Learn — Principles & functions of management

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Management — definition, levels and functions (POSDCORB)

Management is the process of getting work done through and with people by planning, organising, staffing, directing and controlling the resources of an organisation so that its objectives are reached; nursing management applies that process to the delivery of nursing care in a ward, a department or a whole hospital. It sits between administration, which sets the institution's policy and goals, and supervision, which oversees the daily work of individual nurses, and it is judged by the outcomes of care rather than by activity.

Henri Fayol named five functions of management — planning, organising, commanding (directing), coordinating and controlling — and Luther Gulick's 1937 expansion of them is the mnemonic examinations ask: POSDCORB stands for Planning, Organising, Staffing, Directing, COordinating, Reporting and Budgeting.
Planning is the primary function because every other function takes its shape from the plan; controlling closes the loop by setting a standard, measuring performance against it, comparing the two and correcting the gap, so a stem in which a superintendent compares monthly error figures with a laid-down standard and acts on the difference is describing controlling.
Three levels of management carry different work: top management (the nursing director or nursing superintendent) sets policy and strategic plans, middle management (deputy and assistant nursing superintendents, supervisors) translates policy into programmes and coordinates units, and first-line management (the ward sister, ward in-charge or charge nurse) supervises the daily care of patients and the staff who give it.
Robert Katz's three managerial skills are weighted by level: conceptual skill (seeing the organisation whole) matters most at the top, technical skill (knowing the nursing work) matters most at the first line, and human skill (working with and through people) is needed equally at every level.
Henry Mintzberg described ten managerial roles in three groups — interpersonal (figurehead, leader, liaison), informational (monitor, disseminator, spokesperson) and decisional (entrepreneur, disturbance handler, resource allocator, negotiator) — and a ward sister moves through most of them in one shift.
Management and leadership are not the same thing: a manager holds a formal position with authority over resources and is accountable for results, whereas a leader influences people towards a goal and may hold no position at all; the manager plans, budgets, organises and controls, the leader sets direction, aligns and motivates, and a good nurse manager does both.
Effectiveness is doing the right things — the objective is attained — and efficiency is doing things right with the least resources; a ward that finishes every task on time but misses the patient who deteriorated was efficient and not effective.
The objectives of a nursing service are usually stated as safe and quality patient care, the welfare and development of its staff, the education of students, participation in research and the economical use of resources, and every ward-level plan should be traceable to one of them.

Management theories — Taylor, Fayol, Weber, Mayo and Theory X and Y

Management theories are the explanations of how organisations and the people in them are best directed, and they came in three waves: the classical school of the early twentieth century (scientific management, administrative theory and bureaucracy), the human relations and behavioural school that grew out of the Hawthorne studies, and the modern systems and contingency views. A nursing superintendent draws on all three at once, using classical structure for procedures and rosters, behavioural insight for motivation and contingency thinking for the fact that no single approach suits every ward.

Frederick Winslow Taylor, the father of scientific management (1911), studied work by time-and-motion study to find the one best way of doing each task, selected and trained workers scientifically, separated planning from doing and paid by a differential piece rate; the nursing procedure manual and the standardised drug round are his descendants.
Henri Fayol, the father of modern management, described the five functions and fourteen principles of administrative theory, among them division of work, authority with matching responsibility, discipline, unity of command (one superior per employee), unity of direction (one plan for one group of activities), subordination of individual interest, fair remuneration, centralisation, the scalar chain, order, equity, stability of tenure, initiative and esprit de corps.
Max Weber described bureaucracy as the rational form of organisation: a clear hierarchy, written rules and records, division of labour, appointment by technical competence and impersonal application of the rules — the form most government hospitals still take.
Elton Mayo's Hawthorne studies at Western Electric (1924–1932) found that output rose whenever the workers were paid attention to, whatever was done to the lighting; the Hawthorne effect founded the human relations school, which holds that social needs and informal groups shape performance as much as pay.
Douglas McGregor's Theory X assumes people dislike work, avoid responsibility and perform only under close control and the threat of punishment, so the manager supervises and coerces; Theory Y assumes work is as natural as play, that people seek responsibility and direct themselves towards goals they accept, so the manager delegates and involves; William Ouchi's Theory Z added the Japanese pattern of long-term employment, collective decision making and trust.
Peter Drucker introduced management by objectives (1954), in which the manager and each staff member jointly set measurable objectives and later review performance against them, and Abraham Maslow's hierarchy of needs and Frederick Herzberg's two-factor theory supplied the behavioural school's account of what motivates.
Modern views treat the hospital as an open system — inputs, throughput, outputs and feedback with its environment — and contingency theory (Fiedler and others) holds that there is no one best way: the right structure and style depend on the task, the staff and the situation, which is why the same sister is directive in a cardiac arrest and participative in a ward meeting.

Planning — objectives, policies, procedures, SWOT and MBO

Planning is the management function of deciding in advance what is to be done, by whom, how and by when, so that the objectives of the nursing service are reached with the resources available. It is the first and most basic function because organising, staffing, directing and controlling all take their shape from the plan, and a plan that is not written, measurable and time-bound cannot later be controlled against.

