307 Notes

L1
Reasons for learning management
1. Inc. complexity of healthcare (rapid advancement technology, service, change,
human resource management) e.g. telehealth
2. Inc. demand on quality care and professional care (knowledge, patient
management)

Factors that affects decision making

Values, preference, life experience, gender, thinking styles

Management is a process of leading and directing.

-planning, organizing, staffing, directing, controlling, decision making

Manager
-assigned position within a formal organization
-legitimate source of power
-specific functions, duties and responsibilities
-formal responsibility and accountability for rationality and control
-control, decision making, decision analysis and results
-manipulate decision (people, environment, money and time)

Leadership is a process of influencing and motivating people to act towards achieving

a common goal.
Leader
-May not be traditional positions of authority
-obtain power through other means like influence, not delegated authority
-focus on group process, information gathering, feedback, empowering others
-direct willing followers

10 leadership flaws
1. A lack of energy and enthusiasm
2. Acceptance of their own mediocre performance
3. Lack of a clear vision and direction
4. Having poor judgment
5. Not collaborating
6. Not walking the talk
7. Resisting new ideas
8. Not learning from mistakes
9. A lack of interpersonal skills
10. Failing to develop others

6 traits of an integrated leader-manager

1. Visionary and futuristic, think longer term
2. Toward larger organization
3. Influence other beyond their own group
4. Visions, values and motivation
5. Politically astute, coping conflicts requirements and expectations
6. Change and renewal

Development of management theory

1. Scientific management (1900 – 1930)
2. Bureaucratic organizations (1922)
3. Management functions (1925)
4. Human relations management (1930 – 1970)

Scientific management (Frederick Taylor)

Four principles
1. Time, motion studies, expertise of experienced workers
=scientifically designed with greatest efficiency of time and energy
2. Identify employee’s abilities and limitations
=best matched to the most appropriate job
3. Workers should self-fit with the organization and contribute to overall
productivity
4. Enhance cooperation and interdependence between managers and workers
Critiques: lacking humanism, dramatic increase in productivity and profits
Solutions: satisfy workers and managers with adequate financial rewards as a result of
increased productivity.

Bureaucratic organization (Max Weber)

1. Clear division of labor
2. System of rules covering the rights and duties of each position
3. System of regulations governing employment and promotion
= legalized, formal authority and consistent rules and regulations
= increase work efficiency
Critiques: oversimplified management and employee roles, ignore bilateral
relationships between employee and management, unnecessary delay

Management functions
-Five functions of management (Henri Fayol)
Planning, organizing 人机物法, commanding, coordinating, controlling

POSDCORB of Gulick
Planning, organizing, staffing, directing, coordinating, reporting, budgeting

Human relations management

-participatory and humanistic management e.g. participative decision making
- management paid special attention to workers, hence increase productivity
(Hawthorne effect)

-theory X and Y (employee satisfaction = managerial attitudes, influenced by

managers’ assumptions about human nature)
-managerial domination = discouraged and passive workers, cannot fulfill self-esteem
and independence needs
Critiques: time consuming, unmet organizational goals, not everyone likes less
structured (sheep)

Historical development of leadership theory

1. Great Man Theory (some people are born to lead, some born to be led)
/Trait Theory (some characteristics or personality traits are associated with leadership)
e.g. charisma, emotional balance, tact, ability

2. Behavioral Theories (STYLES OF LEADERSHIP)

-Authoritarian leaders
-strong control, motivated by coercion with commands, top down approach, I
and you
-(inc. sense of security, productivity, dec. creativity, motivation, autonomy
-Democratic leaders
-Less control, economic and ego awards, suggestions and guidance, we.
Approach
-(inc. cooperation, coordination, autonomy, dec. work efficiency)
-Laissez-faire leaders
-Little or no control or direction, motivated support (frustration, disinterest)
4. Situational and contingency leadership theories (social system of contingencies)
(dominant style matches situation)
5. Interactional leadership theories (leadership based on organizational environment
and culture, interactive relationship)
-nature of the task according to the ability, experience and motivation
-theory z (human motivations and well-being)
-productivity and worker satisfaction
– Reactive leader (crisis driven, abusive to subordinates)
– Responsive leader (mold subordinates to work together as a team)
– Proactive leader (participative decision making, more future oriented, hold common
values)
– High-performance teams (Maximum productivity, attained worker satisfaction)

