mang 519-modules revised 2009

7/28/2019 MANG 519-Modules Revised 2009

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PRACTICUM IN NURSING ADMINISTRATION

MODULE ONE

REVIEW OF THEORIES AND CONCEPTS

SPECIFIC OBJECTIVES

At the end of the session you will:

1. have reviewed the theories, concepts and principles of the four management functions ofplanning, organizing, directing, and controlling

2. have received an orientation of the course coverage, its objectives and requirements

3. have received an orientation to the hospital/health care facility/nursing schoolsorganizational philosophy, mission, goals, organizational structure, physical set-up

4. have been introduced to the institutions key personnel

5. be able to write a mission statement for a health care facility/nursing school6. begin to observe the facilitys organization climate, communication patterns, leadership

styles

7. examine the organizational chart and determine relationships8. review the different types of organizational charts/structure

9. submit a description and a diagram of the facilitys table of organization including the names

and positions of leaders

___________________________________Practicum in Nursing Administration

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LESSON 1 REVIEW OF MANAGEMENT CONCEPTS

* Definition of Management

Management, sometimes, also referred to as supervision, is a complex process of

coordinating, directing and assigning, both physical and human resources in order to accomplish an

organizations short-term and long-term objectives, (Carroll, 2007). Management is oftensynonymous with constant activity and interaction. The most common image of a manager is of a

firefighter who responds to problems that emerge randomly, and are addressed in order of

emergency.

* Managerial Roles

One of the most frequently referenced taxonomies of managerial roles is from an in-depthstudy of Henry Mintzberg. He identified three categories: 1) information-processing role, 2)

interpersonal role, and 3) decision-making role, (Mintzberg, 1973 ascited by Kelly, 2008). Specificor distinct roles are part of each of the three categories of managerial roles. The informationprocessing roles are monitor, disseminator, and spokesperson, each of which is used to manage the

information needs that people have. The interpersonal roles are figurehead, leader and liaison and

each of these is used to manage relationship with people. The decisional roles are the entrepreneur,

disturbance handler, allocator of resources, and negotiator roles that managers use to take actionwhen making a decision.

* Management Functions

They consist of;

A. Planning: determining the objectives of an institution or organization and what needs to be

done (both in the short term and long term) to achieve those objectives. It consists of four

stage process:

1. establish objectives,

2. evaluate the present and predict future trends and events,

3. formulate a planning statement, and4. convert the plan into an action statement. Nurse Managers are more likely to be

involved in the operational planning. It is done in conjunction with budgeting,

usually a few months before the new fiscal years. It develops the departmental

maintenance and improvement goals for the coming year.

B. Staffing: selecting the people who are able to carry out the action plan. This selection isusually based on:

a. the knowledge, skills, and experience of the nurse

b. the number and type(s) of patients needing carec. number and type of support staff available (Leach, 2003)


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C. Organizing: based on the plan as well as knowledge about the structure of the institution ororganization, organizing is the process of coordinating human and other resources to meet

established goals. Effective organizing consists of:

a. knowledge of factors such as institution, environmental, social structure, people, and

technology

b. ability to assign tasks appropriately to people who can accomplish the taskssuccessfully (delegation);

c. coordinating tasks that have been assigned and changing tasks or staff if goals are not

being met;d. using appropriate and accepted types of authority to ensure that required tasks are

completed. Depending on the organization and the manager, authority may derive

from the managers position in the organization itself, or from the relationship

between supervisor and staff member (Sullivan & Decker, 1992, 2001). Forexample, in a more rigid organizational structure such as a police or fire department,

authority comes with rank.

D. Directing: motivating and leading personnel to accomplish objectives. How a person directs

others depends on that persons authority, power and leadership style. Effective directing isachieved through strategies such as:

a. setting specific, clear expectations that are realistic and measurable

b. providing sufficient resources to accomplish the tasks

c. fostering a work environment that balances challenge and successd. finding ways to recognize and reward work that meets or exceeds objectives in a way

that is meaningful to workers (Costello Nickitas, 1997; Sullivan & Decker, 2001).

E. Controlling: establishing standards of performance, comparing results with these

benchmarks, and correcting performance that differs from accepted standard. Frequently

used means of control include:

a. management by objectives (MBO) devices: determining objectives, measuring to see

if objectives are being met, and comparing objectives with standards (benchmarks)

b. socialization: often a key part of MBO, socialization means that nurses internalizeprofessional values and standard codes of behavior. For nurses, socialization is a

process of moving from the early stages of accepting perceived beliefs and values of

the profession, through formal and informal education, to the final stage of fullmembership in the profession and commitment to its norms and values (Sullivan &

Decker, 1992).

c. Managerial surveillance: the direct observation of staff behavior by the manager as

well as indirect observation, for example, through the managers review of records.A key concept of this function is span of control, which refers to the number of

individuals for whom a supervisor is directly responsible. A narrow span of controlmeans fewer numbers of directly supervised staff and thus higher degrees of direct

observation and control. A wider span of control (more than 10 supervised

employees) means less opportunity for direct observation or control

d. Continuous quality improvement (CQI): in this formal quality improvement process,staff members participate in and lead the team. All team members are continuously

involved in peer review, so that they can identify ways to improve processes or


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programs, and constantly enhance and improve the quality of care (Sullivan &Decker, 2001).

F. Decision Making: key steps of this function include:a. identifying problems

b. establishing criteria that can evaluate potential solutions to the problem(s)

c. seeking alternative solutions, including taking no actiond. evaluating all the alternatives that have been found

e. selecting the best alternative, based on organizational objectives, staff, environment,

and other available resources. (Sullivan & Decker, 2001)

G. A variety of factors affect management roles and decisions. They include:

1. the institutions structure (for example, size how it handles authority,department size and structure, wide or narrow span of control, amount of

centralization or decentralization, how it measures and controls outcomes, and how it

selects, recruits, and rewards employees)2. the organizations objectives: the service(s) it offers (such as a hospital that

specializes in cardiology or an outpatient surgical center that specializes in cataractsurgery), how productive the organization is or how efficiently it meets objectives,the quality and amount of its human resources and how employees participate is goal

setting.

3. environmental factors (for example, the current economics, legal,

technological, or social influences that the organization must consider).4. technology (for example, current state of medical or nursing science,

process technology. (computer systems & informatics)

5. tasks that are required or expected (for example, the nature of tasks thatneed to be completed, how work tasks are designed, and the impact of the

organizations physical layout on the nature and design of tasks.)

6. social structure (for example, the organizations internal culture, how itsocializes employees, the rituals that it uses to conduct work or deal with conflict.


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LESSON 2 ORIENTATION TO THE ASSIGNED FACILITY(HOSPITAL OR COLLEGE OR NURSING)

Mission and Governance

The missions, goals, philosophy and/or objectives of the nursing school and nursing service

unit should be consistent with those of the governing organization or differences are justified by thenursing unit goals (NLN)

Here are some other organizational concepts that are vital in your observation of the

dynamics of, and participation in the management functions:

Leadership is commonly defined as a process of influence in which the leader influencesothers towards goal achievement (Kelly, 2008). Influence is on instrumental part of leadership and

means that the leader affects others, often by inspiring, enlivening, and engaging others toparticipate. The process of leadership involves the leader and the follower in interaction. Thisimplies that ledership is a reciprocal relationship. Leadership can occur between the leader and

another individual; between the leader and a group; or between a leader and an organization, a

community, or a society.

