Introduction to Management in Nursing

BT  Basavanthappa

Introduction to Management in NursingCHAPTER 1

DEFINITION, CONCEPT AND THEORIES

Concept of Management

The concept of management is as old as the human race itself. Management in some form or another is an integral part of living and is essential wherever human efforts are to be undertaken to achieve desired efforts are to be undertaken to achieve desired objectives. Managing “life” is not much different from Managing an organization. A well-managed life is much better organized, goal-oriented and successful—“good management of an organization makes the difference between the success and the failure of the organization.”

Wikipedia (2006, para 1) states that the term management comes from the old French term ménagement which means “the directing” and from the Latin term manu agere, which means “to lead by the hand.” Both word origins imply that management is the process of leading and directing all or part of an organization, often a business, through the deployment and manipulation of resources. The act, manner, or practice of managing, handling, supervision, or control is another description of management.

Management has been defined differently by different writers. Some define it as the “the technique of getting things done while others as a process of planning, organizing, staffing and controlling”. By analysis of the various concepts we can say that management is based on economic resource, goal decided, distinct process, system of authority, unifying force, multidisciplinary subject and universal activity.

Definitions of Management

Some of the definitions of management are as given below:

Management may be defined as an art of securing maximum results with a minimum of effort so as to secure maximum prosperity and happiness for both employer and employee and give the public the best possible service.

—John Mee (1963)

Management is the creation and control of technological and human environment of an organization in which human skill and capacities of individuals and groups find full scope 2for their effective use in order to accomplish the objectives for which an enterprises has been set up. It is involved in the relationship of the individual, group, the organization and environment.

—A Dasgupta

Management is the process and agency which directs and guides the operations of an organization in realizing established aims.

—O Tead

Management is simply the process of decision-making and control over the action of human being for the express purpose of attaining predetermined goal.

—Stanely Vance (1959)

Management is principally the task of planning, coordinating, motivating and controlling the efforts of others towards a specific objective.

—James Lunde (1968)

Management may be defined as the art of securing maximum results with a minimum of effort so as to secure maximum prosperity and happiness for both employer and employee and give the public the best possible service.

— John Mee (1963)

Management is defined as the process by which a cooperative group directs action towards common goals.

—Joseph Massie (1973)

Management is distinct process consisting of planning, organizing, actuating, activating and controlling, performed to determine and accomplish the objectives by the use of people and resources.

—George (1988)

Management is the complex of the continuous coordinated activities by means of which any undertaking or any administration or other service, public or private is considered.

—Advisory Committee of International Labour Officer

Management is a good planning, organizing, directing, coordinating and controlling to eliminate chaos, errors and waste and get better utilization of manpower and materials.

—George A Melresh

Management is a basic integrating process of individual activity.

—Edith-L Alexander

Management is getting things done through other people.

—James L Hayes

By Management we mean a bunch of complexities which in a commercial organization start downward right from the level of directors, while the official work together. It includes supervisory staff at lower level.

—Fredrick Hooper

Management may be broadly defined as the art of applying the economic principles that underlay the control of men and material in the enterprise under consideration.

—Kimball

Management is the act of doing things through and with the people in formally organized groups.

—Koontz

Management is defined for conceptual theoretical and analytical purpose as that process by which managers create, direct, maintain and operate, purpose organization through systematic, and coordinated, cooperative human effort.

—Marfarland

Management as a set of activities directed at the efficient and effective utilization of resources in the pursuit of one or more goals.

—Van fleet and Peterson3

Management is working with human, financial and physical resources to achieve organizational objectives by performing the planning, organizing, leading and controlling functions.

—Meggerison and Mosby

Management is a problem-solving process of effectively achieving organizational objectives through the efficient use of scarce resources in a changing environment.

—Kreitner

On the basis of above definition, management is getting a group of people to work together harmoniously and efficiently to accomplish a common purpose. The purpose of management is the effective allocation and collective utilization of human resources and material in an effort to reach the goals.

According to above definitions management is concerned with getting the work done. It is a process of unification. It brings men, material and machine together.

It is a social process as it belongs to social organizations.
It aims at securing maximum results with minimal efforts and cost-effectiveness.
It is an activity related to human and extra human means of production.
It is a universal process. It exists where there is social organization.
It is purposive as it has objectives to be achieved.
It is based on social sciences, i.e. its tools and concepts belong to social science.
It is concerned with good human relations.

CONCEPT OF MANAGEMENT AND ADMINISTRATION

There is a common tendency to use the terms administration and management as interchangeable. Administration is a wider term encompassing activities like the spelling out of policies and objectives, establishment of suitable organizational structure to conduct and promote an organized task, providing necessary resources from realization of the objectives, etc.

Administration is a variety of component elements which together in action produce the result of getting done a defined task of which a group of people charged. Administration primarily, is the direction of people in association to achieve goal temporarily shared. It is the inclusive process of integrating human efforts so that desired result is obtained. The role of management on the other hand, rests confined within the framework of policy, organizational structure and resources. Management is primarily concerned with those operations leading an organization towards success within the broader framework set by an administration.

Some authorities say that administration is the art of management. Administration certainly is management, but it is something more than management, or to put in another way, management is something less than administration. The generalization of items from wide experience, though no dogmatism is permissible or intended. The term “management” is usually employed to represent activities within and subordinate to administration often the management of the activities of personnel alone.

Thus, management in contrast to administration, refers to the collective utilization of human resources and material in an effort to reach the goal.

Administration or management essentially is a process, for fulfilling certain predetermined objectives. It can be applicable to all walks of life. So it has to be there for smooth functioning of schools, colleges, hospitals, health centers and public and private enterprises.

Administration and management are considered as synonyms. In any enterprise there are two types of functions, i.e. administrative functions and executive functions. Administrative 4functions are entrusted to top level managers or administrators, which include planning, organizing and planning for staffing. Executive functions are entrusted to middle and first level managers or supervisors which includes actual staffing, directing, coordinating and controlling. Usually administration includes a thinking function involving formulation of objectives, plans and policies which rest with top level administrator/managers, whereas management includes operative functions, i.e. a doing function involving executive functions which are under the aegis of middle and first level managers.

This administration is an enabling process for achieving the laid down objectives of an organization through formulated plans and policies whereas management as the process of putting administration into practice or effect. In other words, administrators are responsible for formulating plans, policies and procedure to achieve expected goals; the managers are responsible for translating those formulated plans, policies and procedure into action to achieve the expected goals.

Administrators or managers basically are leaders possessing skills. Although leadership may be one among the functions of management, yet leadership requires more complex skills than management and their management is only one role of leadership.

Generally, management laids emphasis on control, i.e. control of hours, costs, salaries, overtime, use of sick leave, inventory, supplies, whereas leadership increases productivity by maximizing the work force effectiveness. The relationship between the leadership and management can be better understood by function of manager and leader as given below:

Usually the managers:

Have an assigned position within the formal organization.
Have a legitimate source of power due to the delegated authority that accompanies their position.
Are expected to carry out specific functions, duties and responsibilities.
Emphasizes control, decision-making, decision-analysis and results.
Manipulate individuals, the environment, money, time and other sources to achieve organizational goals.
Have a greater formal responsibility and accountability for rationality and control, than leaders.
Direct willing and unwilling subordinates.

Whereas leaders:

Often do not have delegated authority but obtain their power through other means, such as influence.
Have a wider variety of roles than do managers.
Are frequently not parts of the formal organization.
Focus on groups process, information gathering, feedback and empowering others.
Emphasize interpersonal relationships.
Direct willing followers.
Have goals that may or may not reflect those of the organization.

In examining the leadership and management, it becomes clear that these two concepts have a symbiotic or synergistic relationship. Every nurse is a leader and manager at some level, and the nursing role requires leadership and managerial skills. So nurses must strive for the interaction of leadership characteristics throughout every phase of the management process.5

Concepts of Effective Management

The following concepts for effective management.

Management by communication: As manager spends 90% of his time in communication only. Management is getting things done through others. Communication determines the effectiveness of the management. Communication is a continuous, coordinated process of telling, listening and understanding. According to this concept, the success of the management depends upon the successful communication.
Management by systems: This refers to:
1. Recognizing the problems, analysis it and defining the objectives
2. Collection and analysis of necessary data.
3. Finding out various possible alternatives.
4. Reviewing and evaluating each alternative.
5. Testing the conclusions, if possible.
6. Selecting the best alternative
7. Reviewing the results and taking corrective actions if necessary: Management by system is more concerned with experimentation and analysis.
Management by results: This concept states that the end results are significant. Development of progress can be evaluated by looking the end results. Management is result-oriented. The success and strength of the management is determined from the point of the result that it can bring.
Management by participation: This concept takes worker into confidence. Workers are provided opportunity in the decision-making process. It also involves the doctrine of trusteeship. This concept helps in creating a sense of involvement among the workers.
Management by motivation: Motivation is considered as the dynamic aspect. Management distinct from that of mechanical one. The problem of motivation is its action in its executive form. It is among the chief task of the general manager.
Management by exception: It is a special skill of managing by attending only to exceptionally important matters and taking vital decisions. Routine matters are handled by the lower level officers.
Management by objectives (MBO): Is a dynamic system which seeks to integrate the company's need to clarify and achieve its profit and growth goals with the manager's need to contribute and develop himself. It is a demanding and rewarding style of managing a business.

Management and administration sometimes appear to be synonymous, but they are not synonymous terms. If we consider, the administration is the “coin”, the organization and management are the two sides of the same coin. To translate any policy into action, people need structure, that is organization, when structure is there, there are some functions to be performed to accomplish goals, that functional aspect of organization is dealt by management.

Ordway Tead, has made a distinction between these two terms in the following words:

“Administration” is the process and agency which is responsible for the determination of the aims for which an organization and its management are to strive, which establishes the broad policies under which they are to operate, and which gives general oversight to the continuing effectiveness of the total operation in reaching the objectives sought. Whereas “Management” is the process and agency which directs and guides the operations of an organization in the realizing of established aims”.6

Administration refers to the activities of the higher level in the managerial skills and also refers to the determination of major aims and policies while management to the carrying out of the operations designed to accomplish the aims and effectuate the policies.

Wren has stated, “Management is both an art and science. It is an art based on a scientific foundation, obviously, the science of management can be described much more easily than the art of management”.

“Health management is a process, with both interpersonal and technical aspects, through which the objectives of the health services organization are specified and accomplished by utilizing human and physical resources and technology”. This process can be viewed as a simple input-output relationship (Fig. 1.1) in which inputs (human and physical resources and technology) are transformed into desired outputs (accomplishment of the objectives of the organization or some part of it).

Many aspects of health services organization are managed by health professionals. The doctor who finds himself, as a chief of staff, in charge of and responsible for many activities of several hundred fellow doctors needs management skills, the physician incharge of a laboratory or a radiology department needs management skills; the nurse who is incharge of nursing department is responsible for supervising the nursing care/services to the clients, needs management skills. Like this in many cases the health professional is also a manager in a health services organization.

In general, management is in many ways merely an extension of certain rather routine components of human life, setting objectives is a natural human endeavor—to set them in rational way and to set them for other people requires management skill. The provision of high quality health services is the basic objective of health professionals.

“Quality is doing the right thing right the first time and doing it betters the next.”

—Al-Assaf, 1993

“Quality is the degree to which care services influence the probability of optimal patient outcomes”

—American Medical Association, 1991

“Quality is a moving target—a process of continuous improvement, and continuous to suggest, pessimistically, that quality is a prize to be coveted if only ever to be imperfectly achieved”.

—Brooks, 1992.

“Quality is meeting the requirements of the customers, both internally and externally, for defect free products and services”.

—IBM, 1982

“Quality is providing our customers with innovative products and services that fully satisfy their requirements”.

—Xerox, 1983

Quality of nursing practice is achieved when organization's processes and activities and designed and implemented to meet the needs and expectations of the receiver on a competent, consistent and continuous basis.

—INC, 2006

Fig. 1.1: Input-output relationship.

Thus quality is never on accident. It is an accident, sincere effort, intelligent direction and skillful execution. It represents the wise choice of many alterations (Al-Assaf, 2001). Though defining quality is difficult. The expense of quality is an interactive process between customer and provider. Today, the quality of care provided is the common measure in the health delivery system from clinical perspective. Quality serves as the balance that demonstrates professional commitment to the patient care. This balance is needed in the formal processes. Quality is the vehicle to ensure the public trust in health care delivery.

Health service organizations must now be concerned not only with the scope and quality of their services but also the efficiency with which these services are provided. The dual concern for quality and efficiency places a tremendous burden on health professional which includes nursing and those who manage them. So the manager has to think about the skills that an effective manager must utilize. Robert L Katz has identified three types of skills:

Technical skill is the ability to use the methods, processes and techniques of a particular field. It is easy to visualize the technical skills of a surgeon or a physiotherapist, but in a similar way counselling a subordinate or making out a departmental budget also requires a considerable amount of skill.
Human skill is the ability to get along with other people to understand them, and to motivate and lead them in the work place.
Conceptional skill is the mental ability to visualize all the complex interrelationships that exist in a work place—interrelationship among people, among departments or units of an organization and even among a single organization and the environment in which it exists. Conceptional skills permit the manager to understand how the various facts in a particular situation fit together and impact on each other.

