organizations by applying techniques that
provide positive impact on goal achievement.

PRINCIPLES OF GROUP DYNAMICS

▪ The members of the group must have a strong sense of belonging to the
group.
▪ Changes in one part of the group may produce stress in other person,
which can be reduced only by eliminating or allowing the change by
bringing about readjustment in the related parts
▪ The group arises and functions owing to common motives.
▪ Groups survive by placing the members into functional hierarchy and
facilitating the action towards the goals
▪ The intergroup relations, group organization and member participation is
essential for effectiveness of a group.
▪ Information relating to needs for change, plans for change and
consequences of changes must be shared by members of a group.

ELEMENTS OF GROUP DYNAMICS

1. Communication- One of the easiest aspects of group process to observe is

the pattern of communication. The kind of observation we make give us
clues to other important things which may be going on in the group such
as who leads whom or who influences whom.
2. Content versus process- Content of group discussion often tells us what
process issues may be on people’s mind. Process really means to focus on
what is going on in the group and trying to understand it in the terms of
other things that have gone on in the group.
3. Decision- Many kind of decisions are made in groups without considering
the effects of these decision have on other members.
4. Influence- Some people may speak very little, yet they may capture the
attention of the whole group. Other may talk a lot, but other members
may pay little attention to them.
5. Task versus relationship- The group task is the job to be done. People
who are concerned with the task tend to make suggestions as to the best
way to proceed or deal with a problem. Relationships means how well
people in the group work together.
6. Roles- 3 types:
➢ Task roles: (which helps the group accomplish its task)
Initiator: proposing tasks or goals; defining a group
problem; suggesting ways to solve a problem.
Information/opinion seeker: requesting facts; asking for
expressions of feeling; requesting a statement; seeking
suggestions and ideas.
Information or opinion giver: offering facts; providing
relevant information; stating an opinion; giving suggestions
and ideas.
 Clarifier and elaborator: interpreting ideas or suggestions;
clearing up confusion; defining terms; indicating alternatives
and issues before the group.
Summarizer: pulling together related ideas; restating
suggestions after the group has discussed them; offering a
decision or conclusion for the group to accept or reject.
Energizer; who stimulates and prods the group to act and
raise the level of their actions.
Coordinator: who clarifies and coordinates ideas,
suggestions and activities of the group members.
➢ Relationship roles (which helps group members get along better)
Harmonizer: who mediates, harmonizes and resolve
conflicts.
Gate keeper: helping to keep communication channels open;
facilitating the participation of others; suggesting procedures
that permit sharing remarks.
Encourager; being friendly, warm, and responsive to others;
indicating by facial expression or remarks the acceptance of
others' contributions.
Compromiser: when one's own idea or status is involved in
a conflict, offering a compromise which yields status;
admitting error.
Follower: who accepts the group‘s ideas and listens to their
discussion and decisions.
➢ Self oriented roles(which contributes to neither group task nor
group relationship)
Dominator: interrupts others; launches on long monologues;
is over-positive; tries to lead group and assert authority; is
generally autocratic.
Negativist: rejects ideas suggested by others; takes a
negative attitude on issues; argues frequently and
unnecessarily; is pessimistic, refuses to cooperate.
Aggressor: tries to achieve importance in group; boasts;
criticizes or blames others; tries to get attention; shows anger
or irritation against group or individuals; deflates importance
or position of others in group.
 Playboy: is not interested in the group except as it can help
him or her to have a good time.
Storyteller: likes to tell long "fishing stories" which are not
relevant to the group; gets off on long tangents.
Interrupter: talks over others; engages in side conversations;
whispers to neighbour

STAGES OF GROUP DEVELOPMENT

Dr. Bruce Tuckman published his Forming, Storming, Norming, Performance

model in 1965.He then added a fifth stage Adjourning in1970.

Stage 1: Forming: It is the initial stage marked by uncertainty and confusion.

The structure of the group is uncertain and unpredictable. Leadership cannot be
implemented effectively.

Stage 2: Storming: There is a huge rift created because of various disparities

and disagreements between members.

Stage 3: Norming: Situation of chaos is finally settled. The groups are finally
realised and ‘I’ is replaced by ‘We’.

Stage 4: Performing: Team work forms the very essence of the group. The
assigned task is completed with devotion and perseverance.

Stage 5: Adjourning: This represents the end of the group. In this case the
mission is accomplished and its time to disband the group or have a new
composition. All the stages starts over again.

GROUP DYNAMICS PROCESS

A. Group formation
A group is able to share experiences, to provide feedback, to pool ideas,
to generate insights, and provide an arena for analysis of experiences. The
group provides a measure of support and reassurance.
 Participation- Participation is a fundamental process within a
group, because many of the other processes depend upon
participation of the various members. Levels and degrees of
participation vary. Some members are active participants while
others are more withdrawn and passive. In essence, participation
means involvement, concern for the task, and direct or indirect
 contribution to the group goal. If members do not participate, the
group ceases to exist.
 Communication- Communication within a group deals with the
spoken and the unspoken, the verbal and the non-verbal, the
explicit and the implied messages that are conveyed and
exchanged relating to information and ideas, and feelings. Two-
way communication implies a situation where not only the two
parties talk to each other, but that they are listening to each other as
well. It helps in clarification of doubts, confusions and
misconceptions, both parties understanding each other, receiving
and giving of feedback.
 Problem solving - Most groups find themselves unable to solve
problems because they address the problem at a superficial level.
After that they find themselves blocked because they cannot figure
out why the problem occurred and how they can tackle it.
 Leadership- Leadership involves focusing the efforts of the people
towards a common goal and to enable them to work together as
one. In general we designate one individual as a leader. This
individual may be chosen from within or appointed from outside.
B. Development of groups
Viewing the group as a whole we observe definite patterns of behavior
occurring within a group. These can be grouped into stages.
Stages include:
 The initial stage in the life of a group is concerned with forming a
group.
 The second stage in this group is marked by the formation of dyads
and triads
 The third developmental stage is marked by a more serious concern
about task performance.
 This is a stage of a fully functional group where members see
themselves as a group and get involved in the task.
C. Facilitating a group
A group cannot automatically function effectively, it needs to be
facilitated. Facilitation can be described as a conscious process of
assisting a group to successfully achieve its task while functioning as a
group. Facilitation can be performed by members themselves, or with the
help of an outsider.
HUMAN RELATIONS

• It is a skill or ability to work effectively through and with other people.

• Human Relation is defined as a phenomenon of organised human activity
directed towards the promotion of cooperative and happy work
relationship. It is getting the work done by people with their heart in the
job.
• HR can be defined as the way in which people work with one another in a
cordial manner recognizing other needs, views, values and temperament.
• HR is a process of effective motivation of an individual in a given
situation in order to achieve balance of objectives that will yield greater
human satisfaction and help accomplish company goals

Objectives

➢ Practice of good HR
➢ Helps establish a cordial relationship between the management and the
employees
➢ Enable the manager to have an integrated approach to situations.
➢ Establishes a mutual regard and recognition vertically and laterally.
➢ Facilitates employee involvement in the affairs of organisation leading
to better productivity
➢ To facilitate effective organisational communication.
➢ To achieve cooperation between various individuals particularly
between the boss and the subordinates
➢ Will improve team work and team spirit.
➢ To improve organisational behaviour.
➢ To improve employee morale and job satisfaction.
➢ Facilitate close coordination in the environment.

Goals

To gain better understanding of oneself.

To develop respect for others.
To broaden and sharpen sensitivity to the feeling of others.

Elements of Human relations

Five major elements of HR

 1. Human needs satisfaction: According to Maslow theory, there are
hierarchy of needs, physiological safety, esteem and self- actualization
needs.
2. Motivation: Act of stimulating an individual or oneself to contribute
utmost to achieve desired objectives.
3. Distribution of status and roles: Employees should be inspire and
encourage updating knowledge and for staff and professional
development.
4. Informal social groups: Important to have social gatherings to exchange
the views and to share the feelings.
5. Spontaneity of group formation: These are a form of associations through
which they can work together and can take decisions for the betterment of
staff.

Principles of Human relations

 Respect for human dignity of employees

 Encourage for the personality development
 Have provisions for good incentives for good accomplishments
 Be fair and honest
 Be cooperative
 Be punctual and observe punctuality.

Basic Principles of Human Relations Approach:

❖ Recognition and appreciation.

❖ Fair treatment
❖ Informal relations.
❖ Job security and job satisfactions.
❖ Effective communication
❖ Decentralisation: Individual staff and functional areas should be given
greater autonomy and decision making power.
❖ Participatory decision making
❖ Concern for developing self -motivated nurses: Employees should be self
motivated who can set their own task related goals and monitor their own
performance in achieving them.

Advantages of good Human relations

  Great impact on efficiency, productivity and profitability of organisation.
 Reduces the incidence of absenteeism, strikes acts of indiscipline.
 More preventive in nature than curative.

Prerequisites for good human relations

 Providing individual recognition to each staff.

 Understanding the personality of individual staff.
 Avoid arguments.
 Deal with fair mind and facts
 Keep an open mind.
 Act on what is right and who is right

Role of Nurse Manager to develop Human Relations

 Recognise the importance of the individual and deal with human

relations.
 Must be mutual understanding of their position.
 Nurse employees and administrators should have common interest.
 Mutual discussion, exchange of views and good communication should
be inculcated.
 Set a good example for your employees.
 Try to understand nurse employees.
 Be fair and impartial
 Plan work carefully and keep the perspectives.
 Give clear, concise and complete instructions.
 Get result, develop safe, efficient and competent nurses.
 Know your duties, responsibilities and authorities and of your
subordinates

PUBLIC RELATIONS IN CONTEXT OF NURSING

➢ Public relations are the skilled communication of ideas to the various

public with objective of producing a desired result.
➢ Public relations is finding out what people like about you and doing
more of it: finding out what they don’t like about you and doing less of it.