6. transactional and transformational leadership

Transactional leaders
-focus on goal, day to day operation
-set goals
-give directions
-control people by rewards and punishment
Transformational leader
-identifies common values
-right thing for the right person
-charisma and enthusiasm for motivation
-uniqueness of their followers
-care, inspire, encourage, empower people

New leadership and management strategies

1. Servant leadership (serve to employee to achieve collaboration and employee
loyalty) (open minded, ability to deal with ambiguity, paradoxes and complex
issues, clear on goals, sharing critical challenges, think before react, foresight and
intuition, relationships and connection, professional judgement and fair treatment,
collaboration)
2. Principle agent theory (informational advantages and own preferences (conflict of
interests) (solutions: appropriate incentives to act for the best interest)
3. Human and social capital theory (group’s collective knowledge, skills and
abilities) (organization invest in education and professional development)
4. Emotional intelligence (one’s ability to perceive, control, and evaluate emotions)
(rational thinking mind, emotional feeling mind) (self-awareness, self-regulation,
 motivation, empathy, social skills)
5. Authentic leadership
(congruence of activities, actions and deeds and leader’s values, principles and
beliefs)
(balanced processing, internalized moral perspective, rational transparency, self-
awareness)
(purpose, values, heart, relationships, self-discipline)
6. Thought leadership (challenge the status quo and attract followers, problem
orientated, future orientated)
7. Quantum leadership (change is constant, flexible and mobile work environment)
8. Cultural bridging (ethnic diversity, generational diversity)

L2
s
SWOT analysis
Basic steps in management
Types of budgets

Planning is for best possible use of resources, meeting needs and objectives.
e.g strategic and operational planning, planned change, time management, fiscal
planning

Four planning modes

1. Reactive planning (occurs after problem exists)
2. Inactivism (remain status quo and conformity, prevent change)
3. Preactivism (future-orientated, no actual measure, bad at past and present)
4. Interactive an proactive planning (best, all are in consideration)

Strategic planning =long term planning+ countering external environment

SWOT analysis
Strengths:
◦ Internal attributes that help an organization to achieve its objectives
Weaknesses:
◦ Internal attributes that impede an organization in achieving its objectives
Opportunities:
◦ External conditions that promote achievement of organizational objectives
Threats:
◦ External conditions that challenge or threaten the achievement of
organizational objectives

strategic planning as a management process

purpose of the organization
realistic goals and objective
sense of ownership
develop strategies
build a consensus

Organizational planning: the planning hierarchy

Mission
Philosophy (value, vision and mission)
Goals (SMART)
Objectives (process, result focused)
Policies (plans or instruction, set boundaries for action taking and decision making)
Procedures (sequence of steps)
Rules (specific action or non-action)

How to overcome barriers to planning

1. Philosophy must be implemented
2. Setting a goal
3. Congruent strategies
4. Plan needs to be flexible and allow for readjustment
5. Specific, simple and realistic plan

Time management
1. Taking time to plan and establish priority (specific, measurable, accomplish,
realistic, time)
2. Priority setting and break procrastination
3. Reprioritizing

Fiscal planning
-a learned skill that improves with practice
-involves forecasting
-balancing costs and quality
Budget
-estimated expenses and income
Expenses
-fixed expenses
-variable expenses (hourly wages/ cost of supplies)

Set in the budgetary process

Assess-> plan->implementation->evaluation

Types of budgets
Personnel budget
Operating budget
Capital budget (long-term planning)

L3
Concept of planned stage
Phases of change
Responsibilities of a change
Driving and restraining forces for change
Rational-empirical, Normative-reeductive, power-coercive strategies
Manage resistance to change

Concept of Planned Change

Effort + change agent= planned change

Well thought-out, deliberate effort

+
Change agent = person skilled in the theory and implementation of a planned change
=> deliberate application of knowledge and skills by a leader to bring about a change

Inside vs outside change agent

e.g timing affected by stress, baloolance between stability and change, motivation,
extent of the interest
Requirement
Mindset transformation, vision and expert planning skills, reassess goals proactively,
visionary in identifying where change is needed
Kurt Lewin developmental of change theory
Unfreezing=> movement=>refreezing
Unfreezing (recognize the need for change, understand concerns)
Movement- change (plan the change, implementation)
Refreezing (stabilizing the system change into status quo) (at least 3-6 months)
(measure impact of change)

