What are the positions of nursing management control points?

(1) Overview of control types

There are many kinds of management control, and different control systems have different control methods because of their different conditions and external environment. According to the different classification basis, the types of control work can be divided into many types, and the commonly used classification methods are as follows: First, according to the nature of control, it is divided into preventive control and corrective control. Secondly, according to the position of control points in the whole activity process, it can be divided into pre-control, process control, post-control and comprehensive control. Thirdly, according to the source of control, it can be divided into internal control and external control. Fourthly, according to the nature of control information, it can be divided into feedback control and feedforward control. Fifth, according to the control mode, it can be divided into formal organizational control, group control and self-control. Sixth, according to the means used in control, it can be divided into direct control and indirect control.

The above classification methods are not isolated, and sometimes a control may belong to several types. For example, the leadership of nursing department checks the work of nurses, which belongs to process control, formal organization control and feedback control. The hospital strictly implements the medical personnel access system to prevent unqualified personnel from taking up their posts. This control measure is not only a formal organizational control, but also a pre-control and preventive control. Most organizations use preventive control, synchronous control and feedback control simultaneously.

(B) control type division

1. According to the nature of control activities, control can be divided into preventive control and corrective control.

(1) prevention and control prevention and control is to avoid mistakes and take preventive measures before the implementation of the plan, which requires managers to have a deep understanding of the deviation factors and key points in the plan operation, so as to foresee problems and take preventive and control measures. In nursing management, various rules and regulations, various nursing practices, technical operating procedures, working procedures, personnel training, work plans, etc. all play the role of prevention and control. When designing preventive and control measures, people follow these principles in order to achieve organizational goals more effectively. However, it is very important to truly abide by these preventive rules and regulations, which must be guaranteed by good monitoring institutions.

(2) Corrective control is more commonly used in actual management. Corrective control is often because the manager has not encountered problems, or after the manager thinks that there are problems, in order to make the managed behavior return to the predetermined standard, or the implemented procedures return to the original established level. For example, in nursing quality management, regular inspections or spot checks by monitoring institutions can find problems and take corrective measures to solve them through certain feedback channels.

2. Classification of control activity points Because the operation process of any system is an input-conversion-output process, it can be divided into three control types: pre-control, process control and post-control according to the different positions of control points in the whole activity process, as shown in Figure 6-2.

Figure 6-2 Classification by Control Activity Point

(1) Prior control is also called preventive control or feedforward control, and its control point is located at the initial end of system operation, which is not only the input end of the whole activity process, but also the starting point of the whole activity time. Control precedes action, mainly for the future. It means that the supervisor makes use of the latest information, including the experience and lessons of the last control cycle, repeatedly and carefully predicts the possible results, and then compares them with the plan requirements, so as to adjust the plan or control the influencing factors when necessary, thus ensuring the realization of the goal. The characteristic of ex ante control is that the control occurs at the input end of the running process, and it can be corrected before the output result of the running process is affected. The corrective measures are usually preventive. Pre-control is mainly to do a good job in resource allocation, including personnel selection and allocation, material technology and equipment, goods, materials and technology to ensure business needs and capital control. It can prevent the organization from using substandard resources, ensure that the organization's investment reaches the predetermined standard in quantity and quality, and eliminate those congenital defects that are difficult to recover in the control process before the whole activity begins. This is the most economical way. For example, hospitals should establish certain quality standards before purchasing large medical instruments, which can not only ensure the purchase of high-quality medical instruments and equipment, but also reduce the losses caused by possible failures of medical instruments and equipment. It is pre-control for hospitals to formulate preventive plans for major medical negligence and medical accidents and do a good job in hospital safety management. Prior control is also used in human resource management; Staff standards are set for prevention in advance. For example, a 3A hospital only recruits healthy nurses with nurse's practice certificate as new employees. This kind of pre-control is helpful to reduce the low productivity and some unnecessary losses caused by unqualified nurses or diseases.

