Chapter Six

- Monitoring and follow-up

Control concept:

The goal behind oversight is to ensure that implementation is consistent with the desired goal, and this goal requires the presence of an administrative function concerned with the performance measure by correcting it and preventing its recurrence in a way that makes it consistent with the requirements of the facility’s goals and plans.

To enable the manager to carry out this function, this first requires a clear definition of the standards according to which performance efficiency will be measured. The most important characteristic inherent in these standards is that they do not conflict with the established plans. Rather, it is very important that they are fully compatible with these plans.

Types of supervision:

There are two methods of supervision:

•  Personal observation: Control through direct observation requires the manager to go to the implementation site to personally review the workflow and implementation results, evaluate performance, and detect deviations with the aim of correcting them.
•  Oversight of reports.

Control steps:

•   Determine the scope of control: The control information and procedures based on it become more accurate if the goal is precisely defined. The purpose is to identify specific points for control in order to obtain specific information, meaning that we must specify what we want to control, so we must ask whether we want information about:

-    The quality

-    Quantity

-    The time

-    Expenses

-    Or a mixture of all of this?

•   Determine control standards
•   Performance Measurement
•   Correcting the deviation: This is the final step in control, through which things are restored to normal. Correction means working to remove the causes and factors that resulted in the deviation.

- Performance evaluation

:Content

• Definition of calendar.
• The purpose of evaluating employee performance.
• The main axes of the calendar.
• The purpose of each axis of the evaluation.
• Components of the evaluation process.

Definition of performance evaluation:

Performance evaluation is the identification and evaluation of the nurse's level of competence at the present time according to specific and objective standards and methods that must be available to the job holder.

Know the performance appraisal process:

It is a process that aims to determine the worker’s performance, introduce him to him and how he should perform his work, and design a plan for the worker’s development. Performance evaluation not only defines the worker’s level of performance, but also influences his level of performance in the future.

The concept of job performance evaluation :

• Job performance evaluation can be defined as the process of measuring employees’ behaviors in the work environment, their characteristics related to their jobs, and the results of their work, on a regular and periodic basis, by a person or group of people who are appropriately aware of their performance.
• Evaluation is not a goal in itself, but rather a means that ultimately aims to motivate individuals, help them modify their behavior in a positive way, push them to develop their performance, and then raise the organization’s productive efficiency.
• In general , performance evaluation systems aim to achieve the following goals :
  

-  Assist in planning manpower.

- Distributing work to workers according to their abilities and skills .

- Improving the employee selection process.

- Determine the training needs of employees as well as the impact of training on performance.

- Fairness and accuracy in rewards.

- Identifying individuals who can be promoted , and discovering qualified workers to fill leadership positions.

- Helping improve the level of performance , and paying attention to indicators of inefficiency at work.

- Providing feedback to employees about their performance levels.

Performance evaluation objectives:

Administrative objectives:

• Decisions of promotion, transfer and demotion .
• Decisions to renew or terminate contracts .
• Decisions to enroll employees in training and development programs .

Objectives of guidance and counseling:

• Highlighting weaknesses and strengths.
• Guiding employees to training or rehabilitation programs.
• The organization reconsiders existing incentive programs and raises satisfaction levels.

Objectives of scientific research:

• Verifying the integrity of the recruitment and selection processes.
• Evaluating procedures and systems for incentives and employee satisfaction.
• Evaluation of training programs .

Explain the importance of the calendar?

• Discovering deficiencies in performance
• Develop and improve performance
• Achieving goals
• Finding solutions to shortcomings in performance
• It reveals the latent energies and abilities of individuals
• Detecting workers whose abilities, aptitudes, and skills do not match the work they do
• Benefiting from previous experiences.
• Employing energies
• Empowering individuals’ confidence in their institutions
• It helps members benefit from each other

-  Enabling workers to know their strengths and weaknesses in their work and working to avoid and get rid of shortcomings and weaknesses .

- A method for detecting weaknesses in systems, procedures, laws, work methods, and standards followed and their validity;

- It is useful in raising the morale of employees and strengthening connections and relations between the boss and the subordinate

• It represents an opportunity for workers to correct their mistakes, work to avoid them, develop their skills, achieve the promotion they aspire to, and obtain lucrative rewards and compensation.
• It is useful in reducing the rate of negatives in employees’ behavior, such as absence, neglect, and lack of enthusiasm for work.