Plans form a hierarchy from the broad to the specific: the vision (what the service aspires to be), the mission (why it exists), the philosophy and values, goals (broad, long-term), objectives (specific and measurable — SMART: specific, measurable, achievable, relevant, time-bound), policies (standing guides to thinking, such as visiting hours), procedures (the step-by-step way a task is done, such as giving an intramuscular injection), rules (statements that allow no discretion, such as no smoking), programmes and budgets.
Strategic planning is long-range, usually three to five years, done by top management with a SWOT analysis in which strengths and weaknesses are internal to the organisation and opportunities and threats come from outside it; operational planning is short-term, up to a year, done by first-line and middle managers, and includes the duty roster, the ward budget and the in-service calendar.
Management by objectives, introduced by Peter Drucker, has the manager and each staff member jointly set measurable objectives, review progress at intervals and appraise performance against the results; it gives participation and clarity but fails when the objectives are too many, too short-term or set from above.
The steps of planning run from stating the objective, through assessing the present situation and forecasting, listing the alternative courses, evaluating them and choosing one, to implementing the plan and evaluating its result; a Gantt chart shows activities against time, and PERT and CPM show which activities decide the finish date.
Standing plans — policies, procedures and rules — are used again and again and give consistency, whereas single-use plans — programmes, projects and budgets — are drawn up for one purpose and end when it is achieved.
Planning fails as management by crisis when the manager reacts to events instead of anticipating them, and a contingency plan, such as the hospital disaster plan, is the planned answer to an event that cannot be prevented.

Organisational structure — span of control, chain of command and authority

An organisational structure is the formal arrangement of positions, authority and communication that shows who reports to whom and who is responsible for what, drawn as an organisational chart in which solid lines show line authority and broken lines show staff or advisory relationships. In a hospital nursing service it runs from the nursing director or superintendent through the deputy and assistant superintendents and supervisors to the ward sisters and staff nurses, and the shape of that chart decides how fast a decision travels and how many people one manager can supervise.

The chain of command, Fayol's scalar chain, is the unbroken line of authority from the top of the organisation to the bottom; unity of command means each person reports to and takes orders from one superior only, and unity of direction means one plan and one head for each group of activities.
Span of control is the number of subordinates one manager supervises directly; Lyndall Urwick's classical figure is five to six whose work interlocks, nursing texts commonly give five to eight for a ward manager, and the right span depends on the complexity of the work, the competence of the staff, how far apart they are and how much coordination the work needs.
A narrow span produces a tall structure with many levels, slow communication and close supervision, whereas a wide span produces a flat structure with few levels, faster decisions and more delegation; decentralisation pushes decisions down the structure and speeds them, centralisation keeps them at the top for uniformity.
Line authority is the direct right to command that runs down the chain (nursing superintendent to ward sister to staff nurse); staff authority is advisory — the dietitian, the infection control nurse or the clinical instructor advises the ward but cannot order its nurses — and functional authority is a limited right to direct one specific function across departments, such as the infection control officer's authority over isolation practice.
Authority is the right to act or command and belongs to the position, responsibility is the obligation to perform the work assigned, and accountability is answerability for the result; authority can be delegated, accountability cannot, and the parity principle says the authority delegated must match the responsibility given.
Structures come in types: line (simplest, a small nursing home), line and staff (the usual hospital), functional (specialists direct their own function), matrix (dual reporting to a project head and a functional head, used for quality or research projects) and ad hoc committees; alongside the formal structure runs the informal organisation of friendships and the grapevine.
An organisational chart shows the formal positions, levels, spans and reporting lines; it does not show informal relationships, the degree of authority at each position or how well the structure works.

Decision making and problem solving — steps and tools

Decision making is choosing one course of action from among alternatives, and problem solving is the wider process of recognising a gap between what is happening and what should be happening, finding its cause and closing it; every problem-solving process contains a decision, but many decisions are made where there is no problem. A ward manager makes both kinds every shift, and the examinable content is the order of the steps and the tools that keep a choice rational rather than habitual.

The traditional problem-solving process runs in order: identify and define the problem, gather and analyse the data, develop alternative solutions, evaluate the alternatives, select and implement one, and evaluate the result; identifying the problem is always the first step, and the commonest management error is to choose a solution before the problem has been defined.
The nursing process is the same method applied to a patient — assessment, diagnosis, planning, implementation and evaluation — which is why a nurse who can write a care plan already knows how to solve a management problem.
Decisions are programmed (routine and covered by a policy, such as a duty swap) or non-programmed (new and unstructured, such as closing a ward), and are made under certainty, risk or uncertainty; the rational model weighs every alternative, Herbert Simon's bounded rationality settles for the first alternative that is good enough (satisficing), and experienced managers also decide intuitively from pattern recognition.
Group techniques trade speed for quality and acceptance: brainstorming generates ideas without criticism, the Delphi technique gathers anonymous expert opinion in rounds until it converges, and the nominal group technique has members write ideas silently, share them in turn and vote; groupthink, in which a cohesive group suppresses dissent, is the failure to guard against.
The tools have names examinations ask: a decision tree lays out choices with their probabilities and outcomes, a decision grid or matrix scores alternatives against weighted criteria, cost–benefit analysis compares the money in and out, a Pareto chart shows the vital few causes behind most of the trouble (the 80/20 rule), and the fishbone (Ishikawa) diagram sorts possible causes under headings such as people, method, material and environment.
A decision is judged on the quality of the process and the information available at the time, not only on how it turned out, and escalation of commitment — pouring more resources into a failing decision because so much has already been spent — is the trap to name and avoid.

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