Lewin’s Driving and Restraining Forces

Driving force (facilitators)
Increase driving force by,
-opportunity for advancement
-social gratification for status
-enhance self-esteem
-family supportive of efforts
Restraining force (barriers)
-conformity to norms
D.F>R.F= CHANGE

3 Classic change strategies

1. Rational-empirical strategies
(giving current evidence to support the change)
Assumption:
-restraining force due to lack of knowledge
-human are rational beings, will change if there’re factual information
2. Normative-reeducative strategies
(group norms and peer pressure to socialize people)
Change agent:
-Interpersonal relationship
3. Power-coercive strategies
(using authority inherent in an individual position to effect change)
(enactment of new laws, group power)
=change only when rewarded
= authority measures leading to resistance (restraining force)

Resistance
Change= alteration on balance => resistance and conflict
Level of resistance is affected by,
1. Type and level of change (individual are easier than groups, knowledge than
 attitudes and beliefs)
2. Related to values, educational levels, cultural and social background and
experience with change
Natural and expected response to change
-provide change support and resources
-identify promoter or resistance

Planned change as a collaborative process

Change process involves dissatisfaction, gossips or rumors, negative views
=need of collaborative process
-engage and empower subordinates, good communication, repeat message

Leader-manager: the role model

Manager
=change/= threat, but as a challenge and opportunity as new and innovative

How to facilitate change?

-actively engaged, role model to staff
-assist followers in making the needed change requirement in their work

Organizational change: non-linear change theories

1. Complex adaptive system (CAS) theory (micro level)
Non-linear
Micro level, relationships, interactions, simple rules
2. Chaos theory (butterfly effect) (finding the underlying order in systems)
Butterfly effect, tiny changes in variables often dramatically affect the outcomes

Leadership qualities
-embrace the environment
-set priority
-establish direction and be persistent
-stimulate creativity and innovation
-be a role model
-be sensitive to people
-maintain credibility and build trust
-be open and listen
-organization values and goals for ability to live, willingness to change
-personal integrity
L4
Role of leaders/ managers in shaping an organizational culture
Importance of developing well-structured committees in an organization
Elements that determine organizational effectiveness
Strategies to build a personal power base
Different types of patient care delivery systems

Management process
Planning >organizing >staffing >directing >controlling

Organizing
Relationships, Procedures, Equipment, Tasks
Organization
-authority and decision making

Formal organizational structure

-work division, departmentalization
-highly planned, visible, systemically arranged

Informal organizational structure

-social network of employee
-blurred or shifting lines of authority and accountability

Organizational Theory (Max Weber: bureaucracies)

-division of labor
-hierarchy of authority
-impersonal rules and impersonality
-system of procedures
-rules of rights and duties
-technical competence on selection for employment

Organizational structure
+Relationships and chain of command
+Span of control
+Managerial levels
+Centrality
Relationships and chain of command
Solid horizontal line: communication between people with similar spheres of
responsibility and power but different function
Solid vertical line: formal chain of command, status and power, inter-professional
approach (top: decision making authority)
❌command: conflicts, reduce productivity
Dotted line: staff positions, staff to provide information and assistance, limited
authority

Span of control
-number of people directly reporting to one manager
-↑span of control ↓level of hierarchy
-Wider/ narrower, more ppl/less ppl report to manager
Managerial levels
A) Top level managers
B) Middle-level managers (coordinate the efforts of lower levels of the hierarchy)
(bridge)
C) First-level managers (concerned with their specific unit’s work flow)

Centrality
-location of a position on an organization chart, determined by organizational distance

Types of organizational structure

-Line structures
-Ad hoc design
-Matrix structure
-Service line organization
-Flat designs
àcommunication patterns, relationships, authority

Line structures
-Bureaucratic organizational designs
-Authority and responsibility
-Efficiency and simplicity
Cons: Monotony, alienate workers, restrict upward communication

Ad hoc design
-temporary basis to complete a project
-overcome the inflexibility of line structure
-handle increasing large amounts of available information
Cons: reduce strength in the formal chain of command, reduce employee’s loyalty

Matrix structure
-focus on product and function e.g. good patient outcome, staff education and
adequate staffing
Cons: slow decision making, dual authority: frustration and confusion

Service line organization

-care-centered organization, focus on process to achieve goal

Flat designs
-decentralized organization
-more authority and decision making

Decision machining within the organizational hierarchy (scalar chain)