-  It contributes to revealing the untapped latent competencies of employees.

*The importance of the performance evaluation process

** Its importance at the managerial level:

1- Urging teachers and supervisors to develop their skills and intellectual capabilities and enhance their creative abilities to reach a sound and objective evaluation of the performance of their subordinates.

2- Urging managers to develop good relationships with subordinates and approach them to identify problems and difficulties.

2- Its importance at the employee level:

• It makes the worker feel more responsible in order to increase his feeling of justice and that all his efforts are taken into account by the organization .
• Motivate the worker to work diligently, seriously, and sincerely, hoping to win the respect and appreciation of his superiors, morally and financially.

 

Calendar foundations :

• Commitment to clear and specific goals
• Inclusion for all types and levels of goals
• It must be carried out according to clear standards such as (justice - knowledge - credibility... etc.)
• The evaluation should be a collaborative process.
• To be continuous

Important conditions for the success of applying the performance evaluation method :

• The evaluator must be a motivator for sound, objective evaluation.
• The evaluator should use appropriate standards to measure performance.
• These criteria must be derived from the job description of the job whose performance is to be evaluated.
• The evaluator must be responsible for the results of his evaluation.
• The assessor must understand the method used, and be trained on how to use it efficiently.
• The evaluator must be able to actually observe the employee’s behavior while performing his job.
• Human biases and errors should not affect the evaluation process.
• The evaluation method must be properly designed - taking into account scientific and practical foundations.
• The method used should facilitate subsequent procedures, such as interviews and professional consultation.
• The method must be consistent with the culture of the institution, which must be characterized by objectivity and the desire to achieve the goals of work and employees.

* Elements of the employee performance evaluation system :

Determine the purpose: This is the goal that management seeks to achieve through the process and its collection of this information and data  .

• Providing information to the workers themselves about the quality and efficiency of their work performance in order to gain knowledge and improve performance for the better.
• Determine the level of pay, competencies, and bonuses that an individual can receive in exchange for performance.
• Identify the work and tasks that can be assigned to the employee, in case these tasks are needed.
• Identifying deficiencies in the individual’s performance and his need for improvement and development through training efforts.
• Forcing managers to link the behavior of their subordinates to the results of the work and its final value.

Performance evaluation process :

• The performance evaluation process consists of five steps:
• A common understanding between the boss and the subordinate.
• Official recording of performance in the performance evaluation form.
• Continuous evaluation of performance.
• Objective discussion of the evaluation result.
• Appropriate official procedures for the evaluation results.

Performance evaluation responsibilities

1- Direct Boss

He is the person most capable of evaluating the abilities, achievements, weaknesses, and strengths of his subordinates. On the other hand, the subordinates’ awareness and knowledge of the skills and seniority of their boss makes them not mind that he is their primary evaluator.

2- The immediate boss :

The direct superior evaluates the subordinate regardless of the extent to which this agrees with the desire of management. The reliance on the Chairman results from the goal of satisfying the company’s desires without conflict.

3-Committees:

It is composed of department heads - who are directly responsible to the employee at the evaluation site and who have previous connection and knowledge with it. This guarantees fairness and impartiality in the evaluation, but the time these committees take takes a long time.

Human resources management experts or insiders:

• They are required to be aware of the nature of the job being evaluated, and their responsibilities are to meet those conducting the evaluation and explain the elements of the evaluation, the required method of evaluation, and the method of measurement. They are then asked to take implementation steps  .
• The boss evaluates his subordinates.
• Subordinates evaluate their boss.
• Colleagues evaluate each other.
• A group of evaluators conduct the evaluation

Mention the benefits of the process of measuring and evaluating job performance?

• Raising morale among employees:

When employees feel that their efforts are appreciated by management, an atmosphere of good relations will prevail between them and management

• Notifying employees of their responsibilities:

When the worker feels that the results of the evaluation will result in making a set of decisions that will affect his professional future, he will do his best in his work.