- Bernays
 ➢ Public relation is defined as a planned effort to establish and improve the
degree of mutual understanding between an organisation and the public
with the primary objective of acquiring a good reputation.
➢ Public relations is government is the composite to all the primary and
secondary contacts between the borealis and the citizen and all the
interaction of influences and attitudes established in these contacts.

Goals of Public Relations:

• To form, maintain and the organisation reputation, enhance its status and
present a favourable image.
• To create or develop goodwill for the organisation.

Elements of public relations

• Human relations- Getting along with people. One should be aware of

other person and interested in his/her progress.
• Empathy: feeling with others.
• Persuasion: Causing somebody to do something by reasoning with him;
compelling is against the principles of social contact.
• Dialogue: Conversation with a purpose.

Functions of public relation:

 Anticipating, analysing and interpreting public opinion, attitudes and

issues that might impact for good or ill.
 Counselling management at all levels in the organisation with regard to
policy decision, courses of action and communication.
 Researching, conducting and evaluating on a continuing basis, programs
of action.
 Planning and implementing the organisation efforts to influence or
change public policy

FORMS OF PUBLIC RELATION:

• Employee relations: It is a function of public relations that includes

responding to employee concerns and informing and motivating staff.
 • Community relations: It is the function of actively planning and
participating with and within a community for the benefit of the
community and the hospital.
• Government relations: It is a function of relating to government officials
and agencies about issues that impact the hospital and its audiences.
• Media relations: It is often considered synonymous with public relations,
is the function of working with the media to communicate news.

METHOD OF IMPROVING PUBLIC RELATION IN HOSPITAL

• General: High quality patient care by the hospital is the theme of any
public relation programme.
• Physical facilities: Well planned hospital with sufficient waiting area for
the patient and its relation in the hospital, optimum floor space for each
department of t e hospital, logical layout of the department and work
areas, provision of adequate facilities like toilets, public utility services
like canteen, drinking water facility and so on go a long way in improving
the image of the hospital.
• Staff: In a hospital the staff consists of variety individuals drawn from
different status of the society with different levels of education and
background .
• Name Labels and Uniform: All functionaries should wear uniforms and
name labels. This creates initial good impression on patients and reflects
good administration.
• Importance of Color: Color affects many of our moods and emotions.
Proper choice of color can transform depressing and monotonous
atmosphere into pleasing and exciting one.
• Operating facility: The operating efficiency in an organization like,
hospital is the outcome of its soundness of objectives, policies,
procedures, programmes and standing orders.
• The speciality clinics: The speciality clinics if located proximally are
one of the concentrated areas of the OPD services.
• Waiting time: The waiting time in the OPD is invariably the sore point of
public grievances.
• Delay in Admission: Anxiety and distress is the result of delays in
admission due to long waiting list.
 • Ward Reception: Patients are generally vulnerable to anxiety and fear on
arrival in the ward. The reception they get tends to leave a deep
impression
• Privacy: It is normally observed that majority of the patients are
dissatisfied with the type of privacy provided in the ward.
• Food: Good food, well prepared and attractively served to patients,
makes a very favorable impression.
• Cleanliness: Cleanliness is much a desired thing in a hospital.
• Information about Illness: The most important thing to a patient is to
know as to what is wrong with him and how long will it take to recover.
• Visitors: Relatives and friends come rushing to the hospital the moment
they learn about the illness of their near and dear one.
• Complaints and Suggestions: The best way to deal with complaints is to
do everything possible to avoid getting them by anticipating the problems
• Mortuary and Chaplain Facility: The disposal of the dead is influenced by
religion, social and cultural beliefs and practices. It is necessary to
provide within the hospital or its premises a place to which a dead body
can be moved quietly so that other patients do not get upset.

PUBLIC RELATION OPERATES IN TWO AREAS

Within an organization:

1. The first area within an organization is between leadership and the people

2. Second to area is between different professional and specialists. Every

organization is subject to professional jealousies. Conflicts or interest and
personalities

3. A third area is between different departments. There is frequently

competition for funds, honours, and fever with an organization

4. Public relations also operates between individual on all levels of authority

and responsibility

Between an organization and in environment

• Between an organization and its competitions and other unrelated

agencies
• This may be between the organization and the community
 • It also inter groups or organization and regulates with other similar
organizations .

Public Relation Tools

1. Advertising- drawing attention by big public announcement to a
commodity or service with the goal of selling it.
2. Publicity- The technique of telling the story of any organisation. It
includes all the techniques employed to get a story across to the public. It
includes advertising.
3. Propaganda- The political application of publicity and advertising on a
large scale for selling an idea or candidate or both.
4. Diplomacy-The management of international relations by negotiations.
Diplomacy is the application of intelligence and actions to conduct and
maintain official relations
5. Promotions- Commercialisation of publicity usually on a grand and
coordinated scale aimed at selling a product.
6. Campaigns- Concerted single purpose publicity programmes usually on a
large or small scale using coordinated publicity through a variety of
media aimed at a number of targets, but focussed on specific goals.
7. Lobbying- Campaigning for legislative action. It is an informal way of
pulling strings . lobbying entails the exercising influence and pressure.
8. Public affairs- A substantial and significant participation by individuals,
private institutions, foundations and Government in economic, social and
political areas that singly or through interaction shapes the environment
in which the free enterprise exists.
9. PR Counselling- A PR personnel first determines the character of the
company, its existing status or image. He then suggests what should be
done to improve the company’s image.
10.PR Budgetting- A person or establishment desiring to run a PR campaign
should have a budget that will depend upon the need of the individual or
establishment.

SKILLS REGARDED FOR EFFECTIVE PUBLIC RELATIONS:

1. One should have a thorough knowledge of the organization

2. One requires the ability to co-ordinate skill as co-ordain of meeting,
interview.
3. One requires skill in communications
4. He should be able to communicate the manage be it written, spoken,
printed and photographed
5. One also requires the ability to understand people
 6. A good public relations person must understand human nature and
behaviours as well as human needs and aspirations
7. Skill of diplomacy or feet fullness
8. Public relations have to deal with many different people. Causal
diplomacy enables on to fell through the attitudes and prejudices and
reach common ground
9. One should pass integrity so that one is trussed inside and outside the
organization and especially by the media.
10.One must have the skill to guide others to reasonable thought and
orderly considerations and understanding
11.One should be alert to public moods and trends

ADVANTAGES OF PR

▪ Ability to reach specific groups

▪ Image building
▪ Lead generation
▪ Cost
▪ Credibility

DISADVANTAGES OF PR

▪ Lack of communication
▪ Lack of coordination with the marketing department.

ROLE OF NURSE IN MAINTAINING PR

▪ Care provider
▪ Communicator
▪ An administrator
▪ Educator and counsillor
▪ Liason officer

RELATION WITH PROFESSIONAL ASSOCIATION AND EMPLOYEE

UNION: COLLECTIVE BARGAINING, WORK CULTURE

COLLECTIVE BARGAINING

• Phrase coined by Sydney Webb & Beatrice Webb, who believed that
collective bargaining was the collective equivalence of individual being
whose primary aim was achieving economic advantage.
 • The term collective bargaining consists of 2 words-collective which
implies group action through its representative and bargaining which
suggests negotiating. The phrase therefore implies collective negotiations
of a contract between management representative on one side and those
workers on other.

Definition

“Collective bargaining is an agreement between a single employer or an

association of employers on the one hand and a labour union on the other,
which regulates the terms and conditions of employment.

(Tudwig
Teller)

The continuous relationship between an employer and a designated labour

organisation representing a specific unit of employees for the purpose of
negotiating written terms of employment.

(Carrel
& Heavrin)

Collective bargaining is a process of discussion and negotiation between two

parties, one or both of whom is a group of persons acting in concert…. More
specifically it is the procedure by which an employer or employers and a
group of employees agree upon the conditions of work

Objectives of Collective Bargaining

▪ To provide an opportunity to the workers, to voice their problems on

issues related to employment.
▪ To facilitate reaching a solution that is acceptable to all the parties
involves.
▪ To resolve all conflicts and disputes in a mutually agreeable manner.
▪ To prevent any conflict/disputes in the future through mutually signed
contracts.
▪ To develop a conducive atmosphere to foster good organizations
relations.
▪ To provide stable and peaceful organization (hospital) relations.
▪ To enhance the productivity of the organization by preventing strikes
lock – out etc.
Important Functions of Collective Bargaining

• It is a rule making or legislative process- It formulates terms and

conditions under which the labour and management will cooperate and
work together over a certain stated period.
• It is also a judicial process- In every collective bargaining there is a
provision or clause regarding the interpretation of the agreement and how
any difference of opinion about the intention or scope of a particular
clause is to be resolved. Such interpretation can be left to a joint
committee of workers and management representative or the top level
management or to a third party jointly selected by the union and the
management.
• It is an executive process- For both the management and the trade unions
undertake to implement the agreement signed, each accepting a series of
obligations under the agreement.

Characteristics of Collective Bargaining

I. It is a group process
II. Negotiations form an important aspect of the process of collective
bargaining
III. Collective bargaining is a formalized process by which employers
and independent trade unions negotiate terms and conditions of
employment and the ways in which certain employment-related
issues are to be regulated at national, organizational and workplace
levels.
IV. Collective bargaining is a process in the sense that it consists of a
number of steps. It begins with the presentation of the charter of
demands and ends with reaching an agreement, which would serve
as the basic law governing labour management relations over a
period of time in an enterprise. Moreover, it is flexible process and
not fixed or static.
V. It a bipartite process. This means there are always two parties
involved in the process of collective bargaining.
VI. Collective bargaining is a complementary process.
VII. Collective bargaining tends to improve the relations between
workers and the union on the one hand and the employer on the
other.
VIII. Collective Bargaining is continuous process.
 IX. Collective bargaining takes into account day to day changes,
policies, potentialities, capacities and interests.

Legal framework for Collective Bargaining

Employees have the right to

• Form, to join or to assist a labour organisation of their choice.