Centralized vs Decentralized
Centralized
-top-down approach
-rapid decision making
-staff need direction, guidance and coordination of activities
Decentralized
-diffuses and delayed decision making à appropriate individual for problem solving
-larger the org. +decentralized decision making

Organizational culture
-system of symbols and interactions
-thinking, behaving and believing
-values, language, traditions, sacred rules
-shared attitudes and beliefs, written and unwritten rules

Role of managers in shaping the organizational culture

Leader:
-assess unit culture
-interpersonal and communication. Skills
-active roles
-recognized differences
-create norms and priorities

Shared governance (Joint practice committees)

Committee structure in organization
1. Well-constructed committees
-upward communication
-inc. staff participation
-improve quality and quantity
-generate ideas and creative
✓group dynamics, groupthink
✓shared decision making
✓free of status and power
✓aware different needs e.g. culture, gender

Determinants of organizational effectiveness

1. Clearly defined structure
2. Fewest management levels, shortest chain of command
3. Communication
4. Facilitate decision making
5. Sense of belonging
6. Development of future leaders

Concepts of power and authority

Power is the strength to accomplish something, potential to change the attitudes and
behaviors-> accomplish goals

Building a personal power

-hard work
-Determine the powerful in the organization
-learn the language ad symbols of the organization
-organization priorities
-Professional skills and knowledge
-maintain a broad vision
-be flexible
-accept compliments
-develop visibility and voice in the organisation
-sense of humor
-empower others

Organizing patient care

1. total patient care
2. functional nursing
3. team and modular nursing
4. primary nursing
5. case management
Determinants: staff skills, availability of resources, patient acuity, the nature of work

Total patient care

-nurses take total responsibility to meet all needs of assigned patient
-patient were assigned as cases
PROS:
-nurses with high autonomy and responsibility
-simple and direct patient assignment, no planning
-clear responsibility and accountability
-holistic and unfragmented care
CONS:
-different nurses have different approach
-require high skilled personnel, increases cost of care
-unsafe care due to inadequate skilled nurse, heavy workload

Functional nursing
-unskilled workers to do simple task
-assigned personnel to complete certain task
-assigned one to be managers of care
PROS:
-economic means of providing care
-efficient, complete task more quickly
CONS:
-Fragmented care (may overlooking patient priorities needs)
-low job satisfaction (repetition of work)
-cost-ineffective (need to assign care coordinators to supervised unskilled worker)
Team nursing
-team leader know all the condition and needs of each patient
-planning individual care
-various team leaders due to patients’ needs and workload
-less than 5 people in a team
PROS:
-democratic leadership so members have autonomy
-members can contribute their special expertise or skills
-high job satisfaction (nurses recognize individual worth)
CONS:
-effectiveness based on the quality of team leaders, self-discipline of team members
-blurred lines of responsibility, errors, fragmented patient care (insufficient time for
team care)
Modular nursing: mini teams (1-3 a group with 1 nurse) (better use of time)

Primary nursing
-primary nurses provide total direct care
-24-hour responsibility
-primary nurse not on duty, associate nurse will follow
PROS
-clear communication, feedback, consistent and direct patient care
-a sense of job satisfaction and accomplishment
CONS:
-to depends on quality of primary nurse
-incompetent primary nurse can lead to ineffectiveness
-less applicable on nursing shortage

L5
Interviews, limitation

Staffing
-recruiting, selecting, placing, indoctrinating personnel

Nursing shortage
-increasing demand e.g. ageing, technological advancement
-(supply)ageing workforce
-inadequate nursing resources
-shortage of nursing workforce
Maximize their expertise:
◦ Use them as mentors and preceptors
◦ Assign supervisory / administrative role to them
Minimize physical stress
◦ By using lift teams and special beds
◦ By assigning nonphysical work such as admission/discharge
Assign patient care duties based on their capability
Review and adopt benefit packages that accommodate their unique needs
Recognize their long years of service

Online academic degrees to further the education, training, and development

▪The joint venture spans technical, professional, executive, and leadership
training and provides a range of flexible, accessible, and affordable education
opportunities
▪ Scholarship fund to remove financial barriers for education and to increase
equity in healthcare.
▪Collaborative partnerships to train and upskill unemployed and
underemployed job seekers into healthcare occupations
▪Partnerships with community-based organizations and training institutions to
train current and former nurses to become nursing educators and frontline
healthcare workers to train for nursing careers

