Seminar

on
Application of Modern
techniques in nursing service

By
Karthikeyaprasath.P
M.Sc IInd year
 INTRODUCTION
• Management , which basically is concerned
with administration. pervades all spheres of
life and activity.
• Likewise , nursing too is a field where
management plays a pivotal role in
accomplishing organizational goals
Contd…

• Management techniques are systematic

procedures of investigating, planning,
controlling and supervising which can be
applied to the problems, management
techniques are two types,
• Based on the principle of behavioral sciences.
• Quantitative methods
 METHODS BASED ON
BEHAVOURIAL SCIENCES
• Organizational design
• Personnel management
• Communication
• Information system
• Management by objectives (MBO)
 Organizational design
• poor organization results in waste of
resources.
• Its is a theory of management that organization
must be suited to its current situation and the
needs to be serviced. The organization of the
health needs and demands of the people.
• Further the organizational design should be
reviewed every few years because of changing
concepts of purpose, Changing problems and
changing technology.
 Personnel management
• This is skill use of human resources. Proper
methods of selection, training and motivation,
division of responsibility, distribution of roles.
• incentives for better work, opportunities for
promotion and professional advancement are all
fundamental techniques of personnel
management which would contribute the
efficiency of health service delivery
 Communication
• Better communication contributes to
effective functioning of an organization.
• Communication barriers are responsible
for delays in regular reporting and
notification, delays in the compilation of
static’s, delays in the institution of prompt
remedial measures, and release of
supplies and salaries
 Information system
• Information is needed for the day to day
management of health system.
• The function of an information system consists
of collection, classification, transmission,
storage, retrieval, transformation and display of
information.
• A good information system provides data for
monitoring and evaluation of health programmes
and gives the requisite feedback to health
administration and planners at all levels
 Management by objectives
(MBO)
• It is a participants approach for developing and
sharing performance expectations among staff
members at all the levels of.
• The concept was developed by Drucker and also
advanced by Odiorne and humble.
• MBO is defined by odiorne as a process,
whereby superiors and their followers jointly
identify and set goals, define individual areas of
responsibility, plan strategies and designate
tasks for achieving goals and measure the
evaluates success.
Contd…

• The MBO approach, when effectively

implemented enables expectation between
followers and superiors to be public.
• Potential conflict is hereby reduced because of
negotiation between involved parties and then a
contract is set, mutual commitment is therefore
gained.
• MBO can provide a framework for achieving
organizational goals and employee satisfaction
 The process of MBO
• Setting of organizational purposes
and objectives
• Key result areas
• Setting subordinates objectives
• Matching resources with the
objectives
• Appraisal
• Recycling
 Setting of organizational
purposes and objectives
• the first basic step in MBO is the
definition of organizational purposes and
objectives.
• Questions such as “why does the
organization exist?” what business are
we in?” and “what should be our
business?” provides guidelines for the
statement of purpose.
 Key result areas
• organizational objectives and planning
premises provide the basis for the
identification of key result areas(KRAs).
• KRAs are derived from the expectations of
various stake holders and indicate the
priorities for organizational performance.
• KRAs also indicate the present state of an
organization’s health and the top
management prospective in future
Setting subordinates objectives
• The organizational objectives are achieved
through individuals. Therefore, each
individual manager must know in advance
what is expected to achieve.
• Every manager in the managerial hierarchy
is both superior and subordinate, except the
person at the top level and lowest level.
Therefore there is a series of superior and
subordinate relationships.
Contd…

• The process of objectives setting brings with

superior’s proposed recommendations for his
subordinate’s objectives.
• In turn, the subordinate states his own
objective as perceived by him.
• Thereafter a final objective for the subordinate
is set by the mutual negotiation between
superior and subordinate.
 Matching resources with the
objectives
• When objectives are set carefully, they
also indicate the resource requirement.
• Resource availability is an important
aspect of objective setting as it is the
proper application of resources, which
ensures objective achievement.
• Therefore there should be matching
between objectives.
Contd…

