Group IV

 Controling or evaluatiing is an on-going function

of management which occurs during
planning,organizing and directive activities.
 Is the use of formal authority to assure
achievement of goals and objectives
 Action is taken to correct discrepancies between
this standards and actual performance
1. Evaluation ensures that quality nursing care provided.
2. It allows for the setting of sensible objectives and with
men
3. It provides standars for establishng comparisons.
4. It promotes visbility and a means for the employes to
mnitor thier own perpormance.
5. It highlight problems related to quality care and
determines the areas that require priority attention.
6. It provides an indicaion of the costs of poor quality.
7. It justifies the use of resources.
8. It provides feedback for improvement.
1. Must be based on the behavioral standars of
performance which the position requires.
2. There should be enough time to observe employees
behavior.
3. The employee should be given a copy of the job
description, performance standars and evaluation.
4. The employees performance appraisal should
include both satisfactory and unsatisfactory results
with specific behavior instnces to exemplify there
evaluative comment.
5. Areas needing improment must be prioritized to
help the worker upgrade his/her performance.
6. Should be scheduled and conducted at a
covineint time for the rater and the employee
under evatustion in sush a way that it is
perceiveding and with ample time for
discussion.
7. Should be structured in sush a way that it is
perceived and accepted positively as a mean
of improving job performance.
 Standards are desirable sets of condition and
performance necessary to ensure the quality of
nursing care services which are acceptable to
those instrumental to or responsible for setting
and maintaining them.

THREE TYPES OF PERFORMANCE STANDARDS:

A. STANDARDS ON STRUCTURE
 are those that focus on the structure or
management system used by the agency to deliver
care.
B. PROCESS STANDARDS
 Refers to the decision and actions of the nurse
relative to the nursing process which are
necessary to provide good nursing care.
C. OUTCOME STANDARDS
 are design to measure the results of care provided
in terms of changes of health status of clients
served, changes in the level of their knowledge,
skills and attitudes and satisfaction of those
served including the members of the nursing and
health team.
 Measurable criteria or objectives specific to
giving nursing care must be developed to
evaluate process and outcome. The
establishment of objectives provides clear
direction and communication of expected levels
of achievement. The greater the participation of
the employee, the greater the motivation to
achieve. Objectives should be challenging but
attainable. The most commonly used methods
for measuring nursing care are task analysis
and quality control.
 In task analysis task and procedures such
are written guides, schedules, rules, records,
budgets are expected.

Quality control refers to the activities and

techniques employed to achieved and maintain
the quality of a product, service or process, the
level of nursing care provided and its effect to
the client are assessed
A measurement of performance is an on-going, repetitive
process with the actual frequency dependent on the type
of activity being measured. For example, nursing care to
patients is continuously monitored, whereas, a formal
performance appraisal maybe done only twice a year.
Measurements maybe scheduled in advance, maybe done
at periodic but unannounced intervals or may occur at
random. The purpose of measurement should be clarified
and the staff should be informed about the tasks and
levels of care that need attention.
Positive feedback stimulates motivation,
consistently high performance and growth of
the employee. Corrective actions are applied to
improve performance.
Comparing the results of performance with
standards and objectives is one of the
easiest steps in the control process. If
performance matches standards and
objectives, managers are assured that the
needs of patients are met. However, if
performance is contrary to standards and
objectives set, then necessary action should
be taken.
 Being at the first level of supervision, the Head / Senior Nurses are in the
best position to know whether their staff nurses perform satisfactorily at
work. Their influence has an impact on promoting quality care to patients.
 They have the responsibility to instruct subordinates regarding the
appropriate methods and procedures in providing nursing care.
 They should inform the staff of the likely causes of errors or defects and
preventive measure necessary.
 They should initiate and / or facilitate any steps necessary to improve
methods, equipments, materials and conditions in the work area for which
they are responsible.
 The feeling of responsibility to render quality performance must be
instilled in all employees for them to follow agreed upon written
procedures and use materials and equipment correctly as instructed
 -It is a control process in which a
employee’s performance is evaluated
against standards. It is the most valuable
tool in controlling human resources and
productivity.
Purpose of Performance Appraisal
 Determine salary standards and merit increases.
 Select qualified individuals for promotion or transfer.
 Identify unsatisfactory employees for demotion or
termination.
 Make inventories of talents within the institution.
 Determine training and developmental needs of
employees.
 Improve the performance of work groups by
examining, improving, correcting interrelationships
between members.
Improve communication between
supervisors and employees and reach an
understanding on the objectives of the job.
Establish standards of supervisory
performance.
Discover the aspirations of the employees
and reconcile these with the goals of the
institution.
Provide “employee recognition” for
accomplishments.
Inform employees “where they stand”.
 Appraisal System
Compatibility between the criteria for
individual evaluation and organization
goals.
Direct application of rated performance to
performance standards and objectives
expected of the worker.
Development of behavioral expectations
which have been mutually agreed upon by
both the rater and the worker.
 Understanding the process and effective
utilization of procedure by the rater.
 Rating of each individual by the immediate
supervisor.
 Concentration on the strengths and
weaknesses to improve individual
performance.
 Encouragement of feedback from the rated
employees about their performance needs
and interests.
 Provision for initiating preventive and
corrective actions and making adjustments to
improve performance.
Informal
may consist of incidental observation of
performance while the worker is engaged
in performing nursing care or by
responses made by worker during
conferences
 interaction of woker with clients, their
families , visitors and co-workers should
also be noted.
 Formal
is accomplished regularly and
methodically by colleing objective facts
that can demostrate the difference
between what is expected and what was
done.
 this mwthods include essay, checklist,
ranking, rating scale, forced-choice
comparison, and anecdotal records.
 Essay
The appraiser writes a paragraph or more about the
worker’s strengths, weakness and potentials. In
most situations, particularly in managerial positions,
essays appraisals carry significant weight on the
presumption that an honest statement from
someone who knows the person well is valid.