Katz suggested that not all managers will need to utilize these skills to the same degree although every manager must rely on all three types of skill in performing his or her work, which means according to their levels of position they can exercise these skills.

Since the management is a process in which the managers have to think about the different roles they play. Henry Mintzberg has defined roles as “organized sets of behavior” and compared managerial roles to those of actors on a stage. Just as the actor plays a role, the manager, simply because he/she is a manager, must adopt certain patterns of behavior when he/she assumes a managerial position. Mintzberg argues that all managers share the common bond of formal authority over organizational units they manage and that this authority leads them into interpersonal relationships where they must play such interpersonal roles as figure head, leader and liaison with other units of organization. These interpersonal roles provide the manager with the opportunity to gather information. This fact, along with what the manager does with the information permits a second set of roles. These informational roles include monitor, disseminator, and spokesman roles. Finally authority granted to managers, supported by their interpersonal and informational roles requires that they play decisional role. These include disturbance handler, resource allocator and negotiator roles. In addition, a key decisional role for every manager is that of entrepreneur in which the manager functions as an initiator and designer of changes intended to improve the unit over which he or she has authority. These ten managerial roles are summarized in Figure 1.2.

In the practice of management, the manager must take number of actions like planning, organizing, directing, coordinating and controlling, simultaneously and as a part of a continuum. Here the planning—involves the determination of objectives; organizing—is the structuring of people and things to accomplish the work required to fulfill the objectives; directing—is the stimulation of members of the organization toward meeting the objectives; 8coordinating—is the conscious effort of assembling and synchronising diverse activities and participants so that they work harmoniously towards the attainment of objectives; and controlling, in which the manager compares actual results with objectives, so as to provide a measure of success or failure.

Fig. 1.2: Managerial roles of a manager.

PRINCIPLES OF ADMINISTRATION

The science of administration attempts to discover and impart, principles of administration. Principles can mean either of two things, i.e. ethical nature and generalization of behavior.

The first is of an ethical nature; the administration may say we ought to do this list of things in this way. Here the ethical impulse is paramount. Thus, we ought to admit every child that is sick and brought to our door. Or, we ought not let a patient leave, until we are absolutely certain that he is capable of returning to work tomorrow morning, at least to get as strong as he was before he was afflicted. These are standards ambitions, expressions of what is supremely good in the conduct of the enterprise. This is the meaning of ethical nature of principle.

Another meaning of the word “principle” is a generalization from behavior, a succinct statement that experience has shown that if “A” (a purpose) is to be attained, then “B” (a train of policies and activities) must be employed.

There is a relationship between ethical principles and the principles as generalization of cause and effect. The principle, as ethics may set the purpose; the generalization may assist in identifying the means whereby the purpose may be achieved. According to Finer, following are the principles of administration.

Principle of Oneness

From the apprehension of purpose, from its absorption, flows directly the oneness of leadership that gives form to the whole aggregate of people whose skills are needed for its fulfillment. Leadership may take the form of a single executive or a duo or a triumvirate and there are numerous forms of collective administrative bodies. One may be final leader to take ultimate decisions. Oneness implies that all the personnel are members.

The first requirement is the right of people to have positions of authority, or in other words, the representatives of the authority of the situation. This returns to the problem mentioned, that is to say, the selection and promotion methods leading to high places.

However, there are persons involved in all the techniques of persuasion and command; orientation periods, manuals of policy, periodical conferences, social festivities; the administrator rounds in the manner appropriate to the personality of the particular collection and human beings on the staff and individual counselling. It would be idle to protract that list of the techniques of association of the art, as it were, of making love to other people, getting 9them wed a purpose or to achieve conversions. This would involve us in all the sociological and psychological technique.

Principle of Specialism and the Whole

The principle of oneness offers guidance in an endemic problem in administration. The relationship of the specialist or expert to the total plan. In the administration, each one should become an expert. The contribution that expertness make to a whole organization is the sure mastery of part of clinical or administrative practice, a mastery that others need as an ingredient of their service, and must take on the authority of the person who is expert. Failure to do this means either a loss of effectiveness or the need to neglect other work in order to immerse oneself in the specialism, e.g. expert in sweeping, so the expertness of the specialist is indispensable and must be preserved and encouraged.

Principle of Hierarchy and Regimentation

Administration has accepted the idea of hierarchy to denote authority coming downwards from above, but not in the sense of chastising dogmatic rule. It accepts this in the sense only of functional superordination subordination.

When the administrative scientists talk of hierarchy, they mean not regimentation (Properly applied to the urgencies of obedience of military forces under fire or training against the day when they will be) but the pervasion of whole organization with the notion of its oneness, and the fitting together of all the members vertically (downwards) in the line authority, and horizontally (across) of teams and colleagues in specialist skill.

Principle of Morale

Morale is the spirit of active devotion to the persons working together for a common purpose. When it is high, the subjective burdens of the work, its hours, its routines, the patience it demands, the submissions of personal interests and values, are lightly carried, and there is an easy and cheerful demeanor on the part of those who take and give order.

When it is low, the work and purpose looses value, and personality frustrates them. When against, personal tensions, individual and interpersonal, rise is high and rebelliously more endangered. To buy morale, all aspects of employees are taken into confidence at all levels.

Principles of Bureaucracy

Bureaucracy is diseased administration, the disease may be defined as deficiency in the spirit that created its purpose, that caused organization to be created, so that either cooperation has fallen apart or activities are executed without any interest in the object originally assigned to them. Bureaucracy is administration, without purpose, ethos, oneness, or morale; it is the organizational form of personality equal to the individual person called the “Hollowmen” (TS Eliot).

Principle of Self-administration

Administration begins with the self, in relationship to the fulfillment of a purpose. The administrator begins with self-administration, the adaptation of his own stubborn, passive, incompetent or dissentient self to the purpose, even if no one else is at work with him on the job.10

Every professional worker—singer, actor, boxer, author, scientist, nurse is obliged to administer himself or herself, they must retain their caprices, harness their energies and abate spiritual and mental rebellion in their natures for the successful and most economical mastery of purpose. This is self-administration.

In addition to the above, the following principles should be maintained in the administration.

To some extent centralization of authority and clear-cut responsibility is needed for intelligent operational work.
Supervisors should use proper knowledge and skills while directing their subordinates for smooth and efficient programs.
Power supply/communicating information to all officials or units prevents conflicts and avoids many problems.

Proper delegation of authority with some power helps to have efficiency in an organization.
Close supervision needed to carry out.
Alertness or responsibilities of employees must be maintained through repetition.
Complacency and procrastination should be avoided while taking quick decisions.
Competent officials must ensure coordination during stress by intelligent evaluation of events.
Superiors attitude should be approachable to the subordinates.
Superiors should maintain an imagination and resourcefulness in any organization/system.
Communication characterized by clarity, forthrightness, appropriateness.
Flow of information should benefit the subordinates.
Person who neglects to familiarise himself should quit the responsibility.
Officials should never countermand an official instruction on personal basis.
Avoid personal/official/professional jealousies in the organization.
Avoid personal friendship in the administrative position and while dealing any matter.
There should be provision to identify failure and assert responsibility in administration.

PRINCIPLES OF MANAGEMENT

Since principles may be considered as widely accepted statements which are found to be true and reflective of life situations. To sum up, fourteen principles of administration were identified by the Henri Fayol which are as follows:

Division of work: In any organization administrator or manager cannot perform all the activities to achieve its objective. So there should be division of work according to managerial and non managerial, or according to job which grouped according to departments, e.g. Department of Nursing, Department of Pharmacy, Department of medicine and so on.
Authority, responsibility, and accountability: If the person has to perform job assignment effectively according to their own qualification and experience, or convention there should be delegation of authority and responsibility needed, which in turn helps to get accountability.
Discipline: For smooth running of administration to achieve objectives, there should be proper observance of the rules, regulations, norms, decorum, manners, code of ethics and respect; this requires to be enforced within the organization by the managers.
Unity of command: In any organization the subordinates should be supervised by a single superior to whom he/she should be accountable.11
Unity of direction: In any organization, there should be one supervisor to give direction to his/her subordinates.
Subordination of individual interest to organizational interest. This implies that narrow selfish interest should be overcome or should turn to common and broad interest of the organization for its welfare, e.g. collective bargaining (more salary, more production).
Remuneration of personnel: There should be fair policy for payment to the personnel justifying the workload, job hazards, efficiency and quality of performance.
Centralization: There should be a some amount of greater and larger authority resting with top level managers.
Scalar chain of command: Which implies that there is chain or link of directional instructions from the top level to the lowest rank of organizational members in the hierarchy.
Order: In an administration there should be proper, systematic arrangement of staff, materials, supplies and equipment according to requirement of specific job departments.
Equity: In administration, there should be a fair and impartial treatment to all workers irrespective of their job.
Stability of tenure of personnel: Organizations should make proper efforts to ensure stability and continuity in the tenure of personnel, which gives security and promotes productions.
Initiative: Administration should always be encouraging initiative from each employee by allowing him freedom to do his/her best.
Esprit de corps: It refers to sense of belonging. This fosters the team spirit, i.e. the spirit of working together to achieve objectives effectively.

ELEMENTS OF ADMINISTRATION/MANAGEMENT

Administration may be defined as all the actions rationally performed by one person or a number of persons in concert to fulfill a common purpose set by someone else of their accomplishment.

Professor Luther Gullick (1937)—summed up certain principles or elements in the word “POSDCORB”. The hieroglyphic POSDCORB consist of the initials of a number of words under each of which some administrative activity has been classified and named. POSDCORB, is of course a made up word designed to call attention to the various functional elements of the work of a chief executive because “administration” and “Management” have lost all specific content. POSDCORB is made up of initials and stands for the following activities:

“P” stands for Planning: That is working out a broad outline, the things that need to be done and the methods for doing them to accomplish the purpose set for the enterprises or of the purpose in hand.

“O” stands for Organising: That is the establishment of the formal structure of authority through which work of subdivisions are arranged, defined and coordinated for the defined objectives. In other words, building up the structure of authority through which the entire work to be done is arranged into well defined subdivisions and coordination.

“S” stands for Staffing: That is the whole personnel function of bringing in and training the staff and maintaining favorable conditions of work. In other words, staffing is appointing suitable persons to the various posts under the organization and the whole of personnel management.12

“D” stands for Directing: That is the continuous task of making decision and embodying them, in specific and general orders and instructions and serving as leader of the enterprise. Making decisions and issuing orders and instructions embodying them for the guidance of the staff.

“CO” stands for Coordinating: That is all important duty of interrelating the various parts of the work and eliminating of overlapping and conflict.

“R” stands for Reporting: That is keeping those to whom the executive is responsible informed as to what is going on, which thus includes keeping himself and his subordinates informed through records, research and inspection.

“B” stands for Budgeting: With all that goes with budgeting in the form of fiscal planning, accounting and control. In American phraseology, budget stands for the whole of financial administration.

THEORIES OF MANAGEMENT

Management science, like nursing, develops a theory base from many disciplines, such as business, psychology, sociology, and anthropology. Because organizations are complex and varied, theorists’ views of what successful management is and what it should have been changed repeatedly in the last 100 years.

There are several theories of Administration and Management. Although strictly speaking the word “Theory” may not be very correct to use at the present stage of administration. Since the term “Theory” is used because of its popularity. Actually the systematic study and analysis of organization started in the later part of 19th century and early 20th centuries. Few prominent figures who attempted to study the organization are as mentioned below:

Frederic Winslow Taylor (1856–1915)

Frederic Taylor was born in 1856, in a well to do family of Philadelphia. Although not a brilliant student, but had the quality of seriousness of purpose and hard work. At the Philips Academy, he paid the price of serious impairment of vision because of too much study in kerosene light and was advised by doctors not to do anything close study. In 1874, he began as apprentice pattern making in a small work shop in Philadelphia. Attracted by the reputation of Midvale Steel, he applied for a job in Midvale Steel Company. This job was for an ordinary laborer. Within a period of 8 years he progressed through the stage of ordinary laborer to time keeper, machinist, gang boss, foreman, assistant engineer to chief engineer of the works. He completed his technical qualifications by taking a Master's Degree in engineering at the Stevens Institute through evening study. Taylor not only had original ideas in the field of management but he had acquired a technical excellence in the field of engineering which itself would have brought him to an enduring place in the history of engineering. Taylor left the Bethlehem Steel Company 1901 and devoted the rest of his life to spread an understanding of his fundamental ideas. FW Taylor, a mechanical engineer, was born in Pennsylvania, educated in a steel company and a paper mill invented several industrial tools, and conducted research on methods of training workers for increased production. Taylor believed that the principle “best management is a true science”. The term “Science” means a body of knowledge, ascertained through observation and experimentation, whose principles are universally accepted or have reached the greatest projection. It is a systematized and critically tested body of knowledge. According to him the objective of management is to secure the maximum prosperity for the employer, coupled with 13the maximum prosperity for each employee. His philosophy of Scientific management is that there is no inherent conflict in the interest of employers, employees and consumers. It was the result of, higher productivity should equally benefit all people, i.e. worker, employer, consumer in the shape of higher wages to the workers, greater profits to the management and payment of lower prices for the products by the consumers. So he pointed out that management is a true science resting upon clearly fixed laws, rules and principles as a foundation and argued that management comprised of a number of principles which commanded applicability in all types of organization.