• Bargain collectively through that labour organisation.
• Protect employees by defining and prohibiting unfair labour practices
such as:
-interfering with employees in the exercises of their right.
-interfering with the formation or administration of a labour organisation.
-Discriminating against employees for engaging in or refraining from
union activities.

Principles to be followed by the management in Collective Bargaining

i. The management must form and follow a realistic labour policy which
should be accepted and carried out by its representatives.
ii. The management should deal only with one association or trade unions in
the organisation.
iii. The management must agree to reform the trade unions or associations
without any reservation and take it as a beneficial step in the organisation.
iv. The management should treat the trade union fairly in order to make it a
responsible part of the organisation.
v. The management should regularly check the rules and regulations to
determine the attitude and degree of comfort of its employees and in turn
gain their goodwill and cooperation.
vi. The management should place greater importance on social
considerations while weighing the economic consequences of collective
bargaining.
vii. The management should not wait for the trade union to bring employee
problems to its notice but should rather form the condition in which
employees can directly approach the management without taking the help
of trade unions or associations.

Collective Bargaining Process

 I. Prepare: This phase involves composition of a negotiation
team. The negotiation team should consist of representatives of
both the parties with adequate knowledge and skills for
negotiation. In this phase both the employer‘s representatives
and the union examine their own situation in order to develop
the issues that they believe will be most important.
II. Discuss: Here, the parties decide the ground rules that will
guide the negotiations. A process well begun is half done and
this is no less true in case of collective bargaining. An
environment of mutual trust and understanding is also created
so that the collective bargaining agreement would be reached.
III. Propose: This phase involves the initial opening statements and
the possible options that exist to resolve them. In a word, this
phase could be described as ‗brainstorming‘. The exchange of
messages takes place and opinion of both the parties is sought.
IV. Bargain: negotiations are easy if a problem solving attitude is
adopted. This stage comprises the time when ‗what ifs‘ and
‗supposals‘ are set forth and the drafting of agreements take
place.
V. Settlement: Once the parties are through with the bargaining
process, a consensual agreement is reached upon wherein both
the parties agree to a common decision regarding the problem
or the issue. This stage is described as consisting of effective
joint implementation of the agreement through shared visions,
strategic planning and negotiated change.

Steps

• Selection of a bargaining agent.

• Certification to contract.
• Contract administration.
• Decertification.

The nurse manager‟s role:

The nurse manager in a health care organization where nurses are organized into
a collective bargaining unit participates in resolving grievances, using the
agreed upon grievance procedure.
Advantages and Disadvantages of Collective Bargaining:

Advantages:

▪ Equalization of power
▪ Viable grievance procedure
▪ Equitable distribution of work
▪ Professionalism promoted
▪ Nurses control practice

Disadvantages:

▪ Adversary relationship
▪ Strikes may not be prevented
▪ Leadership may be difficult to obtain
▪ Unprofessional behaviour
▪ Interference with management

Relation with Professional Associations and Employee Unions

Professional Associations

• Is a group of professionals who are responsible for maintaining and

enhance the status of their members
• They are self regulating and independent from government.
• Professions tend to regulated by senior, highly qualified members of the
profession.
• Professional bodies have important role in maintaining standards of
professional education.
• "A group of people in a learned occupation who are entrusted with
maintaining control or oversight of the legitimate practice of the
occupation;" also a body acting "to safeguard the public interest;"
organizations which "represent the interest of the professional
practitioners," and so "act to maintain their own privileged and powerful
position as a controlling body."

Objectives:

• To understand the role of professional organisations in empowering

nurses in their emerging professionalism.
• To discuss the functions of each professional organisations.
 • To discuss importance of self-assertiveness in safeguarding our
profession.
• To study the vast scope of collective bargaining in nursing profession

TRAINED NURSES ASSOCIATION OF INDIA (TNAI)

The Trained nurses association of India is a national professional association of
Nurses. The present name and organization were established in 1922.
Objectives
• Improve living and working condition for nurses.
• Uphold the dignity and honour of nursing profession.
• Promote a sense of spirit among all nurses.
• To advance professional education and general welfare of nurses.
Activities
• Establish standards and qualifications for nursing profession.
• Establish standards of nursing education
• Establish code of professional conduct
• Provide professional counselling.
• Promote and protect economic welfare of nurses
• TNAI may support strikes if all other means of negotiating have failed to
being about satisfactory working conditions.
• TNAI gives scholarships for nurses who wish to go on for advanced study
either here or abroad.
• It helped to remove discrimination against male nurses.
Membership
• Obtained by application and submission of a copy of your state
registration certificate. It is possible to apply for a life membership. The
official organ of the TNAI is The Nursing Journal of India which is
published monthly. The cost of this is included in the annual subscription
for membership in the association.
INTERNATIONAL COUNCIL FOR NURSES (ICN)
It was formed in 1899. It’s an international association for all nurses in the
world. Great emphasis has been on non-discrimination.
Objectives
• Promote the development of strong national nurses associations.
• Assist national nurses association to improve the standards of nursing
and the competence of nurses.
Activities
• Makes policy statements on health and social issues.
• Offers a great variety of seminars
• Maintaining and improving the status of Nursing around the world
Membership
 • All nurses can become members of the ICN but not as individuals. The
individual nurse becomes a member if his/her national nurses association
is a member of ICN. Nurses in India become members of ICN when they
become members of the TNAI.
THE COMMONWEALTH NURSES FEDERATION
The Commonwealth Nurses Federation was formally organized in 1973 and
operates in Six regions of the world which are East, Africa, Atlantic, Australia,
Pacific, South Asia and Europe. The TNAI is also affiliated with the
Commonwealth Nurses Federation .It is made up of nurses associations from
commonwealth countries.
Aims
• Promote sharing, better communications and closer relationships between
its member associations.
• Provides expert professional advice.
• Scholarships for advanced study.
• Financial assistance for professional meetings and seminars.
THE INDIAN NURSING COUNCIL (INC)
The Indian Nursing Council, which was authorized by the Indian Nursing
Council Act of 1947, was established in 1949.
Purpose
Providing uniform standards in Nursing education and reciprocity in Nursing
Registration throughout the country.
Responsibilities
• Prescribes curricula for nursing education in all the states.
• Refuses or Recognizes Programmes of Nursing Education according to
standards required.
• Support high standards in Nursing.
• Providing registration for foreign nurses.
• Maintenance of the Indian Nurses Register. This register contains the
names of all nurses, midwives, auxiliary nurse midwives who are
enrolled on all state registers.

RED CROSS SOCIETY

• It follows the directions of the Geneva conventions in an effort to
protect victims of armed conflict. Its headquarters is in Geneva,
Switzerland.
• They delegate visit and inspect prisoner of war camps. They
arrange for delivery of mail and food packages to the prisoners.
They also offer emergency relief by providing food and medical
supplies.
THE WORLD HEALTH ORGANISATION
 • The world health organisation, commonly called the WHO is also a
specialized agency of the United Nations. It was organized in 1948 for
the purpose of helping to achieve the highest possible level of health for
all people
• The WHO has been active in nursing education and practice in a number
of ways in India.

THE STUDENT NURSES ASSOCIATION (SNA)

The Student Nurses Association organized in 1920, is associated with and under
jurisdiction of the TNAI. In addition to providing a means of personal and
professional development for the nursing student. The assistant secretary of the
TNAI serves as advisor for the SNA.
Purposes and functions
• Help student Nurses learn how the professional organisation serves to
uphold the dignity and ideals of the nursing profession.
• Promote a close rapport with other student Nurses.
• Furnish student Nurses advice in their courses of study leading up to
professional qualifications.
Activities
• Fund raising for the TNAI.
• Fund raising done for fine arts and sports competitions and conferences.
• Special prizes given for outstanding achievement in specific areas of
nursing education.
Membership
Fees are minimal and easily met by the nursing student. Nursing students who
participate in the Student nurses association have a valuable opportunity to
begin to develop leadership skills, competitive skills and an interest for the
profession as a whole.
THE NURSES LEAGUE OF THE CLINICAL MEDICAL
ASSOCIATION
The Nurses league of the clinical medical association of India was founded in
1930. It became affiliated to the TNAI in 1936 and promotes membership in
this organisation.
Objectives
• Promote cooperation and encouragement among Christian Nurses.
• Promote efficiency in nursing education and service.
Activities
• Activities include national and area conferences and retreats for its
members. Development of leadership abilities is encouraged by
participation in these meetings.
 • Each meeting also allows for sharing of problems common to the
Christian nurse.
Membership
Membership fees are required and a life membership is available. Nursing
students may become associate members of the league. Membership in the
Nurses league may be a requirement for certain nursing positions under control
of Christian employing authorities.
THE CHRISTIAN MEDICAL ASSOCIATION OF INDIA
The CMAI began in 1905 as a fellowship of Christian missionary doctors to
provide spiritual sharing and support. It gradually developed into a larger
organisation which included other Christian health professionals and health
institutions.
Functions
• To provide professional training through formal and informal education,
publication of textbooks and other materials and scholarships.
• To encourage community health work through training, advisory services
and technical support.
Membership
Membership is open to doctors, registered nurses and ANM/Health workers, all
health professionals. Students in health professional courses may also become
members

UNIONS
Meaning
A union or labor organization is any organization in which employees
participate for the purpose of dealing with their employer about grievances,
labour disagreements, wages, hours of work, and conditions of employment.
Objectives of unions
• Wages- Employees and their union can be expected to ask for wages
which are comparable to those in similar jobs in the local market.
• Promotions- Unions will insist the length of services a factor in
promotion.
• Grievances procedures- The union will insist that grievances procedure
be established where by management decisions will be reviewable by
representatives of management and union.
• Fringe benefits- Pensions, vacations, holidays and general welfare
programs will be the part of negotiation.