True leadership is not based on traditional views of leadership as having authority,

command or power, or power over others. A person in a position of authority is not automatically a

leader. Ideally, nurses in positions of authority have highly developed leadership qualities

Roles are acts of behaviors expected of a person who occupies a given social position.

Positions are location in social systems, such as nurse or teacher. People who occupy a positioncollectively share common behaviors. Specific behaviors associated with positions constitute roles.

Positions and roles have counterparts or counter roles such as nurse client, teacher-student, or leader-

follower (Tomey, 2003)! Behaviors are actions taken by the role enactor. These acts are learned

and influenced by norms. They are often voluntary and goal directed. Prescription refers to whatshould be done by a person in a certain position. Positions often require specific skills, intelligence,

or temperament and may be held based on ones age, sex and education. Positions often imply titles

such as nurse or teacher. People in positions are exchangeable, but the positions are not.

Power is described as the ability to create, get and use resources to achieve ones goals

(Kelly, 2008). Goals within an organization vary widely across departments, health care groups, and

individuals. Power can be defined at various levels: personal, professional, or organizational.Personal power derives from characteristics in the individual. Professional power is conferred on

members of a profession by one another and the larger society to which they belong. This powercomes from offering a service that society values. Organizational power comes from ones position

in an organizational hierarchy; as well as from understanding the organizational structure and

function, and from being authorized to function power fully within an organizational culture.


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Empowerment is the process by which we facilitate the participation of others in decision

making and take action within an environment where there is equitable distribution of power. It isdemonstrated through:

1. an increased ability to solve problems creatively and affectively;2. improved communication between nurses and patients, between nurses and management,

throughout the organization;

3. increased satisfaction with work; and4. improvements in peoples level of self-esteem and ability to function with autonomy

(Carroll, 2007).

Authority or the right to command, accompanies any management position, and is a source oflegitimate power, although components of management, authority and power are also necessary to a

degree, for successful leadership. The manager knowledgeable about the wise use of authority,

power and political strategy is more effective at meetings, personal, unit and organizational goals.

Benchmarking. Many organizations have begun using benchmarking as a tool foridentifying desired standards of organizational performance. It is a process of measuring products,practices, and services against best-performing organizations (Marquis and Huston, 2006). In doing

so, organizations can determine how and why their performance differs from these exemplar

organizations and use them as role models for standard development and performance improvement.

For example, the wound care regime related to nursing time and product use could be analyzed forquality and cost-effectiveness. How much time does it take for a nurse to complete a dressing?

How much do the dressings, tape and other supplies use for the dressing cost?

Organizational Structure refers to the way in which a group is formed, its lines of

communication, and its means for channeling authority and making decisions (Marquis and Huston,

2006). Each organization has a formal and informal organizational structure. The formal structureis generally highly planned and visible, whereas the informal structure is unplanned and often

hidden. Organizational structure are affected by the economic, political, social and technological

pressures in society and follow changes in vertical and horizontal integration, geographical

dispersion and unit volume. The structure delimits responsibilities, communication channels and thedecision-making process environment.

Organizational Chart is a drawing that shows how the parts of an organization are linked.It depicts the formal organizational relationships, areas of responsibility, persons to whom one is

accountable and channel of communication. The organizational chart may be used for policy

making and planning to evaluate strength and weaknesses of the current structure, and for showing

relationships with other departments and agencies.


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LEARNING ACTIVITIES

1. Meet with the institutions administrators and be introduced to the key personnel including

your precept or/resource persons/facilitators and others who will assist you in achieving theobjectives of this course.

2. Have an orientation to the facilitys organizational mission, goals, and philosophy. Theinstitution will assign a staff to give you the orientation.

3. Examine and comment on the institutions mission statements and goals.

4. Make a diagram of the institutions table of organization. Include the names of

administrators and their respective positions.

5. If assigned in an educational institution, interview faculty members and discuss with them

their own beliefs about nursing and nursing education.

6. If assigned in a nursing service facility, interview staff nurses and/or nurse managers and

discuss with them their institutions and nursing service departments philosophy of service.

7. Know the names and qualifications (educational, professional and personal) of the facilitysadministrators.

8. Have a tour of the facility and be oriented to the institutions physical facility.

9. Be aware of the institutions organizational climate.

10. Begin to observe channel of communication.


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MODULE TWO

TOOLS FOR PLANNING

SPECIFIC OBJECTIVES

At the end of the session in either nursing service or nursing educational system, the

student will have observed/participated in:

1. budgeting

2. staffing/faculty assignments and load3. policy formulation4. development of standards

5. employee hiring

6. employee orientation7. staff development

Planning is the first element of management. It is during the planning stage where initially,

objectives are formulated, budgetary allotments are determined, decisions are made as the size and

type of staff are needed, organizational structure is designed, operational policies and procedures and

all the other activities and decision related to the management process are conceived and discussed.Planning makes uses of several tools, including budgeting, setting of criteria and standards.


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LESSON 1 BUDGETTING

A key factor that influences patient care is the cost involved in the delivery of service.Resources - people, equipment, and time - are required to support the services delivered by nurses.

These resources cost money. The economic success of a health care organization depends on those

who are involved with service delivery. Nurses play an integral role in the preparation,implementation, and evaluation of a unit or department budget.

Hospitals use several types of budget to help with future planning and management. Theseinclude:

1. Operational budget accounts for the income and expenses associated with day to

day activity with a department or organization.2. Capital budget accounts for the purchase of major new or replacement equipment.

Equipment is purchased when new technology becomes available or when older

equipment becomes too expensive to maintain because of age related problems.3. Construction budget is developed when renovation or new structures are planned. The

construction costs generally include labor, materials, building permits, inspection,equipment, etc. If it is anticipated that a department will need to close duringconstruction, then projected lost revenue is accounted for in the budget (Kelly, 2008).

Budgeting is frequently classified according to how often it is done and the base on which

budgeting takes place. Three of the most common budgeting methods are:

1. Incremental budgeting or the flat percentage increase is the simplest method for

budgeting. By multiplying current year expenses with a certain figure, usually theinflation rate or consumer price index, this method arrives at the budget for the coming

year.

2. Zero based budgeting. This method does not automatically assume that because aprogram has been funded in the past, it should continue to be funded. This budgeting

process is labor intensive for nurse managers. The use of decision package to set

funding priorities is a key feature of this method. Key components of decision package

are the following:

1. listing of all current and proposed objectives in the department,

2. alternative plans for carrying out these activities,3. counts for each alternative, and

4. advantages and disadvantages of continuing or discontinuing an activity.

3. New performance budgeting emphasizes accountability, efficiency, economy byemphasizing outcomes and results instead of activities or outputs. The manager would

budget as needed to achieve specific outcomes and would evaluate budgetary successaccordingly.


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Managed Care

Managed care is a system that attempts to integrate efficiency of care, access, and cost ofcare. Common denominators of managed health care include panels of contracted providers, some

type of limitation on benefits to subscribers who use noncontracted providers (unless authorized to

do so), and some type of authorization system (Kongstvedt, 1977 as cited by Marquis and Huston,2006). Other key principles of managed care include the use of primary care physicians as

gatekeepers to the healthcare system, a strong focus on prevention, a decreased emphasis on

inpatient hospital care, the use of clinical practice guidelines for providers, selective contracting(whereby providers agree to lower reimbursement levels in exchange for patient population

contracts), utilization review, the use of formularies to manage pharmacy care, and continuous

quality monitoring and improvement.

