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Leadership

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Leadership & Management in Hospitals & Healthcare Agencies Martha Highfield, PhD, RN, AOCN Associate Professor Nursing California State University, Northridge, USA – PowerPoint PPT presentation

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Title: Leadership


1
Leadership Management in Hospitals Healthcare
Agencies
  • Martha Highfield, PhD, RN, AOCN
  • Associate Professor Nursing
  • California State University, Northridge, USA

2
  • Presented at the invitation of the Guangzhou
    Municipal Health Bureau
  • Guangzhou, China
  • August 2001

3
Driving Forces
  • Professional scope standards of nursing
    practice
  • Legal requirements
  • JCAHO
  • Fiscal solvency
  • Ideals of compassionate care valuing the
    individual

4
ANA Administration Standards
  • NURSE EXECUTIVE
  • 1. Leading
  • 2. Collaborating integrating nursing in
    interdisciplinary environment
  • 3. Facilitating effective, efficient,
    compassionate care.
  • 4. Evaluating
  • MANAGER
  • 1. Report to executive
  • 2. Defined area
  • 3. Allocate resources for compassionate care
  • 4. Upward downward communication

5
Differences Leader Manager
  • Managers
  • Assigned formal position
  • Delegated authority
  • Specific functions, duties, responsibilities
  • Emphasize control, decision-making, analysis
    results
  • Manipulate resources
  • Direct willing unwilling followers
  • Leaders
  • Informal or formal
  • More roles
  • Focus on group process
  • Emphasize relationships
  • Direct willing followers
  • Goals

6
Both Executives Managers...
  • 1. Promote vertical horizontal communication
  • 2. Inspire critical thinking for proper
    decision-making
  • 3. Efficient effective highest possible
    individualized care at the lowest possible cost

7
Standards
  • Standards Statements that describe a level of
    care or nursing performance by which the quality
    of nursing practice can be judged.
  • (p. 38-9)

8
Standards of Nursing Administration
  • 1. Standards of Care statement of a competent
    level of clinical nursing practice, such as
    identifying problems and planning taking action
    to correct them
  • 2. Standards of Performance statement of
    competent role activities, such as collaboration
    quality of care

9
Standards of Care
  • Standard 1 Assessment
  • Standard 2 Diagnosis
  • Standard 3 Identification of Outcomes
  • Standard 4 Planning
  • Standard 5 Implementation
  • Standard 6 Evaluation

10
Standards of Care
  • 1. Assessment Develops, maintains, evaluates
    patient/client and staff data collection systems
    and processes to support the practice of nursing
    and delivery of patient care.
  • 2. Diagnosis Develops, maintains, evaluates an
    environment that supports the professional nurse
    in analysis of assessment data and in decisions
    to determine relevant diagnoses

11
Standards of Care (cont.)
  • 3. Identification of Outcomes Develops,
    maintains, evaluates information processes that
    promote desired client-centered outcomes
  • 4. Planning Develops, maintains, evaluates
    organizational planning systems to facilitate the
    delivery of nursing

12
Standards of Care (cont.)
  • 5. Implementation Develops, maintains,
    evaluates organizational systems that support
    implementation of the plan
  • 6. Evaluation Evaluates the plan and its
    progress in relation to the attainment of
    outcomes.

13
Standards of Professional Performance
  • Standard 1 Quality of care
  • Standard 2 Performance appraisal
  • Standard 3 Education
  • Standard 4 Collegiality
  • Standard 5 Collaboration
  • Standard 6 Research
  • Standard 7 Resource utilization

14
Standards of Performance
  • 1. Quality of Care Administrative Practice
    Systematically evaluates the quality and
    effectiveness of nursing practice nursing
    services administration
  • 2. Performance Appraisal Evaluates own
    performance based on professional practice
    standards, relevant statutes regulations
    organization criteria

15
Standards of Performance (cont.)
  • 3. Education Acquires maintains current
    knowledge in administrative practice
  • 4. Collegiality Fosters professional environment
  • 5. Ethics Decisions actions are based on
    ethical principles

16
Standards of Performance (cont.)
  • 8. Collaboration Collaborates with nursing staff
    at all levels, interdisciplinary teams, executive
    officers, and other stakeholders
  • 9. Research Supports research integrates it
    into the delivery of nursing care
    administration
  • 10. Resource Utilization Evaluates administers
    the resources of organized nursing services

17
Standards met incarrying out Decision-Making
18
Decision-Making
  • Fundamental skill for all aspects
  • Traditional decision-making starts with
    identifying problem
  • Management decision-making starts with writing
    objectives--fixed end goals

19
Decision-Making Grid
  • List alternatives down the first column on left
  • For each write out
  • Financial effect
  • Political effect
  • Department effect
  • Time
  • Last column write decision about each alternative

20
Standards met incarrying out Planning
21
Roles Functions Planning
  • Mission
  • Philosophy
  • Goals objectives
  • Strategies to achieve goals objectives
    programs, policies, procedures
  • Time management
  • Delegation