Unions in India
At present three unions of nurses are working at the central level.
1. All India Government Nurses Federation (AIGNF)
2. Trained Nurses’ Union (TNU) and
 3. Trained Nurses Association of India (TNAI)
Besides, there are two state level unions, namely,
• Orissa Nursing Employee’s Association (ONEA)
• Trained Nurses Association of India, Orissa branch.
• United nurse association (UNA)

CONTROLLING
It is an important element of the management process. It is the process of
verification and comparison that ascertains anticipated performance.
Definition:
• Controlling can be defined as the regulation of activities in accordance
with the requirements of plans.
• Controlling is determining what is being accomplished, that is, evaluating
the performance and if necessary, applying correctives so that
performance takes place according to plans.
-George
R Terry

Steps of control:
The control function, whether it is applied to cash, medical care, employee
morale or anything else, involves four steps.
1. Establishments of standards.
2. Measuring performance
3. Comparing the actual results with the standards.
4. Correcting deviations from standards
Importance of controlling
i. Facilitates decision making
ii. Facilitates decentralisation
iii. Stimulates action
iv. Enhances employee morale
v. Promotes efficiency of operation
vi. Promote coordination
vii. Psychological pressure

COORDINATION
Is the essence of nursing management. It is the life line for the management. It
is the process in which different people or things work together to attain specific
goals or aims.
Definition
 • Coordination is the achievement of orderly group efforts and unity of
action in the pursuit of common goals.
-Mooney and
Railey
• Coordination is the integration of several parts into an orderly whole to
achieve the purpose of understanding.
-Charles
Worth
Features of coordination
• Group effort
• Essence of management- it is inherent in all managerial function.
• Conscious activity- Various skills are required to have the coordination
within the department.
• Responsibility of management
• Continuous and dynamic process
• Unity of actions
• Unity of purpose
• Integration of activities
• Pervasive function- It is required at every level and by every manager.
• Common purpose
Principles of coordination
i. Direct personal- Coordination is best achieved through direct personal
contact with the people concerned. Direct face to face communication is
most effective way to convey ideas and information and remove
misunderstanding.
ii. Early beginning- Coordination can be achieved more easily in early
stages of planning and policy making.
iii. Reciprocity- Means that all factors in a given situation are interdependent
and interrelated. Coordination becomes easier when people appreciate the
reciprocity of relations.
iv. Continuity- Coordination is an on-going or never ending process rather
than a once for all activity
Types of Coordination
On the basis of scope
• Internal- Coordination between the different units of an organisation
within and is achieved by integrating the goals and activities of different
departments of the organisation.
• External-between an organisation and its external environment
comprising Govt.community, customers etc.
On the basis of hierarchy
• Vertical-When coordination is between different levels of the
organisation and has to ensure that all the levels in the organisation act in
 harmony and in accordance with the goals and policies of the
organisation.
• Horizontal or lateral- It refers to coordination between different
departments and other units at the same level of the management
hierarchy.
Barriers of Effective Coordination
 Loss of Adhoc communication- lack of informal communication can lead
to ineffective coordination.
 Lack of contact among employees
 Time to initiate contact or communication
 Common difference or preferences
 Lack of trust
 Personal work style differences
 Different background of members
 Not realising there is a need to communicate.

QUALITY MANAGEMENT
The process by which people are mobilised to achieve quality goals. Quality
management is becoming integral to health care.

QUALITY ASSURANCE
QA provides the mechanisms to effectively monitor patient care provided by
health care professionals using cost effective resources. QA originated in
manufacturing industry. The idea was to ensure that product consistently
achieved customer satisfaction
Definition
• Quality assurance is a judgment concerning the process of care based on
the extent to which that care contributes to valued outcomes.

Donabedian 1982
• Quality assurance is the measurement of provision against expectations
with declared intention and ability to correct any demonstrated weakness.
–
Shaw
• QA is an ongoing systematic, comprehensive evaluation of health care
services and impart of those services on health care services.
-Kozier.

Objectives and goals:

1. To establish technical assistance and frame effective planning strategies
to implement and monitor quality care by checking and correcting errors
in health care services.
 2. To upgrade the existing system of nursing care and improve the care to
obtain maximum quality care by conducting evidence based research
activities.
3. To create awareness and popularise the work of nurses in the public thus
improving the image of nurses by providing quality nursing care.
4. To frame the evaluation process methodically which help to attain and
improve quality patient care.
5. To demonstrate the efforts of health care provider to deliver quality care.
6. To successfully achieve sustained improvement in health care, as clinics
need to design processes to meet the needs of the patient.
7. To design processes well and systematically in order to monitor, analyse
and improve patient outcomes.
8. To ensure that a designed system includes standardised, predictable
processes based on best practices.
9. To set incremental goals as needed.

Purposes/ Need
• Rising expectations of consumer of services.
• Increasing pressure from national, international, government and other
professional bodies to demonstrate that the allocation of funds produces
satisfactory results in terms of patient care.
• The increasing complexity of health care organizations.
• Improvement of job satisfaction.
• Highly informed consumer
• To prevent rising medical errors
• Rise in health insurance industry
• Accreditation bodies
• Reducing global boundaries.

Components of QA
1. Structure evaluation- focus on the setting in which care is provided to the
patient.
2. Process evaluation-focus on how the care was provided
3. Outcome evaluation- focus on visible changes in the patient’s health
status as result of nursing care provided.

Approaches
➢ General approach
➢ Specific approach
General approach: - It involves large governing or official bodies evaluating a
person or agencies‘ ability to meet established criteria or standard during a
given time.
 a) Credentialing- It is the formal recognition of professional or technical
competence and attainment of minimum standards by a person and
agency. Credentialing process has 4 functional components
o To produce a quality product
o To confirm a unique identity
o To protect the provider and public
o To control the profession
b) Licensure- It is a contract between the profession and the state in which
the profession is granted control over entry into an exit from the
profession and over quality of professional practice.
c) Accreditation- It is a process in which certification of competency,
authority, or credibility is presented to an organization with necessary
standards.
d) Certification –Certification is usually a voluntary process with in the
profession. A person’s educational achievements, experience and
performance on examination are used to determine the persons
qualifications for functioning in an identified speciality area
e) Charter- It is a mechanism by which a state government agency under
state law grants corporate state to institutions with or without right to
award degrees.
f) Recognition- It is defined as a process whereby one agency accepts the
credentialing states of and the credential confined by another.
g) Academic degree

Specific approach: - These are methods used to evaluate identified instances of

provider and client interactions.
a. Audit- It is an independent review conducted to compare some aspect of
quality performance, with a standard for that performance.
b. Direct observation- Structured or unstructured based on presence of set
criteria.
c. Appropriateness evaluation- The extent to which the managed care
organization provides timely, necessary care at right levels of service.
d. Peer review- Comparison of individual provider‘s practice either with
practice by the provider‘s peer or with an acceptable standard of care.
e. Bench marking- A process used in performance improvement to compare
oneself with best practice.
f. Supervisory evaluation
g. Self-evaluation

Quality assurance cycle:

In practice, QA is a cyclical, iterative process that must be applied flexibly to
meet the needs of a specific program. The process may begin with a
comprehensive effort to define standards and norms

I. Planning for Quality Assurance -This first step prepares an

organization to carry out QA activities. Planning begins with a review of
the organizations scope of care to determine which services should be
addressed.
II. Setting Standards and Specifications
To provide consistently high-quality services, an organization must
translate its programmatic goals and objectives into operational
procedures. In its widest sense, a standard is a statement of the quality
that is expected.
III. Communicating Guidelines and Standards
Once practice guidelines, standard operating procedures, and
performance standards have been defined, it is essential that staff
members communicate and promote their use. This will ensure that each
health worker, supervisor, manager, and support person understands what
is expected of him or her.
IV. Monitoring Quality
Monitoring is the routine collection and review of data that helps to
assess whether program norms are being followed or whether outcomes
are improved. By monitoring key indicators, managers and supervisors
can determine whether the services delivered follow the prescribed
practices and achieve the desired results.
V. Identifying Problems and Selecting Opportunities for Improvement
Program managers can identify quality improvement opportunities by
monitoring and evaluating activities. Other means include soliciting
suggestions from health workers, performing system process analyses,
reviewing patient feedback or complaints, and generating ideas through
brainstorming or other group techniques. Once a health facility team has
identified several problems, it should set quality improvement priorities
by choosing one or two problem areas on which to focus. Selection
criteria will vary from program to program.
VI. Defining the Problem
 Having selected a problem, the team must define it operationally-as a gap
between actual performance and performance as prescribed by guidelines
and standards. The problem statement should identify the problem and
how it manifests itself. It should clearly state where the problem begins
and ends, and how to recognize when the problem is solved.
VII. Choosing a Team-
Once a health facility staff has employed a participatory approach to
selecting and defining a problem, it should assign a small team to address
the specific problem. The team will analyze the problem, develop a
quality improvement plan, and implement and evaluate the quality
improvement effort. The team should comprise those who are involved
with, contribute inputs or resources to, and/or benefit from the activity or
activities in which the problem occurs.
VIII. Analyzing and Studying the Problem to Identify the Root Cause
Achieving a meaningful and sustainable quality improvement effort
depends on understanding the problem and its root causes. Given the
complexity of health service delivery, clearly identifying root causes
requires systematic, in-depth analysis.
IX. Developing Solutions and Actions for Quality Improvement
The problem-solving team should now be ready to develop and evaluate
potential solutions. Unless the procedure in question is the sole
responsibility of an individual, developing solutions should be a team
effort. It may be necessary to involve personnel responsible for processes
related to the root cause.
X. Implementing and Evaluating Quality Improvement Efforts
The team must determine the necessary resources and time frame and
decide who will be responsible for implementation. It must also decide
whether implementation should begin with a pilot test in a limited area or
should be launched on a larger scale. The team should select indicators to
evaluate whether the solution was implemented correctly and whether it
resolved the problem it was designed to address.
QA Methods
o Nursing audit
o Peer review
o Patient care profile analysis
o Quality circles- is a small group of 5-15 employees who perform
similar work and meet for an hour each week to solve problems
related their work.
o Patient satisfaction

Factors affecting QA in nursing

1. Lack of resources.
2. Personnel problems
 3. Improper maintenance
4. Unreasonable patients and attendants
5. Absence of well -informed population
6. Absence of accreditation laws
7. Lack of good hospital information system
8. Absence of patient satisfaction surveys
9. Lack of nursing care records
TOTAL QUALITY MANAGEMENT(TQM)
• Introduced by Edward Deming
• Is a management approach in an organisation centered on quality based
participation of all its members and aiming at long term success through
customer satisfaction
• TQM is a systematic approach to the practice of management requiring
changes in an organisational process, strategic priorities, individual
beliefs, individual attitude and individual behaviour.
• TQM is a management approach in an organisation centered on quality,
based on participation of all workers.
• TQM means that the organization culture is defined by and supports the
constant attainment of customer i.e., the patient satisfaction through an
integrated system of tools, techniques and training.
• It involves the continuous improvement of organization processes,
resulting in high quality products and services.
• Hence, TQM is “a continuous, customer- centered, employee driven
improvement.”
Elements

Customer focused which will bring satisfaction to clients.