• A means to ensure fair treatment.
• Oversight of superiors.
• Continuing oversight and supervision.
• Evaluate selection and training policies.
• Controlling recruitment and transfer processes.
• Achieving discipline and commitment to work.
• Detecting training needs.
• Determine incentive rewards and grant bonuses .

Characteristics of an effective performance appraisal system :

• Clear goals and standards.     Validity
• Reliability
• Linking individual results to organizational results
•  It can be applied
• Provides feedback
• Catalyst
• It takes into account the human touch of workers
• Futuristic
• It helps managers reward high performance and achievement
• Aligned with the organization's policy.

Qualities that must be present in a resident person:

• To have practiced evaluating employees’ performance and appreciated its results and responsibilities.
• To be familiar with the employee’s work.
• His judgments are based on accurate and realistic standards.
• It is based on facts and not personal impressions or opinions.
• Evaluates all employee actions and qualities.
• He does not cope with personal considerations or external pressures.

Common difficulties and errors:

• Resident leniency.
•  Influenced by personal considerations.
• Decreased resident motivation.
• The resident or employee is not familiar with the work of the job.
• The evaluator's inability to accurately distinguish between individuals.
• The work environment and human relations between the boss and superiors.
• Fear of confronting employees with unpleasant news.
• Believing that evaluation for high-level professions is unnecessary.
• Because the evaluation process takes a lot of time and effort from them.
• The performance evaluation process is subjective and has no justification.

Problems with evaluating employee performance :

  - Personal impressionThis impression is represented by the president’s reliance on his evaluation of the individual’s performance  Based on a false assumption, an example of this is when the president assumes that an excellent person In a certain job, he is excellent in the rest of the work, so an evaluation of this person’s performance is based  On someone's wrong impression.

  - Discrimination:  Which depends on personal relationship, kinship, religion, sect, or region  Or the party.

Fear of hurting employees' feelings .

 - LeniencyIt is based on giving general positive results to employees regardless of their actual  performance .

 - ExtremismWhere the supervisor gives low grades or evaluation due to the nature of  the supervisor himself and his personal qualities  -  neutrality or mediation.

   :  Supervisors give average ratings due to the lack of data  Specific criteria capable of classifying employees within their true capabilities  .

 -    Feeling guilty .  Some managers often feel guilty when they carry out the process of evaluating the performance of employees, especially when the results of the evaluation process result in some negative effects on the employees in terms of promotions, incentives, and continuing work. So managers must overcome such feelings; So that they can perform the evaluation process efficiently and effectively .

*Suggestions to improve the level of the calendar:   

• Resident selection.
• Involve more than one resident.
• Training of arbitrators or evaluators.
• Choose the method that suits the organization and the nature of the business.
• Performance measures must be objective, accurate, observable and measurable.
• Informing the employee of the final report and discussing it.

Evaluation forms

- The quality

Definition of quality:

Definitions of quality vary according to needs and customs, and these definitions may apply to many services. Accordingly, there are many definitions of quality, as follows: 

 ▪ Quality is judging a specific thing based on specific specifications or conformity with needs and specifications.

 ▪ Quality is doing the right thing in the right way. 

 ▪ Quality health care is the application of medical science and technology in a manner that achieves the maximum benefit for public health without exposure to risks.

Different dimensions of quality:

 ▪ Effectiveness and impact: The more effective the service is, the more it can be described as being of high quality.

 ▪ Efficiency: meeting society’s requirements.

 ▪ Ease of access to the service: ensuring benefit from resources and achieving fair distribution of the service to the community.

 ▪ The relationship between people: whether between workers and each other or between beneficiaries of the service.

 ▪ Continuity: To ensure continued use of the service to reach a high level of quality.

 ▪ Resources: Providing what is necessary to provide care so that it is an integrated service.

 ▪ Professional empowerment of workers to provide the service.

Quality assurance : 

 Quality assurance in the field of health services is the application of standards in a safe and acceptable manner to the community and at an acceptable cost, such that it leads to an impact on the incidence of disease rates, mortality rates, disability, and malnutrition.

Quality assurance principles:

 There are four principles for quality assurance, which are as follows:

1- Focus on customer/beneficiary services: Service planning must depend on the needs and desires of the customer or beneficiary. There are two types of beneficiaries: internal and external:

(a) Internal beneficiaries: They are those individuals within the work who depend on each other to provide the service, for example service providers, supervisors, and the rest of the team members.