22
Overcoming Barriers to Planning
  • Goals objectives increase effectiveness
  • Plan is a guide must be flexible
  • Include all stakeholders in planning
  • Plans should be simple, specific, realistic
  • Planned change

23
Planning Managing Change
  • STAGE 1-UNFREEZING
  • STAGE 2 - MOVEMENT
  • STAGE 3 - REFREEZING

24
Planning Emotional Stages of Change
  • 1. Equilibrium
  • 2. Denial
  • 3. Anger
  • 4. Bargaining
  • 5. Chaos
  • 6. Depression
  • 7. Resignation
  • 8. Openness
  • 9. Readiness
  • 10. Reemergence

25
Planning Time Management
  • 1. Prioritizes day-to-day planning to meet
    short-term long-term unit goals
  • 2. Schedules time for planning
  • 3. Analyzes others use of time
  • 4. Eliminates environmental barriers
  • 5. Handles paperwork promptly efficiently

26
Time management (cont.)
  • 6. Breaks down large tasks into smaller
    achievable ones.
  • 7. Uses technology for documentation
    communication
  • 8. Discriminates between inadequate staffing
    inadequate time

27
Planning Examples of Specific Strategies
  • Use last 30-60 minutes of day to plan next
    clean desk
  • Plan what you will do in each 30-60 minute block
  • Number tasks in order of priority
  • Start with most difficult priority task work
    for set time
  • Plan communication with staff

28
Standards met incarrying out Organizing
29
Roles FunctionsOrganizing Delivery of Nursing
Care
  • Organizational structure
  • Authority power in organizations
  • Nursing systems
  • Organizing client care
  • Committees
  • Nursing informatics

30
Organizing Management Functions
  • 1. Understand agencys structure personal
    responsibility authority within it
  • 2. Informs staff of unit organizational chart
  • 3. Maintains clarifies unity of command as
    possible
  • 4. Follows subordinate complaints upward
  • 5. Establishes proper span of control

31
Organizing Management Functions
  • 6. Knowledgeable about agency culture
  • 7. Uses informal organization to meet agency
    goals
  • 8. Uses committee structure for quality
    quantity of work

32
Organizing Decision-Making
  • Centralized Few managers at the top
  • Decentralized At the lowest level possible

33
Organizing Assessing Culture
  • 1. How does the organization view physical
    environment?
  • 2. What is the organizations social environment?
  • 3. How supportive is the organization
  • 4. What is the organizational power structure?
  • 5. How does the organization view safety?
  • 6. What is communication environment?
  • 7. What are organization taboos heroes?

34
Organizing Span of Control
  • The appropriate number depends on the
    organization, the maturity of the subordinates,
    and the type of work to be done. An
    inappropriate span of control can result in
    inefficiency.
  • (p. 161, Marquis Huston, 2000)

35
Organizing Committees
  • Groups who want to work on a project
  • Manager must give parameters--A clear assignment
    with deadlines
  • Written agendas chairperson
  • Large enough to do task small enough to talk
  • Discourage group think

36
Organizing Patient Care
37
Organizing Patient Care
38
Organizing Patient Care
39
Organizing Patient Care
  • Primary Nursing
  • 1 RN plans manages care for the patient in
    collaboration with Associate RNs
  • Interfaces with MD, Charge RN, resources
  • Case Management
  • All RNs use resources to expedite health OR
  • A special nurses monitors facilitates use of
    resources in the agency for many patients in
    collaboration with their nurses

40
Organizing Informatics
  • Data recording retrieval used to
  • Manage care
  • Monitor care
  • Computer/technology
  • RNs must be educated

41
Standards met incarrying out Staffing
42
Roles Functions Staffing
  • 1. Personnel
  • 2. Fiscal planning/budgeting
  • 3. Staffing scheduling
  • 4. Staff Development

43
Staffing Management Functions
  • 1. Ensures adequate, skilled workforce to meet
    agency goals
  • 2. Shares recruitment responsibility
  • 3. Interviews with proper techniques
  • 4. Develops selection criteria
  • 5. Places based on agency needs employee
    strengths
  • 6. Interprets employee handbook
  • 7. Participates in employee orientation.

44
Staffing Personnel
  • Recruiting Actively seeking out and hiring those
    who can best do job
  • Interviewing
  • Based on specific job criteria
  • Best predictor of future performance is past
    performance
  • Give person clear information about job
  • Try to contradict your first impressions
  • More than 1 interviewer is ideal

45
Staffing Structured Interview
  • Motivation
  • Physical
  • Education
  • Work experience
  • Present work
  • Previous work
  • Personal characteristics goals
  • Anticipated contributions to this agency

46
Staffing Orientation Socialization
  • Orientation --gt Competence --gt Quality
  • Socialization
  • Introduce to others their roles
  • Coach as take on role responsibilities
  • Carrot stick
  • Recognize current skills knowledge build on
    these

47
Staffing Scheduling
  • Scheduling should
  • Meet agency need
  • Be fair to all
  • Policies should include, for example
  • Lateness, absence, illness, emergencies
  • Vacations regular time off Special requests
  • Expectations for working in other areas of the
    agency

