The basic control process, irrespective of the department or activity, is the same. It involves establishing standard measuring the performance, and correcting deviations.
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1. Establishing standards:
Basically, standards are criteria of performance, made to give managers signals as to how things are going with their having to watch every step.
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End results are the best measures of plan achievement, and therefore, excellent standards of control.
End result may be stated in terms such as quantities of products, units of service, speed volume of sales, costs, capital expenditure, or profits.
In health care, control standards can be broadly classification into “output controls” and “activity (or process) controls Length of stay, bed occupancy, and number of outpatient’s visits per specialty are common examples.
Other examples are revenue to expense ratio (to monitor financial viability and utilisation of new service (to monitor growth).
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Standards can also be decided for programme implementation, resource allocation and resource utilisation. Some examples of these are staff turnover rate, consumption of stores and material, equipment utilisation, inventory levels and payroll expenses.
Quality of care as monitored through quality assurance activities “is an example of process (activity) control, reflective of the hospital’s primary objective of quality patient care.
Quality assurance is a critical control activity to ensure that patient care results are consistent with expectation and the processes associated with patient care are consistent with laid down procedures.
Monitoring covers such parameters as utilisation review, lengths of stay, readmissions, infection control, surgery review, etc.
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Intangible Standards:
Where human relationships count in performance, it is hard to measure what is “good”, “effective”, or “efficient. Many managerial controls over interpersonal relationships must continue to be based upon intangible standards, considered judgments, trial and error and, on occasions, even hunch.
2. Measurement of Performance:
Appraisal of actual performance becomes easy if means are available for determining exactly what subordinates are doing. In health care, there are many activities where it is difficult to develop accurate measures of performance.
As jobs move away from routinised activities of the assembly line type (for example, mechanical laundry or CSSD), controlling then becomes more complex. Not only many standards are difficult to develop, but appraisal may also be equally difficult.
3. Correction of Deviations:
Deviations in performance need correction. A negative deviation from standards is an indication that something is wrong, the cause of which should be examined.
Correction of negative deviations in performance incorporates other managerial functions. Deviations are corrected by re-appropriation organisational process through reassignment of duties, fuller explanation of the job, by additional staffing, or by better training of personnel. At times correction of deviations may need better directing and leading.
Apart from negative deviation, a positive deviation from standards may also suggest a problem. While this kind of performance may appear a happy matter, it is necessary to determine whether the positive deviation was a chance result or result of superior performance.
Less than expected maintenance expenditure (and resultant budgeted saving) may point to a capping of the preventive maintenance activities or not replacing sick equipment.
The control process is a combination of many actions in the management of an institution. The top management takes the following steps:
1. Get the entire staff to understand and agree to the objective and goals set up by the management. Provide performance standards to guide all personnel on a job- to-job basis.
2. Monitor current performance after objectives have been stated in measurable terms.
3. Compare performance results with objectives and goals.
4. Analyse causes of variance above or below the standards.
5. Decide corrective action where required. Management may decide to lower the objectives if objectives cannot be reached, or it may choose a different course of action to solve the problem and continue to fulfill the objectives.
6. Implement corrective action or new course of action.
7. Continue to monitor the results of the corrective/new action.