Adopts the philosophy of continuous improvement and should start from
top management.
Commitment and attitude of work force
Encourage active participation of employees
Develop leadership at top level management.
 Education and training at the work force.
Good communication networking
Mutual respect and team work.
Principles of TQM by Deming
 Create a constancy of purpose for improvement of service.
 Adopt a philosophy of continual improvement
 Focus in improvement process
 End the practice of awarding service on price alone
 Constantly improve every process of quality management
 Institute job training and retraining
 Develop leadership in the organisation
 Encourage employees to participate actively in the process
 Foster interdepartmental cooperation
 Eliminate target on work force
 Focus on quality and not quantity
 Promote team work
 Educate and train employees to maximise personal development.
 Charge all employees for carrying out the TQM package.
Benefits of TQM
 Satisfaction of patient and relatives
 Improved job
 Less staff conflicts
 Continuous improvement of organisation
 Increased organisation outcome and image
 Improvement in employee morale
 Good team work and work culture
 Motivated employees
 Good communication among employees and good relationship between
patient and relatives.
Barriers of TQM
 Lack of policy and administrative manuals
 Lack of motivation among employees
 Lack of proper leadership
 Deficient work culture dynamism
 Lack of adequate resources
 Poor evaluation system
 Lack of good hospital management system
 Lack of incident review procedures
Role of nurse manager in TQM
▪ Encourage all staff to involve actively in quality control process
▪ Communicate goals and outcome to all staff
 ▪ Act as a role model for subordinates
▪ Actively involve in research activities related to quality assurance
▪ Organising continuing education program
▪ Create a work culture. Support and actively participate in activities of QA
process.
▪ Develops a system for continuous monitoring of nursing service
▪ Develops QA tool and criteria for evaluation, teaching and training the
nurses to use tool
▪ Observe nursing care services and review nurses documentation
▪ Participate in team activities
▪ Continuous evaluation of program is essential for periodic and continuous
appraisal of nursing care.
▪ Actively participate in implementation of program.
▪ Regularly evaluate quality management system being implemented.
Identify defects and its cause.

PROGRAM EVALUATION AND REVIEW TECHNIQUE (PERT)

Meaning

The program evaluation & review technique (PERT) was developed by the
Special Projects Office of the U.S. Navy and applied to the planning &control
of the Polaris Weapon system in 1958. It worked then, it still works; and it has
been widely applied as a controlling process in business & industry.

PERT uses a network of activities. Each activity is represented as a step on

chart. It is an important tool in the timing of decisions. In simplest form of
PERT, a project is viewed as a total system and consisting of setting up of a
schedule of dates for various stages and exercise of management control, mainly
through project status reports on this progress.

Program (Project) Evaluation and Review Technique (PERT) is a project

management tool used to schedule, organize, and coordinate tasks within a
project  It is basically a method to analyze the tasks involved in completing a
given project, especially the time needed to complete each task, and to identify
the minimum time needed to complete the total project.
Objective 
The main objective of PERT is to facilitate decision making and to reduce both
the time and cost required to complete a project.

Prerequisites
 • Personnel should already have a good understanding of formal project
management terminology, tools, and techniques
• PERT form template of equivalent tool (e.g. software)
• Create of project plan
• Choose the most appropriate scheduling method
• Select and organize a team to perform project tasks.
Program Evaluation & Review Technique includes:
1. The finished product or service desired
2. The total time & budget needed to complete the project or program.
3. The starting date & completion date.
4. The sequence of steps or activities that will be required to accomplish the
project or program.
5. The estimated time & cost of each step or activity.

Steps for accomplishing the project are:

a. The optimistic time: This occasionally happens when everything goes right.
b. The most likely time : It represents the most accurate forecast based on
normal developments.
c. The pessimistic time: This is estimated on maximum potential difficulties.
Calculation of the ―critical path, the sequence of the events that would take the
greatest amount of time to complete the project or program by the planned
completion date. The reason this is the critical path because it will leave the
least slack time.
Steps

Uses
1. It forces planning and shows how pieces fit together.

2. It does this for all nursing line managers involved.

3. It establishes a system for periodic evaluation & control at critical points in

the program.

4. It reveals problems & is forward- looking.

5. PERT is generally used for complicated & extensive projects or programs.

6. Many records are used to control expenses and otherwise conserve the
budget.

Advantages of PERT:

• It encourages logical discipline in planning, scheduling and control of

project.
• It encourages more long range & detailed project planning
• It provides a standard method of documenting and communicating
project plans, schedules, and time and cost- performance.
• It identifies the most critical elements in the plan, thus focusing
management attention .i.e. most constraining on the schedule.
• It illustrates the effects technical procedural changes on overall schedules

Limitations of PERT

▪ Expert guidance is always needed for the proper judgement of time.

▪ It will be difficult to categorise the activities if there are more than
hundreds or thousands of them
▪ Mere guess or approximation of time estimate can lead to errors in the
evaluation of time during work.
▪ PERT chart is usually very large and requires several pages for printing.
It also needs a special signed paper.
▪ Before planning a PERT chart one needs to do proper planning to
estimate the time frames for each activity.

GANTT CHARTS

Early in this century Henry L. Gantt developed the Gantt Chart as a means
of controlling production. It depicted a series of events essential to the
completion of a project or program. It is usually used for production activities.
Definition

Gantt chart is a type of bar chart that illustrates a project schedule.  This chart
lists the tasks to be performed on the vertical axis, and time intervals on the
horizontal axis.  The width of the horizontal bars in the graph shows the
duration of each activity.  Gantt charts illustrate the start and finish dates of the
terminal elements and summary elements of a project
Elements of Gantt chart
• Task list: Runs vertically down the left of the Gantt chart to describe
project work and may be organized into groups and subgroups
• Timeline: Runs horizontally across the top of the Gantt chart and shows
months, weeks, days, and years
• Dateline: A vertical line that highlights the current date on the Gantt chart
• Bars: Horizontal markers on the right side of the Gantt chart that
represent tasks and show progress, duration, and start and end dates
• Milestones: The diamonds that call out major events, dates, decisions,
and deliverables 
• Dependencies: The lines that connect tasks that need to happen in a
certain order
• Progress: Shows how far along work is and may be indicated by %
Complete and/or bar shading 
• Resource assigned: Indicates the person or team responsible for
completing a task
Uses of Gantt chart
▪ To show the current schedule status
▪ To measure task duration in the project
▪ To represent cost, time and scope of the project
▪ A useful tool for planning and scheduling projects
▪ To plan how long a project should take
▪ Lays out the order in which the tasks need to be carried out
▪ Modern Gantt chart software provides dependencies between tasks
▪ To monitor a project’s progress
▪ To visualize immediately what should have been achieved at any point in
time
▪ To assist in taking remedial action to bring the project back on course , if
required
Advantages of Gantt chart
 It helps in planning and monitoring the work of project
 Time is explicitly expressed in the chart
 All tasks are visible at a glance in relation to other
 Deadlines are depicted in the chart
 It organizes your thoughts.
  It demonstrates that you know what you’re doing.
 It (should) help you to set realistic time frames.
Disadvantages of Gantt chart
 They can become extraordinarily complex.
 The size of the bar does not indicate the amount of work
 They need to be constantly updated.
 Difficult to see on one sheet of paper.
BENCHMARKING