In nursing management, the control of basic quality and essential quality before the start of nursing service activities, the examination and assessment of nursing graduates before entering the department, the inspection of instruments before surgery or operation, and the inspection of disinfection items before use all belong to this control. Nursing quality control should focus on prevention, and do a good job in quality input, so that people who do not meet the quality requirements will not be employed, instruments, equipment, medicines and materials that do not meet the quality requirements will not be purchased, and those who have not received education and training will not be employed. Nursing managers should fully estimate possible problems and prevent them before they happen. The concept of "prevention first" is to change quality management from passive to active, which requires nursing managers to have the concept of "three-level prevention". Primary prevention to avoid quality problems; Secondary prevention eliminates quality problems in the bud; Three-level prevention is to reduce the adverse effects and damage of quality problems, and the continuous improvement of quality can be achieved only after prevention first.

(2) Process control Process control is the synchronous control of various elements during the implementation of the plan to ensure that activities are carried out in accordance with the prescribed procedures and methods, also known as synchronous control and link quality control. For example, the workers on the assembly line are the operators of this process and the quality inspectors of the previous process. This control is characterized by the use of corrective measures in the ongoing implementation of the plan. Managers guide and control the activities of subordinates through on-site supervision and inspection, and take corrective measures immediately when they find deviations that do not meet the standards to ensure the correct implementation of the plan. For example, checking the implementation of some nursing rules and regulations, nursing procedures and operating procedures all belong to this kind of control.

The most common method of process control is visual observation. Managers personally supervise and inspect the activities of their subordinates by going deep into the site, and give immediate guidance and control when problems arise. It includes the following contents: (1) Instruct subordinates on appropriate working methods and processes; (2) Supervise the work of subordinates to ensure the realization of planned objectives; (3) found substandard deviation, take corrective measures immediately. During the implementation of the plan, a lot of management and control work, especially grass-roots management and control work, belongs to this type. This control method requires managers to complete the complete control work including comparison, analysis and correction of deviation immediately. Therefore, although the control standard is the action goal, policy, norm and system determined by the plan, the effect of control work depends more on the personal quality, style, guidance method of the on-site manager and the subordinate's understanding of these guidance. In the field control, we should pay attention to avoid working only by subjective will. Managers must strengthen their own learning, improve their own quality, attach importance to the role of "setting an example", implement control step by step, and ensure the realization of plans and goals. So synchronous control has higher requirements for managers.

Process control is suitable for grass-roots managers, especially those who need quick response, such as customer complaints, products and services (including pre-sale, in-sale and after-sale). This kind of problem is complex and changeable, so it can't be controlled beforehand. Only by doing a good job of on-site control and improvisation can we achieve our goal, and on-site control needs full authorization. For example, the on-site control and supervision of nursing managers at all levels, especially the head nurse's five rounds a day, and the noon, evening and holiday rounds organized by the nursing department belong to the on-site control, which aims to ensure the nursing work in one day, especially in the weak period. Nursing quality control insists on link quality control, which is a management process of monitoring, evaluating and correcting deviations in nursing process. Paying attention to self-control, step-by-step control and weak link control are the fundamental guarantee for patients to obtain high-quality care.

Process control also adapts to employees' self-control. For example, when a nurse transfuses blood for a patient, she finds that the transfusion bag is damaged and leaks blood, and immediately contacts the blood bank to return the relevant matters, which belongs to on-site control.

However, with the popularization of computer application and the development of information technology, real-time information can be quickly transmitted between different places, which makes the synchronization control between different places realize and breaks through the limitations of the scene. For example, when doctors prescribe drugs, they can know the inventory information of drugs through the hospital network. Some hospitals use modern information technology for remote surgery. During the operation, the patient's physiological indexes are transmitted to the expert group in different places through the information network so that the expert group can control the operation.

(3) Post-event control The control point of post-event control is located at the end of the activity process, which is the evaluation control of the final result after the completion of the plan, also known as result control and feedback control. The main control feature is to analyze the implementation result of the work, compare it with the control standard, analyze its causes and possible impact on the future, formulate and implement corrective measures in time, prevent the deviation from continuing to develop or reoccur, and ensure that the error situation will not expand after the last level, which is helpful to ensure that the outside of the system is in a normal state. But the fatal flaw of post-event control is that the whole activity has ended, and the deviation in the activity has caused irreparable damage within the system. Financial statements are an ex post facto control.