• A superior manager is better able to

see the need and economy of
allocating resources.
• The allocation and movement of
resources should be done in
consultation with the subordinate
manager
 Appraisal
• Appraisal aspect of MBO tries to measure
whether the subordinate is achieving his
objectives or not.
• If not what are the problems can be
overcome,
• Appraisal is undertaken as an ongoing
process with a view to find out deficiency
in the working and also to remove it
promptly
 Recycling
• Though appraisal is the last aspect of
MBO process.
• It is used as an input for recycling
objectives and other actions.
• The three objectives involved in recycling
process include setting of objectives at
various levels, action planning, which in
turn, gives basis for objectives and action
planning.
• This process goes on a continuous basis
 Benefits of MBO
• Better managing

• Clarity in organizational action

• Personal satisfaction

• Basis for organizational changes

 Better managing

• MBO helps in better managing the

organizational resources and activities.
• Resources and activities are put in such a
way that they result in better performance.
 Clarity in organizational action

• MBO tends to provide the KRAs where

organizational efforts are needed.
• Since organizational objectives are
defined clearly, they help in relating the
organization with the environment
 Personal satisfaction

• MBO provides greatest opportunity for

personal satisfaction.
• This is possible because of two closely
related phenomena participating in
objective setting and rational performance
appraisal
Basis for organizational changes

• MBO simulates organizational change and

provides a framework and guidelines for
planned charge, enabling the top
management to initiate, plan direct and
control the direction and speed of change
Problems and limitations of MBO
• Time and cost
• Failure to teach MBO philosophy
• Problems in objective setting
• Inflexibility
• Emphasis on short term objectives
• Frustration
 QUANTITATIVE METHODS

• Quantitative methods are derived from the

field of economies. Operation, research
and budgeting. Some of these techniques
have a great role in a management of
health services, those are
Contd…

• Cost benefit analysis

• Cost effective analysis
• ABC analysis
• Cost counting
• Input- output analysis
• Systems analysis
• Net work analysis
 Cost benefit analysis
• This is a management technique , which
has attracted the widest attention for
application in health field.
• The economic benefits are expressed in
monitory terms to determine whether a
given programme is economically sound
and to select the best out of several
alternative programmes
Contd…

A cost benefit ratio (Z) is defined as the ratio of

the value of benefits of an alternative to the
value if alternative cost.

PRESENT VALUE OF ECONOMIC BENEFITS

Z=---------------------------------------------------------------
PRESENT VALUE OF ECONOMIC COSTS
Contd…

• The analysis consists of the following steps:

• A clear statement of objectives.
• Identifying all alternative actions that can
achieve the objectives.
• Identifying all costs and all benefits with each
alternative.
Contd…

• Converting all costs and all benefits for

each alternatives to monetary value and
quantitative evaluation of cost and benefits
of each
• Selection of the best –effective approach
Drawback of cost benefit analysis

• The main draw back with this technique is

that the benefits in the health field.
• As a result a particular programme cannot
always be expressed in monetary terms.
We generally express the benefits in terms
of births or death or illness avoided or over
come.
• Hence the scope of applying this method
is rather vague
 Cost effective analysis

• it is the technique for choosing. From

alternative courses of action, a preferred
choice when objectives are not very clear
in such areas as scales, costs or profiles.
• This is more promising tool for application
in the health field than the benefit.
Contd…

• For example number of life saved or

number of days free from disease.
• Cost effectiveness analysis is easier to
make as it clear. It helps the administrator
in managing his resources at the local
level.
 ABC analysis

• it is a technique which would enable a

busy executive to choose those activities
ardently which would enable the wheels of
administrative machinery.
• by arranging his work in to an order of
priorities he can decide on which item to
concentrate first, which others to deal later
and which others to delegate to his
assistants.
Contd…

ABC analysis sorts items on cost criteria.