 (b) External beneficiary: He is the beneficiary of the service, such as the patient or the community.

 2- Focus on the system or processes (procedures):

 Processes are defined as a successive set of steps or tasks that transform people, methods, and materials into products or services. These operations are implemented within a system, where the system is defined as a group of interconnected operations. Quality problems may result in one process as a result of a deficiency in one or several other processes belonging to the same system, or resulting from a failure to coordinate these interconnected processes. If the processes are incomplete, then the outputs will also be incomplete. Therefore, improving quality requires an understanding of processes and acceptable levels of their variability.

3- Focus on information-based decisions:

 Information in the organization is like blood in the human body, so it must be accurate and timely, which ensures the correctness of decisions. Information is particularly needed in places that suffer from scarcity because of its importance in the following:

(a) Define the problem

 (b) Identify the causes of the problem or the processes in which errors are expected to occur

 (c) Measure the results of the solutions applied and ensure that they work correctly

 4- Focus on participation and the work of quality improvement teams:

 All employees must participate in implementing the correction plans resulting from the application of quality improvement steps, and this has advantages including the following:

(a) Employees have a more accurate sense of the errors that occur in their work and the best way to correct them. (b) Employees prefer to implement changes that they feel involved in making decisions.

 The difference between quality assurance and quality improvement There are three basic differences between quality assurance and quality improvement, as follows:

1- The quality assurance system relies on quality control by reviewing patient files and verifying the implementation of treatment according to sound scientific foundations, then identifying deficiencies or errors and determining methods for correction, while quality improvement focuses on preventing errors before they occur.

2- The quality assurance process leads to accusing those who made a mistake and raising strong sensitivities among employees, while quality improvement focuses on increasing cooperation and participation among employees, which leads to determining the correct path to avoid mistakes.

3- Quality assurance processes are always carried out separately from administrative development, while the proper application of quality assurance achieves the integration of the two processes together, which leads to achieving the desired goals. Quality assurance process: The quality assurance process includes steps that came as a result of numerous experiments and are called the steps of the quality assurance program or elements of quality assurance, and sometimes it is called the quality assurance cycle or quality improvement cycle. Whatever the title, this course includes three groups of activities

- Standards

Standards constitute a very important part of any quality assurance program at the organization’s levels. It is not enough for the organization to be aware of the quality dimensions on which the quality of the services provided depends or to be judged. Rather, the organization must help those who work in it to achieve the customer’s expectations accurately by setting the standards for them. Which makes this easier for them.

 The definition :

 The standard is a definition of expected quality, and its goal is to ensure that the service matches the needs and expectations of the customer and not the needs and expectations of the hospital.

 Standard characteristics:

1- Credibility: It means that there must be a strong relationship between the standard and the desired results, and that the standards rely as much as possible on research evidence.

2- Reliability (stability): It means that the standard always gives the same results every time it is used in the same measurement conditions.

3- Realism: means the possibility of using standards within the resources available to the organization.

4- Clarity: The standards must be understandable to those who use them. 

5- Modernity: The standard reflects the latest available scientific information.

Sources of standards: There are many sources of standards. There are standards that have been previously prepared, and sometimes it may be necessary to prepare new standards, as follows:

 Standards previously prepared:

 o Local standards. 

 o International standards. 

 o Standards from service bodies and institutions.

 o Standards from educational institutes and institutions. 

 o International experts. 

 o Local experts

 Standards being re-established:

 Sometimes it may be necessary to prepare a new work manual and prepare updated specifications. In such a case, there are many sources that can be relied upon, such as:

 o The World Health Organization and other international organizations.

 o Professional bodies such as unions and scientific societies. 

 o Educational institutes. 

 o International experts.

 o Local experts. 

 Nursing standards:

 They are acceptable and honest definitions that express the quality of nursing care. Standards are not considered valid unless they have a means of measurement so that they are given the opportunity to measure the quality and effectiveness of nursing care. Nursing standards have been set by multiple institutions concerned with the quality of nursing care, and these standards differ depending on the institution, as some consider the standards to be the minimum required level of service. Whatever the definition, the function of the standard is to provide the means by which the level of quality is measured. 