Frederic Taylor was a pioneer who propounded scientific principles of management as the result of his keen research in different areas of industrial activity. Before scientific management workers were completely dominated by their superiors and the relationship was based on social cast and autocracy. This was a stage when everything was determined on the basis of authority. This period came to an end when French Revolution gave the cry for fraternity, liberty and equality. In scientific management, we take into account as many variables and try to correlate in rational manner.

Frederick W Taylor, the “father of scientific management,” was a mechanical engineer in the Midvale and Bethlehem Steel plants in Pennsylvania in the late 1800s. Frustrated with what he called “systematic soldiering,” where workers achieved minimum standards doing the least amount of work possible, Taylor postulated that if workers could be taught the “one best way to accomplish a task,” productivity would increase. Borrowing a term coined by Louis Brandeis, a colleague of Taylor's, Taylor called these principles scientific management. The four overriding principles of scientific management as identified by Taylor (191) are:

Traditional “rule of thumb” means of organizing work must be replaced with scientific methods. In other words, by using time and motion studies and the expertise of expertise of experienced workers, work could be scientifically designed to promote greatest efficiency of time and energy.
A scientific personnel system must be established so that workers can be hired, trained, and promoted based on their technical competence and abilities. Taylor thought that each employee's abilities and limitations could be identified so that the worker could be best matched to the most appropriate job.
Workers should be able to view how they “fit” into the organization and how they contribute to overall organizational productivity. This provides common goals and a sharing of the organizational mission. One way Taylor thought that this could be accomplished was by the use of financial incentives as a reward for work accomplished. Because Taylor viewed humans as “economic animals” motivated solely by money, workers were reimbursed according to their level of production rather than by an hourly wage.
The relationship between managers and workers should be cooperative and interdependent and the work should be shared equally. Their roles, however, were not the same. The role of managers, or functional foremen as they were called, was to plan, prepare, and supervise. The worker was to do the work.

Taylor's Scientific Principles

Scientific management is neither efficiency device, nor a new scheme of paying men. It is not holding a stop watch on a man and writing down things about him, it is not time and motion study nor an analysis of the movements of men. In its essence, scientific management involves a complete mental revolution on the part of the workman engaged in any particular 14establishment. It involves complete mental revolution on the part of those on the management's side. This new technique of managing involved two major elements:

Discovery by experiment the best way of performing and the proper time for every operation and every component, unit of an operation in the light of the best material, tool, machine, manipulation of tool or machine.
The division of labor in between management and workers. The great gains in productivity accruing from this technique of management came not from greater exertion on the part of workers but from elimination of wastages of workers time and machine time through delays of misapplied efforts failure in coordination of quantities and so forth.

Taylor was thoughtful and systematic in his approach and advocated the following:
- The replacement of rules of thumb with more carefully throughout guidelines to action.
- The collection of data to support decisions rather than reliance on casual judgment.
- The elimination of waste effort.
- Emphasis on fitting workers to particular task.
- Greater care in training workers to the specific requirements of their jobs.
- Greater specialization of work activities.
- The establishment of standards for performance.

Managers can always improve various operations by a simple reflection in the way in which the work is being done and there is always a room for improvement. In association with Carl Barth, who was a better mathematician, Taylor developed a slide rule on which any foreman could calculate various variables for any job. It was apparent that many of the delays and interruptions in work were the consequences of faculty planning. The main aim of scientific management was to maximize the production and efficiency of each worker and to design a system which would maximize the carrying of worker and employers. The scientific management do not take into account the informal relationship existing in the organization which have its own structure. This concepts gave birth to Human Relation Approach.

Taylor advocated a philosophy of management under which management would undertake the basic responsibility of planning and control and prescribe the rules, laws and formulas to guide the actual operations by man and machines, so as to help employers to produce at lower cost giving more remuneration to workers. Taylor contended that workers should not be left to choose their own method of producing, and developing their skills on their own. Management should evolve laws of standard work and rules for work measurement.

Standardization, Simplification, Time and motion studies, Functional foremanship, Production planning and control, Piece-Wage system of payment on differential basis, were the main ideas enunciated by Taylor.

Taylor's concept of management attracted following criticism:

Taylor's emphasis on extreme specialization is considered unrealistic. His advocacy of first class with developed skills raised an expectation that each worker should be an extraordinarily talented. The standards of efficiency evolved as result of time and motion studies etc. were conceived as too high, beyond the caliber and capacity of an average workers.
Taylor ignored human elements. He thought man as a cog in the wheel. His emphasis on efficiency at all costs turned the workers into mere machine.
In Taylorism the workers are speeded up without fundamental improvements in factory layout, production methods, tool design, training, etc.
Worker's wage would not be increased in direct proportion to the additional productivity exhibited by the workers.15

Frank Gilbreth

Frank Gilbreth and his wife Lillian Gilbreth made memorable contribution to improvement of working methods. He contended that it would be essential to find out the best way to perform a particular job with marked efficiency and least exertion. He developed a unique technique of speed work. Speed work, however, did not refer to hurrying with the work but economising the time sequence by eliminating unnecessary time sequence and exhausting motions and methods of doing a work.

The best method is that which implies least motions. Worker should not waste his energy and effort in moving his body unnecessarily. He advocated “rhythm in work” with balanced movement of concerned members of body while at job. His work analysis indicated 17 basic elements in working on any job. These elements were termed as ‘therbligs’. To improve operational efficiency workers should be guided to develop balanced rhythmic motions. Gilbreth also introduced the use of micromotion study. In such studies the operations were recorded on a film along with time values ascertained from a clock set up within the camera's focus. By this method he could analyze minute subdivisions of manufacturing activity. The present concept of scientific management is that the old methods are ineffective in giving productive ends. Hence, a new set of ideas are needed for orderly organization of complex industrial activities.

Scientific method is comprised of following sequences:

Identifying the problem and objectives.
Defining the objectives and problems.
Collection of data on the problem and the objectives.
Analysis and interpretation of the data.
Consideration of alternatives.
Formulate tentative conclusions about tackling the problems.
Taking up selected action on the basis of conclusions and testing the results.
Reviewing and evaluating the results and introducing any corrective action if necessary.
Framing “laws and models” to serve as a guide to planning and execution.

Scientific management has been viewed as a systematic approach to conduct the enterprise on the basis of observation experimentation, rational conclusions or decision rather than depending on conventional methods based on trial and error.

Taylor advocated in the interest of societal prosperity, close collaboration and deliberate cooperation between the employees and employer. His philosophy of management was based on mutual interests and on four basic principles of scientific management:

The development of true science
The scientific selection of employees
The scientific education and development of employees, and
Intimate and friendly cooperation between employees and employer.

In scientific management, these principles are not separable and tells us the philosophy that the scientific management:

Is based on Science, not Rule of Thumb
Is attained by harmony, not discarded
Has attained by cooperation, not individually
Can yield maximum output, in place of restricted output, and
Enhances development of efficiency and prosperity.16

According to Taylor the scientific management required a mental revolution by both managers and workers, regarding their duties, towards their work, towards their follow workers and towards all of their daily problems to achieve the objectives. Taylor also specified nine qualities of which will make a good foreman/workman, includes education, special technical knowledge, manual dexterity and strength, tact, energy, spirit, honesty, judgement and good health. By all accounts, Taylor must be regarded as a pioneer in the study of human beings at work. He was the first person to initiate the quest for better performance at work.

However, most of the view expressed by Taylor can be applied to our nursing situation. To sum up, Taylor's system for work improvement consisted of the following steps:

Observing the workers performance through time and motion study to determine the one best way to carry out each task.
Scientifically selecting the best worker to perform each job, that is, the person with characteristics and abilities needed to carry out job tasks in the most efficient manner.
Training the selected worker to perform tasks in the most efficient manner.
Paying the worker a differential piece rate, to motivate him or her to perform the task in prescribed and efficient fashion.
Appointing a few highly skilled workers to managerial positions and giving each manager responsibility for planning tasks for subordinate workers.
Appointing foreman for each aspect of the work and instructing the production worker to report to a different functional foreman for each aspect of the job.

Henri Fayol (1841–1925)

Henri Fayol was born in France, educated as an Engineer at the National School of Mines, and employed as Mining Engineer and then as General Manager of a coal and steel company. He divided all activities in an Organization into following six groups, i.e. technical, commercial, financial, security, accounting and administrative. Fayol broke down the key function of administration into five main aspects; to plan, to organize, to command, to coordinate and to control. Actually, it will be seen that there are 6 main aspects; forecasting and planning, organizing, commanding, coordinating and controlling. These six aspects of administration, fall into two main groups related as, process and effect as follows:

Process	Effects
1. Forecasting	Plan
2. Organization	Coordination
3. Command	Control

These six aspects of administration follow each other in logical sequence, i.e. forecasting is needed prior to formulation of plan. The plan needs organization which in turn needs coordination of the efforts of the persons involved, and can be achieved by an effective command:

Forecasting → planning → organizing → coordinating → controlling

Fayol's experience as famous French industrialist led him to develop the following propounded fourteen principles of administration:

A French industrialist developed a general theory of management in all aspects of business of an undertaking. Fayol identified the following functions of management:

Planning policies, programs and procedures.
Organization based on hierarchy of authority.17
Commanding means directing the business in order to gain optimum return from all workers.
Coordination, signifying harmony in activities of the organization and to facilitate its working.
Control, meant to rectify the errors of the functionaries of organization and to ensure that such errors do not reoccur.

Fayol divided all the work carried out in a business enterprises into the following categories:

Technical activities (production, manufacture, etc.).
Commercial activities (buying, selling, personnel, and industrial relations).
Financial activities (to have optimum use of capital).
Security activities (production of property and persons).
Managerial activities (planning, organizing, commanding, directing, coordination control, communication, motivation and leadership).

According to Fayol the managerial activities consisted of drawing a plan of action, building up a dual structure material and human to organize activities, unifying all activities and efforts through coordination and ensuring conformity of work to establish rule and express command.

Fayol's General Principles of Management

Fayol also laid down the following principles of general management. Which have already, required earlier, for more understanding are mentioned here:

1. Division of labor, 2. Authority and responsibility, 3. Discipline, 4. Unity of command, 5. Unity of management, 6. Subordination of industrial interests to the common good, 7. Remunerative, 8. Centralization, 9. Hierarchy, 10. Order of team members, 11. Justice, 12. Stability of tenure, 13. Initiative, 14. Sense of union.

Division of labor: It is a law of nature. That is each man can develop special skill. The purpose of division of labor is to attain more and better returns from the same amount of effort.
Authority and responsibility: Authority is the power to give orders and accept obedience. It is derived from one's personal qualities such as intelligence, knowledge, moral, attitudes, skills and leadership and calls for both statutory and personal authority, responsibility is inseparable from authority. If follows whenever authority is exercised, the man with authority carries responsibility for his decisions and actions.
Discipline: The agreement between an enterprise and its employee calls for obedience, diligence, energy, cooperative attitudes.
Unity of command: Authority to give instructions to an employee must be limited to one man. If this rule is broken, authority will be weakened. An employee must know whom to given instructions, and he must not be confused by having to follow the instructions of several people who have authority.
Unity of management: There should be only one plan and one manager directing all operations.
Subordination to industrial interests to the common good: In any undertaking the interests of single members, or of some of the members of the team, must not take precedence over the interests of the enterprise as a whole.18
Remuneration of the team members: Fair rewards for work done must be offered to all members of the organization.
Centralization: Like division of labor, centralization is one of the natural principles of organization. In all organizations it is present to some degree. The question is: To what extent in a given enterprise will it be most advantageously adopted?
Hierarchy: The line of command extends downward in order of rank from the top of the organization through all levels of authority to the lowest employee. It is the channel through which all official communication travel.
Order: Order is an organization calls “A place for everyone and everyone in his place”. When the order of persons is clearly well established the function may easily identified in relation to the whole.
Justice (equity): The employees will put all their devotion and good intentions to work for the common effort if they are treated with friendliness and justice.
Stability of tenure: An organization need employees who will stay with it. Such employees help the organization to achieve stability.
Initiative: Providing opportunity to subordinates to exercise their initiative which gives them, satisfaction.
Sense of union (Espirit de corps): Harmony and unity in the enterprise are source of strength. That is why modern management tries to bring the individual members of an organization to work themselves as a team.

In addition to the requirements listed above, there are still more principles by which good organization can be recognized. They are as follows:

The number of organization units should be the minimum needed to cover the major enterprise functions.
All related functions should be combined within one unit.
The number of levels of authority should be kept to a minimum.
There should be room for initiative with the limit of his assigned authority.
Functions should be assigned so as to minimize cross relations between organizational units.
No more employees should report to a superior than he can effectively direct and coordinate.

Fayol also stressed that managers should possess physical, mental, moral, educational and technical qualities to conduct the multifaceted operations of business enterprise. Fayol desired that management training should be provided to imbibe the principle and qualities essential for management. Technical ability according to him was the most important. But as one moves up the scalar chain, managerial ability becomes more significant and quality to be cultivated for top-level executives. Thus, Fayol advocated some valuable concepts in management which can be incorporated usefully in present day analysis of management science. His emphasis on unity of command and direction, non-financial incentive, decentralization, coordination have greater relevance even today.