In nursing management, nursing quality is often evaluated by the quality of nursing results, because it is more specific to evaluate nursing quality by nursing results, and it is easy to get accurate measurement results with high reliability. For example, the incidence of pressure ulcers, the qualified rate of basic nursing, the incidence of nursing errors, the analysis of nursing errors and accidents, and the statistics of nursing quality are all within this control range. The purpose of result control is to prevent the bad results that have happened from developing further, or to eliminate the risk factors and prevent them from happening again in the next cycle. There is a certain lag, so the feedback speed must be greater than the change speed of the controlled object, otherwise, the control will be difficult to play its role.

It can be seen that this control work is a process of continuous improvement, and its focus is on the implementation results as the basis for future behavior.

Although the above three controls have their own characteristics, they are often used alternately in practical work. Although pre-control can make preparations in advance and nip in the bud, some emergencies cannot be prevented and must be supplemented by process control, otherwise all previous efforts will be in vain. Similarly, both ex ante control and process control need to be tested by ex post control. In addition, in the process of system development, the former stage is controlled afterwards, but the latter stage is controlled afterwards.

(4) Total control Total control is also called comprehensive control. It includes two meanings: first, it refers to the control of the whole process of plan implementation, that is, from the beginning of input link to the end of output result, comprehensive control before, during and after the event; Second, all staff participate in the control work, implement all-round comprehensive control, and ensure the realization of the goal. For example, total nursing quality management aims at comprehensively controlling the implementation of nursing plans and reducing deviations; Ensuring that all work meets the established standards is the ideal control work.

reading material

/kloc-At the end of 0/8th century, the British government decided to send all criminals from Britain to Australia. Some private ship owners have signed contracts to transport prisoners from Britain to Australia on a large scale. Most ships are converted from very old cargo ships. The ship is poorly equipped, and there is no medical medicine, let alone a doctor. In order to make huge profits, shipowners try to pack as many people as possible, which makes the conditions on board very bad. Once the ship leaves the shore, the shipowners get the government's money according to the number of people, regardless of whether these people can cross the ocean to reach Australia alive. In order to reduce costs, some shipowners even deliberately cut off water and food. Three years later, the government found that the death rate of prisoners transported to Australia reached 12%, of which 424 prisoners died on the most serious ship 158, with a death rate as high as 37%. The British government spent a lot of money, but failed to achieve the goal of large-scale immigration.

The British government has thought of many ways. Each ship is supervised by a government official, and then a doctor is assigned to take care of the prisoners' medical care and health care. At the same time, the living standards of prisoners on board are hard and fast. However, the mortality rate has not decreased, and some supervisory officials and doctors on board have died inexplicably.

It turned out that some ship owners bribed officials to make huge profits, but the officials did not agree and threw them into the sea to feed the fish. The government paid the supervision fee, but died as usual.

The government has adopted a new method, bringing shipowners together for education and training, educating them to cherish life, and understanding that the development in Australia is for the long-term plan of Britain, and money is not more important than life, but the situation has not improved. The mortality rate is still high.

A British parliamentarian believes that the key is that control is not well grasped, and those private ship owners have used control means. The drawback of ex post facto control is that the government pays shipowners to calculate the number of ships. Therefore, he proposed to change the control mode and start to take prior control: the government calculates the money according to the number of people who landed in Australia, and no matter how many people you have on the ship in Britain, you will count the number of people to pay when you arrive in Australia. After the control mode was changed, the shipowner took the initiative to ask the doctor to accompany the ship, prepare medicines on board, improve life, and let everyone on board arrive in Australia as healthily as possible. A person means an income. Since the implementation of the landing counting method, the mortality rate on board has dropped below 1%, and some ships carrying hundreds of people have not died after sailing for several months.

It can be seen that ex post control is not as good as ex post control, and ex post control is not as good as ex post control. The key to control is to seize the opportunity, and whether the control opportunity is reasonable or not has a great influence on the control effect.

3. According to the types of control sources, control can be divided into three types, namely formal organizational control, group control and self-control.

(1) Formal organizational control is controlled by some systems or regulations designed and established by managers. Guide the actions of members of the organization through planning, control consumption through budget, and check whether departments or individuals carry out activities in accordance with the provisions of the organization through auditing. Finding deviations and correcting them in time, such as criticizing or punishing those who violate the operating rules in nursing quality inspection, and punishing medical and nursing errors and accidents, all belong to the category of formal organizational control. The main contents of formal organizational control are: first, the implementation of standardization, such as standard working procedures and operating procedures; The second is to protect the organization's property from infringement; Third, quality standardization is mainly to ensure the level of nursing or the quality of nursing service; The fourth is to prevent abuse of power; The fifth is to guide and measure the work of employees.