48
Staffing Scheduling Budgeting
  • NCH/PPD Nursing hours in 24 hour period
  • Patient census
  • Acuity of patients calculated to adjust RNs
  • Cost controlled

49
Staffing Staff Development
  • Interface with educators
  • Own role in orientation motivation
  • Preceptor program
  • Identification of clinical teaching expertise
  • Education of preceptor
  • Adjustment in assignments of preceptor new
    staff
  • Competence checklists

50
Standards met incarrying out Directing
51
Roles Functions Directing
  • 1. Use authority to provide reward system
  • 2. Use positive feedback as reward
  • 3. Unit goals that integrate agency employee
    needs
  • 4. Environment that
  • Reduces job dissatisfiers
  • Focuses on employee motivators
  • 5. Maintain tension for productivity along with
    job satisfaction

52
Roles Functions Directing (cont.)
  • 6. Clear communication of expectations
  • 7. Communicates sincere respect, concern, trust,
    sense of belonging to subordinates
  • 8. Assigns work appropriate to employee
    competence
  • 9. Identifies what motivates subordinates, and
    develops motivational strategies to meet these.

53
Directing Communications
  • 1. Understand use agency formal communication
    network
  • 2. Uses appropriate communication mode for
    distribution of information
  • 3. Prepares appropriate written communication
  • 4. Consults/coordinates with others who have
    overlapping functions
  • 5. Differentiates between information
    communication and recognizes need for both.

54
Directing Communications
  • 6. Protects subordinate confidentiality
  • 7. Prepares self staff for use of technology
  • 8. Uses group dynamics knowledge to achieve
    agency goals

55
Directing Delegation
  • 1. Creates follows specific job descriptions
    that conform to national/professional standard of
    care
  • 2. Understands legal liabilities of management
  • 3. Delegates based on abilities/limits of staff
  • 4. Delegates authority appropriately to achieve
    goals
  • 5. Maintains periodic review of delegated task
  • 6. Recognition rewards for task completion

56
Directing Managing Conflict
  • 1. Anticipates minimizes sources of conflict on
    unit
  • 2. Uses authority when quick, unpopular decision
    must be made
  • 3. Facilitates conflict resolution between
    employees
  • 4. Accepts mutual responsibilities for reaching
    goals
  • 5. Effectively negotiates for needed resources
  • 6. Compromises unit needs only on the noncritical

57
Directing Labor Issues
  • 1. Uses union contract appropriately
  • 2. Administers policies fairly
  • 3. Works cooperatively with administration
    personnel when dealing with unions
  • 4. Understands laws relating to managers work
  • 5. Safe work environment
  • 6. Alert for discrimination
  • 7. Ensures licensing requirements met

58
Standards met incarrying out Control
59
Leadership Management
  • Leader focus more on
  • Agency system for quality control
  • Maximizing employee potential
  • Manager focus more on control
  • Unit criteria for quality control
  • Controlling employee behavior to meet standards

60
Roles Functions Controlling
  • 1. In collaboration with others, establishes
    clear-cut measurable standards of care
    determines the most appropriate method for
    measure whether those standards have been met.
  • 2. Selects uses process, outcome structure
    audits as quality control
  • 3. Gathers data from appropriate sources
  • 4. Determines discrepancies between performance
    standards determine why

61
Roles Functions Controlling
  • 5. Uses quality findings for performance review,
    rewards, development of employees
  • 6. Educates self about state accrediting
    regulations that define quality
  • 7. Participates in benchmarking efforts and
    best practices initiatives.

62
Controlling Quality
  • STEPS
  • 1. Identify standards expected outcomes
  • 2. What information would objectively measure
    these standards/outcomes?
  • 3. Determine how where to collect the
    information
  • 4. Gather information
  • 5. Compare information to standards/outcomes
  • 6. Make a judgment about quality
  • 7. Share information take corrective action prn

63
Controlling Quality
  • Audits
  • 1. Structure
  • 2. Process
  • 3. Outcomes

64
Controlling Quality
  • Total Quality Improvement (TQI or QI or QAI or
    CQI) is a different philosophy
  • Identifying doing the right things, the right
    way, the first time, and problem-prevention
    planning--NOT inspection and problem-solving--lead
    to quality outcomes
  • (p. 402, Marquis Huston, 2000)

65
Controlling Performance Appraisal
  • 1. Uses formal, established system of appraisal
  • 2. Gathers fair objective data
  • 3. Uses to determine staff education training
    needs
  • 4. Based on written standards that have been
    communicated
  • 5. Documents process
  • 6. Follows up on deficiencies
  • 7. Conducts appraisal in way that promotes
    positive outcome
  • 8. Provides continuous feedback to employees.

66
Example
  • Part of an oncology nurse performance evaluation
    tool for Professional Performance Standard 3
    Education The oncology nurse acquires and
    maintains current knowledge in oncology nursing
    practice.
  • Rating scale used
  • 1. Performance below standards
  • 2. Performance meets standard
  • 3. Performance exceeds standard

67
(No Transcript)
68
Promoting Professionalism
  • Professional standards
  • Professional relationships commitment
  • Patient advocate
  • Staff education career planning
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