Another frequent hallmark of managed care is capitation, whereby providers receive a fixed

monthly payment regardless of what services are used by that patient during the month. If the cost

of caring for a specific person is less than the capitated amount, the provider profits. If the cost isgreater than the capitated amount, the provider suffers a loss. The goal, then, for capitated providers

is to see that patients receive the essential services to stay healthy or to keep from becoming ill, butto eliminate unnecessary use of healthcare services.

One of the most common types of managed care organizations (MCO) is the health

maintenance organization (HMO). An HMO was originally defined as a prepaid organization that

provided healthcare to voluntarily enrolled members in return for a preset amount of money on aper-person, per-month basis. With the increase in self-insured businesses or financial arrangements

that do not include prepayment, this definition now generally includes two possibilities: (1) it is a

licensed health plan that places at least some of the providers at risk for medical expenses, and (2) itis a health plan that utilizes designated (usually primary care) physicians as gatekeepers (although

some HMOs do not) (Kongstvedt, 1977 as cited by Marquis and Huston, 2006).

It is important to remember that there are different types of HMOs as well as different types

of plans within HMOs that members may subscribe to. Several types of HMOs include: (1) staff, (2)

independent practice association (IPA), (3) group, and (4) network. In staff HMOs, physician

providers are salaried by the HMO and under direct control of the HMO. In IPA HMOs, the HMOcontracts with a group of physicians through an intermediary to provide services for members of the

HMO. In a group HMO, the HMO contracts directly with one independent physician group. In

network HMOs, the HMO contracts with multiple independent physician group practices.


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LESSON 2 STANDARDS, POLICIES AND PROCEDURES

A standard of care outlines the level or degree of quality considered adequate by a given

profession. These standards represent the skills and learning commonly possessed by members of

the profession and generally are the minimal requirements that define an acceptable level of care.Standards of care, which guarantee patients safe nursing care, include organizational policy and

procedure statements, job descriptions.

In nursing service, the purpose of enunciating, circulating and enforcing standards is

threefold:

a) to improve the quality of nursing careb) to decrease the cost of nursing care

c) to provide a basis for determining nursing negligence.

In nursing education, standards for institutional performance are usually set by the

accrediting body, but the institution itself sets its own standards for faculty and student performance,as well as for determining the effectiveness of its educational program and its use of resources.

Policies

Policies and procedures are means for accomplishing goals and objectives.

Policies explain how goals will be achieved and serve as guides that define the general

course and scope of activities permissible for goal accomplishment. They serve as abasis for future decisions and actions, help coordinate plans, control performance, and

increase consistency of action by increasing probability that different managers will

make similar decisions when independently facing similar situations.

Policies should be comprehensive in scope, stable, and flexible so they can be

applied to different conditions that are not so diverse that they require separate sets of

policies. Consistency is important because inconsistency introduced uncertainty andcontributes to feelings of bias, preferential treatment, and unfairness. Fairness is an

important characteristic that is attributed to the application of the policy. Policies

should be written and understandable.

Policies can be implied or expressed. Implied policies are not directly voiced

or written but are established by patterns of decisions. They may have either favorable

or unfavorable effects and represent an interpretation of observed behavior. Courteoustreatment of clients may be implied versus expressed.

Expressed policies may be written or unwritten. Oral policies are more

flexible than written ones and can be easily adjusted to changing circumstances. They

are less desirable than written ones because they may not be known.


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Procedures are plans that establish customary or acceptable ways of accomplishing a

specific task and delineate a sequence of steps of required action. It may have some variation in the

steps as long as the same outcome is obtained. Procedures identify the process of steps needed toimplement a policy and are generally found in manuals at the unit level of organization. The nurse

manager has the responsibility to review and revise policies and procedure statements to ensure

currency and applicability.

Procedure manuals provide a basis for orientation and staff development and are ready

reference for all personnel. They standardize procedures and equipment and can provide a basis forevaluation. Good procedures can result in time and labor savings. Improvement in operating

procedures increases productivity and reduces cost.

Writing procedures demands a consistent format that considers the definition, purpose,materials needed and how to locate, requisition, and disposition of them, steps in the procedure,

expected results, precautions, legal implications, nurse, patient, and doctors responsibilities and

appropriate charting.

LEARNING ACTIVITIES

Answer the following and submit your answer/reaction to your professor.

1. Observe/interview nurse administrators (dean or director of nursing) to determine what theinstitutions long range/strategic plans are in connection with physical resources, clientele,

and service development.

2. Interview and/or observe nursing service director, supervisors, staff or dean and faculty to

determine the following

2.1) Time set aside for planning;2.2) How time is managed both by his/her and staff;

2.3) Time set aside for planning for emergencies and crisis.

2.4) In planning, how he/she considers priorities, deadlines, organizational goals,characteristics of work.

2.5) How plans/projects are developed.

2.6) How plans/projects are approved.

2.7) How plans are implemented and monitored.

3. Observe the budgeting process:

3.1) Determine the approaches used in planning the budget.

3.2) Determine staff/faculty participation in planning the budget.

3.3) Identify the individuals within the organization who have responsibility for budgetpreparation, approval and monitoring.

3.4) Make a sample budget report for a nursing unit/college of nursing.


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3.5) Determine the main sources of revenue as well as the major expense;3.6) Examine the budget worksheet used and note its components.

3.7) Determine how the budget is allocated, e.g., how many percent of the budget are

allotted for personnel, equipment, supplies physical resources, and so on.

4. Read the institutions Administrative and Policy Manuals and determine the following:

4.1) The role of the nurse administrator in formulating administrative orders/policies, rules

and regulations

4.2) The process and steps involved in writing them. For example, how employees arerecruited and selected

5. With your preceptor, sit in committee meetings as for example, Administrative Committee,

Committee on Standards, Nurse Managers Committee, faculty meetings.

6. While attending any of the meetings, observe the following processes and make a briefreport of your observation:

6.1) Decision-making process: how problems are identified, alternatives explored,choosing most desirable alternatives.

6.2) Values, attitudes, personality, of participants;

6.3) Group dynamics, group process;

6.4) Time Management6.5) Leadership styles


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MODULE THREE

ORGANIZING

SPECIFIC OBJECTIVES

At the end of the sessions the student will have observed/ examined, and/or participated in

the following processes in either a Nursing Service Department or a College of Nursing:

1. recruitment, selection, hiring and interviewing of new employees;2. activities related to the retention of old employees;

3. orientation program

4. staff development activities and programs5. writing and implementing job descriptions of staff/faculty, supervisors, college of nursing

dean, nursing service director;

6. determining the qualifications of nursing administrators, faculty and staff;

7. determining the purpose, compositions, functions of committees and8. determining the other organizing tasks and activities to achieve the agencys goals and

mission.


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LESSON 1 STAFFING

The manager is responsible for providing adequate staffing to meet patient care needs. It

involves: a) the selection of personnel, b) selection of assignment system, and c) the determination

of staffing schedules.

Recruitment of qualified personnel is the first step in the selection of personnel. The nurse

manager attracts applicants for existing positions. Although at any given time an organization mayhave an adequate supply of personnel to meet the demand, it should be an ongoing process. The

manager maybe greatly or minimally involved with recruiting, interviewing and selecting personnel

depending on 1) the size of the institution; 2) the existence of a separate personnel department; 3) the

presence of a nurse recruiter within the organization and 4) the use of centralized or decentralizednursing management.

Recruitment, however, is not the key to adequate staffing in the long term. Retention is, andit only occurs when the organization is able to create a work environment that makes staff want to

stay. Some turnover is normal and desirable. Turnover infuses the organization with fresh ideas. Italso reduces the probability of groupthink in which all the people in the organization share similarthought processes, values, and goals. Excessive or unnecessary turnover reduces the ability of the

organization to produce its end-product and is expensive.