• A -Item which are of high cost.
• B - Items which are intermediate cost.
• C - Items which are low cost.
Contd…
In so for inventory control is concerned,
following guide lines will help in keeping the
system optimum:
• A items
• tight control
• Rigid estimates
• Strict and close watch
• Management of items should be done at top
management level
 Contd…
• B items
– moderate control
– Reasonably strict watch and control.
– Safety stock moderate
– Management should be done at middle level.

• C items
– ordinary control measures
– Purchase based on used estimates
– Control exercise by store keeper
– Safety stock high
– Management should be done at lower level
 Cost counting
• it provides basic data on cost structure of
day programme.
• Financial records are kept in manager
permitting costs to be associated with the
purpose for which they incurred.
• The important purposes of cost
accounting in health services are cost
control and planning, and the allocation of
people and the financial resources.
 Input- output analysis
• input analysis is an economic technique in the
health field input refers to all health service
activities which consume resources {manpower,
materials and time}
• And output refers to such useful outcomes as
treated lives saved or inoculations performed.
• input –output table shows how much of each
input is needed to produce a unit amount of
each output
 Systems analysis
• The purpose of systems analysis is to keep the
decision maker to choose an appreciate course
of action by investigating his problems,
• searching out objectives , finding out alternative
solutions , evaluation of alternative terms of cost
effectiveness,
• re examination of objectives if necessary and
finding out the cost effectiveness of available
alternatives.
 Net work analysis
A network is a graphic plan of all events and
activities to be competed greater
discipline in planning. The two common
types of network techniques are:
– Programme evaluation review technique
(PERT)
– Critical path method (CPM)
 Programme evaluation review
technique (PERT)
• PERT is planning tool developed in the
1950s as a method used by the US Navy
to and control the Polar Missile program
me.
• PERT can be considered as a roadmap of
a particular project in which all major
events have been identified and
relationship among events clearly
indicated
 The main elements of PERT are
activities and events
• An activity is a factor ,which takes time to
complete and usually demands resources.An
event is a notional point in time at which one
set of activity gives way to another.
• The important point is that no activity
subsequent to an activity can begin, until all
activities before that event have been
completed
Contd…
• the longest pathway between events is the
critical path. It is used as a planning,
scheduling, organizing, coordinating and
controlling technique.
• A typical PERT analysis may run in to
hundreds of events
 Advantages

• Provides logical sequence activities.

• Clarifies where delays are permissible and
where not, essential deadlines become
evident.
• Clsrifies where additional resources are
required to complete the task on time.
Contd…

• depicts a larger number of independent

activities that makes up the total task.
• Every principal activity can be assigned to
a person whose attention is constantly
drawn to deadlines in particular areas
 Critical path method (CPM)
• CPM is the most versatile planning and
controlling technique used in business. It was
first employed in USA in 1958 by E.I. du Pont de
Nemous Company.
• Unlike PERT it is applied in those projects
where activity timings are relatively well known.
• It is used for planning and controlling the most
logical sequence of activities for accomplishing
the project
 Contd…
• Under CPM the project is analyzed in to different
operations or activities and their relationships are
determined and shown on the network diagram.
• The network or flow plan is then used for
optimizing the use of resources and time. CPM
marks critical activities in a project and
concentrates on them.
• It is based on the assumption that the expected
time is actually the time taken to complete the
project,CPM is suitable for construction of projects
and plant maintenance
 Contd…

• CPM requires greater planning than required

otherwise.
• Thus it increases the planning cost, but this
increase in cost is justified by concentrating on
critical paths and avoiding expenses on the strict
supervision and control of the whole project.
• Besides ascentaining time schedule CPM
provides standard method of communicating
project plans, schedule and costs
 Advantages
• It provides on analytical approach to the
achievement of project objectives which
are defined clearly.
• It identifies most critical demands and
pays more attention on these activities.
• It helps in ascertaining the time
schedules.
 Contd…

