(a) Overview of the types of control
There are many types of control of management, and different control systems are controlled in different ways because of their different conditions and external environments. According to different bases of division, the type of control work can be divided into a variety of commonly used classification methods are as follows: First, according to the nature of control can be divided into preventive control and corrective control. Secondly, according to the position of the control point located in the whole process of activities can be divided into prior control, process control, after the fact control, comprehensive control. Third, according to the source of implementing control can be divided into internal control and external control. Fourth, according to the nature of control information can be divided into feedback control and feed-forward control. Fifth, according to the way of control can be divided into formal organizational control, group control and self-control. Sixth, according to the means used for control can be divided into direct control and indirect control.
The above categorization is not isolated, sometimes a control may belong to several types. For example, the leadership of the nursing department to randomly check the work of nurses, that is, belongs to the process control, but also belongs to the formal organizational control and feedback control. Hospitals strictly implement an access system for medical personnel to prevent unqualified personnel from working, this control measure is both formal organizational control, prior control, and preventive control. Most organizations use both preventive control, synchronous control and feedback control.
(ii) control type division
1. according to the nature of the control activities divided into types according to the nature of the control activities can be categorized control can be divided into preventive control and corrective control.
(1) preventive control Preventive control is to avoid errors, take preventive measures before the implementation of the program, which requires managers to run the program what will occur in the deviation factors and activities of the key points have a deep understanding in order to foresee the problem, to take preventive control measures. In nursing management, things like various rules and regulations, various nursing routines, technical operation procedures, work procedures, staff training, and work plans all play a preventive control role. The principles followed in designing preventive controls are all aimed at achieving organizational goals more effectively. However it is very important that these preventive rules and regulations are actually followed and must be ensured by a good monitoring organization.
(2) Corrective control Corrective control is more commonly used in practical management. The use of corrective control is often due to the manager did not meet the problem, or after the manager believes that something has gone wrong, in order to make the behavior of the managers to return to a predetermined standard, or the implementation of the procedure to return to the level of the original established. For example, the quality of care management, the monitoring organization's regular inspection or random inspection at any time, can find problems, through certain feedback channels, take corrective measures to solve the problem.
2. According to the point of control activities divided into types As the operation of any system is expressed as the process of input - conversion - output process, it will be based on the control point is located in the whole process of activity of the location of the different points of the prior, the process and the aftermath of the three types of control to do to focus on, see Figure 6-2.
Figure 6-2 divided into types according to the point of control activities
(1) Prior control, also known as preventive control or feed-forward control, the control point is located at the initial end of the system operation, which is both the input of the entire process of the activity, but also the beginning of the entire activity time. Control is earlier than action, mainly future-oriented control. It is a process whereby supervisors use the most up-to-date information available, including lessons learned from the previous control cycle, to repeatedly and carefully anticipate possible outcomes, and then compare it to the requirements of the plan, thereby adjusting the plan or controlling influencing factors as necessary to ensure that the objectives are achieved. Prior control is characterized by the fact that it occurs at the input end of the operating process, and it enables corrective action to be taken before the output results of the operating process are affected. The corrective action is often preventive. Prior control is mainly to improve the allocation of resources, including personnel selection and configuration, physical and technical equipment, commodities, materials and technology to ensure that the operational needs and the control of funds, etc., it can prevent the organization to use the resources that do not meet the requirements to ensure that the organization's inputs in terms of quantity and quality to meet the pre-determined standards, in the whole activity before the start of the process can be eliminated in control of the process of difficult to undo the inherent defects. This method is one of the most economical. For example, when a hospital purchases large-scale medical equipment, it establishes certain quality standards beforehand, which not only ensures the purchase of high-quality medical equipment, but also reduces losses due to the possibility of malfunction of medical equipment. Hospitals to develop a major medical negligence and medical accident prevention plan, good hospital safety management, is a prior control. Prior control is also used in human resource management; setting employee standards is preventive prior. For example, a tertiary hospital only recruits nurses who have a nursing license and are in good health as new employees; this prior control helps to reduce low productivity and some unnecessary losses caused by unqualified or sick nurses on duty.