Indocrination as a management function, refers to the planned, guided adjustment of anemployee to the organization and the work environment. Induction and orientation are

frequently used to describe this function, the indoctrination, process includes three separate phases:

1) induction; 2) orientation, and 3) socialization. Induction takes place after the employee has beenselected but before performing the job role. It includes all activities that educate the new employee

about the organization and employment and personnel policies and procedures. Orientation

activities are more specific for the position. The purpose of the orientation process is to make theemployee feel a part of those team. This will reduce burnout and help new employees more quickly

become independent in their new roles. Socialization according to Maquiz and Huston (2006) is a

sharing of the values and attitudes of the organization by the use of role models, myths and legends.

It involves little structured information.

Job Description are derived from job analysis and are affected by job evaluation and design.

They contain specifications which are the requirements for the job, major duties and responsibilities,and the organizational relationships of a given position. Job description are useful for recruitment,

placement, promotion, transfer and evaluation. It helps prevent conflict, frustration and overlapping

of duties.


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LESSON 2 ASSIGNMENT SYSTEMS FOR STAFFING

Changes in assignment systems are a response to changing needs. Functional nursing is

predominant in response to the shortage of nurses. Team nursing is use to maximize the knowledge

and skills of professional nurses and to supervise auxiliary workers. Each system has its ownadvantage and disadvantages.

Pros and Cons of Various Assignment Systems

Assignment System Pros Cons

Case method Total patient care Different nurse, different shifts,

different days

Functional nursing Efficiency Nurses do managerial work

Nurses aides do patient care

Team nursing Team effort

Frees patient care coordinator tomanage the unit

Nursing care conferences help

problem solve and develop staffNursing care plan

Time needed to coordinate

delegated work

Modular nursing Useful where there are few RNsRNs plan care

Paraprofessionals do technicalaspects of care

Primary nursing RNs give total patient carePrimary nurse has 24 hour-a-day

responsibility

Associate nurse works with patient

while the primary nurse is off duty

Accountability in place

Continuity of care is facilitatedReduces number of errors from

relay of ordersFewer patient complaints

Shorter hospitalization

Confines nurses talents to alimited number of patients

Associate nurse may change care

plan without discussing with

primary nurse

Managed care Unit-based

Can be used with any nursing caredelivery system

Standard critical paths

Questionable continuity of care

Case management Focuses on entire episode of illness

Emphasizes achievement of

outcomes

Incorporates managed care

Care is coordinated by a casemanager

Second-generation primary nursing

Critical paths

Variation Analysis

Intershift reportsHealth care team meetings

Quality assurance

Interdisciplinary approach

Effort to coordinate


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LESSON 3 STAFFING SCHEDULES

Scheduling of staff is the responsibility of the nurse manager, who must ensure that the

schedule places the appropriate staff on each day and shift for safe, effective patient care. There aresome considerations in scheduling the staff: 1) the patient type and acuity; 2) the number of

patients; 3) the experience of the staff; 4) and supports available to the staff.

Advantages and Disadvantages of Various Scheduling Methods

Scheduling Method Pros Cons

Self-scheduling Coordinated by staff nurses

Saves manager scheduling time

Helps develop accountabilityIncreased perception of autonomy

Increased job satisfaction

Improved team spirit

Improved morale

Decreased absenteeism

Reduced turnoverEffective for recruitment and

retention

Increases amount of time staff

spends on scheduling

Rotating work shifts Can rotate teams Rotates among shifts

Increases stress

Affects health

Affects quality of workDisrupts development of work

groups

High turnover

Permanent shifts Can participate in social activities

Job satisfaction

Commitment to the organization

Fewer health problems

Less tardiness

Less absenteeism

Less turnover

Most people want day shift

New graduates predominately

staff evenings and nights

Difficulty evaluating evening

and night staff

Nurses may not appreciate the

work load or problems of othershift

Block, or cyclical, scheduling Same schedule repeatedly

Nurses not so exhausted

Sick time reducedPersonnel know schedule in

advance

Personnel can schedule social

events

Decreased time spent on scheduling

Staff treated fairly

Helps establish stable work groupsDecreases floatingPromotes team spirit

Promotes continuity of care

Rigidity

Variable staffing Uses census to determine number

and mix of staffLittle need to call in unscheduled

staff


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Pros and Cons of Centralized and Decentralized Staffing

Pros Cons

Centralized Fairness

Cost containment

Lack of individualized treatment

Decentralized Managers have authority

Staff get personalized attention

Staffing is easierStaffing is less complicated

Unfair treatment

Schedule used to punish and reward

Time-consuming for managersLess efficient use of resources

Cost containment is more difficult

Pros and Cons of Variable Staffing

Pros Cons

8 hours Traditional Longer workday

10 hours Time to complete work

Long weekends

Extra days off

Decreased overtimeCover peak workloads

Decrease costs

Fatigue

Overlap

Difficult to find substitute

12 hours Lower staffing requirementsLowers cost per patient day

Increased knowledge of patients

Get new admissions settled

Not so rushed

Better continuity of care

Team development is possible

Less daily reporting

Less time to do staffing

Reduced travel time

Less personal expenses for gas, meals,babysitting

OvertimeExhaustion increases at end of work-

week

Tension increases at end of workweek

Increases in minor accidents

Increases medication errors

Home and social life suffers the week

worked

Baylor plan/weekend option Fewer people need to work weekendsWeekends off more frequently

Work fewer hours for greater pay

Staffing improved

Morale improved

Illness increasedAbsences increased

Patient Care Delivery System and Assignment System Used in Community Health

Services are: Managed care, case management, and collaborative practice. Managed care,according to Marriner-Tomey (2003) is a unit-based care system that can be used in any nursing

delivery system. Activities, consultations, diet, discharge planning, medications, teaching, tests,

treatment are noted. Case management focuses on the entire episode of illness, including all settings

in which the client receives care. It emphasizes achievement of outcomes in designated time frameswith limited resources. Typically, it incorporates managed care. Care is coordinated by case

manager, usually a registered nurse. Case management is sometimes called second-generation

primary nursing. Collaborative practice can include interdisciplinary teams, nurse-physicianinteraction in joint practice, or nurse-physician collaboration in care giving.


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LESSON 4 FACULTY ASSIGNMENT

In Article III (Administration) Section I. of CHED Memo No. 30 Series of 2001, which is called theUpdated Policies and Standards for Nursing Education, the college of nursing should be

administered by a full-time dean who:

a. is a Filipino citizen;

b. is a current Registered Nurse in the Philippines;

c. is a holder of Masters degree in Nursing;d. has at least five (5) years of competent teaching and supervisory experience in

colleges or institutes of Nursing;

e. is an active member of good standing of the Association of Deans and Philippine

Colleges of Nursing (ADPCN) and the accredited national nurses association

Section 2. The general functions and responsibilities of the Dean of Nursing are to:

a. assist the administrators to attain institutional goals, e.g. instruction, research, community

extension services and all related matters;b. initiate curriculum development programs;c. implement faculty development programs;

d. recommend faculty for appointment, promotion and tenure including leave and non-

reappointment;

e. approve faculty teaching load;f. oversee facultys academic advisement of the student;

g. collaborate with student services, admission policies and referrals based on established

criteria;h. ensure adherence to established standards of instruction;

i. ascertain that requirements for graduation are complied with;

j. represent the school in professional and community civic affairs;k. attend to physical and budgetary resources;

l. collaborate with the health services and other academic units in the implementation of

instructional programs.


