Nursing Administration & Management

1. Leadership Roles and
management functions
associated with the planning
hierarchy and strategic planning
Dr. Jayesh Patidar
www.drjayeshpatidar.blogspot.com

2. Leadership roles
• Assesses
• - the internal and external driving forces and barriers to strategic planning.
• Demonstrates
• -innovation, vision, creativity within the organizational unit planning, inspiring
proactive rather than reactive planning.
• Influences and inspires
• -group members to be actively involved in long term planning
• Clarifies
• -the leaders recognition of the employees value ,to increase self awareness
• Encourages
• - employees to be involved in policy formation, developing and implementing
company philosophies, goals, objectives, policies, procedures and rules.
• Communicates
• - and clarifies organizational goals and values
• Receptive
• - to new and varied ideas
• Role models
• - proactive planning to employees
04/10/2015 www.drjayeshpatidar.blogspot.in 2

3. Management Functions
• Knowledgeable
• -regarding all the factors that effect healthcare planning, political, economic and social.
• Demonstrates
• -appropriate planning techniques
• Organizes
• -opportunities for participation from employees, peers, competitors, regulatory agencies, and the
general public in planning.
• Coordinates
• -unit level planning to be congruent with organizational goals
• Assesses
• - the units constraints assets and resources for planning
• Develops and articulates
• -the Unit goals and objectives that reflect, philosophy, unit policies, procedures, and rules.
• Reviews
• - if the goals are being met and if not, what changes need to be made.
• Participates
• -actively participates in all areas of unit planning and operations.
04/10/2015 www.drjayeshpatidar.blogspot.in 3

4. Proactive planning
• Reactive
• -planners respond to a crisis which can lead to hasty decision and
mistakes.
• Inactivism
• -these planners do not like change and put all of their efforts into
maintaining conformity and the status quo.
• Preactivism
• -these planners are unsatified with the past or present, believing the
future is always preferable.
• Interactive or proactive
• - these planners are dynamic, considering the past, present, and
future. Leaders and managers must be adaptive in order to promote
growth within their organization.
04/10/2015 www.drjayeshpatidar.blogspot.in 4

5. Planning hierarchy
• Mission
• Philosophy
• Goals
• Objectives
• Policies
• Procedures
• Rules
04/10/2015 www.drjayeshpatidar.blogspot.in 5

6. Mission
• Mission statement
• -Is a brief statement outlining the reason an
organizations exists, and addresses its position
regarding ethics, principles, and standards of practice. It
is the highest priority in the hierarchy of planning
because it influences all the other planning components
in the pyramid
• Vision statement
• -Is are always future oriented while mission statements
provide the foundation for organizational planning, an
example of a vision statement would be “To become an
exemplar for healthcare in the region”
04/10/2015 www.drjayeshpatidar.blogspot.in 6

7. philosophy
• Organizational
– Flows from the mission statement and defines the set of values and beliefs that guide all actions of the
organization, it is the basic foundation that directs all further planning toward the mission, a philosophy
statement can usual be found in policy manuals and are available upon request
• Nursing
• -The concepts of holistic care, education, and research, as well as the quality, quantity, and scope of
nursing services
• Societal
• -Sets of beliefs that guide their behavior, called values. Some strongly held american values are
individualism, the pursuit of self-interest, and competition, we will be discussing the effect of these
values on our healthcare system later on.
• Individual
• -Shaped by the socialization processes experienced by that person.
• Value criteria
– 1. It must be freely chosen from among alternatives only after due reflection
– 2. It must be prized and cherished
– 3. It is consciously and consistently repeated (part of a pattern)
– 4. It is positively affirmed and enacted
• Each nurse-leader should encourage self-awareness in their employees through examination of
their value system and understanding the role that it plays in decision making and resolving conflict.
04/10/2015 www.drjayeshpatidar.blogspot.in 7