Division of work: There should be division of work and task specialization than different workers consistently carrying out different job responsibilities.
Authority: Each worker should be given authority to commensurate with the amount of his responsibility.
Discipline: Each worker and management should maintain proper discipline, voluntarily according to their placement.
Unity of command: Each employee should receive orders from one supervisor only.19
Unity of direction: One person should direct all activities that support a single objective.
Subordination of individual interest to general interest, i.e. the interest of the individual work, should be subordinated to the interest of the total work group.
Remuneration: Proper remuneration which includes salaries, allowance and other incentives to be given to all employees according to their level of performance and responsibility by the management or employee.
Centralization or decentralization: Certain powers and functions reserved with top level authorities and other powers and functions are distributed to executives and co-executives and workers also to some extent.
Scalar chain: There should be an unbroken scalar chain/hierarchy of authority extending from the top executive to the lowest level worker.
Order: There should be proper policies, rules and regulations to maintain an orderly situation in the organization.
Equity: All employees should be treated with equity and justice.
Stability and tenure: There should be prescribed tenure which is needed for all employees.
Initiative: All employees and management should take proper initiation to achieve the objectives of the organization.
Esprit de corps: The group spirit and group morale can be cultivated among employees and employer to accomplish objectives.

Fayol recognized the tentative and flexible nature of these principles, stressing that effective management results from basing each action on the appropriate principle.

Luther Gulick

Luther Gulick a classicist was influenced by Taylor and Fayol. He used Fayol's five elements of administration, viz. Planning, Organizing, Command, Coordination and Control as a frame-work for his neutral principles. Gulick condensed the duties of administration into a famous acronym “POSDCORB”. Each letter in the acronym stands for one of the seven activities of the administrator as given below:

Planning (P): Working out the things that need to be done and the methods for doing them to accomplish the purpose set for the enterprise.
Organizing (O): Establishment of the formal structure of authority through which work subdivisions are arranged, designed and coordinated for the defined objective.
Staffing (S): The whole personnel function of bringing in and training the staff, and maintaining favorable conditions of work.
Directing (D): Continuous task of making decisions and embodying them in specific and general orders and instructions, and serving as the Leader of the enterprise.
Coordinating (CO): All important duties of interrelating the various parts of the work.
Reporting (R): Keeping the executive informed as to what is going on, which includes keeping himself and his subordinates informed through records, research and inspection.
Budgeting (B): All that goes with budgeting in the form of fiscal planning, accounting and control.

Here, the list of activities is an improvement over Fayol's elements of administration. The term “POSDCORB” came into wide use, in the administrative processes. With its merits and demerits, it served a number of writers well in dealing different aspects of administration including the author of this book.20

After stressing the significance of the structure as a designing process and identifying the functions of the Executives in terms of “POSDCORB”, he is one among the administrative experts concentrated his efforts on the discovery of Principles of Organization based on which the structure may be designed. Gulick was very much influenced by Fayol's 14 basic elements of administration in expressing his principles of administration as follows:

Division of work or specialization
Bases of departmental organization
Coordination through hierarchy
Deliberate coordination
Coordination through committees
Decentralization
Unity of command
Staff and line
Delegation, and
Span of control.

In assigning functions to groups of people, the division of work principle is homogenicity based on the identity or simplicity of four factor (4 Ps of Gulick) well suited to nursing, i.e. the Purposes they serve (function), the process they use, the persons or things which they deal with (clientele) and the place where they work. Like this other principles also well suit to Nursing Administration.

Lyndall Urwick

Lyndall Urwick also one among classical theorist, attached more importance to the structure of organization than the role of the people in the organization. He traces a very large proportion of the people in the society. With its manifest consequences in human suffering, to the faulty structural arrangements in organizations. Therefore, he stressed the importance of design in organization and pointed out that it is impossible for humanity to advance the knowledge of organization unless this factor isolated. He further considered lack of design as “illogical, cruel, wasteful and inefficient”.

Urwick also concentrated his efforts on the discovery of principles and identified eight Principles of Administration applicable to all organizations as given below:

The “Principle of Objective”—that all organizations should be an expression of a purpose.
The “Principle of Correspondence”—that authority and responsibility must be co-equal.
The “Principle of Responsibility”—that the responsibility of higher authorities for the work of subordinate is absolute.
The “Scalar Principle”—that a pyramidical type of structure is built up in an organization.
The “Principle of Span of Control”
The “Principle of Specialization”—limiting one's work to single function.
The “Principle of Coordination”
The “Principle of Definition”—Clear prescription of every duty.

Max Weber

Max Weber (1864-1920) was a German intellectual with no managerial experience, who studied at the University of Heidelberg, taught Law at the University of Berlin and Economics of Freiburg University, then studied politics, sociology and economics as a private scholar. His major work on theory of Social and Economic Organization had a major impact on American Management. He advocated bureaucracy as the ideal form of organization for a complex institution. Weber described a bureaucracy as having a well defined hierarchy of authority, 21division of work based on specialization, highly specific rules governing worker's duties and rights, debuted work procedures, impersonal interpersonal relationships and promotion based on technical competence.

Weber also claimed that bureaucracy was superior to other forms of organization, because it provides greater stability, precision and reliability in controlling employees. Interestingly, “Bureaucracy” which he considered highly efficient in dealing with changing circumstances, is seen as too rigid and ponderous to respond to today's rapid societal change. He provided the classical theory of organization and management. He felt the bureaucracy was the most efficient form for complex organization. His areas of emphasis are: (i) Hierarchy of authority, (ii) A system of rules, (iii) Division of labor, (iv) Impersonality of relationship, (iv) A system of work procedure, and (vi) Legal authority and power.

Mary Parker Follett

Mary Parker Follett (1869-1933) was an American who studied government and business Administration at Radcliffe and abroad. She viewed management as a social process aimed at motivating individuals and groups, to work towards a common goal. She advised managers on avoid arbitrary authority and put stress on successful leadership skills that should be developed, rather than possessing specific personality traits.

Follett also said that investigator should analyze manager's job in the same way that Taylor analyzed laborers job, so that executives could be taught effective management skills and allowed to practice new skills under supervision until they become habitual. In relation to authority, she advised that manager should never give orders to an employee, instead manager and employee should analyze the situations together, and then both should take orders from the situation.

Mary's area of contribution has been the psychological foundations of a human activity and the emotional Elections in the working of human groups. She contended that none can become a full person unless he becomes a member of a group. Follelt major areas of contribution are:

Removal of conflicts. Three areas of removing conflict are viz. domination, compromise and integration. She considered integration as the best alterative of meeting the real needs of both the parties.
Participation of workers.
Group dynamics. It regards group as more than a mere collection of individuals.
Leadership.
The law of situation.
Management as a profession.
Coordination.
Authority.

Follett evolved ideas and theories which have stood the against time and changes which are stimulating the thinking of manager even today. According to Follett “Man can discover his true nature, can reach greater release of his own relative powers, gains his true freedom only through powers of the group.

Elton Mayo

The contribution of Mayo to administrative organization has been great innovation of the modern times. For the first time, Elton Mayo and Fritz Roethlisberger conducted studies 22(1927–1933) at Chicago's Hawthorne Western Electric plant to test several assumptions of scientific management. The purpose of the study was to determine relationship between intensity of illuminations and workers productivity. When research increased the level of illumination of the experimental group—work output increased, as expected. However, when illumination was decreased, output continue to increase. The researcher concluded that an unidentified psychological factor had influenced work output.

Elton Mayo (1880–1949). A harvard Sociologist and director of Hawthorne studies offered evidence that an organization is not only a formal arrangement of men and functions, but also a social system which can be operated successfully only with the application of the principles of psychology and other behavioral sciences. Elton Mayo's, recognized for the first time the importance of new aspect of the problems of industrial civilization and this new aspect related to the complexity of the work situation. Mayo's initial interests were in fatigue, accidents and labor turnover. Mayo was the first to emphasize the understanding and realization of the human factor in organization. He concluded that of all the factors influencing employee's behavior the most powerful were those emanating from the workers participation in social groups.

Mayo felt that work satisfaction depends to a large extent on the informal social pattern of the working group. He thought that the supervisor could be trained to play a different role which could help him to take personal interest in the subordinates and discharge his duties in better manner. He also noted that the worker should be made to come out openly with their needs, interact freely and without fear with company officials. The term “human relations” mostly refers to relations between workers and employer, which are not regulated by legal norms. These relations are concerned with moral and psychological factors rather than legal factors. The human relations concepts is concerned with devisory concrete methods for ideological orientation of workers in the factory/enterprise.

Kurt Lewin

Kurt Lewin a social psychologist, developed the Field theory of human behavior (1951). He claimed that a worker's job behavior is influenced by interactions between workers personality, work group structure and sociotechnical climate of the work place. On the basis of his study, Lewin concluded that the process of behavior changes occurs in three phases.

He is described as the father of Group Dynamics. Kurt developed the field theory of organization. The core idea of this theory is that the behavior of a man is a function of the person and his field or environment. Lewin and his associates demonstrated through experiments that authoritarian leadership impairs initiative and breeds hostility while the democratic style is more effective in building morale and promoting active participation.

Unfreezing: When an alteration in Social and Psychological forces is perceived, an individual's equilibrium is distributed, facilitating attitudinal and behavioral change. When thus imbalanced, an individual can be motivated to other behavior, either by increasing pressure to make the change or reducing threats associated with the change.

Changing: The individual demonstrates the desired attitudes and behavior either by mimicking behavior of a role model who portrays those behaviors or by “discovering” the desired attitudes and behaviors when placed in a situation that required trend.

Refreezing: The individual integrates the newly acquired attitudes and behavior into daily activities and organizing relationships. Whether the new behaviors are learned through 23identification or self-discovery, the individual will not display permanent behavior change unless the desired behavior is continually reinforced by superior, peers, and subordinates.

Abraham Maslow

Abraham Maslow an American psychologist has given best known classification of human needs known as “Need Hierarchy.” According to Maslow, human needs can be categorized as: Basical psychological needs, security and safety needs, social needs, ego or esteem needs and self-fulfillment or self-actualisation needs. These need are further divided into primary needs—psychological and security needs and secondary needs—social, ego and self-fulfillment needs. Maslow's work most employees experience a variety, motivating them to come to work and perform at a given level of effort.

Maslow in his classic paper “A Theory of Human Motivation” (1943) outlined an overall theory of motivation. He analyzed the relationship between the human beings and organizations from the stand point of “human needs”. Human beings join the organization to fulfill their needs. These needs arise in many areas. Fulfillments of these needs motivate the human beings to a higher level of performance. Nonfulfillment of needs will have adverse effect on the motivations of the individuals to contribute to organization to realise the organizational objectives.

Maslow arranged individual needs in an hierarchical manner as shown in Figure 1.3.

As shown in figure, physiological and security needs are lower order needs in the hierarchy. Self-actualization need is higher in the hierarchy. In between comes the social and esteem needs. Maslow believed that unless the need at the lower level is satisfied, it will not moderate a person. The meaning of these needs in relation to administration is as follows:

Physiological needs includes the basic things necessary for human survival, e.g. hunger, thirst, shelter, etc. The human being has to satisfy these needs first—once these are satisfied, individual no longer strives hard to obtain these and he himself is motivated to work hard for organization.
Security needs include job security or safety and the work place, thus giving psychological security to human beings. Safety includes both physical and emotional safety. Human being is a safety seeking mechanism. Once safety and security is ensured, they no longer motivate the human being.

Fig. 1.3: Presentation of individual needs in hierarchical manner.
24
Social needs represent the relationship between and among groups of people working in the organization. This need provides emotional security to people and also gives a sense of belongingness and association. Every human being needs friendship with others. If these needs are not met the employee becomes resistant and hostile.
Esteem needs represent higher level needs of human beings. At this level, they strive for power, achievement and status. Esteem connotates both self-esteem and esteem from others.
Self-actualization is a higher level need represents culmination of all other needs. The fulfilment of this need gives a higher degree of satisfaction to individual in work and life. Further, it improves the person's performance in the organization. A self-actualized person has fulfilled all his potential. This represents person's motivation to transform perceptions of self into reality.

It is the responsibility of the administration, to fulfill the needs of its employees. Physiological needs of the employees are met in the form of salary and other amenities. Once his basic needs are satisfied, he expects satisfactory safety and security needs. Here the management of the organization can provide proper safety according to their placement or positions and nature of work and also job security is must for all employees in the far fixing tenure of employment. Human beings are social beings and they value affiliation and association which includes employees, acceptance in the organization. After satisfying social needs, next the human mind searches for autonomy and prestige in the organization and freedom of work with and through people. The fulfillment of esteem needs gives self-confidence to people and prepares them to take up leadership positions, guidance to others and appraising the performance of others. After satisfying the esteem needs person proceeds to achieve self-actualization need. This is described as achieving the meaning and purpose in life through personal and professional growth. It is expressed by achieving higher performance on a role, be it a worker, or a supervisor or a manager or administrator in an organization. This is spirit of excellence found in all societies and organizations. This can be achieved only when all needs lower to it are fulfilled. Need fulfillment in an organization requires self-control, goal-orientation and work ethics from the organization as well as from its members.

Douglas McGregor

McGregor is the father of the classical theory of management which he termed theory.