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ARTICLE IVFACULTY

Section 1. The faculty shall have academic preparation appropriate to teaching

assignment. In addition, she/he must:

a. be a Filipino citizen;

b. be a current Registered Nurse in the Philippines;

c. be a holder of Masters degree in their major field and / or allied subjects;d. have at least three (3) years of clinical practice in the field of specification;

e. be a member of good standing of the accredited national nursing association

Section 2. When vacancies occur in the teaching force of the college during the school

year, substitute or replacement with similar or higher qualifications shall be employed.

Section 3. The following conditions of employment must be observed:

a. The salary of faculty shall be commensurate with their rank.b. Full time faculty member who shall be responsible for both classroom and

Related Learning Experience (RLE) must teach nursing courses.

Section 4. The faculty shall be assigned academic ranks in accordance with theiracademic training and clinical expertise. The recognized ranks are: instructor, assistant professor,

associate professor, and professor.

Section 5. The faculty development program plays a role in the effective operation of the

college. It consists of activities and programs towards the development of the faculty for

intellectual, personal, and professional as well as moral and spiritual growth. The program may bein the form of:

a. scholarship grant

b. graduate studiesc. in-service and continuing training programs

d. clinical skills enhancement for at least two weeks a year

Section 6. The teaching load of college faculty members should be as follows:

a. Dean not to exceed a total of six (6) units of lecture in a semester.

b. Full-time faculty members may carry a regular teaching load of 15-24 units per semester.One hour of related learning experience supervision is equivalent to one (1) unit credit.

c. Government employees who serve as part time faculty for non-nursing course mustsecure permit from the employer and may be given a maximum teaching load of nine (9)

units.

d. Part-time faculty employed full-time elsewhere may carry a teaching load of not more

than 9 units in all the schools in which he teaches.


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Selection of Faculty Members. Colleges of nursing may vary in their requirements forhiring faculty members. However, there are guidelines/standards that have to be followed and these

are related to educational, professional and teaching experience and license requirements. The

Masters Degree is the minimum credential required for teaching in colleges of nursing. Theselection of faculty members must take into consideration the criteria and requirements of the

regulating bodies such as the Board of Nursing and the Commission on Higher Education.

Nursing School Administrator. A college of nursing is administered by the dean. The

dean must be experientially and academically qualified to assume the authority and responsibility for

the development and administration of the BSN program. The dean may also have instructionalload, an ex-officio member of all standing committees, an active member or leader of professional

and community service organizations. She prepares an annual report and may report either to the

vice-president for academic affairs or to the Board of Trustees.

Committees. In all democratic organizations, committees are formed to assist the

administrators in their functions of planning, organizing, directing and controlling. In schools and

colleges of nursing, the usual standing committees are Admissions and Promotions, Curriculum,Faculty Development, Evaluation, Recruitment and Publicity, Library, Physical Resources. The

duties of the chairperson of standing committees include preparation of agency for meetings,presiding, channeling recommendations between the Committee and administration, presenting anannual report to the Administrator (dean). The duties of the secretary are to record attendance and

minutes of all meetings, and to submit them to the chairman.


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ARTICLE VIINSTRUCTIONAL STANDARDS

Section 1. The institution must maintain a high standard of instruction, utilizing

appropriate and updated syllabi and instructional methods/strategies that contribute to sound nursing

education.

a. The professional nursing subjects must be offered observing strictly pre-requisite

requirements and sequence.b. Credit for the completion of the course is based on the fulfillment of curricular

requirements.

c. The ratio of faculty to student in science laboratory class is 1:25; in regular classroom is

1:50.d. The institution shall provide for a systematic and continuing plan of evaluation of the

students progress through a marking system that is consistent and congruent to set

objectives.e. A system of supervision should be instituted and implemented for the purpose of

evaluating teaching performance.f. There should be a regular academic audit of instructional resources such as syllabi,

textbooks and others.

g. Record management must be maintained.

Section 2. The Related Learning Experience (RLE) are highly selected to develop

competencies utilizing the nursing process in varying health situations. The following conditions

must be observed.

a. There should be close correlation of theoretical knowledge to related learning experience.

Classroom and RLE activities must be congruentb. Classroom and RLE is a continuous process. Faculty teaching in the classroom must

continue to teach the students in their RLE.

c. Related learning experiences are organized around the objectives and competencies set

for the course and all students must be able to achieve such.d. Faculty compensation is based on the computation of one (1) hour RLE equivalent to

one (1) lecture hour.

e. Effectiveness and efficiency of the related learning experience, must consider thefollowing factors:

1. Background knowledge and capacity of the learner.

2. Size and nature of the learning resources both in institutions and communities.

3. Adequate number and variety of clientele.4. Adequate number of qualified nursing and other personnel.

5. Evidence of quality nursing care services.6. Compliance with the required equivalence of fifty one (51) hours to (one) 1 unit RLE

7. Ratio of student to clientele depends upon the objectives and the capacity of the

student. The ratio of student to clientele is:


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Level 1st Sem 2nd SemIII 1:1 1:2

IV 1:2-3 1:3-5

8. A faculty-student ratio of:

Level 1st Sem 2nd SemIII 1:8-10 1:8-12

IV 1:12-15 1:12-15


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LEARNING ACTIVITIES

Answer the following and submit your answer/reaction to your professor.

1. Read and study the Administrative Employee manuals. Determine the following:

a) activities related to recruitment;

b) activities related to retention;c) policies related to selection and hiring of employees;

2. Get a copy of application form and note the information needed.

3. Get a copy of a job description of staff nurse/faculty, nurse manager/dean. Write one longrange plan and one short plan objectives for each position.

4. Attend an orientation program for new employees

5. What are the components of the orientation program?6. Attend a staff development class. Determine what continuing education programs are

available to staff/faculty.7. Interview staff. Ask them about their professional and educational needs.8. Attend committee meetings/obtain copies of committee minutes. What are the standing

committees? What are their compositions and functions? In the college of nursing, for

example, how does the curriculum committee organize learning activities of students in order

to achieve the goals and mission of the school?9. Submit a weekly report and evaluation of your learning activities including suggestions and

recommendations for the institution and for the course.

Specifics of Nursing Service:

1. Interview the supervisor/nurse manager who is in charge of staffing. Determine the

following:

a) patient care delivery modes or assignment systemb) policies regarding staffing

c) staffing system to determine the number of full-time staff needed for vacation,

holiday, absentee coverage per year.

2. Study staffing schedules

3. Determine the patient classification system used

4. Determine an assignment system to be used in one of the units. Calculate the number andlevel of staff needed on an 8 hour shift.


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Specifics for Nursing Education:

1. Read the Faculty Manual. Interview a faculty, school officer and determine the following:

a) Faculty load

b) Basis of faculty assignment

c) Faculty-Student ratio: 1) in the classroom 2) in the clinical area.

2. Observe how the process of organization works: a) in the clinical teaching setting b) in the

classroom teaching.

3. Attend: Curriculum Development Committee and faculty meetings. Observe how the

meeting is organized.

4. Study the Curriculum. Write a brief comment on how the curriculum is organized.

5. Study the Student Manual.

6. Take note of the learning resources.


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MODULE FOUR

CONTROLLING AND EVALUATION

SPECIFIC OBJECTIVES

At the end of the session the student will have observed/participated in the controlling

and evaluation function of the nurse administrator in the assigned facility, either in nursing

education or nursing service. Specifically, the student will have observed/participated in:

1. establishing standards;

2. measuring performance; and

3. correcting deviation.