 Checklists
A checklist is a compilation of all nursing
performances expected of a worker. The appraiser’s
task is to mark the appropriate column whether the
worker does or does not show the desired behavior.
Ranking
In simple ranking, the evaluator ranks the
employees according to how he or she fared
with co-worker with respect to certain aspects
of performance or qualifications.

Rating Scales
A rating scale includes a series of item
representing the different task or activities in
the nurse’s job description or the absence or
presence of desired behaviors and the extent
to which these are possessed.
 Forced-choice Comparison
In this method, the evaluator is asked to choose the statement
that best describes the nurse being evaluated. The items are so
grouped that evaluator is force to choose from favorable as well
as unfavorable statements and to counter the tendency
towards leniency by some evaluator.
 Anecdotal Recording
It describes the nurse’s experience with a group or a person, or
in validating technical skill and interpersonal relationship.
The anecdotal records should include
1. A description of the particular occasion
2. A delineation of the behavior noted including answers to the
question who, what, when, and how
3. The evaluator’s opinion or assessment of the incident or
behavior
 Assurance
-means achieving a sense of
accomplishment and implies a guarantee of
excellence.
 Quality
-is the degree of excellence
-common language for improvement
-enables different people to communicate
with each other in pursuit of common goal.
Quality of Care
-degree to which health services for individuals and
population increase the likelihood of desired health
outcomes and are consistent with the current
professional knowledge.
-exist to the degree that service is efficient, well-
executed, effective and appropriate.*Workers must
accept the responsibility that they have to do the right
thing/job the first time and every time.
Quality Assurance
-is a process of evaluation that is applied to the health
care system and the provision of health care services
by health workers.
Quality Improvement Program
-is the umbrella program that extends the
many areas for the purpose of accountability
to the consumer and payor.
- continuous, on-going measurement and
evaluation process that includes structure,
process, and outcome.
Sentinel event indicators
-Measures a low volume but serious
undesirable and often avoidable process or
outcome such as falls and medication errors.
Benchmarking
-is a tool to assists in quality of care
decision making.
-It is a continuous process of measuring
what exists against the best in search for
industry best practices.
Best Practice
-is a service, function or process that has
been fine tuned, improved and implemented to
produce superior outcomes.
-lead in establishing benchmarks
Total Quality Management
-Is way to ensure customer satisfaction by involving
all employees in the improvement of the quality of
every product or service.
- all systems are evaluated and improved.
-It aims to reduce waste and cost of poor quality
-It is a structured system for involving an entire
organization in a continuous quality improvement
process targeted to meet and exceed customer
expectations.
Continuous Quality Improvement
-is a process of continuously improving a system by
gathering data or performance and using multi-
disciplinary tem to analyze the system, collect
measurements , and propose changes.
FOUR MAIN PRINCIPLES
 Customer focus
 Identification of key processes to improve quality
 The use of quality tools and statistics
 Involvement of all people in problem solving
PRINCIPLES UNDERLYING QUALITY
ASSURANCE EFFORTS
1. All health professionals should collaborate in the
effort to measure and improve care.
2. Coordination is essential in planning a
comprehensive quality assurance program
3. Resource expenditure for quality assurance
activities is appropriate.
4. There should be focus on critical factors such
as functions and activities that promise to
yield the greatest health and financial
benefit to reveal significant findings.
5. Quality patient care is accurately evaluated
through adequate documentation.
6. The ability to achieve nursing objectives
depends upon the optimal functioning of the
entire nursing process and its effective
monitoring.
7. Feedback to practitioners is essentials to
improve practice. It perpetuates good
performance and replaces unsatisfactory
interventions with more effective methods.
8. Peer pressure provides the impetus to
effect prescribed changes based on the
results of assessments and needed
improvements on the quality of care
9. Reorganizations in the formal
organizational structure may be
required if assessment reveal the need
for a different patternof health care.
10. Collection and analysis of data should
be utilized to motivate remedial action.
Quality Assurance and Performance Evaluation
Performance Evaluation
-focuses on the worker. It asks questions about how well the
worker satisfies the requirements of his or her job within the