• It makes use of better and detailed

planning.
• It assists’ avoiding waste a time, energy
and money on unimportant activities.
• It provides a standard method for
communicating project plan, schedules
and costs.
 Steps in PERT/CPM
• Identification of components
The first step in the application of PERT/CPM is
identification of all key activities and phases
or events necessary for the completion of the
project.
For example, a construction company having a
project for the construction of a two-storied
commercial complex can identify the broad
activities from A to J
 Contd…

• Sequencing of activities and events

A network diagram is prepared to show the
sequence of activities and events. It has a
beginning point and a termination point of
the project.
It also depicts a number of path or activities
from beginning to completion of the
project. Each event is given a serial
number for the sake of convenience.
Contd…

• Determination of estimated time:

It is essential to determine the expected time

required to completer each activity.
 Contd…
• Determination of critical path:
– Under this stage, it is required to identify the
sequence of those activities whose
completion is critical for the timely
completion of the project.
– The lines in the network diagram connecting
the critical activities from start to finish of the
project denote the critical path. In the figure
the pick line joining the activities A,
B,C,D,H,I&J represent the critical path.
Contd…

• Modification in initial plan:

• The project analysis should not stop after
the critical path as been identified. The
potential exist for substantially improving
upon critical plan.
Contd…

• Controlling the project:

• The project manager as to be in constant
touch with the person engaged in critical
activities .if they have been any difficulties
or obstacles these are to be removed
Contd…

• Planning, programming, budjeting system

(PPBS):
• The PPBS is a system to help decision maker to
allocated resource so that the available resource
of an organization are used in the most effective
way in achieve in objectives. Another approach
is known as zero budgets i.e. all budget start of
zero and no one gets any budget that he cannot
specifically justify on year to year basics
 Contd…
• Job analysis:
– It is the process of gathering information on all
aspects’ of a specific job. It is a scientific study and
statement of all the facts about a job. Which reveal
its content and modify factor’s which surrounded it.
– One of the purposes of job analysis and
measurement is to set standards for a specific job.
There are no of methods measuring work & setting
standards as follows.
 Contd…
• Analyses of past production records:
• It is perhaps the strongest method of
measuring works and setting standard
production records on the activities of the
department can be maintained and analyzed.
• The manager can select the best past
performance and used as a standard on the
assumption that if it was done before workers
should be able to do it again.
Contd…

• The advantage of this is that it is easily

used and at a relatively low cost with no
need for highly person ale to administer
it.
• The disadvantage is of course that
existing in efficiency are not corrected
they are merely recorded an analyzed
contd…

• Time analysis method:

– Here various work activities done by an
individual during the day are identified and
placed on the form. Then worker records the
actual time spend and units produce.
 Contd…

• Work sampling method:

– It is specific of observation and recording of
activities of one or more individual carried
out at predetermined or random interval it
provides quantitative measurements of
various activities. The major parameters
that are analyzed are the time needed to do
specific jobs or the type of activities
performed.
Contd…

• Times study:
– It is a method of measuring job performance
to establish the time required for performing
for each operation at an average pace. The
purpose is to measure the output of a
worker of average skill who0 is performing is
work with average effort under standardized
condition so that standard time can be
determined.
Contd…
• Motion study:
– It goes beyond mere measurement. Its purpose is
to make work performance easier and more
productive by improving manual motion.
– During the end or 19th century Frank gilbreth made
a detailed motion study and consider it a scientific
method of eliminating wasted effort in work.
– He suggested that motions study Consists of
dividing the work in to the most fundamental
elements possible, studying these elements
separately and in relation to one another, and from
these studies building methods of least waste.
 Advantages of job analysis:
Job analysis helps the management in many
ways:
• It provides solid base upon which to
choose the right people and to plan the
right training for them.
• It reveals the inessentials, the irrelevant
practices,which often encounter the job in
actual performance.
• It shows where there is overlapping.
Contd…

• It provides the basic material for

procedure manual.
• It helps to promote good morale that
enables the administrator to deal
intelligently with complaints.
• It also keeps to administrator to establish
definite even for promotion.