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LESSON 1 CONTROL MEASURES

Controlling is the last stage in the management process. Measuring performance and taking

corrective actions are leadership functions which ensure the accomplishments of organizationalgoals.

Control measures include; 1) discipline; 2) rounds, reports, audits; 3) evaluation devices;and 4) quality control and improvement.

Discipline

Disciplining Problem Employee. Problem employees include the substance abusers, those with

excessive tardiness or absenteeism, those whose performance is below par and those who arewithdrawn, angry, quarrelsome.

When an employee reports to work in apparently intoxicated state, the manager should notethe signs objectively and should ask a second person to validate her observation. The intoxicated

employee should be removed from the area, confronted briefly and firmly about the behavior, and

sent home. The incident is recorded.

Each time a performance problem occurs, it should be documented. The date and time, who

was observed by whom and description of the incident should be noted. At a pre-arranged

conference, the employee is confronted with the observations. The employee is given theopportunity to explain, alternatives are explored, and a course of action is planned. The

supervisor/manager may refer the employee for remedial measures, treatment or counseling. For

example, an alcoholic may be referred to a treatment facility, or a nurse whose clinical performanceis below par, may be referred to the staff development instructor for further practice.

Audits

Auditing in healthcare organization provides managers with a means of applying the control

process to determine the quality of service rendered. It can occur retrospectively, concurrently, orprospectively. The audits frequently used in quality control include outcome, process and structure

audits. Outcome audits determine what results, if any, occurred as a result of specific nursing

interventions for clients. It assumes that the outcome accurately demonstrate the quality of care that

was provided.

Process audits are use to measure the process of care or how the care was carried out. It istask oriented and focus on whether practice standards are being fulfilled. It assumes that a

relationship exists between the quality of the nurse and the quality of care provided. It can be

documented in patient care plans, procedure manuals, or nursing protocol announcements. Structure

audits assume that a relationship exists between quality care and appropriate structure. It ensures asafe and effective environment but does not address the actual care provided.


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Performance Measurement

The only way to know whether the staff are meeting their goals is to measure performance.

1. Purpose of performance measurement is to:

a. provide feedbackb. justify merit increase and other compensation adjustments

c. identify candidate for promotion

d. confirm hiring decisionse. counsel and terminate

2. To effectively assess employee performance, the nurse manager must know the

principles of performance managementa. know the job description and performance standards for the person being

evaluated

b. remain objective and evaluate performance over time, not just the monthbefore the formal performance appraisal is due

c. encourage employee to set attainable short-term and long term goals and toinclude professional development activities

d. allow the person being evaluated to respond to the evaluation and discuss

any performance successes or difficulties

e. identify specific ways for employee to improve job performance and

specific ways to motivate employeef. write down goals and objectives in a contract that specifies expectations and

encourages growth

3. The Key Elements of Performance Measurement

a. Quality and Volume of Work. Does the person perform the amount of work

expected and do it according to standards set by the department?b. Work Knowledge. Does the employee understand department policies and

procedures, regulations, resources, and trends that are applicable to his or her

daily responsibilities?

c. Work Judgment. Does the person show reliable and consistent decision makingand predictable, appropriate behavior?

d. Organization. Does the person effectively plan and organize work, and meet set

deadlines and use time wisely?e. Responsibility and Flexibility. Does the employee accept responsibility for his or

her work and avoid blaming others for failures? Does he or she accept instruction

or direction appropriately? Can the employee readily adapt to changing

conditions such as admissions, changes in patient condition, and othermodifications to do the assignment during a given shift?

f. Interpersonal Skills. Does the employee communicate effectively with other staffmembers, families etc.?


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The Importance of Job Descriptions as Part of Performance Measurement

1. Job description help nurse managers produce results such as customer satisfaction, anefficient and effective work environment, meeting patient care objectives, and cost-

effective care

2. Effective Job Descriptions

a. help employees understand their dutiesb. improve work flow

c. evaluate job performance

d. clarify relationships among jobs

e. identify potential training needsf. help determine employee hiring and placement needs

g. establish a structure for promotion and salaries (Costello Nickitas, 1997)

h. consistent with licensure laws and do not assign duties to noncredentialed staff thatcan only be performed by licensed nurses

Quality Improvements

Health care organizations need to continually monitor their services to improve quality of

care. The concepts of quality assurance and quality improvement (QI) began in the manufacturingindustry, but it is applicable to health care as well.

A. Difference between Quality Assurance and Quality Improvement

1. focus on quality assurance (also called doing it right)

a. assess or measure performance

b. determine whether performance meets standards (goal in manufacturing, for example, is

zero defects)

c. improve performance when it does not meet standards

2. focus on quality improvement (also called doing the right thing)

a. meet the customers needs

b. build quality performance into the work process

c. assess the work process to identify opportunities for improved performance

d. employ a scientific approach to assessment and problem solvinge. improve performance continuously as an on going management strategy, not just

when standards are not met (McLaughlin & Houston, 2003)f. performance integrates processes and outcomes and continually seeks a better

way to accomplish desired outcomes


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B. General principles of quality improvement

A. Priority is to benefit patients and other internal and external customers

1. customer is anyone who receives

2. internal customer works within the organization (for example, nurses in the intensivecare unit are customers of radiologic technologists using portable equipment in the

unit for radiographs)

3. external customer is anyone outside the organization who receives the output of theorganization (for example, patients, insurance companies, regulators, and the

community; surgeons who bring patients to a hospital for surgery are also customers

of the hospital)

B. Organizations achieve quality through the participation of everyone in

that organization; this promotes ownership so that employees

1. take responsibility for an organizations success or failure

2. take an active role in developing new ways of doing business and bringing in newcustomers

3. know that their efforts are valued

4. for example, a nurse organizes her day so that she can spend a few moments with a

critically ill patients family; or a respiratory therapist checks with the nurse so as to

coordinate treatment times for patients with chronic obstructive pulmonary disease toreduce patient fatigue

C. Focusing on work process provides opportunities for improvement

1. processes are causes or conditions that repeatedly come together in a series of steps to

transfer inputs into outcomes2. steps in a process can be studied, based on evidence-based practice, eliminated,

changed, or standardized to improve the overall work process

3. for example, all the steps required to take a patients blood sample can be observed,

analyzed, compared with best practices, and changed to eliminate repetition of stepsor otherwise improve speed and accuracy of results

D. Decisions to change or improve a system are based on data

1. a system is an interdependent group of items, people, or processes with a common

purpose

2. outcomes can be observed and improved on, by analyzing their systemic roots3. for example, to improve the time required to take a patients blood sample and

receive diagnostic results, you would need not only to improve the response time ofthe phlebotomist, but also examine the processes at work in the lab


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E. Improvement of service quality is a continuous process (McLaughlin &

Houston, 2003)

1. products or services are designed and made based on the knowledge about the

customer

2. the customer judges the product or service and how well it does or does not meethis / her needs

3. based on this information, the product or service is improved (Sullivan & Decker,

2001; McLaughlin & Houston, 2003)


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LESSON 2 EVIDENCE BASED PRACTICE

Evidence based practice (EBP) is the conscientious, explicit and judicious use ofcurrent best evidence in making decisions about the care of individual patients. It uses outcomes

research and other current research findings to guide the development of appropriate strategies to

deliver quality, cost-effective care. Outcomes research can also identify potentially effectivestrategies that can be implemented to improve the quality and value of care, (Kelly, 2008). EBP is a

total process that begins with knowing what clinical questions to ask, how to find the best practice,

and how to critically appraise the evidence for validity and applicability to the particular care

situation. The best evidence is then applied by a clinician with expertise based on the patientsunique values and needs.