In nursing management, the control of basic and elemental quality before the start of nursing service activities, the examination and test of nurse graduates before joining the department, the inspection of instruments before operation or surgery, and the checking of sterilized items before use all belong to this kind of control. The quality control of nursing is mainly based on prevention, and the quality input is good, so that personnel not meeting the quality requirements can not be appointed, instruments and equipment not meeting the quality requirements of drugs and materials can not be purchased, and personnel without education and training will not be put on the job. Nursing management personnel should fully estimate the possible problems and prevent them from occurring in the first place. The idea of "prevention-oriented" is to make quality management from passive to active, requiring nursing managers to have a "three-level prevention" concept. The first level of prevention for quality problems do not occur; the second level of prevention to nip quality problems in the bud; the third level of prevention is to reduce the quality of the problem of the adverse effects and damage, prevention-oriented in order to achieve continuous quality improvement.
(2) process control process control is the implementation of the plan in the process of synchronized control of various elements to ensure that the activities carried out in accordance with the prescribed procedures and methods, also known as synchronized control, link quality control. Such as in the assembly line workers, that is, the operation of the process workers, but also the quality control personnel of the previous process. This type of control is characterized by corrective measures used in the ongoing process of plan implementation. The manager directs and controls the activities of subordinate personnel through on-site supervision and inspection, and takes corrective measures immediately when deviations from the standard are detected, in order to ensure the correct implementation of the program. Such as checking the implementation of some nursing rules and regulations, nursing procedures, and operational procedures belong to this type of control.
The most common method of process control is visual observation, in which the manager personally supervises and inspects the activities of subordinate personnel by going into the field and immediately provides guidance and control when problems occur. It includes the following: ① to the subordinate instructions for appropriate work methods and work processes; ② to supervise the work of subordinates to ensure the realization of the program objectives; ③ found substandard deviations, immediately take corrective measures. In the implementation of the plan, a large number of management control work, especially at the grassroots level belongs to this type of management control work, this control mode because of the need for managers to instantly complete the complete control work, including the comparison, analysis and correction of deviations, so that, although the standard of control is the plan of action to determine the objectives, policies, norms and systems, but the effect of the control work depends more on the site manager's personal qualities, style, manner, and guidance. The personal qualities, style, guidance, and subordinates to the degree of understanding of these instructions and other factors. In the field control, we must pay attention to avoid working by subjective will alone, supervisors must strengthen their own learning and quality improvement, pay attention to the role of "teaching by example", the implementation of the control level by level to ensure that the plan and the goal to achieve. Therefore, the control of the same period of time on the higher requirements of managers.
Process control is adapted to the grass-roots managers, especially those who need to respond quickly to the work of customer complaints, product services (including pre-sale, sale, after-sale), such issues are complex and volatile, the prior control of prevention, only to do a good job of on-site control, adaptive, in order to achieve the goal of the on-site control needs to be fully authorized. For example, all levels of nursing management personnel on-site control, supervision, in particular, the head nurse of the department a day five room, the nursing department organized by the lunch, night and holiday room are on-site control, its purpose is to protect the day nursing work, especially the weak time of the smooth progress of nursing. Nursing quality control adhere to the link quality control, the nursing process of supervision, evaluation and correction of deviations in the management process. Focusing on self-control, level-by-level control and control of weak links is the fundamental guarantee that patients receive high-quality care.
Process control is also adapted to employee self-control. For example, the nurse in the patient blood transfusion, found that the blood transfusion bag has broken leakage phenomenon, and immediately contact the blood bank to return the relevant matters, it belongs to the scene control.
But with the popularization of computer applications and the growing development of information technology, real-time information can be quickly transferred between different places, which makes the same period of control can be realized between different places, breaking through the limitations of the scene, for example, the hospital doctor for prescribing medicines, you can through the hospital network to learn about the stock of drugs information. Some hospitals utilize modern information technology to perform remote surgery, in which the patient's physiological indicators are transmitted to an off-site team of experts through an information network, enabling the team to control the operation.
(3) Ex post facto control The control point of ex post facto control is located at the end point of the activity process, which is the evaluative control for the final result after the completion of the plan, also known as the result of control, feedback control. The main feature of control is to analyze the result of work execution and compare it with the control standard, analyze the cause and possible impact on the future, formulate corrective measures and implement them in time to prevent the deviation from continuing to develop or reoccurring, and keep the last hurdle so that the wrong situation will not expand, which helps to ensure that the system is in a normal state outside. However, the fatal flaw of ex post facto control is that the whole activity has been completed, and the deviation in the activity has already caused damage within the system and cannot be compensated. Financial statements are a form of ex post facto control.