McGregor put forth the theory as a modest beginning for a new theory with respect to the management of human resources. McGregor thesis is that the average employee has high degree of imagination ingenuity and creativity and under conducive atmosphere the individual seek responsibility and if committed to objectives he will exercise self-direction and self-contract. He advocated the task of management to be creating opportunities; encouraging growth; removing obstacles; providing guidance and releasing potential. To sum up McGregor's contribution towards the solution of industrial problems of today is certainly significant.

The Hawthrone studies launched the Human relation school of management, with Douglas McGregor—Chirs Argyris, and Rensis Likert as leading theorists.

Douglas McGregor is a behavioral scientist and a strong believer in the potentialities of human beings in contributing organizational performance. His focus is on utilizing human potentials in organizations and getting the best out of people by creating a conducive and harmonious environment. According to him the traditional manager in a bureaucracy operates on a set of assumptions about human nature and human behavior; that he called as “Theory X”. Accordingly these assumptions are:25

The average human being has an inherent dislike of work and will avoid it, if he can, when possible.
Because of dislike of a work, most people must be coaxed, controlled, directed, threatened with punishment to get through, put forth adequate effort towards the achievement of organizational objectives.
The average human being prefers to be directed, wishes to avoid responsibility, has rationally little ambition and is more interested in financial increments and wants security above all than personal achievements.

Accordingly “Theory X” assumes human beings as lazy, lacking in ambition, resisting change, non creative, capable of being deceived easily, etc.

In such a case, management has two strategies to adopt viz. hard and soft. Hard strategy implies the use of technique like close supervision, tight center, coercion and threat. Soft strategy on the other hand, is more permissible, meets the demands and attempts to harmonise the demands of the organizations and that of employees. Theory “X” represents classical administrative theory, lays stress on efficiency and economy by putting direction and control.

McGregor holds opinion that Theory “X” assumptions about organization, management and man are obstacles to performance and productivity and inadequate to realise all the human potentialities. McGregor himself questioned the validity of these assumptions and suggested that a different set of assumptions, broadly known as “Theory Y” to provide a more accurate assessment of human nature, one that encourages workers to develop their full potential.

The assumption about human nature under “Theory Y” are:

The expenditure of physical and mental effort in work is as rational as play or rest. The average individual does not inherently dislike work.
External control and the threat of punishment are not the only means of bringing about efforts towards organizational objectives. People will exercise self-control and self-direction when pursuing goals to which they are personally committed.
Committment to objectives is a function of the rewards associated with their achievement. The most significant of such rewards, e.g. the satisfaction of ego and self-actualization needs, can be direct products of efforts directed towards organizational objectives.
The average human being learns, under proper conditions, not only to accept but to seek responsibility. Avoidance of responsibility, lack of ambition and emphasis on security are generally consequences of experience, they are not inherent.
The capacity to exercise a relatively high degree of imagination, ingenuity and creativity in the solution of organizational problems is widely not narrowly, distributed in the population.
Under the conditions of modern industrial life, the intellectual potentialities of the average human being are only partially utilized.

The Theory “Y” underlines the importance of maintaining an organization where people feel confident and motivated. It emphasize on developing and improving performance orientation of the people working in the organization. It involves lot of leadership skills on the part of the manager to achieve these objectives. The corner stone of McGregor framework, is self-restraint, self-direction, goal orientation and human values in the organization.

Chris Argyris

According to Argyris (1964) during maturation, the individual moves to a condition of greater independence, more achievements, musts and activities, longer time perspective and increased self-control. Argyris claimed that the rigid structure and stringent rules of a bureaucracy block 26normal maturation, encouraging employees to become passive and dependent and decreasing their job satisfaction and emotional health.

According to Chris, as the individual grows from infancy to adulthood, he has a tendency to move from passivity to activity; from dependency to independence; from lack of awareness of self to awareness of self. Argyris suggested the redesign of jobs. Organization structures and content system and positive leadership styles for the effective motivation of employees. According to him managers must provide them with opportunities for a variety of experiences, give them responsibility and rely more on the employees, self-direction and self-content.

Rensis Likert

Rensis Likert proposed that effective organization are those where supervisors focus attention on building effective work groups with high performance goals, so worker will support organizational goals and cooperate with superiors and peers. Likert advocated “system 4” approach to organizational development in which organizational structure facilitates continuous interaction among various groups in the organization, so work is controlled through mutual influence by employees. A “system 4” organization is one in which superiors and subordinates trust each other in all matters, information flows freely throughout the organization (upwards, downwards, laterally) employees participate in setting high but achievable goals, decisions are made at all levels, training is provided to upgrade personnel and the control mechanism stimulates workers to solve their own problems.

Likert conducted an extensive research at Institute of Social Sciences, Michigan, USA and based in the findings of research work he advocated four styles of management viz: Exploitative; Authoritative: Benevolent Authoritative; consultative and Participative, Likert advocated participative style of leadership. He maintained that the use of supportive relationships; Group decision-making and high performance goals are must for achieving higher productivity. Likert put forward the supportive style of leadership as the new pattern of management. He concluded during the research that these are two distinct leadership orientations:

Orientation towards employees with emphasis on interpersonal relations on the job.
Orientation towards production with emphasis on technical aspects of the job.

He concluded that employee orientation coupled with general rather than close supervision leads to higher productivity, greater group cohesiveness, better morale, less anxiety and lower turnovers of employees.

Herbert Simon

Herbert Simon is a decision theorist who views business and service institutions are networks of decision-makers. He analyzed the human behavior in terms of its value preference in decision-making process. Human behavior, involves conscious or unconscious selection of particular alternative which is physically possible and organizationally effective. The selection of a choice refers to preference of a course of action over other courses of action. In any mechanised action, the choice and the action are directly related. The decision-making process involves three important phases of activities. These are:

Intelligence activity
Design activity
Choice activity.27

Intelligence activity: Involves finding, access to taking decision, for which executive has to analyze the organizational environment and identify the conditions that need decision. He likes the alternative strategies for problem solving.

Design activity: Involves development of alternatives to do a particular job. Here also the executive identifies the merits and demerits as well as problems involved in each of the alternatives, determining likely consequences of each alternative.

Choice activity: In this stage, decision-maker should choose or select one of the alternative or course of action, keeping in view the organizational goals. Here, executive evaluates consequences and selects the course of actions.

This behavioral approach of Simon emphasized that insight into the structure and function of an organization can best be gained by analysing the manner in which the decision and the behavior of such employees are influenced within and by the organization.

Simon advises that work decisions should be made at all levels of an organization and that each decision be based on premises about people as information processors. He contrasts two approaches to decision-making; optimizing, the approach applied by so called “economic man” and “satisfying”, the method used by so called “administrative man”.

Economic man is completely rational and so uses optimizing decision strategy to Bernard seek greater possible gain from each action. Where as administrative man uses a satisficing method, in which the manager looks for the one that is good enough to satisfy a set of minimum criteria. Economic man is a rational decision-maker and is expected to visualise all possible problem solutions and product all consequences of every action. An administrative man is willing satisfy, realising his perception of the world and use single rules of thumb to guide decision-making.

Chester I Barnard

Chester I Barnard (1886–1961). Barnard was a sociologist by choice and had wide experience as President of New Jersey Bell Telephone Company and of Rockefeller Foundation. His major contribution was how to develop cooperation among individual through the formal organization. The formal organization is a system of consciously coordinated activities or forces of two are more persons. Barnard defined that there are three universals in each system:

Willingness to cooperate
Common purpose
Communication.

In a system these are nonlogical elements influencing the behavior of the members of an organization. These elements constitute the informal organization. Informal organization is the aggregate of the personal contacts and interactions which are neither a part of nor governed by, the formal organization. But still informal organizations are indispensable to formal organization. Barnard also highlighted the function of the Executives as (i) Providing a system of communication, (ii) Securing efforts, (iii) Formulating and defining purpose. His other areas of contribution are upward delegation of authority and decision-making process.

Chester Barnard viewed organization as a social system. A system is defined as a set of arrangements of things so related or connected to form a unity or organic whole. A system is compose of elements under one related and dependent upon one another but that wherein interaction form a unity whole.28

Barnard laid emphasis on organizations as cooperative systems. This conveys the very essence of group effort (He expanded the nature of formal structure and informal organization (relationship) and then mutual inter dependency in a lucid way). It is the cooperation system that gives risk to formal organizations. He defines organization as a system of consciously coordinated personal activities or forces. The organization came into existence when:

There are persons able to communicate with each other
Who are willing to contribute action
To accomplish a common purpose.

Accordingly, the elements of organization are communication, willingness and common purpose. The process of cooperation in an organization require the following to make it effective.

The place where work is done
The time which work is done
The person with whom work is done
The things upon which work is done
The method or process by which work is done.

Barnard also laid emphasis on the acceptance of authority by others in an organization. He defines authority as “the character of communication (Order) in a formal organization by virtue of which it is accepted by a contributor or member of the organization as governing the action he contributes”. The acceptance of authority, in an organization depends upon the zone of indifference, i.e. if the orders fall within these zones, they are unquestionably accepted.

Barnard views helps understand the organization in a better way.

Henry Mintzberg

Henry Mintzberg, had the opportunity to observe the top level managers, activities that make him to refute the notion that managers spend most of their time in planning, organizing, coordinating and controlling activities. He claimed that a modern manager is not thoughtful, systematic planner whose decisions derive from careful analysis of objective data. He asserts that managerial activities are more reactive than productive and are characterized by brevity, variety and discontinuity. He concludes that managers do not base their decision on so called hard data supplied by a management information system but on soft data acquired during informal conversations with others.

Mintzberg reports that the topical manager or administrator patrons ten roles; which includes those are interpersonal, they are informational and decisional role as given below:

Interpersonal roles; are figurehead, leader and liaison. As a figurehead, a manager represents his institution at ceremonial events such as conducting visiting dignitaries through the organization and hosting other function. As a leader a manager hires and trains subordinates, schedules work hours, distributes assignments and direct group efforts to organizational goals. As a liaison a manager communicate with persons outside his or her vertical chain of command, to give or receive informations, maintain goodwill and integrate contribution from different work groups.
Informational roles are monitor, disseminator and spokesman. As monitor a manager sees the environment for information needed a portrary other roles. As disseminator a manager transmits some recently acquired informations to superiors, peers, subordinates or clients. As a spokesman a manager directs work related information to persons outside the unit or agency.29
Decisional roles are entrepreneur, disturbance or handler, resource allocator and negotiator. As Entrepreneur, a Manager develops new projects, or program to enhance agency image and welfare. As disturbance handler, a manager responds to high-pressure disturbances that threaten to disrupt the workforce and defeat goals. As Resource allocator, a manager determines what portion of agency is financial, personnel, supply and equipment resources should be allocated to each employee. In addition to allocating material resources, the manager allocates power, states, and time among subordinates, by developing work hard, making assignments and evolutionary performance. As Negotiator, a manager confers with persons inside or outside the agency to obtain concession or render agreement on pivotal issues.

W Ouchi

W Ouchi developed “Theory Z” as a means for applying, Japanese management principles to American industry. This approach combines elements of Japanese and American management approaches in order to combine the strength of both.

Japanese management methods derives from executives, underlying philosophy about workers, work and product. This philosophy incorporates the following concepts:

Lifelong employment on the same firm. Here worker are identified with organization.
Infrequent evaluation and promotions
Non-specialized carpet path development
Implicit control of worker behavior
Collective decision-making
Group responsibility for quality, and
Holistic concern for the employees welfare.

Theory “Z” calls for long-term employment, a combination of specialized and generalized training. For career development, slow promotion based on non-threatening peer evaluation, group decision-making based on both quantitative and qualitative data, decentralized control of performance quality and concern for both employee and agency welfare is required. The principles of group decision-making and decentralized control of quality are implemented through quality circles. In a quality circle, the manager and members of the primary work group meet for an hour, each week to solve work problems and improve work processes and outcomes.

Yoshida (1989) presented following Japanese management principles for those nurses who extend to implement and Japanese management system.

To improve service delivery. Each employee must start with a clear conception of what the most desirable service would include.
A manager can eliminate the need for continuous inspection by building quality into the process or product in the first place.
If employee do not understand the fundamental institutional purpose, single application of rules and procedures will not improve productivity and quality.
The notion of replacing and unsatisfactory worker with a more satisfactory worker, requires that one perceives the total organization as a complex that is composed of separate and replaceable parts.
Replacement of an unsatisfactory worker with a more satisfactory worker causes insecurity for remaining worker.30
Too close linking of responsibility to authority produces feeling of sectionalism and decreases loyalty to the organization as a whole.

Henry L Gantt (1861–1919)

Taylor's ideas were further strengthened and developed by Henry Gantt and Gilbreth. Among the chief contribution of Gantt some of them are:

Graphic chart: It helps in showing daily progress of production and thus facilitating production planning and control.
Emphasis on the human element: It emphasizes the respect for human nature and the development of talent and potential of workers. It amounts to directing their development instead of driving them.
Industrial democracy: It amounts the organization of industry in such a way that each individual has an equal opportunity to function at his highest capacity.
Social responsibility: It emphasizes that the business system must accept its social responsibility and devote itself primarily to service. Gantt also brought out that the responsibility of management is to teach and train workers to become more skilled, for better work habits and more dependability.