Ingersoll has defined evidence-based nursing practice (EBNP) as the conscientious,explicit, and judicious use of theory derived, research-based information in making decisions about

nursing care delivery to individuals or groups of individuals and in consideration of individual needsand preferences (Tomey, 2000). Evidence-based practice has a medical focus, whereas evidence-based nursing practice considers the individuals needs and preferences based on nursing theory and

research.

The role of the nurse is to participate in developing a comprehensive, interdisciplinaryevidence-based plan of care in conjunction with the patient and members of the health care team.

Why is evidence-based care important?

1. patients, health care providers, and payers recognize the significance of collecting dataand analyzing outcomes to achieve optimum care.

2. outcome strategies developed in evidence-based practice are based on science, not

tradition, and used to create clinical protocols, guidelines, pathways, and algorithms,

which are the key tools for health care interventions3. evidence-based practice is most successful when the entire organization is invested in

the process and participates in and supports it

4. evidence-based practice has become the key to identifying and developing betterstrategies to monitor and improve quality of care.


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LEARNING ACTIVITIES

Read the following:

1. Accreditation Manual;2. The employee/Faculty/Student manuals;

3. Administrative and Policy Manuals and study the institutions general policies,

rules and procedure relating to personnel, resources, programs/standards and criteria fordesired levels of performance.

4. Observe/interview a nurse administrator and staff to determine the following:

a) How employees /students performance are monitoredb) Performance appraisal/grading techniques used: Examine and study the different

methods used, such as anecdotal notes, rating scales, peer evaluation and interview.

Study the grading system of the school.c) How the manager/dean deal with problem employees, including substance abuser,

those who are habitually .late or absent, those whose performance are below par,those who are quarrelsome. In the same manner, how does the school administratordeal with problem students?

d) Disciplinary measures used: Do employees/students have the right to appeal?

e) Measures resorted to before suspending and/or terminating an employee/student

f) How the use of resources are monitoredg) Cost saving measures: How is the budget used as a control measure?

2. Study the Quality/Assurance/Improvement Program of the institution. How was itdeveloped?

3. Study the institutions Planned Evaluation Program, if there is any. What is the institutions

status in terms of being accredited?

Other Suggested Activities Specific for Nursing Education:

Interview faculty members and ask them about their views regarding education, nursing, and

the schools responsibility to the student.

Analyze minutes of meetings of the standing committees and faculty organizations if

important issues are being addressed properly;

Examine school organizational charts for relationships.

Confer with members of the Evaluation Committee to determine their evaluation system.

Review the Committees annual report. Speak to one or two faculty members to determine their professional and educational needs.

Speak to faculty members to determine how they evaluate current forms and process used in

evaluating them.

Read the student manual and interview students if necessary to determine how policies are

implemented.

Examine the counseling program, health program, and financial assistance program.

Interview the dean and faculty members and ask about students performance in the Board

Examination and in the job market.


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Student curriculum. Compare the curriculum objectives to the philosophy and goals of the

school. Analyze course content in relation to the course objectives:

Attend a class/clinical laboratory. Note adequacy of facilities and resources.

Study the faculty and student evaluation tools.

Visit the school library. Note adequacy of current materials.

Visit the administrative office to determine the recording system as to:

a) faculty records, b) student records c) graduate records.


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MODULE FIVE

COLLECTIVE BARGAINING

SPECIFIC OBJECTIVES

At the end of the session the student should be able to:

1. relate the process of managing in a union environment.

2. analyze the pros and cons of collective bargaining in the workplace.


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LESSON 1 COLLECTIVE ACTION

Historically, nurses have often been perceived as hard-working, submissive staff who do

what they are told. The scope of nursing has changed so drastically that today nurses cannot affordto have a submissive image and do what they are told. Nurses are educated to advocate for their

patients and themselves. Clinical situations arise in which nurses must voice their opinions and

stand up for what is best for patients.

One of the main purposes of collective action for nurses is to advance the profession of

nursing. Two types of collective action are; 1) workplace advocacy; and 2) collective bargaining.

Workplace advocacy refers to activities nurses undertake to address problems in their

everyday workplace setting. This is the most common in nursing. An activity that falls under

workplace advocacy is forming a committee to address problems, devising alternative to achieveoptimal care, and conducting new inventory ways to implement change. An example of an issue that

would be addressed by this is patient advocacy. Patients rely on nurses to do this.

In collective bargaining the group is bargaining with management for what the group desire.

If the group cannot achieve its desires through informal collective bargaining with management, the

group may decide to use a collective bargaining agent to form a union.

Factors Influencing Nurses to Unionize

In general, nurses who are content in their workplace do not unionize. It is when nurses feel

powerless that they initiate attempts to unionize. Other motivation to unionize include job stress,

physical demands, need to communicate concerns and complaints to management without fear oflosing their jobs. Issues that are commonly the subject of collective bargaining include poor wages,

unsafe staffing, health and safety issues, mandatory overtime, poor quality of care and job security.

Many nurses are morally opposed to unions because they believe if they are members of aunion, they may be forced to strike. In reality, a collective agent cannot make the decision to strike.

The decision to strike is made only if the majority of union members decide to do so. Most nursing

collective bargaining agents insert in the contract a no strike clause, stating that striking is not anoption for its members.

Whistle blowing is the act in which an individual discloses information regarding a

violation of a law, or regulation, or a substantial and specific danger to public health or safety. As apatient advocate, nurses have an ethical and moral duty to protect their patients.


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LEARNING ACTIVITIES

1. You are the nurse in a medical unit. The nurse manager explains to you that the unit uses

workplace advocacy. How will it affect your functioning as the nurse in the medical unit?

Explain the workplace advocacy in the place where you are working, e.g. hospital,community health center, college of nursing.

2. You are hired in a hospital that is a union shop. How does unionization differ from aworkplace advocacy? Give 3 examples of how unionization differs from workplace

advocacy.


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LESSON 1 GLOBAL AND COUNTRY HEALTH IMPERATIVES

HEALTH GLOBAL AND COUNTRY IMPERATIVES

Public health systems are operating within a context of ongoing changes, which exert a number of

pressures on the public health system.

These changes include:

1. Shifts in demographic and epidemiological trends in diseases, including the emergence andre-emergence of new diseases and in the prevalence of risk and protective factors:

2. New technologies for health care, communication and information;3. Existing and emerging environmental hazards some associated with globalization;4. Health reforms.

In response to above trends, the global community, represented by the United Nations GeneralAssembly, decided to adopt a common vision of poverty reduction and sustainable development in

September 2000. This vision is exemplified by the Millennium Development Goals (MDGs) which

are based on the fundamental values of freedom, equality, solidarity, tolerance, health, respect fornature, and shared responsibility. The eight Millenium Development Goals are as follows:

1. Eradicate extreme poverty and hunger2. Achieve universal primary education

3. Promote gender equality and empower women

4. Reduce child mortality

5. Improve maternal health6. Combat HIV/AIDS, malaria and other diseases

7. Ensure environmental sustainability

8. Develop a global partnership for development

Except for goals 2 and 3, all the MDGs are health or health-related. Health is essential to the

achievement of these goals and is a major contributor to the overarching goal of poverty reduction.

In order to achieve these goals, the participation of all members of the society from both developing

and developed countries is required. Achievement of these goals by 2015 is now a priority of theglobal community and dictates the priority public health programs that should be implemented.