Definition

▪ Benchmarking is a process of finding what best practices are and then

proposing what performance should be in the future.
▪ It is a practice of identifying, understanding and adapting successful
practice and processes used by other companies, which help to improve
chances of success in one’s own company.
The three principles of benchmarking are maintaining quality, customer
satisfaction and continuous improvement
Purposes
To improve the competitive position of a company.
To gain a better understanding of efficiency, effectiveness of business
process.
To recognise the strength and weakness of company business.
To create a positive driving force in the company there by promoting
more profits.
To learn from those who are excelling in performance.
To incorporate the best practices made possible through benchmarking.
The Bench marking Process
i. Planning-Benchmarking involves deciding what is to be benchmarked,
who are the members and partners and what data collection methods are
going to be employed. Through this one will come to know how to
understand the business strategy in a better way.
ii. Analysis of Benchmarking- It involves analysing the performance of the
partners and comparing their work to figure out how and why they are
better.
iii. Integration of Benchmarking- It involves developing the goals and
combining them to perform standard benchmarking to improve the
performance. Main focus is on whether the management agrees on the
findings, whether there is any need to modify goals based on the findings,
and whether all goals are clearly explained to all the partners involved or
not.
iv. Action in Benchmarking- This phase involves creation of action phase
based on modified goals. There is recalibration of benchmark in this
 phase. It involves new plans to achieve the goals, plans to evaluate the
progress and work schedule for recalibration of the benchmarks.
Stages of Benchmarking
i. Identify the subject or problem area- Identify the point where it needs
improvement in terms of quality control, satisfaction of consumers or profit
increase.
ii. Defining the process- Be clear what should be benchmarked.
iii. Identify the potential barrier- Identify as to whom comparisons are made,
their strengths and weakness.
iv. Identify the data sources- Identify from where the information is obtained.
v. Collecting the data and selecting the partners-Analyse the information
whether it is true or not. Select the partners after detailed analysis.
vi. Determining the gap- Find out what is the correction to be made from the
beginning
vii. Establishing difference in benchmarking process.
viii. Targeting future performance.
ix. Communicating efficiently
x. Modifying the goals framed
xi. Implement the newly framed goals of benchmarking
xii. Reviewing and recalibrating
Types
 The benchmarking literature can be mainly separated into two parts:
internal and external bench marking.
 Competitive, functional and generic benchmarking are classified under
external benchmarking .The process is essentially the same for each
category. The main differences are what is to be benchmarked and with
whom it will be benchmarked.
Internal benchmarking
 Internal benchmarking covers two way communication and sharing
opinions between departments within the same organisation or between
organisations operating as part of a chain in different countries
Advantages of internal benchmarking
▪ Ability to deal with partners who share a common language, culture
and systems.
▪ Easy access to data, and giving a baseline for future comparisons.
▪ The outcomes of an internal benchmarking can be presented quickly.
 External benchmarking-External benchmarking requires a comparison of
work with external organisations in order to discover new ideas, methods,
products and services
 Competitive benchmarking - Comparison with direct competitors only.
 Generic benchmarking -Refers to the comparisons of business function
that are same regardless of business.
  Functional benchmarking -Refers to comparative research and attempts
to seek world class excellence by comparing business performance not
only against competitors but also against the best businesses operating in
similar fields and performing similar activities or having similar
problems, but in a different industry
Benefits
 It’s a powerful management tool because it overcomes “paradigm
blindness” it can be summed as “The way we do it is the best because this
is the way we have always done it”.
 Benchmarking opens organisations to new methods, ideas, and tools to
improve their effectiveness.
 It helps crack through resistance to change by demonstrating other
methods of solving problem than the once currently employed.

BUDGETTING

• Budget word derived from the old English word Budgettee means a sack or pouch or leather
bag.
• Coined by British Kings and the concept is very old.
• Term budget now refers to the financial papers.
• Budget is defined as a statement of anticipated results during a stipulated period expressed in
financial and non- financial terms.

Definition:
▪ Budgeting is an operational plan, for a definite period usually a year
▪ A budget is a tool for planning, quantifying the plans and controlling costs.
-Finkler
▪ Budget is a numerical description of expected income and planned expenditure for an
organisation for a specific period of time.
▪ Budget is a financial plan of the government for a definite period.
-Taylor
▪ Expressed in financial terms and based on the expected income and expenditure.
▪ Budgeting is a concrete precise picture of the total operation of an enterprise in monetary
terms.
H.M. Donovan
Purpose of Budgeting:
▪ Mechanism for translating fiscal objectives into projected monthly spending pattern.
▪ Enhances fiscal planning and decision making.
▪ Clearly recognizes controllable and uncontrollable cost areas.
▪ Offers a useful format for communicating fiscal objectives.
▪ Allows feedback of utilization of budget.
▪ Helps to identify problem areas and facilitates effective solution.
▪ Provides means for measuring and recording financial success with objectives of organization
Characteristics of Budgeting:
▪ Should be flexible.
▪ Should be synthesis of past, present and future.
▪ Should be product of joint venture and cooperation of executive/department head at different
level of management.
▪ Should be in the form of statistical standard laid down in the specific numerical terms.
 ▪ Should have support of top management throughout the period of its planning and
implementation.
Importance of Budgeting:
▪ Needed for planning future course of action and control over all activities in the organization.
▪ Facilitates coordinating operation of various departments and sectors.
▪ Helps to weigh values and make decision when necessary.
Principles of Budgeting:
• Should provide sound financial management by focusing on requirement of the
organization.
• Should focus on the objectives and policies of the organization.
• Should ensure the most effective use of financial and non-financial resources.
• Programme activities should be planned in advance.
• Requires consistent delegation for framing and executive budget.
• Should include coordinating efforts of various departments establishing a frame of
reference for managerial decision and evaluate managerial performance.
• Requires an adequate checks and balance against adoption of too high and too low
estimates.
• Must be appropriate to nature of business, services and to the type of budget.
• Prepared under the direction and supervision of administrator or financial officer.
• To be prepared and interpreted throughout the organization.
• Requires review of performance of previous year and adequacy both quantitatively and
qualitatively.
• Provision should be made for flexibility.
Types of Budgeting:
1. Operating budget (Revenues and Expenses): Provides an overview of agency function by
projecting the planned operation for upcoming year. Deals with salaries, medical-surgical
supplies, office supplies, laundry services, books periodicals, recreation and contractual
services.
2. Capital expenditure budget: Related to long range planning. Includes physical changes
(replacement and expansion of plant, major equipments and inventories). They are major
investment and reduce flexibility in budgeting.
3. Cash budget: Planned to make adequate funds available and to use extra funds profitably.
Should not have too much cash on hand during budgetary period.
4. Labor or personnel budget: Estimate cost of direct labor necessary to meet agency
objectives. Determine the recruitment, hiring, assignment, layoff, discharge of personnel.
Nurse Manager has to decide number of aids, orderlies required during a shift months and
areas.
5. Flexible budget: Some costs are fixed, others changes with volume of business. Some
expenses are unpredictable and can be determined only after change has begun. Periodic
reviews required to compensate for changes.
6. Strategic planning budget: Long range budget for long range planning. Projected for 3-5
years. Programme budget is a part of this budget.
7. Incremental: Based on estimated changes in present operation plus a percentage increase for
inflation, all of which is added to previous year budget.
8. Open ended: A financial plan in which each operating manager presents a single cost
estimate for what is considered optimal activity level.
9. Fixed ceiling budget: The uppermost spending limit is set by top executive before the unit
and divisional manager develop budget proposal for the areas of responsibility.
10. Roll over budget: Forecast programme, revenues and expenses for a period greater than a
year, to accommodate programme larger than annual budget cycle.
11. Performance budget: Allocates functions not divisions (direct nursing care, in service
education, nursing research, quality improvement).
12. Program budget: Where cost are computed for a total program (group total cost for each
service program). Example- MCH, FP, UIP.
 13. Zero base budgets: Requires nurse manager to examine, justify each cost of every program
both old and new in every annual budget preparation.
14. Sunset budget: Designed to “self destruct” within a prescribed time period to ensure the
cessation of spend in by a predetermine date.
15. Sales budget: Is starting in budget program, since sales are a basic activity which gives shapes
to other activities. Compiled in terms of quantity and value.
16. Production budget: Aims at securing the economical manufacture of production and
maximizing the utilization of production facilities.
17. Revenue and expense budget: Expressed in financial terms and take the nature of Performa
income statement for future. Shows the item of profits and loss.
18. Cash budget: Prepared by way of projecting the possible cash receipts and payments over
budget period.
Budgeting Process:
• It is a systematic activity that develops a plan for the expenditure of a usually fixed resources
such as money or time during a given period to achieve a desired result.
• The budget process consists of activities that encompass the development, implementation
and evaluation of a plan for the provision of services and capital assets.
Steps
1. Establishment of operational goals and objectives and policies.
2. Goals must be translated into quantifiable management objectives for organizational
units. Departmental goals are made.
3. Formal plan for budget preparation and review including assignment of responsibilities
and timetable is prepared.
4. Departmental budget are revised and master budget is prepared.
5. Financial feasibility of master budget is tested and final document is approved and
distributed to all parties involved.
6. Every head of the office required to prepare budget estimate in respect of salaries of
establishment, contingent expenditure and others. Example- Telephone, office expenses,
rent of building etc

Preparing a budget estimate

Sl.no Income or Actual last year Current year Budget next year
Expenditure

Budget Actual Proposed Approved

Advantages of budgeting:
▪ Fixes accountability, assignment of responsibility and authority.
 ▪ Encourages managers to make careful analysis of operation.
▪ Weakness is revealed, corrective measures taken.
▪ Financial matters can be handled in orderly fashion. Activities are balanced.

Disadvantages of budgeting:
▪ Converts all aspects of organizational performance in monetary values. Only easy aspects can
be considered and equally important facts such as organizational development may be
ignored.
▪ May become an end in itself instead of means to end. Budgetary goals may supersede agency
goals.
▪ Skills and experiences are required for successful budgetary control.
▪ Time consuming and expensive.

COST BENEFIT ANALYSIS

Is a procedure by which all costs incurred in installing and operating a system are assessed and
converted to money and the ratio is calculated define the relationship of costs and benefits.
CBA is a tool for decision maker as he/she recognises the difficulty in determining the true costs and
benefits of various alternatives.
Cost benefit ratio(Z) is defined as the ratio of the value of benefits of an alternative to the value of the
alternative cost.
Z = Present value of economic benefits
Present value of economic costs
CBA is designed to estimate the social costs and benefits attributable to the projects. Benefits are
expressed in monetary terms to determine whether a given programme is economically sound and to
select the best of several programmes considered.
Techniques of cost benefit analysis
1. Cost of the programme is estimated
2. Outcome is estimated in terms of monetary units
The course of action that gives highest monetary returns for the lowest income is regarded as the best
one.
In the health field however benefits cannot be expressed in monetary terms. Benefits made is
translated such as morbidity and mortality preventing by considering the direct and indirect costs.
Limitations
• Difficult to convert indirect benefits into monetary benefits
• Can lead to confusion in calculation of monetary units.(eg. Intervention to prevent and
control of typhoid in community by providing protected water supply- added benefits not
only typhoid other water borne diseases also is prevented)
• Lead time (interval between the application of the intervention and benefits) is often too long.
Can lead to difficulty in converting the benefits into monetary units.
• Loss of benefit due to rejecting the other programme is not considered.

