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One process of controlling is to make improvement deemed necessary from the

feedback wherein connect deviation remedial actions must be undertaken. In this
process, it opens opportunities for improvement and comparing performance against set

Second is establishing standards for all elements of management in terms of

expected and measurable outcomes, this is to ensure that quality of nursing care
provided including the delivery processes and procedures, and the desired outcome of
these processes.


1. Principles of uniformity ensure that controls are related to the organizational

2. Principles of comparison ensure that controls are stated in terms of the
standards of performance required.
3. Principles of exceptions provide measures that identify exceptions to the


1. Reflect the nature of the activity
2. Report errors prompt/timely
3. Forward-looking and comprehensive
4. Point out expectations at critical points
5. Objective, specific and appropriate
6. Flexible
7. Reflect organizational pattern; reflect authority and responsibility pattern.
8. Economical
9. Use understanding devices
10. Indicate corrective actions

Health care is the diagnosis, treatment and prevention of disease, illness, injury
and other physical and mental impairments in human beings. Health care is delivered by
practitioners in allied health, dentistry, midwifery, obstetrics, medicine, nursing,
optometry, pharmacy, psychology and other care providers.
It refers to the work done in providing primary care, secondary care and tertiary care as
well as in public health. Quality is the standard of something as measured against other
things of a similar kind. The Institute of Medicine (IOM) has defined the quality of health
care as the degree to which health services for individuals and populations increase the
likelihood of desired health outcomes and are consistent with current professional

To reduce the risk of unnecessary harm associated with healthcare to an

acceptable minimum. An accepted minimum refers to the collective notions of given
current knowledge, resources knowledge, resources available and the context in which
care was delivered weighed against the risk of non-treatment or other treatment (WHO).


There are 3 types of measures used in quality work:

Structure: Physical equipment and facilities

Process: How the system works
Outcome: The final product, results

Structure refers to the setting in which care is delivered including adequate facilities and
equipment, qualification of care providers, administration structure and operations of
programs. Using this approach, good care settings and supporting structures contribute
to good care. Structure variables are often concrete and accessible, making them
relatively easy to assess.
Process examines how care has been provided in terms of appropriateness,
acceptability, completeness or competency. These measurements are typically have
more grey area and are less definite than those obtained through assessing
outcomes. Instruments that assess process variables are categorized under the
following headings: communication, patient knowledge, performance appraisal and
quality of care.

Outcomes refer to the end points of care, such as improvement in function, recovery or
survival. Outcomes are usually concrete and precisely measured. Some drawbacks to
using outcomes to evaluate care include: choosing a relevant outcome to measure and
time lapse required for measurement. As well, there are outcomes like attitudes and
satisfaction that are not precisely measured. Instruments that assess outcome variables
are categorized under the following headings: patients, health
providers and organization and health system. Each of these three types of outcomes
contain unique sub-categories.


Quality Improvement or QI is meant to enhance the safety, efficiency and

effectiveness of all businesses from health care processes and the performance of
delivering products to human resources. The improvement is achieved using various
methods, both qualitative and quantitative. Healthcare delivery is becoming more
complex with the passing of time, and there is a requirement for new and enhanced
methods that will reduce costs and provide access to new technologies.

The main idea of improvement is that, when a system remains unchanged over
time and no enhancements are made, it cannot generate better results than the ones
already created. Bringing a change into the system can facilitate the achievement of a
new performance level. The inefficient parts of the structure are replaced with new
inventions that can prove to be worthy.


Cost containment affect heath care systems in several ways. First is to ensure
the quality of care received by patients. Second, is to maintain ethical basis of health
care system. Finally, maintaining access to health care.
What cost containment measures are being used in your organization? Do you think they
are reasonable and fair?

Our organization mainly focuses cost containment on measuring and limiting the
cost of each department in terms of supplies requisitions, water and electric
consumption, and by cutting the staffing in the departments.
In a business side, I think it would be fair to just limit the resources being
consumed or limit manpower so that the costs will be lower than the gain. In that sense,
there will be a higher revenue. But thinking as a nurse, the more resources we have the
better we can perform. The more manpower we have, the better health care we can
give, since being a nurse is a service-oriented job.

Describe the performance appraisal used in your organization. How does it compare with
the performance appraisal describe in this module?
In our institution, we are conducting staff evaluation every six months to
document employees performance which includes both satisfactory and need for
improvement. However, in our department our performance is very rarely appraised. Our
leaders in our area are the only ones who see the improvement in the skills and in the
performance of our jobs. Also, the potential of our co-staff nurses were just evaluated
within our level.
Compared to the module, it is a little too far from what is really recommended.
Improvements on our institution is recommended in this aspect of controlling.

Describe the advantage and disadvantage of peer review. What are your feelings about
being evaluated by a peer?
Peer reviews allow an employee's colleagues to assess the individual's
performance. They can provide important insight into how employees interact with each
other, including employees who have quietly emerged as leaders within the ranks
without the accompanying formal title. However, these review system can also be
subjective which makes it a disadvantage because of employees personality issues and
competition. I am very open to being evaluated by any of my peers. My peers are the
ones who see every aspect of me being in my work place. They know my strengths and
my weaknesses. In fact, I would like to believe that a peer evaluation is one of the best
ways of evaluating ones performance.

Describe the disciplinary measures used in your organization. Do you agree with the
methods used and the penalties imposed?
The purpose of disciplinary measures short of termination is corrective, to
encourage employees to improve their conduct or performance. The Management
expects all employees to behave in a mature and responsible manner and to perform
their jobs conscientiously, without the need of disciplinary action.
In our institution, we are practising Oral Warnings by immediate superior and
Written Warnings done by HR personnel to discuss the disciplinary action and the
employee will be asked to sign the warning.
In our institution it is more of coercive, I cannot say that I total agree in this kind of
disciplinary actions. I would recommend that there should be a concrete set of rules,
policies and guidelines with according disciplinary actions that are applicable for
everyone. There would be no exceptions, and also some departments have set their own
rules and regulations independently and putting some of their staff confused on the
those set of regulations as being compared to the companys own set of rules. I believe
that disciplinary actions should be done only of needed, and if done, make sure it is
appropriate and consistent for everybody.