organization.
Quality Assurance
-focuses on the care and service the patient receives than
on how well the professional performs the duties the duties
that the position requires.
Quality Assurance Methods
-purpose is to measure and improve the quality
of nursing delivered in the agency.
Several methods:
 Concurrent and retrospective patient care audits
 Patient care profile analysis
 Peer review
 Quality circles
Developing Quality Assurance Criteria
Structure, process and outcome or any
combination of these, are common approaches to
evaluation.
 Structure Approach – includes physical
setting, instrumentalities and conditions
through which nursing care is given such as the
philosophy and objectives, the building,
organizational structure, financial resources,
and equipment.
 Process Approach- includes the steps in the
nursing process in compliance with established
standards of nursing practice.
 Outcome Approach- identifies desirable
changes in the patient’s health status such as
modification of symptoms, signs, knowledge,
attitudes, satisfaction, skill level, and
compliance with the treatment regimen.
 A nursing audit is composed of a
representative from all levels of the
nursing staff:
 A member of the training staff
 Supervising Nurse
 Head/Senior Nurse
 Staff Nurse
Patient Care Audits
Patient care audits may be
concurrent or retrospective.
 Concurrent Audit
1. Is one in which patient care is observed and
evaluated. It is given through:
2. A review of the patient’s charts while the
patients are still confined in the hospital.
3. Observation of the staff as patient care is
given.
4. Inspection of patients and/or observation of
the affects of patient care where the focus is
on the patient.
 Retrospective Audit
-Is one which patient care is evaluated
through
 A review of discharged patient’s charts;
 Questionnaires sent to or interviews conducted on
discharged patients.
Peer Review
-Patient care audits may be done by peers
(employees of the sane profession, rank, and
setting) evaluating another’s job performance
against accepted standards.
Quality Circles
-One of the most publicized approaches to quality
control introduced by the Japanese.
-A group of workers doing similar work who meet
regularly, voluntarily, on normal working time,
under the leadership of their supervisor, to
identify, analyze and solve work related problems
and to recommend solutions to management.
Utilization of Results
-The Nursing Staff in the unit is given a feedback on
the results of the quality assurance study.
-Positive Feedback reinforces desirable performance.
Consistent positive findings deserve a commendation
from the nursing service.
-Negative Feedbacks should tactfully be conveyed in
a face-to-face situation so that assessment results
may easily be clarified.
Control of Resources
-Part of the control process is the periodic
review of the utilization of materials and
supplies in the various nursing units.
-Requisitions of and/ or stocking a large
number of supplies and materials should be
avoided to prevent pilferage, misuse, or
spoilage.
Discipline meant rigid obedience to rules and
regulations, the violation of which resulted in
punitive actions in the past. Today, discipline
is regarded as constructive and effective
means employees take personal responsibility
for their own performance and behavior.
Factors that influence self
discipline

1.A strong commitment to the vision, philosophy,

goals and objectives of the institution

2.Laws that govern the practice of all

professionals and their respective codes of
conduct.

3.Understanding the rules and regulation of the

agency.

4.An atmosphere of mutual trust and confidence

 Disciplinary Approaches
This should include a set of disciplinary policies and
procedures, a uniform application of discipline rules, a
disciplinary committee, and an orientation program
for all new employees were expectations of
appropriate performance and behavior are
emphasized. There must be continuous
communication to all employees regarding changes in
personnel and discipline policies.

 Problem Solving
An effective supervision aids supervisor is analyzing
the work problems of their subordinates.
 Disciplinary Action
Any employee charged for breach of the rules and
regulations, policies, norms of conduct shall be
given due process.
 Counseling and Oral warning
-The employee is given a fair chance to air
his/her side

 Suspension
-Suspension over minor violation is given
after an evidence of oral and written
warnings. Suspension is applied when
management feels that the employee can still
be rehabilitated.
 Dismissal
-Dismissal is invoked only when all the other
disciplinary efforts have failed.

 Written warning
-The employee must be told after the interview
that he will be given a written warning this
include the statement of the problem,
identification of the rule which was violated,
consequences of continued deviant behavior,
the employee’s commitment to take correction
action, and any follow-up action to be taken.