8. GOAL
• Goal
– The ends toward which the organization is
working, it is the aim of the philosophy, it is
what makes the philosophy operational
– The desired result toward which effort is
directed
– Measurable and ambitious, but realistic, just
like the criteria we use in our nursing care
plans to identify pt. outcomes
04/10/2015 www.drjayeshpatidar.blogspot.in 8

9. objectives
• Objectives
– Identify how and when the goal is to be accomplished, they are
more specific and measurable than goals in this regard
• Process objectives
– Are written in terms of the method to be used, an example of a
process objective might be “100% of nurses will teach their pts
how to use the callbell within 30 mins of admission, and request
return demonstration”
• Result-focused objectives
– Specify the desired outcome, an example of this would be “ All
post-op pts will perceive a decrease in their pain after the
administration of pain medicine”
04/10/2015 www.drjayeshpatidar.blogspot.in 9

10. Policies and Procedures
• Policies
– Plans reduced to statements or instructions that direct organizations in
their decision making; it is a statement of expectations that sets
boundaries for action taking and decision making
– Many policies come from JCAHO (Joint Commission Accreditation of Healthcare Organizations)
• Implied policies
– Not written or verbally expressed, and usually developed over time and
follow a precedent; for example a hospital may have a policy that
employees should be encouraged and supported in their activity in
regional, community, and national healthcare organizations
• Expressed policies
– Delineated verbally or in writing
– May include a formal dress-code, a policy for sick leave or vacation
time, and disciplinary procedures
04/10/2015 www.drjayeshpatidar.blogspot.in 10

11. Procedures
• Procedures
– Plans that establish customary or acceptable
ways to accomplishing a specific task and
outline a sequence of steps of required
actions.
– For example, the unit manager must provide a
clearly written procedural statement regarding
how to request vacation time
04/10/2015 www.drjayeshpatidar.blogspot.in 11

12. Rules
• Rules and Regulations
– Plans that define specific action or non-action
– Describe situations that only allow one choice
of action
– Least flexible
– Because rules are the least flexible type of
planning, there should be as few rules as
possible, however existing rules should be
enforced to keep morale from breaking down
04/10/2015 www.drjayeshpatidar.blogspot.in 12

13. Overcoming Barriers to Planning
• Omitting Goals or Objectives
– The organization can be more effective if movement within it is directed at specified goals and objectives
– Goals and plans keep managers focused on the bigger picture and keeps them from getting lost in the
minute details
– Similar to our care plans, we establish patient goals before we make interventions
• Lack of Flexibility
– The plan must be flexible to reach a goal, and allow for readjustment as unexpected events occur
– “Those who are flexible will not break” – Ms. Mancer
• Lack of Communication & Buy-in
– Manager should include in the planning process people and units that could be affected by the course of
action
– Although everyone will not want to contribute, they should all be invited
• Unrealistic Expectations
– Plans should be specific, simple, and reasonable
– A plan that is vague or too global can be difficult or impossible to implement
• Over- & Under-Planning
– Know when and when not to plan
– The over planner has “paralysis by analysis”
– The under planner is makes false assumptions that people and events will naturally fall into place and has
difficulty prioritizing against real needs
• Failure to Execute the Plan
– Have built-in evaluation checkpoints
– If goals are not met, the manager must determine why and what needs to be changed
04/10/2015 www.drjayeshpatidar.blogspot.in 13

14. Strategic Planning in the
Organization
• Strategic planning as a management process includes
the following steps:
1. Clearly define the purpose of the organization
2. Establish realistic goals and objectives consistent with the
mission of the organization
3. Identify the organization’s external constituencies or stakeholders,
then determine their assessment of the organization’s purposed
and operations
4. Clearly communicate the goals and objectives
5. Develop a sense of ownership of the plan
6. Develop strategies to achieve the goals
7. Ensure the most effective use of resources is made
8. Provide a base from which progress can be measured
9. Provide a mechanism for informed change as needed
10. Build a consensus about where the organization is going
 A manager has to be willing to take risks
04/10/2015 www.drjayeshpatidar.blogspot.in 14