Oliver Sheldon

Oliver recognized that a company should play an important role as a part of socially rather than a means of earning. Better working conditions and efficient management are some of the important factors.

Henry Dennison

Dennison developed the concepts of motivation, leadership, team work, etc.

Alvin Brown

Alvin concentrated on the evaluation of the principles of delegation of authority.

Mooney and Reiley

They evolved the logical framework for the theory of organization by presenting certain principles of organization which occupy an important place in the modern theory of organization and management.

MODERN MANAGEMENT THEORIES

The modern era is characterized by trends in management through viz: (i) microanalysis of human behavior, motivation, group dynamics leadership leading to many theories of organization, and (ii) the macro search for fusion of the many systems in business organization—economic, social, technical, political and quantitative methods in decision-making. The microanalysis of human behavior has been discussed as behavior scientists contribution under the new classical theory. Modern management era can be further classified as three streams viz:

(i) Quantitative approach, (ii) Systems approach, and (iii) Contingency approach – indicating further refinement, extension and synthesis of all the classical and neo-classical approaches to 31management. The contingency approach can be described as the behavioral approach. While other two streams of management can be described as systems approach with its off-shoot in Management Science and Operations Research.

Systems Approach

According to system approach the organization is a unified, purposeful systems composed of interrelated parts and also interrelated with its environment. Each unit must mesh/interact with the organization as a whole, each manager must interact/communicate and deal with executives of other units and the organization itself must also interact with other organizations and society as a whole.

Ludwig von Bertalanffy

Bertalanffy, a biologist is credited with coining the general systems theory. His contention were that it was possible to develop a theoretical framework for describing relationship in the real world and different disciplines, with similarities could be developed into a general systems model. The similarities were:

Study of organization
State of equilibrium
Openness of all systems and their influence on the environment and environment influence on the system.

Kenneth Boulding

Boulding emphasized the need for general systems theory to describe the relationships of the empirical world. Harvard business review pointed out that some executive viewed management as a social system, some as data processing system, some as a system of fund flow. Based on this concept executives task can be grouped into four basic elements viz: (i) Defining company as a system of interrelated parts, (ii) Determining objective of each part, (iii) Creating formal subsystems, and (iv) Integrating all the subsystem and the environment system approach focus on the interdependence and interrelatedness of the various subsystems from the stand point of the effectiveness of the larger system. For instance our body is also a system being a resultant of other subsystem like the nervous systems, the circulatory system and the digestive system. In the real life we realize that even though systems are given boundaries so that we can analyze them. There can be no system that is completely isolated or independent of others. According to Koontz and O'Donnel there are no system which are closed that is completely independent of others. Systems do play a key role within the area of managing itself. System include organization system, planning systems, control system, etc. One can further identify within those many subsystem viz. system of delegation, budgeting and feedback of information for control.

Management Science: An Application of Quantitative Methods to Management

Management science refers to the application of quantitative methods to management. Management science has an interdisciplinary basis; in other words management science is a combination and interaction of different scientists. Management scientists who lay significant contribution are Russell L Ackoff; Eleonard Arnoff; C West Churchman; Edward H; Bowman; Robest B Felter; Elwood S Buffa; Jay W Forrester; and Samuel B Richmond. The others who are 32worthy of mentioning for their contribution viz. Norbert Wiener in USA and Stafford Beer in Britain. Since operation research is still in the early stages of application there are too many names who have made a significant contribution. John Diebold is probably the best known for his contribution in the field of computers and automation.

Schools of Management Thought

The pioneers on management have made several attempts to identify themselves with various schools of thought in management or have contributed to several schools of thought in management. Following are the major schools as analyzed by Harold George R Terry:

Management Process
Empirical
Human behavior or human relations
Social system
Decision theory
Mathematical or quantitative management
System management
Contingency

NEED FOR MANAGEMENT IN NURSING

Nursing is a major component of the health care delivery system, and nurses make up the longest employment group within the system. Nursing services are necessary for virtually every client seeking care of any type, including health promotion, diagnosis and treatment, and rehabilitation. Because nursing is such an important part of the health care delivery system and because the delivery of nursing services is tied to other components of the health care delivery system, the nurse needs to understand the system to effectively deliver quality care within it. Every nurse practicing today needs to appreciate that health care is a business. The success of health care business depends on nursing participation in changing the systems for delivering cost-effective care and creating strategies to ensure that clients receive quality care.

Since ancient times, nursing has been required to respond to changing technological and social forces, e.g. managerial responsibilities evolved in response to an increased emphasis on the business of health care, thus requiring managerial expertise in the financial and marketing aspects of their departments. Because of the trends in the health care delivery the nurse supervisor/administrator manager role is becoming critical to effective, quality, patient care; to confronting these expanding responsibilities, and demands the nurse manager must taken on new dimensions to facilitate quality outcomes in patient care and meet other strategic institution goals and objectives.

There is need to develop managerial skills and leadership skills. Two of the foremost tasks of a new nursing leadership will be to raise the consciousness of nurses through an ongoing critique of the present system and to offer philosophical and practical rationales for fundamental change, based on nursing values and the control role that nursing plays in the health care process. These skills are also necessary for team building at the organizational level, ensuring success in all aspects of nursing administration and maintaining high quality in the areas of nursing service, nursing education and nursing administration as a whole.

The nursing administrator historically has been the nurse who endured, who followed the administrators and physicians directions well, and who characteristically was seen as having 33less power and competence than other administrators. With today's pressures, that nursing administrators cannot exist long. Trends in the nursing community have produced nursing administrators who can think independently and can solve problems as well as direct others in goal setting and achievement. Unfortunately, the issues facing nursing today and in the nearing future are extremely complex and involve more than just nursing.

The present nursing administrators have been ill-prepared to face those issues in all level of their administration. So there is a need for all nurses irrespective of their primary job, must assume responsibility for the management or administrative functions that are inherent in every nursing job. It is often said that the role of the professional nurse is becoming increasingly bureaucratic. If bureaucracy includes managing others, managing proper work and managing multiple program or agendas of the health care delivery system/enterprise, then there is truth in that statement. The increasing complexity of delivering patient care requires a multifaceted role for the professional nurse and includes managerial responsibilities.

These managerial activities differ depending on the specific job and situation, but they always include effective communication, delegation, human relations and the management of people, time and resources. The professional nurse also plays an important role in managing change, resolving conflicts and making organizational goals. The role of the nurse is composed of a multidimensional set of activities that focus on care of the patient, support of the organization, and support of the profession and oneself as a professional.

Since many years, nursing has rigidly adhered to categorization of nurses as clinicians, educators, managers or researchers. Their role categories have referred to primary focus of the job. Now there is a need for every nurse to have a sound management base from which to operate. This aspect of the clinical work role cannot be delegated or relegated as a low priority. Management is a key to success in the professional nursing job. The issue has become one of the many aspects of job—clinical, managerial, educational and research with overall consistency. As with most learning it is easier to start with simple and move to the complex. The new nurse can identify the basic managerial behaviors necessary for success and practice these until mastery is achieved. She/he can move towards the more complex managerial activities that ultimately may result in a change in her/his primary role from clinical nurse to manager.

Nurses in managerial roles must be able to understand the conditions promoting and innovating the expression of talent among team members. This understanding requires a close look at the new responsibilities and activities with which managers should be involved and an equally close look at which of the traditional roles must be modified to accommodate the every evolving changes. As the health care industry/system has changed dramatically in the past few years, so have the roles of nurses. These changes have led to role ambiguity as nurses search for models that will meet changing demands.

The managerial roles being assumed by clinical nurses are the result of requirements to push decision making to lower of the organization and encourage nurses to determine the ways in which the delivery system can best function. The contemporary manager is finding that the pure managerial role is changing. No longer an authoritarian order gives, today's manager a concentration on providing a climate in which individuals have a sense of working for themselves. Thus, role of the manager should be able to:

Provide visibility for organization goals
Provide resources and define constraints
Mediate conflict
Serve as a coach or member34
Monitor results
Stay out of the way so that individuals can manage their work.

This redefines managers role to provide opportunities for persons to manager their own work gives clear direction to the nursing personnel to assume responsibility, whether clinical or managerial.

For all the above reasons, the nurses must be prepared to look into the matters of all types of management. So, managerial concepts or concepts of administration needed by the nurses at all level, focus on how to deal with people, how to manage resources, and how to manage ones job. This preparation is important in making that first job more meaningful and understandable.

Nursing administration describes the managerial role of the nurse in complex organization, the management of one's professional career, and the issues related to contemporary professional nursing practice.

TECHNIQUES OF MANAGEMENT

Management handles the tools and techniques to achieve a desired goal. Management inferes planning, organizing, directing, coordinating and controlling of human and other resources to achieve the specified goals. A technique is a set of procedural steps which may be loosely or rigorously stated, which embody a multiple idea content and which are concerned with doing a work to achieve goals.

“Management techniques are systematic procedures of investigating, planning, controlling and supervising which can be applied to the management problems”.

Classification of Management Techniques

Management techniques can be classified in different ways. The classification of management techniques is given by MJ Clay, which is based on the objectives of the technique, as he mentions the following eight objectives which various management techniques attempt to achieve.

Detection: To find out or discover something, e.g. what is happening or what is wrong? The techniques which include detection are, input-output analysis, attitude survey, production study, activity sampling, critical examination, breakeven analysis.
Evaluation: To measure or estimate the value of an item. The techniques which includes in evaluation are, job evaluation, work measurement, work estimation, performance, appraisal, cost benefit analysis, network analysis.
Improvements: To improve performance. The techniques used here are, management by objectives (MBO), method study, value analysis, management by exception (MBE) etc.
Optimization: To optimize performance. The techniques used here are linear programming ergonomies, operational research, etc.
Specification: To specify a desired value of situation or action. The techniques will be used here are layout planning for offices and plants, etc.
Control: The techniques used here are cost control, credit control, labour control, inventory control, production control, budget control.
Communication: To communicate information. The techniques used here are, visual aids, suggestion schemes, report writing, communications theory, information theory, management information, etc.
Demonstration to demonstrate something. The techniques used here are, programmed learning, job instruction, management development and training etc.

Brief descriptions of the new techniques and their utilization are as follows:35

Job Analysis

Job analysis is the process of gathering information on all aspects of a specific job. Job analysis is a “scientific study” and statement of all the facts about a job which reveal its content and the modifying factors which surround it.

One of the purposes of job analysis and measurement is to set standards for specific job. Job analysis help the management in many ways as follows:

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 and obsolete practices which often encrust the job in actual performance,
It shows where there is overlapping or duplication of work and the faulty use of existing personnel
It provides basic material for the production of work and procedure manuals,
It helps to promote good morale that enables the administrator to deal intelligently with complaints,
It also helps the administrator to establish definite lines of promotion.

Work Measurement and Setting Standards

There are number of methods of measuring work and setting standards as follows:

Analysis of past production records is perhaps the strongest method of measuring work 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 use it as a standard on the assumption that if it was done before, the workers should be able to do it again. The advantage of this method is that it is easily used and at a relatively low cost with no need for highly trained personnel to administer it. The disadvantage is, of course, that existing inefficiencies are not corrected, they are merely recorded and analyzed.
The time analysis method: It is fairly simple method of establishing work standards. Various work activities done by an individual during the day are identified and placed on a form, then the worker records the actual time spent and unit produced. The determination of a standard time from such information involves a great deal of subjectivity at best.
The work sampling method: It is an important over the time analysis method in which a trained analyst makes random observations (based on statistical method) of the various work activities done by individuals. The data thus obtained are more reliable than those from the time analysis method. However, they do require the services of trained analyst.
Time study: It is a method of measuring job performance to establish the time required for performing each operation at an average pace. The purpose is to measure the output of a worker of average skill who is performing his work with average effort under standardized conditions so that standard times can be determined.

The initial phase of a time study is to acquire sufficient familiarity and knowledge of the operation, equipment and working conditions. A job is divided into work elements or groupings of basic movements. Element times are taken directly at the work place by clock readings or remotily by motion picture analysis.
Motion study: It goes beyond mere measurement. Its purpose is to make work performance easier and more productive by improving manual motions. During the end of 19th century, Frank B Gilbreth made a detailed motion study and considered it a scientific method of eliminating wasted efforts in work. He suggested that motion study consists of dividing 36work into the most fundamental elements possible studying these elements separately and in relation to one another, and from these studies building methods of least waste.

These work measurements and method study are used in the examination of human work in all its contexts, and which lead systematically to the investigation of all the factors which affect the efficiency and economy of the situation being reviewed in order to effect improvement.

Cost Benefit Analysis

Cost benefit analysis is a tool with great potential for the decision maker so long as he or she recognizes the difficulty in determining the true costs and benefits of various alternatives. This tool can be especially useful when trying to decide between alternative expenditure of money.

A cost benefit ratio (Z) is defined as the ratio of the value of benefits of an alternative to the value of alternative cost

Cost benefit analysis is designed to consider the social costs and benefits attributable to the project. The benefits are expressed in monetary terms to determine whether a given program is economically sound, and to select the best out of several programs.

Cost Effective Analysis

Cost effective methods are those that search for the least costly way of achieving a defined result. Cost effective analyzes are easier to make, as that is clear. It helps the administrator in managing his health resources at the local level. The problem is to find the way of achieving the objective at lower cost.