Interview
1. unconstructed interview
-unclear hiring goal
-little planning
2. structured interview
-planning
-information on skills and quality
-determine the willingness or motivation

Limitations of interviews
-subjectivity
-Quality of interviewers (attitudes and biases)firs
-first impression, not clinical skills
-performance at interviews =/= job performance
How to overcome interview limitations
1. well-prepared for the interview e.g. list of competencies
2. team approach (prevent individual bias)
3. use scenarios e.g. patient care situations
4. multiple interviews
5. training on interviewers

legal aspects of interviewing

Inquiry cannot be made regarding:
❑Age
❑Marital status
❑Children
❑Race
❑Sexual preference
❑Financial/credit status
❑National origin
❑Religion

Indoctrination
1. induction (introduce personnel policies and procedure)
2. orientation (specific for the position, part or the team and independent)
3. socialization

L6 Development and staff socialization

The learning organization

1. System thinking (staff connects to the whole organization)
2. Personal mastery (personal abilities)
3. Team learning (collaboration)
4. Mental models (diverse thinking)
5. Shared vision

Staff Development
-increasing productivity
-staff training (necessary knowledge, knowledge and skills for specific purpose)
-staff’s knowledge level and capabilities
à save money
Adult learning theory (concept of how adult learn, differs from children)
Adult learners
-mature
-self-directed
-willing to solve problems.
Obstacles to adult learning:
◼ Institutional barriers
◼ Time
◼ Self-confidence
◼ Situational obstacles
◼ Family reaction
◼ Special individual obstacles
Assets for adult learning:
◼ High self-motivation
◼ Self-directed
◼ A proven learner
◼ Knowledge experience reservoir
◼ Special individual assets

Social learning theory

-behavior>environmental factor>personal factor
-people learn through interactions with others
-direct experience and observation

L7
•Intrinsic and extrinsic motivation
•Motivators and hygiene factors
•Strategies for creating a motivating climate
•Common delegation errors
•Strategies for effective delegation
•Categories of conflict
•The conflict process
•Conflict resolution strategies

Intrinsic and extrinsic motivation

Intrinsic: within the person, own level of aspiration, intrinsically motivated at work
Extrinsic: work environment, external rewards
1. Stimulate both intrinsic and extrinsic motivation
2. Human beings hv different needs, various motivation

Motivation-hygiene theory

Motivation theory (basic needs of motivation)

1. Achievement
2. Affiliation
3. Power

Theory X (work for money) and theory Y(self motivated)

Positive reinforcement
1. Positive feedback

Work engagement (committed, passionate)

work empowerment (decision making, creative and innovative thinking)

delegation
is getting work done through others
-provide learning opportunities for subordinates, sense of accomplishment and
enrichment

1. Plan ahead
2. Identify necessary skills and education levels to complete the delegated task
3. Select capable personnel
4. Communicate goal clearly
5. Empower the delegate
6. Set deadlines and monitor progress
7. Model the role and provide guidance
8. Evaluate performance
9. Reward accomplishment

Delegation error
1. Underdelegating
-manager treats delegation as lack of ability, lack of trust,
 -manager is lack of time, failure to anticipate that help they need
2. overdelegating
-managers burden employees with many assignments
-managers should be aware of workload constraints
-staff have right to refuse tasks
3. improper delegating
-wrong time, wrong person, wrong reason
-the task beyond the capability of the person

The five rights of delegation

The five rights of delegation
1) Right task
➢ One that is delegable for a specific patient
2) Right circumstances
➢ Appropriate patient setting, available resources, and other relevant factors
considered
3) Right person
➢ Right person (e.g., WM) is delegating the right task to the right person (e.g., RN)
to
be performed on the right person (e.g., patient of bed X)
4) Right direction / communication
➢ Clear, concise description of the task, including its objective, limits, and
expectations
5) Right level of supervision
➢ Appropriate monitoring, evaluation, intervention, as needed, and feedback

Conflicts
Intergroup conflict (>2 groups)
Interpersonal conflict
Intrapersonal conflict (internal struggle)

Conflict process
1. Latent conflict (antecedent conditions)
2. Perceived conflict (intellectualized)
3. Felt conflict (emotionalized)
4. Manifest conflict
5. Conflict aftermath
Conflict resolution strategies
1. Compromising
2. Competing
3. Cooperating
4. Smoothing
5. Avoiding
6. collaborating