15. Forces Effecting Long-Term Plans
• Changes in the future of the healthcare
organization
– Change in information technology
• Will result in elimination of duplication and provide immediate
access of information
– Change in patient demographics
• The increasing number of seniors (baby boomers) will create
enormous demands on the healthcare system
– Change in economics
• US ranks 21st in life expectancy and 27th in infant mortality
• Cost of drugs is highest in the world
– Changes in providers
• Nurses will continue to decrease in supply and some
physician specialties will increase in supply
04/10/2015 www.drjayeshpatidar.blogspot.in 15

16. Integrating Leadership Roles and
Management Functions in
Planning
• Leader-Manager must be skilled in determining, implementing, documenting, and evaluating all
types of planning in hierarchy
• The leader should demonstrate a proactive rather than a reactive management style to employees
• Manager draws on the philosophy and goals established to implement planning
• Manager appropriately assesses the constraints, assets, and resources available for planning
• Manager draws on leadership skills in creativity, innovation, and futuristic thinking to translate
philosophies into goals, goals into objectives, and so on down the planning hierarchy
• Leader-Manager will develop the interpersonal skills necessary for inspiration of employees
• Leader-Manager must be receptive to new and varied ideas
• The Leader-Manager’s final step in the process involved articulating identified goals and
objectives clearly
• If the unit manager lacks management or leadership skills, the planning hierarchy fails
• Managers who are uninformed about the legal, political, economic, and social factors effecting
healthcare make planning errors that may have disastrous implication for the organization
04/10/2015 www.drjayeshpatidar.blogspot.in 16

17. Discussion
• Considering the societal philosophies and
values of the US today -- individualism, the
pursuit of self-interest and competition…
– Do you agree or disagree that the US healthcare
system represents these societal values?
– This is a topic that effects managers and leaders
planning and decision-making
• Would you be willing to have fewer healthcare
choices if access could be granted to all?
• Do you believe the cost of universal coverage
should be picked up by the consumer or by the
employer?
04/10/2015 www.drjayeshpatidar.blogspot.in 17

18. Strategic Planning in a Clinical
Setting
• You are a nurse chosen to be on the
board of a major county hospital, the
board has begun the strategic planning
process for the year…
04/10/2015 www.drjayeshpatidar.blogspot.in 18

19. Key issues to consider in
developing the strategic plan:
• Quality
– Sample Objective/Goal: “To reduce medication administration errors by 10%”
• Information Technology
– Consider implementation of electronic charting/drug administration system
• Staff Levels
– Analyze staff to patient ratios
– Are nurses overworked?
• Baylor of Garland case study
– Baylor of Garland still uses paper charting -- because of this many medication errors may occur
– For example, a patient received the incorrect dosage of an anti-seizure medication for 2 days because the pharmacy
scanned the incorrect doctors order due to the disorganization of the paper chart. Because of this, the patient experienced
an unnecessary seizure before the error was found
• Access
– Sample Objective/Goal: “Provide care to 15% more patients than we did last year”
• Assess resources to available to achieve the objective
– How much additional staff will be needed?
– How much additional space will we need?
• Will we need new construction?
– New wing or modular building?
– How will we pay for the addition – seek funding, charity or debt financing (taking out a loan)?
• Cost
– Sample Objective/Goal: “Decrease the unnecessary waste of supplies by 5%”
• Implement incentive-based motivation for staff to decrease wasted supplies
– Consider implementing a competition for the least amount of supplies wasted, winner gets first right on holiday scheduling
decisions
– Consider implementing additional policies for supply uses? (Example: Mandatory workshops or refresher courses on
proper patient assessment)
– Many times supplies will be wasted because the patient was not properly assessed prior to getting the supplies – for
example grabbing a male-sized catheter for a female and not realizing it until the procedure.
04/10/2015 www.drjayeshpatidar.blogspot.in 19