At the country level, the Philippines has experienced considerable improvements in its health status

for the past 50 years, yet it has also in recent year experienced decline as shown in its poorperformance in reducing infant and maternal mortality rates. The Philippines is also experiencing an

epidemiologic shift, which means that while it is still contending with the burden of communicable


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diseases, it is also at same time contending with the devastation brought about by non-communicable, chronic lifestyle-related diseases. Currently, the country is being threatened with the

devastating of a triple whammy which will be brought about not only by this epidemiologic shift

but also by the emergence of plague-like infectious diseases such as Severe Acure RespiratorySyndrome (SARS) and Avian Flu. With this scenario, the need to strengthen the capability of the

public health infrastructure including the public health nurse to adequately respond is imperative.

Currently there are various country initiatives to implement a more cost-effective health care

services. The Health Sector Reform Agenda (HSRA) implemented through FOURmula ONE and

operationalized in the National Objectives for Health 2005 to 2010 spells out the programimperatives of the health sector. All these are in line with Millenium Development Goals and the

Medium-Term Development Plan of the country.


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LESSON 2 DEPARTMENT OF HEALTH (DOH)

Vision

The DOH is the leader, staunch advocate and model in promoting Health for All in the Philippines.

Mission

Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor and shall

lead the quest for excellence in health.The DOH shall do this by seeking all ways to establish performance standards for health human

resources; health facilities and institutions; health products and health services that will produce the

best health systems for the country. This, in pursuit of its constitutional mandate to safeguard andpromote health for all Filipinos regardless of creed, status or gender with special consideration for

the poor and the vulnerable who will require more assistance.

Goal: Health Sector Reform Agenda (HSRA)

Health Sector reform is the overriding goal of the DOH. Support mechanisms will be through soundorganizational development, strong policies, systems and procedures, capable human resources and

adequate financial resources.

Rationale for Health Sector Reform

Although there has been a significant improvement in the health status of Filipinos for the

last 50 years, the following conditions are still seen among the population:

Slowing down in the reduction in the Infant Mortality Rate (IMR) and the Maternal MortalityRate (MMR).

Persistence of large variations in health status across population groups and geographic areas.

High burden from infectious diseases.

Rising burden from chronic and degenerative diseases.

Unattended emerging health risks from environmental and work related factors.

Burden of disease is heaviest on the poor.

The reasons why the above conditions are still seen among the population can be explained by the

following factors:

Inappropriate health delivery system as shown by an inefficient and poorly targeted hospital

system, ineffective mechanism for providing public health programs on top of health human

resources maldistribution.


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Inadequate regulatory mechanisms for health services resulting to poor quality of health care,

high cost of privately provided health services, high cost of drugs and presence of low quality

of drugs in the market.

Poor health care financing and inefficient sourcing or generation of funds for healthcare.The following are the implications of the above situation:

There is poor coverage of public health and primary care services. There is inequitable access (physical and financial) to personal health care services.

There is low quality and high cost of both public and personal health care.

In order to address the problem in the way the Philippines health care system delivers and pays for

health services, interrelated reforms in five areas have been identified as critical in transforming the

health system into one that ensures the delivery of cost effective services, universal access toessential services and adequate and efficient financing.

Areas that needed to be reformed are on health financing, health regulation, local health systems,

public health programs and hospital systems.

Framework for Implementation of HSRA: FOURmula ONE for Health

This is adopted as the implementation framework for health sector reforms under the currentadministration. It intends to implement critical interventions as a single package backed by effective

management infrastructure and financing arrangement following a sectorwide approach.

Goals of FOURmula ONE for Health

1. Better health outcomes

2. More responsive health systems

3. Equitable health care financing

The four elements of the strategy are:

1. Health financing the goal of this health reform area is to foster greater, better and sustainedinvestments in health. The Philippine Health Insurance Corporation, through the National

Health Insurance Program and the Department of Health through sectorwide policy support

will lead this component jointly.2. Health regulation the goal is to ensure the quality and affordability of health goods and

services.

3. Health service delivery the goal is to improve and ensure the accessibility and availability

of basic and essential health care in both public and private facilities and services.4. Good governance the goal is to enhance health system performance at the national and

local levels.

A key feature of the FOURmula ONE for Health implementation strategy is the engagement of the

National Health Insurance Program (NHIP) as the main lever to effect desired changes and outcomesin each of the four implementation components. The NHIP supports each of the elements in terms

of:


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financing, as it reduces the financial burden placed on Filipinos by health care costs;

governance, as it is a prudent purchaser of health care thereby influencing the health care

market and related institutions;

regulation, as the NHIPs role in accreditation and payments based on quality acts as a driver

for improved performance in the health sector; and,

service delivery, as the NHIP demands fair compensation for the costs of care directed atproviding essential goods and services in health.

Roadmap for All Stakeholders in Health:

National Objectives for Health 2005 to 2010

The NOH 2005-2010 provides the road map for stakeholders in health and health-related sectors tointensity and harmonize their efforts to attain its time-honored vision of health for all Filipinos and

continue its avowed mission to ensure accessibility and quality of health care to improve the quality

of life of all Filipinos, especially the poor.

The NOH sets the targets and the critical indicators, current strategies based on field experiences,

and laying down new avenues for improved interventions. It provides concrete handle that wouldguide policy makers, program managers, local government executives, development partners, civil

society and the communities in making crucial decisions for health.

Building on the initiatives under Health Sector Reform Agenda and as set forth in the NOH

1999-2004, an implementation is defined through FOURmula ONE for health whichstrategically focuses on interventions that create the most impact and generates buy-in from

all partners. FOURmula ONE for Health is an overarching philosophy to achieve the end

goals of better health outcomes, a responsive health system and equitable health care

financing. It is directed towards ensuring accessible, affordable quality health.

Building on the initiatives under Health Sector Reform Agenda and as set forth in the NOH 1999-2004, as implementation is defined through FOURmula ONE for Health which strategically focuseson interventions that create the most impact and generates buy-in from all partners. FOURmula

ONE for Health is an overarching philosophy to achieve the end goals of better health outcomes, a

responsive health system and equitable health care financing. It is directed towards ensuringaccessible, affordable quality health care especially for the more disadvantaged and vulnerable

sectors of the population.


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LESSON 3 PRIMARY HEALTH CARE (PHC)

WHO defines PHC as essential health care made universally accessible to individuals andfamilies in the community by means acceptable to them through their full participation and at a cost

that the community and country can afford at every stage of development.

Primary Health Care was declared during the First International Conference on PrimaryHealth Care held in Alma Ata, USSR on September 6-12, 1978 by WHO. The goal was Health for

All by the year 2000. This was adopted in the Philippines through Letter of Instruction 949 signed

by President Marcos on October 19, 1979 and has an underlying theme of Health in the Hands ofthe People by 2020.

The concept of PHC is characterized by partnership and empowerment of the people thatshall permeate as the core strategy in the effective provision of essential health services that are

community based, accessible, acceptable and sustainable at a cost which the community and the

government can afford.

It is a strategy, which focuses responsibility for health on the individual, his family and the

community. It includes the full participation and active involvement of the community towards the

development of self-reliant people, capable of achieving an acceptable level of health and wellbeing. It also recognizes the interrelationship between health and the overall political, socio-cultural

and economic development of society.

Although the goal of PHC of Health for All in the Year 2000 may have already been

challenged as unrealizable in the given time frame, the concept and processes has already taken root

all over the world and has shown progress in the lives of peoples in communities it has empowered.

The recent PHC Summit held on February 23-24, 2006 has showcased the various

mang 519-modules revised 2009

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