Nursing management is often used to assess the quality of care by the outcome of care, because the quality of care with the outcome of care is more specific, easy to get the right measurements, and its credibility is higher. Such as outpatients or discharged patients quality of care determination of pressure ulcer incidence rate, basic care pass rate, nursing error rate, nursing error, accident analysis, nursing quality statistics belong to the scope of such control. The purpose of outcome control is to avoid the continuation of adverse outcomes that have occurred, or to eliminate risk factors and prevent them from recurring in the next cycle. Has a certain lag, thus requiring feedback must be faster than the rate of change of the control object, otherwise, the control is difficult to play a role.
As you can see, this type of control is a continuous improvement process, which focuses on the results of the implementation of the focus on the results and use it as a basis for future behavior.
The above three kinds of control, although each has its own characteristics, but in practice is often cross-used. Prior control can be prepared in advance to prevent problems, but some emergencies can not be prevented, which must be supplemented by process control, otherwise, it will be wasted. Similarly, both prior control and process control need to be tested afterward. In addition, in the process of system development, it is ex post facto control for the previous stage, but ex ante control for the latter stage.
(4) Comprehensive control Comprehensive control is also known as integrated control. It includes two meanings: one refers to the control of the whole process of implementation of the plan, that is, from the beginning of the input link to the output results, comprehensive prior, process, after the fact control; the second refers to all staff are involved in the control work, the implementation of a full range of comprehensive control to ensure that the goal is achieved. For example, the purpose of total nursing quality management is to carry out comprehensive control of the implementation of the nursing program in order to reduce the deviation; to ensure that all work is consistent with the established standards, which is the ideal control work.
Reading Materials
In the late 18th century, the British government decided to send all Englishmen who had committed crimes to Australia. Some private shipowners contracted to transport convicts from Britain to Australia on a large scale. Most of the ships were converted from old freighters with poor equipment, few medical drugs, and even fewer doctors, and the shipowners loaded as many people as possible in order to make a huge profit and make the conditions on the ships very bad. Australia does not care, some shipowners in order to reduce the cost, and even deliberately cut off water and food, three years later, the government found: the mortality rate of the prisoners transported to Australia reached 12%, the worst ship 424 prisoners died 158 people, the mortality rate as high as 37%, the British government spent a large amount of money, but failed to achieve the purpose of mass immigration.
The British government tried many things. A government official was assigned to supervise each ship, and another doctor was assigned to take care of the prisoners' health care, while the prisoners' standard of living on the ships was rigidly regulated. But not only did the death rate not go down, some of the ships' supervising officials and doctors even died in unexplained circumstances.
It turned out that some shipowners bribed officials for profiteering, and if the officials didn't agree to go along with them, they were thrown into the sea and fed to the fish. The government spent money on oversight, but people died as usual.
The government took a new approach, gathering all the shipowners together for education and training, teaching them to value life, to understand that going to Australia for development was for the long-term good of Britain, and not to value money over life, but the situation remained unchanged. The death rate has remained high.
A British MP believes that the key lies in the lack of control at the time of control, those private boat owners to exploit the control methods. And the flaw in the control after the fact is that the government gives the boat owners compensation to the number of people on board. So, he proposed to change the control method to start to take control beforehand: the government to Australia to the number of people ashore to calculate the money, no matter how many people you get on board in the United Kingdom loaded, to Australia and then count the number of people to pay the remuneration. After the change of the control method, the shipowner took the initiative to invite the doctor to follow the ship, on board the ship to prepare medicines, improve life, as far as possible, so that each person on board the ship are healthy to arrive in Australia, a person means an income, since the implementation of the disembarkation counting method, the mortality rate on board the ship dropped to less than 1%, some of the hundreds of people on board the ship in the experience of a few months of boating surprisingly, there is not a single person died.
This shows that control after the fact is not as good as control during the event, and control during the event is not as good as control before the event. The key to control lies in the grasp of the timing, whether the timing of the control is reasonably grasped, will have a great impact on the effect of control.
3. According to the source of control divided into types According to the source of control can be divided into three types of control, namely, formal organizational control, group control and self-control.
(1) Formal Organizational Control Formal organizational control is exercised through some institutions or regulations designed and established by managers. The actions of the members of the organization are guided through planning, consumption is controlled through budgets, and audits are conducted to check whether each department or each individual is carrying out activities in accordance with the organization's rules. Detecting deviations and correcting them in time, such as criticizing or punishing those who are found to have violated operating procedures in nursing quality inspections, and disciplining medical and nursing errors and accidents, all fall within the scope of formal organizational control. The main elements of formal organizational control are: first, the implementation of standardization such as standard work procedures, operating procedures, etc.; second, to protect the organization's property from being violated; third, the standardization of quality is mainly to ensure that the level of care or the quality of nursing services; fourth, to prevent the abuse of power; and fifth, the work of the staff to guide and measure.