AUDIT
It is an assessment of the management practices, financials and operations of an organisation.
It is an evaluation of a person, organisation, system, process, enterprize, project or product.
Purposes
• It make sure that all the financial statement of concern are presented fairly.
• Audit gives a fair and true picture in accordance with financial reporting framework.
• It enhances the degree of confidence of intended users in financial statement.
Types of Audit
1. External Audit
2. Internal Audit
External Audit:
It is a review of the financial statements or reports of an entity usually a Govt. or business or someone
not affliated with the organisation or agency. This is an independent review of the financial
documents provided to the auditor. The audit is conducted by regularly agency hired by the entity and
the auditors are generally the public accountants.
Purposes:
• To ensure that internal control, processes, guidelines are adequate and in line with the Govt.
requirements.
• To provide an independent and unbiased assessments of an organisation internal governance
and financial matters.
• To verify internal procedures.
• To evaluate the adherence of the organisation to standard and principles.
• To evaluate the adequacy and effectiveness of existing internal control
Types
➢ Financial – Verification of financial statements.
➢ Operation – To detect errors in internal control procedures and machines.
➢ Compliance- To evaluate how employees are abiding by regulations in performing task.

Internal Audit:
It is an independent management function which involves a continuous and critical appraisal of the
functioning of an organisation with a view to suggest improvements and add value to and strengthen
the overall governance mechanisms of the organisation and including the organisation risk
management and internal control system.
Purposes:
 To establish standards and to provide guidance in respect of planning internal audit.
Objectives:
 To suggest improvement to the functioning of the organisation.
 To strengthen the overall governance mechanisms of the organisation including risk
management as well as internal control system.
 To prepare for external audit.

MATERIAL MANAGEMENT
Materials are the major cost factor in an organisation. It is one of the very important function of
management.
Materials may be defined as equipments, apparatus and supplies procured, stocked and utilised by an
organisation. These are the things needed for smooth functioning of an activity in the organisation.
Material management is a scientific technique, concerned with planning, organizing & control of flow
of materials form their initial purchase to destination.
Definition
➢ Material management can be regarded as the function responsible for the coordination,
planning, sourcing, purchasing, moving storing and controlling materials in an optimum
manner so as to provide service to the consumer at a minimum cost.
➢ Material management is the management and control of medical surgical clerical,
interdepartmental services and equipments from acquisition to disposition.
- Judith
➢ Material management is that aspect of management function that is primarily concerned with
the acquisition, control and use of materials needed and the flow of services connected with
the production, process having some predetermined objectives in view.
Aim of Material management
To have
 Right quality of material
 Right quantity of supplies of materials at right time, at the right place for the right cost.
Objectives of Material management
• To ensure the supply of availability of material quality, quantity and at right time and right
place.
 • To avoid surplus of materials
• To have appropriate storage and easy to retrieve.
• To ensure distribution to the point of usage whenever required.
• To ensure effective and efficient utilisation of available resources.
• To optimising the use of resources to meet the needs in an efficient manner.
• To obtain correct quality of materials at lowest possible price.
Purpose of Material Management
➢ To gain economy in purchasing
➢ To satisfy the demand during period of replenishment
➢ To carry reserve stock to avoid stock out.
➢ To stabilize fluctuations in consumption
➢ To provide reasonable level of client services
➢ To increase efficiency of health care systems.
➢ To develop knowledge and skills of health care
➢ To provide materials in required quantity and quality as when required.

Basic Principles of Material Management

→ Effective management and supervision; it deals on material functions of; planning,
organizing, staffing, controlling, report and budgeting.
→ It should be based on sound purchasing method
→ Skillful and hard poised(determined) negotiation
→ Effective purchase system
→ Should be simple
→ Simple inventory control program
→ Must not increase other costs

Functions of Material Management

 Material planning & budgeting
 Purchasing
 Inventory control
 Cost reduction Value analysis
 Receiving & inspection
 Stocking & distribution
 Disposal.
Elements of Material Management
 Material planning
 Purchasing
 Receiving & warehousing
 Store keeping
 Inventory control
 Value analysis
 Standardization
 Production control
 Transportation
 Material handling
 Disposal scarp

PROCEDURE
Demand estimation:
 Based on the data of past levels of performance and on plans, capital equipment, supplies to
be procured during the year ahead can be projected department wise. This is the materials
budget which should be prepared annually.
 Important in budgetary control and reduction of material cost is the concept of
standardisation. This involves grouping together similar items depending on their use so as to
choose one of these more universally acceptable for the purpose.
 Estimation of right amount of each material is the most crucial factor for maximising
availability with minimum wastage. Materials in a hospital may be requisitioned : For an
urgent / immediate use on a one – time basis or repeatedly and continuously to replenish the
stock ; As a single unit or a bulk requirement.
 The greater the crisis situation and immediate need for the item and the smaller the quantity
required, the greater will be the procurement price and the incidental cost of purchase. Bulk
price can be affected with maximum price discounts through demand forecasting.
Procurement
 Most organizations have a detailed set of rules and regulations regarding the procedure
for ordering for materials. An effective procurement system aims at purchasing of items
of acceptable quality, in appropriate quantities, at the minimum price and within the
available time.
 Purchases may be made by the individual department of the hospitals or by a single
purchase department. Centralised purchasing has the advantages in that quantity discounts
are possible because of standardization and bulk orders. There is better management
control as all aspects of purchase can be screened by the administration.
 A group of hospitals having common interest (e.g. locates in the same region), may also
get together and constitute an agency to effect bulk purchases on their behalf.
Receipt, inspection, acceptance and payment
Procedure for receipt, inspection and acceptance of supplies:
 While taking delivery from the road transporters, railways, customs, check containers for
deficiency and damages.
 If packing is damaged, insist on „open‟ delivery, checking quantity of packages, individual
items, weights, etc. against packing slip / challan.
 Any damage / loss should be registered immediately through a „claims‟ statement.
 Cross check with purchase order
  On receipt of the hospital checks supplies for discrepancies in quantity, quality, product
specifications etc.
 Record shortages, incorrect damaged material, out dated supply and take action accordingly.
 Carry out all necessary documentation, day book of receipt, goods inward note, purchase
register and bin card.
 Notify indenters of special purchase requisition regarding arrival of materials.
Procedure for payment:
 On accepting the goods and certifying correctness, send the bills to the accounts department
for payment.
 Before releasing payment, the account department should ensure that the bills bears proof of
receipts of goods, certification of acceptance and completion of purchase documentation.
Inventory control or storage and distribution
 It is the process of having the necessary equipment and supplies available at the
appropriate time. It means stocking adequate number and kind of stores, so that the
materials are available whenever required and wherever required. Scientific inventory
control results in optimal balance
 Storage and Preservation are an important part of the storekeeping function.
 When materials remain idle in the store these materials should be taken care of and
looked after properly. Otherwise these materials may get perished due to natural chemical
reaction like rusting by moisture, melting by heat etc and also may get affected by insets,
rats etc.
 The department stores should be conveniently located to facilitate easy receipt of
materials from suppliers and easy dispatch of supplies to the wards and departments. The
materials should be adequately protected from fire, pests, water sewage etc.
 Actions to protect the materials from various adverse effects:
1. Store must be of adequate space.
2. Divide the store in to homogenous sections with separate areas mark for different
groups of items e.g. stationary, furniture etc
3. No material should be stocked on the floor as it may be affected by dampness,
white ants etc.
4. Categorize items in a group based on their generic name/ application, store
similar items contiguously. Eg : a. Stationery, Electrical, Civil Engineering,
Cleaning and Similar items may be stocked in the steel racks. b. Medicine items
may be stocked in the fridge. c. Perishable items may be stored in the cold
rooms. d. Explosive, film, and fuse items may be stored in the AC room. e.
Attractive items may be stored in shelves under lock and keys.
5. Keep heavy items as low and as near to the door as possible for easy retrieval.
Light items may be placed on top shelves
6. Daily and periodical cleaning should be carried out.
7. Daily and periodical verification of stock should be carried out to ensure
correctness of stock.
8. Proper method of handling should be followed to avoid damages to the
materials.
9. Preservation materials should be applied to protect the items.
10. Hazardous materials should be segregated and stocked in a separate store house
away from other store houses.
11. Safety precautions should be taken and safety appliances should be provided.
12. First-in, first-out principle to be followed
13. Follow two bin or double shelf system, to avoid Stock outs
14. Reserve bin should contain stock that will cover lead time and a small safety
stock
Maintenance and repair:
  Proper maintenance of equipment, furniture, and fixtures not only ensure their almost
continuous availability for use but also an extended life and productivity for the items, thus
resulting in lower material costs.
 Time and costs of maintenance can be reduced by consideration of following factors during
purchase :-
a) Durability:- Since the equipment will be handled by multiple users provide for an
element of over specification so that the item is more sturdy than that available for
single person use in the home environment.
b) Periodical disinfections: The external surface of the items should be washable and it
should provide for sterilization by moist heat, formalin vapour, spirit or other
disinfectants
c) Repair ability:- Go for items which are more easily repairable.
d) Spare parts availability:- Standardization of items and choosing those easily available
in the market ensures easy availability of spare parts required for repair and
mainaintence.
e) Operation and service manuals: When purchasing sophisticated equipment it is
essential to obtain the operating and service manuals so that repairs can be attended to
by the hospital maintenance department without relying on the supplier.
f) Service contracts:- Better terms for service are possible by negotiating service
contracts for maintenance prior to purchase of the equipment. Such contracts should
specify minimum number of preventive maintenance over hard schedules, service
charges etc.
g) Stand by units: Since the hospital work must carry on even when the equipment is
down, wherever possible it is necessary to provide for replacements to tide over the
period of repair .
Disposal/ condemnation:
Indents are often improperly examined and unofficial inventory builds up in wards / departments
because of hoarding of supplies. Thus the nursing supervisors should periodically inspect the stocks
attached to each ward and arrange for return of excess stock/equipment. Each hospital should also
have a condemnation to review used materials that are to be disposed off. At times it is possible to
recycle or reuse materials or find some other use for the item. If no further use can be found for
disposables, used consumables and damaged equipments, it may still have value as scrap.