Writing nursing standards:

 In order to write nursing standards, seven steps must be followed as follows:

1- Choose the specialization that will be covered by the standards and type.

2- Determine the goal of setting standards and specify the purpose of achieving them if:

 • Patient focused

• Nurse-focused 

3- Determine the nursing actions necessary to achieve the goals.

4- Determine the time required to complete nursing work.

5- Writing the standard in an acceptable form.

6- Review each standard, taking into account that there are no ambiguous words or actions that are difficult to measure.

7- Measuring the availability of the standards’ characteristics in each standard that has been developed.

- Measurement

The Definition :

 Measurement is a phrase that describes performance and behavior, and expresses the scientific or skill state that represents the positive level required for something. Measures are considered indicators of standards, and must be specific to a specific specialty or patient care. 

Measurement characteristics:

 The standard must have:

 • A detailed indicator of the standard

 • Specific to a particular specialty or type of patient

 • It can be measured 

 • It contains elements that: are easy to understand, can be performed, reflect all aspects of care required, and are reviewed from time to time 

Types of metrics:

Improving the work environment (kaizen philosophy)

It is a primary means of achieving “change for the better.” It is a compound word of two parts that means continuous improvement, and it includes many

Improvement tools used in management, one of these tools is 5S.

Five S?

5S is the philosophy of taking care of the workplace by organizing and cleaning it. It consists of five basic steps and each step is called in Japanese with a word that begins with the letter S, hence the name 5S. This philosophy became known worldwide by this name, and even these words were translated

The five Japanese are converted to English words that start with S in order for the nomenclature to be valid. Where we can translate these five words to arabic words that start with the letter T, which are classification, organization, cleaning, standardization, and stabilization.

The five elements of this philosophy:

Five T consists of five elements:

1 - Sorting classification, which is called Seiri in Japanese:

Taking care of the workplace begins with classifying everything in it.

Meaning of classification: Classification here means that we classify things into things that are necessary for work at the present time and things that are not necessary for work. after

This means we get rid of things that are not needed for work and keep those that are needed for work. Such as: tools, files, materials, waste, Papers, equipment.

The classification process is the first step in this process

2 - Set in Order, which is called Seiton in Japanese:

After that comes the organization process, which aims to preserve the things that we decided to keep in an organized way that helps us perform the work

Efficiently, the process of organization does not only include arranging tools or files on shelves, but also includes reconsidering the general plan

For the workplace itself. We have to think about the most appropriate way to organize the workplace based on our current work.

3 - Cleaning or polishing (Shining), which is called Seiso in Japanese:

The goal is a very clean work environment. This process is a process that is carried out in sections every shift or every day. There are things he needs to clean

The person who uses or deals with them, such as work tools, such as keys, tools, and supplies, uses them.

4 - Standardise, which is called Seiketsu in Japanese:

After all this effort and experience in organizing and cleaning, specific rules should be set for what the place should be like

the job. This includes defining each individual's responsibilities, establishing standard methods for the cleaning process, and announcing all of this so that everyone knows

The duty he has sworn in and how to perform it. This ensures that the situation will continue in this good manner and we will not return to old habits again.

5 - Install Sustain, which is called Shitsuke in Japanese:

We come to the final step, which is establishing systems to ensure the continuity of this entire process. For example, systems are put in place to review the cleanliness of places.

An effective method is for one party to inspect another party, and a representative from a department inspects the process of keeping files at the office

Another department or job site cleaner.

Benefits of five s:

There are many benefits including:

1 - Reducing time wasted searching for documents or tools

2 - Reducing injuries due to the cleanliness of the floors, the absence of anything lying here and there, and the clarity of safe passage places

3- Reducing equipment malfunctions due to their early detection

4- Eliminate excess effort and unnecessary movements through the process of serious organization

5- Feeling a beautiful work environment as a result of the cleanliness and organization process

6- Replace damaged tools as soon as they are damaged, instead of discovering it late and disrupting work

7- Easily discover lost things

8 - Reducing the malfunctions that occurred after maintenance operations as a result of some dust entering the delicate components, and extend this to other fields.

9- Reducing quality problems that occurred due to pollution and dust.