(2) Group control Also known as informal organizational control. Informal organizations have their own set of behavioral norms, which are the values and codes of conduct of their group members. Informal organizations are based on this set of behavioral norms to control the group, the main use of people from the herd mentality, so managers should take advantage of the situation, to the organization's goals in the direction of positive guidance, otherwise it will play a negative role in the realization of organizational goals.
(3) Self-control Self-control refers to the individual consciously go according to a certain behavioral norms or quality standards to carry out activities. Self-control is related to personal qualities. People with good cultivation and people who care about the big picture have strong self-control. Self-control in nursing work occupies a very important position, because nurses work independently very much, so the nursing staff should have a strong self-control ability, that is, "prudent" spirit, strict compliance with the rules and regulations, operating standards, in order to ensure the quality of care, and promote the health of patients.
4. According to the nature of the control information divided into types According to the nature of the control information can be divided into feedback control and feedforward control management control.
(1) Feedback control Feedback control is the process of guiding present and future behavior based on feedback information. Norbert Wiener, the founder of cybernetics, pointed out that the natural world through information feedback to find errors, and trigger the correction of errors in the behavioral process, in order to control themselves. For example, a person's body temperature, blood pressure, pulse, and respiration are maintained in equilibrium with the help of feedback control. The same is true of management control, which is often achieved with the help of information to control activities. Therefore, it is necessary to establish and improve the information feedback system to provide timely and accurate information to the nursing authorities, so that managers can take appropriate control measures according to different situations.
(2) feed-forward control feed-forward control is the continuous use of the latest information for prediction, the formulation of standards with the predicted results compared to take measures to make the inputs and implementation of activities with the desired results. For example, in order to make the passing rate of the basic knowledge examination for nurses meet the standards required by a Class IIIA hospital, a variety of training measures can be taken to gradually improve the knowledge level of nurses, and finally achieve the desired purpose. Therefore, it can be said that the focus of feed-forward control is to control by predicting the inputs or processes of the controlled object in order to ensure that the desired process and results are obtained.
5. Types of control according to the means of control According to the means used can be divided into two types of control: direct control and indirect control.
(1) direct control direct control refers to the manager (the controlled object) directly from the manager to receive control information, or the manager directly to the controlled object to send control information to constrain the behavior of the controlled object of control, such as the state to the enterprise issued a directive plan to directly constrain the economic behavior of the enterprise, is a typical direct control behavior. Direct control is mainly carried out between two neighboring levels. In nursing management activities, the director of the nursing department and the head nurse or the head nurse and the nurse between the control relationship belongs to direct control.
Direct control has two distinctive features: first, it is administratively mandatory, that is, administrative orders and administrative measures as the main means of control, the object of control has a mandatory binding force; second, it is direct, that is, the control instructions do not go through any intermediate conversion links, directly to the object of control, directly binding the object of control behavior.
(2) Indirect control Indirect control refers to the controlled object is not directly from the manager to receive control instructions, but from the manager to develop systems, policies, accountability and other "controllers" to receive control information, self-regulation, self-control of a form of control. This form of control is the main form of control between nursing managers and nurses, relying on a variety of rules and regulations, nursing routines, operating procedures and a variety of guidelines, policies and constraints on the behavior of nursing staff, nursing staff to control.
Indirect control is conducive to improving the efficiency of control, eliminating the obstacles to the lateral flow of information under direct control, broadening the space of information flow, reducing the information decay and information changes in the process of hysteresis. Can make managers free from a large number of trivial matters to focus on the study of major, critical, global issues. But indirect control also has certain limitations, its effectiveness and control mechanism is perfect, whether in line with the control object of the law of behavior and the interests of the requirements of a great relationship, not as simple and flexible as direct control.
The two control methods have their own advantages and disadvantages, in nursing management, indirect control and direct control should be combined organically to achieve the purpose of achieving the desired results.
In addition, control in management can also be divided by business technology can be divided into business control, technical control, quality control, financial control, human resources control. According to the control time can be divided into daily control, regular control. According to the coverage of the control content can be divided into thematic control, special control and comprehensive control