(2) Group control is also called informal organization control. Informal organizations have their own codes of conduct, that is, the values and codes of conduct of their group members. Informal organizations control groups according to this code of conduct, mainly using people's herd mentality. Therefore, managers should take advantage of the situation and actively guide organizational goals, otherwise it will play a negative role in the realization of organizational goals.

(3) Self-control Self-control means that individuals consciously carry out activities according to certain behavioral norms or quality standards. Self-control ability is related to personal quality. People with good self-cultivation and the overall situation have strong self-control ability. Self-control plays an important role in nursing work, because nurses have many opportunities to work independently, so nurses are required to have strong self-control, that is, the spirit of "being cautious and independent" and strictly abide by various rules and regulations and operating norms to ensure nursing quality and promote patients' health.

4. According to the nature of control information, management control can be divided into feedback control and feedforward control.

(1) feedback control feedback control is to guide the current and future behavior process according to the feedback information. Norbert wiener, the founder of cybernetics, once pointed out that nature finds errors through information feedback, and triggers the behavior process of correcting errors, thus realizing its own control. For example, through feedback control, people's body temperature, blood pressure, pulse and breathing can be kept in balance. The same is true for management control, which often relies on information to realize control activities. Therefore, it is necessary to establish and improve the information feedback system to provide timely and accurate information for nursing authorities so that managers can take corresponding control measures according to different situations.

(2) Feedforward control Feedforward control is to constantly use the latest information to make predictions, compare the proposed standards with the predicted results, and take measures to make the input and execution activities coincide with the expected results. For example, in order to make the pass rate of the basic knowledge examination of nurses reach the standard required by a third-class first-class hospital, various training measures can be taken to gradually improve the knowledge level of nurses and finally achieve the expected goal. Therefore, it can be said that the focus of feedforward control is to control by predicting the input or process of the controlled object, so as to ensure the expected process and result.

5. According to the classification of control means, control can be divided into direct control and indirect control.

(1) Direct control Direct control refers to the control mode in which the managed person (controlled object) directly receives control information from the manager, or the manager directly sends control information to the controlled object to restrain the behavior of the controlled object. For example, the state issues mandatory plans to enterprises, which directly restricts the economic behavior of enterprises. This is a typical direct control behavior. Direct control is mainly conducted between two adjacent levels. In nursing management activities, the control relationship between the director of nursing department and the head nurse or between the head nurse and the nurse belongs to direct control.

Direct control has two obvious characteristics: first, administrative compulsion, that is, administrative orders and administrative measures are the main means of control, which is mandatory and binding on the controlled object; The second is direct, that is, the control instructions are directly issued to the controlled object without any intermediate conversion links, which directly restricts the behavior of the controlled object.

(2) Indirect control Indirect control refers to a form of control in which the controlled object receives control information from the "controller" such as the system, policy and responsibility system formulated by the manager, instead of directly receiving control instructions from the manager to carry out self-adjustment and self-control. This control mode is the main control form between nursing managers and nurses. It relies on various rules and regulations, nursing practices, operating procedures and various principles and policies to control the behavior of nursing staff.

Indirect control is conducive to improving control efficiency, eliminating the obstacles of horizontal information flow under direct control, broadening the information flow space, and reducing the lag in the process of information attenuation and information change. It can make managers get rid of a lot of trivial matters and concentrate on dealing with major, key and overall problems. However, indirect control also has some limitations. Its effectiveness is closely related to whether the control mechanism is perfect and whether it conforms to the behavior law and interest requirements of the controlled object. Direct control is not as simple and flexible as direct control.

Both control methods have their own advantages and disadvantages. In nursing management, indirect control and direct control should be organically combined to achieve the expected effect.

In addition, the control in management can also be divided into business control, technical control, quality control, capital control, human resource control and so on according to business technology. According to the control time, it can be divided into daily control and regular control. According to the coverage of control content, it can be divided into thematic control, special control and comprehensive control.