ABC Analysis

It is technique which would enable a busy executive to chase those activities ardently which would quicken the wheels of administrative machinery. By arranging his work into an order of priorities, he can decide on which items to concentrate first, on which others to deal later and on yet which others to delegate to his assistants. When done more systematically and in quantitative terms, this system building up priorities of work called the ABC analysis.

ABC analysis can be of great use in dealing with materials management. Here it is the analysis of store items on cost-criteria. It has been seen that large number of items consume only a small percentage of resources and vice-versa. A—items high cost centers, B—items intermediate cost centers, and C—items are low cost centers. In so far as inventory control is concerned the following guidelines will help in keeping the system optimum.

A—items	Tight controls Rigid estimates Strict and close watch Safety stocks should be low Management of items should be done at top management level.
B—items	Moderate control Purchase based on rigid requirements Reasonably strict watch and control Safety stocks moderate Management to be done at middle level. 37
C—items	Ordinary control measure Purchase based on usage estimates Control exercises by store keeper Safety stocks high Management to be done at lower level.

The other form of ABC analysis is VED analysis, i.e. arranging the activities in the orders of vital, essential are desirable.

Management by Objectives (MBO)

Prof Peter F Drucker of the New York University (1954) a noted authority on management, coined the phrase “management by objectives” (MBO) to illustrate their central importance to the effective management of any undertaking. The MBO idea is simply that every person in an organization should have specific, attainable, measurable objectives that mesh with those of the organization and that each person's performance should be assessed against achievement of these objectives.

Wendell L French suggests that MBO is a process in which there is “periodic agreement between a superior and a subordinate, on the subordinates objectives for a particular period and a periodic review of how well the subordinate achieved those objectives”. The MBO process is schematically viewed as follows (Fig. 1.4).

MBO is not a panacea for managers, but it does provide a number of benefits as follows:

It lets individuals, to know what is expected from them.
It helps in planning by making managers to establish objectives and target dates.
It improves communication between managers and subordinates.
It makes individuals more aware of the organizations objectives.
It makes the evaluation process more equitable by focussing on specific accomplishments. It also let the subordinates to know how well they all are doing in relating to the organizations objectives.

Fig. 1.4: The MBO process.

Network Analysis

Network planning provides the basis for PERT and CPM (Critical path method) as follows:

Program evaluation and review technique (PERT): PERT is an important tool in the timing of decisions. In simplest form of PERT, a project is viewed as a total system and consisting of setting up of a schedule of dates for various stages and exercise of management control, mainly through project status reports on its progress. The basic tool used in the PERT approach is the network, or flow, plans.

Modern and Philips enlist the following advantages of PERT:

It encourages logical discipline in planning, scheduling and control of project,
It encourages more long-range and detailed project planning,
It provides a standard method of documenting and communicating project plans, schedules, and time and cost-performance,
It identifies the most critical elements in the plan, thus focussing management attention on the 10–20% of the project that is most constraining on the schedule,
It illustrates the effects of technical and procedural changes on overall schedules.

To make the network understandable and usable, the time between various events (activity time) must be computed. As anyone concerned with large scale projects knows, it is not always possible to estimate accurately how long it will take to complete the various parts of the project. However, a method does exist whereby fairly accurate estimated time between events can be determined. This approach involves estimating three different times for each activity;

Optimistic time: This occasionally happens when everything goes right. This estimate is predicated on minimal and routine difficulties in the activity.
Most likely time: It represents the most accurate forecast based on normal developments if only one estimate was given, this would be it.
Pessimistic time: This is estimated on maximum potential difficulties. The assumption is that here is whatever can go wrong will go wrong.

The characteristics of these three time estimates are best described by a beta curve as follows:

Optimistic	More likely	Pessimistic
O	M	P

A formula based on the probability distribution of time involved in performing the activity is then used. The formula is—

Whereas, O is optimistic time,

M is most likely time, and

P is pessimistic time.

Critical path method (CPM): The critical path method is basically a technique to reduce the time required to implement a project. By breaking the project into activities that must be undertaken for its implementation and by determining their time sequence, it is possible to isolate the most critical path schedule for their implementation.

PERT illustrates the interrelatedness of management functions, especially planning and controlling and the basic role of decision making. It can be used to great advantage in any 39building or remodelling project, for the addition of new equipment, for physically moving a department or unit, as well as for many management jobs, like budget preparation or policy manual development.

The application of PERT and CPM can be profitably utilized in the programs and projects of health, e.g. construction of hospitals, eradication of communicable diseases, family planning programs, administration of environmental programs etc.

Network analysis promotes the community health nurse to examine a client's relationships in a dynamic rather than a static capacity. Sociological variables such as perceived closeness, potential for resources, and resource availability related to location may differ for different clients or the same client overtime. Network analysis is a mechanism for ordering the potential overflow of random information about a client and his or her environment. It provides a systematic approach to assessment that can be adapted to different kinds of clients with different kinds of health problems.

FUNCTIONS MANAGEMENT

Henri Fayol (1925) first identified the management functions of planning, organization, command, coordination, and control. Luther Gulick (1937) expanded on Fayol's management functions in his introduction of the “seven activities of management”—planning, organizing, staffing, directing, coordinating, reporting, and budgeting—as denoted by the mnemonic POSDCORB. Although often modified (either by including staffing as a management function or renaming elements), these functions or activities have changed little over time. Eventually, theorists began to refer to these functions as the management process.

The management process, shown in Figure 1.5, is this book's organizing framework. Brief descriptions of the five functions for each phase of the management process follow:

Planning encompasses determining philosophy, goals, objectives, policies, procedures, and rules; carrying out long- and short-range projections; determining a fiscal course of action; and managing planned change.
Organizing includes establishing the structure to carry out plans, determining that most appropriate type of patient care delivery, and grouping activities to meet unit goals. Other functions involve working within the structure of the organization and understanding and using power and authority appropriately.
Staffing functions consist of recruiting, interviewing, hiring, and orienting staff. Scheduling, staff development, employee socialization, and team building are also often included as staffing functions.
Directing sometimes includes several staffing functions. However, this phase's functions usually entail human resource management responsibilities, such as motivating, managing conflict, delegating, communicating, and facilitating collaboration.
Controlling functions include performance appraisals, fiscal accountability, quality control, legal and ethical control, and professional and collegial control.

Fig. 1.5: The management process.

Usually the actions of manager (planning, organizing, directing, coordinating and controlling) are referred to in the management literature as the functions of the management process.

Planning

Planning means to decide in advance what is to be done. It charts a course of actions for the future. It is an intellectual process, and it aims to achieve a coordinated and consistent set of operations aimed at desired objectives. So planning is very essential in the health services organizations as follows:

Good planning yields reasonable organizational objectives and develops alternative approaches to meet these objectives,
Good planning helps to eliminate or reduce the future uncertainty and chance,
Good planning helps to gain economical operation,
Good planning lays the foundation for organising,
Good planning facilitates coordination,
Good planning helps to facilitate control,
Good planning dictates those activities to which employers are directed.

Management is the mobilization, protection and utilization of resources. Health service organizations operate in an environment of change. They must be able and prepared to accept change as the inevitable consequence of operating in a dynamic world. The modern health service organization faces further problems that no one can predict with certainty. Effective planning can reduce the impact of this uncertainty (Whole planning process is explained in chapter on Planning.

The main activities in the planning are the formulation of strategies and setting the objectives. Strategy is the set of decisions that determine the character (size, scope and mixture of services) of a health services organization and give it direction in the market place. In real sense objectives are the key to the entire management process.

Organizing

Once objectives have been established through planning, management concern must turn to developing an organization that is capable of carrying them out. The basic objectives of the organizing function is development of a structure or framework called the formal organization structure. The management function of “organizing” can be defined as relating people and things to each other in such a way that they are all combined and interrelated into a unit capable of being directed toward organizational objectives.

The most basic premise of organization is that division of work is essential for efficiency, work activities required for organizational performance are seperated through the process of vertical and horizontal differentiation (i.e. dividing the organization into operational units). Vertical differentiation establishes the hierarchy and the number of levels in the organization. Horizontal differentiation comes about because of the need to separate activities for more effective and efficient performance.

The formal organization depends on two basic principles: (1) responsibility and (2) authority.

Responsibility: Can be thought of as the obligation to execute functions at work. The source of responsibility is one's superior in the organization. By delegating responsibility to a subordinate, the superior creates a relationship based on obligation between himself and the subordinate. Responsibility in organization is divided among available personnel by grouping 41functions that are similar in objectives and content. This should be done in a manner that avoids overlaps and gaps as much as possible. Responsibility may be continuing or it may be terminated by the accomplishment of a single action.

Authority: When responsibility is given to a person, he must also be given the authority to make commitments, use resources and take the actions necessary to carry out his responsibilities.

Directing

Directing means the issuance of orders, assignments and instructions that permit the subordinate to understand what is expected of him, and the guidance and overseeing of the subordinate so that he can contribute effectively and efficiently to the attainment of organizational objectives.

Once plans have been made and an organization has been created to put them into effect, the next logical function of management is to stimulate the effort needed to perform the required work. This is done through the directing, which includes the following activity. (1) giving orders, (2) making supervision, (3) leading, (4) motivating, and (5) communicating.

Giving Orders

The central task in directing is issuing the orders. The order is the technical means through which a subordinate understands that, what is to be done. Ideally there would be understanding and acceptance of the order by the subordinate. To facilitate this there are certain characteristics of good orders which manager should be aware of:

The order should be clear, concise and consistent. The purpose is to give sufficient information to ensure understanding.
Orders should be based on obvious demands of particular situations or the order conforms to the requirements of a particular situation, it seems logical to the subordinate and not just an arbitrary whim of the manager.
The tone of the order is important. If the subordinate is to accept the order fully, he must feel that the manager is doing his job pointing out something that needs to be done and not merely exercising his power over the subordinates. The manner in which the manager delivers the order has a great deal to do with its acceptance by the subordinate.
Whenever possible, the reason for the order should be given. A subordinate will accept an order more readily if he understands the need for it. There are occasions when lack of information on the part of the manager or scarcity of time prohibits this; however this should be the exception and not the rule.

In some instances, the manager uses delegation of authority instead of issuance of orders for avoiding too many specific orders.

Supervision

Supervision is the activity of management that is concerned with the training and discipline of the work force. It includes follow-up to assure the prompt and proper execution of orders. Supervision is a required function for every manager from the top of the health organization to bottom.

Supervision is the art of overseeing, watching and directing with authority, the work and behavior of other.

Supervision is essentially an educational process, in which you (PHN) take responsibility for helping your subordinates to develop themselves and become more competent in their jobs.42

The supervision was earlier conceived as inspecting and finding fault with subordinates. The modern concept of supervision is to guide and help the subordinates in their work by way of training, demonstration, checking, individual counselling and guidance.

Old concept	Modern concept
Inspection Finding fault	Training Guidance Demonstration Checking Individual counseling

Scope of Supervision

The effectiveness of workers depends largely on the supervision they reserve. In other words, quality of work is directly related to the degree of supervision. High degree of supervision improves the quality of work, poor supervision leads to poor work. So good supervision is very important for HWs, and VHG and Dais. Even well trained highly motivated health workers eventually become discouraged and ineffective when supervision is lacking.

Objectives of Supervision

To help subordinate to do their job skillfully/efficiently,
To develop subordinates capacity to the fullest extent,
To guide/assist in meeting predetermined work objectives (targets),
To promote effectiveness of subordinates,
To motivate subordinates and to maintain high morale, and
To promote team work.

Methods of Supervision

Staff meetings,
Informal discussions and observations,
Training sessions,
Review of records and reports,
Formal evaluation—What is the. . . . . style,
Is this style effecting in the,
What style should we use,
Should we change style, and
If not change what will happen (perhaps using checklist)

In the job, supervision is the best, because the supervisor can identify shortcomings and immediately give guidance.

Functions of Supervision

A supervisor is called upon to assume many roles and responsibilities in the course of his work. He is often called an educator, a resource person, a group member, an observer, a learner and an administrator. The major supervisory functions are:

Orientation of newly posted staff: Transfers and postings of personnel are common in all organizations. All new comers should be informed about their functions, the methods that they should use, the personnel with whom they will work, and the community wherein they will work.
Assessment of the workloads of individuals and groups: It must be ensured that the workload is within the physical and mental competence of a worker. Otherwise the job 43should not be assigned to him. A supervisor should not expect from workers a level of effort that is beyond them.
Arranging for the flow of materials: A supervisor must find out the needs for supplies and equipment and arrange for their supply in good time.
Encouraging community participation: A supervisor assists his workers in influencing community leaders to support the health program, and orienting other development agencies and social groups to contribute, to promote better health in the community.
Coordination of the efforts: A supervisor coordinates the work of all his/her workers and agencies and promotes team work.
Promotion of effectiveness of workers: This may be done by evaluating their work performance so as to:
- Identify the causes of difficulty
- Providing continuing education and guidance on the job, and
- Helping individuals to plan and carry out their work in an organized manner, the worker himself should be involved in preparing the plan in order to ensure his/her commitment to action.
Promotion of social contacts within the work team: Social contacts help to bring the staff together and increase group cohesiveness. A good supervisor should provide opportunity for it.
Helping individuals to cope with their personal problems: Personal problems are likely to come up while dealing with workers. They may be outside the supervisor's duties, but a sympathetic understanding on his part improves the individuals morale.
Facilitating the flow of communication: A free flow of communication among members is necessary for team work. Supervisors should encourage free communication among peers, between workers and community representatives and among members of the health team. Depending on hierarchical channels alone is not sufficient.
Raising the level of motivation: All good work should be given due credit through recognition. Supervisor must provide opportunities for growth and achievement.
Establishment of controls: The supervisor must know what work is being done and with what effectiveness. A number of methods such as observation and record reviews can be used for this purpose.
Development of confidence: Supervisors must know the background of workers and try to develop mutual confidence. Too much fault finding will only undermine the workers confidence in the supervisor. There is need to combine understanding with firmness and to take a personal interest without sacrificing impartiality or discipline.
Emphasis on achievement: It has been proved that the development of a smooth work routine and the improvement of human relations without corresponding emphasis on goal achievement are not likely to increase productivity. Supervision should therefore aim at reminding workers to achieve the goals expected of them.
Record keeping: The supervisor should maintain a system of records and should use the information stored in the records.