PROCUREMENT
Is the sourcing and purchasing of goods and services for business use. It is also defined as the process
of obtaining goods and services from preparation and processing of a requisition through to receipt
and approval of the invoice for payment.
Procurement is defined as a systematic act of acquiring items that requires preparation, processing of
demand of supplies and equipment as well as obtaining the receipt and getting the approval of the
payment from the management.
Procurement process is a method by which items are purchased from external suppliers. It involves
managing the ordering receipt, review and approval of items from suppliers. A procurement also
specifies how the supplier relationship will be managed to ensure a high level of service is received.

Objectives of procurement system

• Acquire needed supplies as inexpensively as possible
• Obtain high quality supplies
• Assure prompt and dependable delivery
• Distribute the procurement workload to avoid period of idleness and overwork
• Optimize inventory management through scientific procurement procedures

Procurement process
 • Need recognition- recognise the need for procuring the materials from the department either
from internal or external sources. The item may be one that needs to be reordered, or it may
be a new item for the unit.
• Specific need- determine specifications for the item required to be procured. Take help of
suppliers to visit the department or from engineering department.
• Source options- determine from where to obtain the product. The hospital might have an
approved vendor list. If not search for a supplier using purchase orders or a variety of other
orders such as magazines, internet or sales representatives etc.
• Price and terms- investigate all relevant information to determine the best price and terms for
the product. Usually look for three suppliers before it make a final decision.
• Purchase order- the purchase order is used to buy materials between the buyer and seller. It
specifically defines the price, specifications and terms and conditions of the product or
services and any additional obligations.
• Delivery- the purchase order must be delivered personally, email or other electronic means.
The recipient then acknowledges receipt of the purchase order.
• Expediting or follow up- Expedition of the purchase order addresses the timelines of the
service or materials delivered.
• Receipt and inspection of purchases- once the sender supplier delivers the product the
materials is checked for quality, quantity as per the order placed.
• Invoice approval and payment- three documents must match when an invoice requests
payments -the invoice itself the receiving document and the original purchase order. Any
discrepancies must be resolved before the bill is paid by the finance department.
• Record maintanence- in case of audits, the department must maintain proper records. These
include purchase records to verify any tax information and purchase orders to confirm
warranty information. Purchase records reference further purchase as well.
Methods in Procurement Process
• Open tender- public procurement method
• Restricted or limited tender-restrict/limit the request for tender
• Negotiated procurement –without formal advertising and formal price competition
• Direct procurement- manufacturing firms
• Rate contract- contract for a specified rate
• Spot purchase-contract of buying or selling a commodity

PURCHASING
Means to buy various materials by paying money or its equivalent from the suppliers.
Purchasing process may vary from organisation to organisation. But the major fundamental remains
the same. In this process materials are bought and acquired using standardised specifications
Purchasing process
Requisition----- find supplier and place order--------- send orders
Steps of purchasing
1. Requisition- identify the need, what to buy and how much of it and when it is needed to
deliver.
2. Supplier selection- identify supplier, price and lead time.
3. Purchase order- raise purchase order and send to supplier
4. Fulfilment- supplier procures the items and send to buyer
5. Order receipt- items are checked for quality and quantity as per the order placed.
6. Supplier invoice/ payment- supplier send the invoice which is processed by the finance
department before the supplier is paid.
Principles of purchasing
• Purchasing is based on the need assessment
• Aim of purchasing is right quality, right quantity, right prices, right sources and at right time
to the right place with the right mode of transportation and right attitude.
 • Centralise the purchase system
• Back up of a good system management.

Storage
• Store must be of adequate space
• Materials must be stored in an appropriate place in a correct way
• Group wise and alphabetical arrangement helps in identification and retrieval
• First-in, first-out principle to be followed
• Monitor expiry date
• Follow two bin or double shelf system, to avoid stock outs
• Reserve bin should contain stock that will cover lead time and a small safety stock.
Issue and use
Can be centralized or decentralized

INVENTORY CONTROL
It is the process by which inventory is measured and regulated according to predetermined norms such
as economic lot size of order, safety stock, minimum level, maximum level, order level etc.
It means stocking adequate number and kind of stores, so that the materials are available
whenever required and wherever required. Scientific inventory control results in optimal balance.
Inventory control is the process of maintaining the optimum needed quantity that is sufficient for the
smooth functioning of the organisation.
Objectives of inventory control
• To supply the materials in time.
• To reduce or minimise investments in inventories
• To minimise the idle time by avoiding stock out and shortages
• To avoid shortage of stock
• To minimise the loss due to deterioration, damage of stock.
• To meet unforeseen future demand
• To average out demand fluctuations
• To balance various inventory costs such as carrying costs, order cost etc.
How to achieve inventory control
Inventory control can be achieved through
1. Purchasing items at economic price at proper time and in sufficient quantity.
2. Provision of suitable and secured location with sufficient space
3. Inventory identification system
4. Upto date and accurate record keeping
Steps in inventory control
• Fixing minimum quantities or points of ordering and maximum quantities on all materials
• Arranging a method for allocation of materials and orders that are in process.
• Creating stores accounts that will control the store room

Functions of inventory control

• To provide maximum supply service, consistent with maximum efficiency and optimum
investment.
• To provide cushion between forecasted and actual demand for a material

Principles of inventory management

• Determination of quantity of order.

• Determination of reorder point of record level

Inventories classification
ABC analysis- ABC analysis helps us in segregating the items from one another and tells us how
much valued the items is and controlling it to what extent is in the best interest of the organization. It
is the analysis of stores items on cost criteria. It has been seen that a large number of items consume
only a small percentage of resources and vice versa.

• A items- Represents high cost centre

• B items- intermediate cost centre
• C items- low cost centre.

It is the process of classifying items by using values as measure.

The ABC method of inventory control

Also called as Pareto analysis. In ABC analysis, the entire lot of inventory is classified into three
groups based on their annual value and not on their individual cost given as:

Class A: High value items, which accounts for major share of annual inventory value. Stricter control
must obviously be applied on these items right from the initial stages of estimating requirement,
fixing the minimum stocks, lead time.

A items:

1. Rigorous value analysis

2. Rigid estimates

3. Strict and close watch

4. Management of items should be done at top management level

5. Centralized purchasing and storage

Class B: Medium value items, which do not belong to either of the classes and not so strict control
procedures, need be followed in regard to the items in this group.

B items

1. Moderate controls

2.Purchase based on rigid requirement

3.Reasonably strict watch and control

4. Management be done at middle level

Class C: Low values items, but are required in large quantities and consists of various types and
varieties like clips, washers. It needs only a simple and inexpensive system of control in which some
of the routine may be relaxed.

C items

1. Ordinarily control measures

2. Purchased based on usage estimates

3. Controls exercises by store keeper

4. Management be done at lower levels.

5.Decentralized (delegated) purchasing

VED ANALYSIS

In VED Method (vital, essential and desirable) , each stock item is classified on either vital, essential
or desirable based on how critical the item is for providing health services. The vital items are stocked
in abundance, essential items are stocked in medium amounts and desirable items we stocked in small
amounts. Vital and essential items are always in stock which means a minimum disruption in the
services offered to the people.

Vital:

Items without which treatment comes to standstill: i.e. non- availability cannot be tolerated. The vital
items are stocked in abundance, essential items and very strict control.

Essential:

Items whose non availability can be tolerated for 2-3 days, because similar or alternative items are
available. Essential items are stocked in medium amounts, purchase is based on rigid requirements
and reasonably strict watch.

Desirable:

Items whose non availability can be tolerated for a long period. Desirable items are stocked in small
amounts and purchase is based on usage estimate.

Sl.no Types Description

1. ABC analysis Type of inventory categorization method in which inventory is divided
into three categories, A, B, and C, in descending value. A has the highest
value items, B is lower value than A, and C has the lowest value.
2. VED analysis stands for Vital Essential Desirable
3 HML analysis Materials are classified according to their unit value as high, medium and
low
4 XYZ analysis X items are those whose stock values are high, while Z items are those
whose values are low and Y falls in between the two categories
5 FSN analysis Movement analysis forms the basis for this classification. The items are
classified as fast moving, slow moving and non-moving based on their
consumption pattern
6. SDE analysis Classification methods are based on source of supply. SDE classification
is a system where materials are sorted out as scarce to obtain, difficult to
obtain and easy to obtain.
7 GOLF analysis Classification is based on the availability and nature of supplies.
Government, Ordinarily, Local and Foreign
8 SOS analysis Raw materials can be classified into Seasonal and Off season items

Advantages
 • Delivery on time
• Possibility of discount for bulk purchase.
• Unforeseen circumstances can be handled to some extent.
• Workers and machinery need not be idle.

Disadvantages

• Working capital is tied up.

• More space is required.
• Increase in insurance charges.
• Increase in overhead expenses.
• Increase in charges for damage, pilferage, replacement etc.
• Increase in charges for obsolescence.

DOCUMENTATION

Documentation is one of the important responsibilities of nurses which aim at facilitating

communication and decision making.

RECORDS

Records are defined as legalised administrative tools that are formally applied permanently to
document the provided nursing care

Purpose of Keeping Records

1. Communication.
2. Aids to diagnose
3. Education
4. Documentation of continuity.
5. Research
6. Legal documentation
7. Individual case study

Types of Records
1. Patients clinical record.
2. Individual staff records
3. Ward records
4. Administrative records

REPORTS
A report is a system of communication aimed at transferring essential information necessary for safe
and holistic patient care.

Purposes
• To communicate progress of patient
• To prepare staff members for their daily work
• To provide quality and continuity of care
• To act as an aid in planning
• To coordinate care given by several people.
• To act as an aid in studying health condition
Types
• Oral
▪ Report between head nurse and assistant.
▪ Report of staff nurse to charge nurse.
▪ Report of charge nurse to physician
▪ Report of charge nurse to supervisor
▪ Report of supervisor to nursing director
• Written
▪ Census reports
▪ Reports on mistakes and accidents
▪ Interdepartmental reports