Supervision is an essential component for developing an effective organization. It leads to attainment of objectives through checking and guiding the work of subordinates. Deviations from plan of action can be corrected and the skills of the subordinates can be upgraded through continuous education by the supervisors.44

Principles of Supervision

Supervision should not overburden any individual or group,
Causing unreasonable pressure for achievement, results in low performance and low confidence in the supervisor,
Supervision should be general and not close,
Supervision calls for good planning and organization,
Encourage workers participation in decision making,
Effective supervisors are good communicatiors,
Capacity to influence downwards depends on capacity to influence upwards,
Supervisors need to understand the problem and situation,
Supervision is a process of cooperation and coordination,
Create suitable climate for productive work,
Give autonomy to workers depending on their personality, competence and characteristics,
Technical competence of supervisor contributes to success,
Supervision should be a teaching learning process,
Make considerable efforts to train subordinates,
Supervisor should focus on continued staff growth and development,
Supervisors are responsible for checking and guidance,
Good leadership is part of good supervision.

Qualities of Supervisor

Forcefulness, integrity and firmness,
Full awareness of the job and the rules and regulations,
Full awareness of existing situations,
Intelligence and willingness to grow,
Good judgement, impartial understanding of others emotions, attitudes and feelings and quickness in recognising achievements of subordinates,
Ability to delegate duties and responsibilities through the right ones to the right persons,
Non-interference unless necessary,
Continuous guidance, cooperation and coordination,
Sympathetic attitude and good listening,
Willingness to adopt new policies and accept changes if necessary,
Good health, self-confidence, enthusiasm for work and human interest,
Ability to communicate information skillfully and tactfully,
Above all, ability to work with others, ability to inspire and take immediate action,
Knowledge of the activities, techniques and procedures,
Objectivity, impartiality and fairness in dealing.

Leading

Leadership is the ability to inspire and influence others to contribute to the attainment of the objectives. Traditionally success in leadership was thought to be dependent on personal traits of the leader. More recently, it has been shown that successful leadership is the result of interaction between the leader and his subordinates in a particular organizational situation.

There are a number of styles of leadership that have been identified, such as autocratic, democratic, participative leadership. In any style of leadership there will be a relationship between superior and subordinate that follows a continuum of leadership behavior. Let's consider each of these seven gradations of leadership behavior as follows in Figure 1.6.45

Fig. 1.6: Continuum of leadership behavior.

Manager makes decision and announces: This form of leadership represents the most autocratic form, i.e. there is no room for the subordinate to express his thoughts either in the formulation or the solution of the problem. The superior formulates the problem, solves it, and announces his decision. Coercion, to assure the execution of the decision, is not necessarily implied since subordinates may be willing to follow such directions.
Manager “sells” decision: At this stage the manager recognizes the feelings of subordinates and the possibility that there might be resistance to his decision. Consequently, he/she attempts to persuade them to recognize the merits of his/her decision. However, the manager is still in control of all phases of the decision making process.
Manager presents ideas and invites questions: The third form of leadership behavior marks the beginning of a degree of participation on the part of subordinates—at least they are being asked to express their ideas. However, the manager has in his own mind made the decision. Nonetheless, the presentation of his ideas to subordinates with the opportunity of their expressing themselves opens up the possibility that the decision may be modified.
Manager presents a tentative decision subject to change: Here at the midpoint of the range of leadership styles, there is a definite participation on the part of subordinates in shaping a final decision which is tentative, he still defines the problem and works out for the initial solution.
Manager presents problem, gets suggestions, makes decision: This is the first time the manager comes to the group without having at least a tentative solution to the problem, however, he still defines the problems in general terms. Consultation with the group prior to making a tentative decision increases the number of possible solutions.
Manager defines limits, ask a group to make decision: Upto this point the decision is made by the manager with varying degrees of participation on the part of subordinates in influencing his decision. However, the manager still states the problem and the limits within which the decision must be made. Usually these limits are expressed in terms of either cost or time or both.
Manager permits subordinates to function within limits defined by superior: The last stage of managerial behavior on the scale represents the maximum degree of subordinate participation within formal organizations. The manager, himself usually a subordinate, is limited in the extent to which he may permit participation by the limits of authority granted to him. The greatest degree of subordinate participation is possible within the framework of a functional teamwork or task-force type of operation. Even, here, the objectives of the organization are stated by higher authority, but subordinates may define and solve problems consistent with the attainment of the objectives of the health services organizations.46

The above continuum of leadership styles, therefore ranges from the completely authoritarian situation with no subordinate participation to a maximum degree of democratic leadership, enabling the subordinate to participate in all phases of the decision making process. This concept is a realistic view of the leadership styles available to the manager. The problem then becomes are of selecting the style that is most appropriate. A number of considerations must be taken into account when selecting ones own styles which includes:
1. The organizational environment,
2. The personalities of organization members, and
3. The congruence of objectives.

Motivating

Motivation refers to the way in which needs (urges, aspirations, desires) control, direct or explain the behavior of human beings. The manager must motivate, or cause, the employee to follow directives.

Communicating

Communication is the passing of information and understanding from a sender to receiver.

Communication is vital to the directing function of management, one way to visualize this importance is to view the manager on one side of a barrier and the work group on the other. Communication is the means the manager has of reaching through the barrier to attain work group activity (Fig. 1.7).

Coordinating

Coordinating is the act of synchronizing people and activities so that they function smoothly in the attainment of organization objectives. Coordination is important in management, it becomes the central task of the manager to reconcile differences in approach timing effort or interest and to harmonise cooperative and individual goals.

Coordination is more important in the health services organization, because functionally they are departmentalized. Different kinds of organization require different amount of coordination. There are several basic approaches to coordination, i.e. corrective, preventive, regulatory and promotive.

Corrective coordinations are those coordinative activities that rectify the present error or correct a dysfunction in the organization.
Preventive coordination comprises those coordinative activities that are aimed at preventing the occurrence of anticipated problems of coordination, or at least, minimizing the impact of these problems.
Regulatory coordination comprises those coordinative activities that are aimed at the maintenance of existing structural and functional arrangements in the organizations.

Fig. 1.7: The means adopted by manager to bring about work group activities through communication barrier.
47

It does not require cognisance of any particular malfunctions or problems, whether in retrospect or anticipation.
Promotive coordination has those coordinative activities that attempt to improve the articulation of the parts of the organization, or to improve the existing organizational arrangements without regard for specific problems.

When coordination fails or is ineffective, the end result is conflict, which is defined as all kinds of opposition or antagonistic interaction. The manager must realize that conflict can be harmful but that it also has some positive benefits to the organization. The chief benefit of conflict is the stimulation of innovative organizational change.

There are several mechanisms through which organization can achieve coordinated effort. The most basic way is through the hierarchy of organization. In complex organization this usually has to be supported by other mechanisms, such as through the administrative system which carried out automatically a good deal of the necessary coordinative activity. Also in health service organizations, the high degree of professionalism leads to a significant amount of voluntary coordination, especially where the patient care activity is involved. The committee is used in health services organizations to achieve coordination among other things. The committee approach fosters communication among the participants and thus law improve coordination.

Controlling

Controlling can be defined as the regulation of activities in accordance with the requirements of plans. Controlling is directly linked to the planning function as follows (Fig. 1.8).

The managerial function to control consists of measuring and correcting the activities of people and things in the organization to make certain that objectives and the plans made to attain them are accomplished. Newman has pointed out the real nature of control as a management function in the following way:

Control is a normal, pervasive and positive force,
Managerial control is effective only when it guides someones behavior,
Successful control is future-oriented and dynamic,
Control relates to all sorts of human endeavors.

Steps of Control

The control function, whether it is applied to cash, medical care, employee morale or anything else, involves four steps:

Establishment of standards,
Measuring performance,

Fig. 1.8: The relationship of controlling and planning.
48
Fig. 1.9: Basic steps in control function.
Comparing the actual results with standards, and
Correcting deviations from standards.

These steps of controlling are given in Figure 1.9.

Establishing Standards

Standards are the established criteria for the practice of any profession which also includes nursing. Standards are statements that are widely recognized as describing nursing practice and are seen as having permanent value.

Standards can be defined as established criteria against which actual results can be compared. If standards are realistically developed and if means are available for determining exactly what subordinates are doing, measuring performance and comparing actual results with standards is fairly easy. In the field of community health nursing practice, the American Nurses Association published following standards.

Standard I: The collection of data about the health status of the consumer is systematic and continuous. The data are accessible, communicated and recorded.

Standard II: Nursing diagnosis are derived from health status data.

Standard III: Plans for nursing services include goals derived from nursing diagnosis.

Standard IV: Plans for nursing services include priorities and nursing approaches or measures to achieve the goals derived from nursing diagnosis.

Standard V: Nursing actions provide for consumer participation in health promotion, maintenance and restoration.

Standard VI: Nursing actions assist consumers to maximize health potential.

Standard VII: The consumers progress toward goal achievement is determined by the consumer and the nurse.

Standard VIII: Nursing actions involve ongoing reassessment, reordering of priorities, new goal setting and revision of the nursing plan.

Standards may be quantitative or qualitative, they can be useful in the control function. There is a large variety of possible standards that is necessary for the manager to be selective. It is impossible to check the performance of each activity against all of the possible standards which might be applied to it. The technical term for those chosen for control purposes is “Strategic control standards”. This means simply that the manager should select those standards that best reflect the objectives he is trying to meet and that best show whether or not they are being met. The standard selected should be timely, economical and permit comprehensive and balanced control.

There are number of methods of measuring work and setting standards. Among them are:

Analysis of past production records
Time analysis method49
Work sampling method
Time study
Motion study.

Measuring Performance

Once suitable standards have been set, the next steps in the control process can be taken. These consist of measuring actual performance and comparing it to standards that have been established. The manager does this by personally observing work and checking on his/her employees, and by analyzing summaries of data and report, submitted to him. Comparing information obtained in these ways with existing standards is a continuous daily function of the manager as he/she controls his area of responsibility.

Take Corrective Action

Any deviations occur in the performance of the subordinates or in the planning process. The manager has to take corrective action according to the set standardizing practice in the management.

In addition to these, other control devices are the budget, management, audit and performance appraising has been dealt with, in previous chapters).

ROLE OF NURSE AS MANAGER

Management is the purposeful and efficient use of resources. Being a manager at the middle level of the organizations of health services one must realize that he/she must mobilize, protect and utilize two types of resources: (1) Material resources, and (2) Human resources. Another type of resources is also there that finance, there also manager has to follow certain procedures to be followed, which relates to both human and material resources.

The functions of the manager at the middle level for example Nurse-Manager, refers to the mobilizing the resources, protecting the resources and utilizing the resources as follows:

Mobilizing the Resources

Mobilizing resources means obtaining the supplies, equipment and persons needed for the program for example to conduct an immunization session, the nurse-manager needs to mobilize the resources like vaccines, needles and syringes, vaccines carriers, transport carriers, and manpower to have a immunization campaign in rural area including health workers, health guides, trained dais, etc.

In order to mobilize resources, nurse-manager should know what resources are available at Primary Health Center and at the subcenter level and in the community, and what resources can be obtained from the social worker development officers and others outside the health field. To obtain these resources the nurse-manager must have the qualities of good leadership.

Protecting the Resources

Protecting the resources means storing and maintaining the supplies, equipment, and personnel. For example, when epidemics occur, often or suddenly as a nurse manager should secure, procure, store and maintain reserve stock of drugs, vaccine, needle and syringes and other material, for according to the particular epidemic combuting campaign and also required staff must be trained and kept ready to face the emergency situations or to carry out 50particular health campaign. In addition, the nurse-manager should provide good supervision and guidance provided before and during campaign.

Utilizing the Resources

In order to use resources efficiently the nurse-manager needs skills in planning, organizing directing coordinating and controlling. Utilizing resources means using supplies, equipment and personnel to do a job to achieve objectives of program, e.g. in immunization clinic, there should not be any wastage of money, men and material and should use proper skill in directing, delegating, coordinating and controlling for effective implementation of program.

Chapter Notes

Introduction to Management in NursingCHAPTER 1