Definition of Controlling

Controlling or evaluating is an on-going function of management which occurs during,

planning, organizing, and directing activities. It includes assessing and regulating
performance in accordance with the plans that have been adopted, instruction issued and
the principles established.
Control is the use of formal authority to assure the achievement of goals and objectives.
Here, performance is measured and corrective action is taken to ensure the accomplishment
of organizational goals. It also involves assisting, regulating, monitoring and evaluating
individual and group performance.
The controlling process opens opportunities for improvement and comparing performance
against set standards. It provides information about how well processes and people function
so they can be motivated to perform better in the future.
The means of good performance and management includes leadership and commitment, full
employee involvement, good planning, sound implementation strategy, measurement and
evaluation, control and improvement and the achievement and sustenance of standards of
excellence.
Some people react strongly against the phrase management central. The world itself can
have a negative connotation, e.g. it can sound dominating, coercive and heavy handed. It is
now preferred to use the term coordinating rather than controlling. But for all intents
and purposes, coordinating is controlling.
The control or coordinating function of management can be a critical determinant
organizational success.

Functions of Control
Control serves both as a means and an end. It promotes effective use of resources, provides
professional reinforcements, and maintains activity and expectations.

Principles of Controlling
There must be:
1. A Critical Few, meaning that fewer people involved in control brings about the best
results.
2. A defined Point of Control or a centralization or decentralization of authority.
3. Self-control or Discipline, which translates to personal acceptance of responsibility
and accountability.

Reasons for Conducting Evaluation

Evaluation plays an important role in quality and productivity improvement for several
reasons.
1.
2.
3.
4.
5.

Evaluation ensures that quality nursing care is provided.

It allows for the setting of sensible objectives and ensures compliance with them.
It provides standards for establishing comparisons.
It promotes visibility and a means for employees to monitor their own performance.
It highlights problems related to quality care and determines the areas that require
priority attention.
6. It provides an indication of the costs of poor quality.
7. It justifies the use of resources.
8. It provides feedback for improvement.

Evaluation Principles
In order that employees may be evaluated accurately and fairly, certain principles must be
observed.

1. The evaluation must be based on the behavioral standards of performance which the
position requires. The goals and objectives are clearly presented to the employee and
performance evaluation is based on these.
2. In evaluating performance, there should be enough time to observe employees
behavior. Usual and consistent behavior should be evaluated rather than those
isolated or typical actuations.
3. The employee should be given a copy of the job description, performance standards
and evaluation form before the scheduled evaluation conference. This way, the rater
and the employee to be rated can discuss issues from the same frame of reference.
4. The employees performance appraisal should include both satisfactory and
unsatisfactory results with specific behavioral instances to exemplify these evaluative
comments.
5. Areas needing improvement must be prioritized to help the worker upgrade his/her
performance.
6. The evaluation conference should be scheduled and conducted at a convenient time
for the rater and the employee under evaluation, in a pleasant surrounding and with
ample time for discussion.
7. The evaluation report and conference should be structured in such a way that it is
perceived and accepted positively as a means of improving job performance.

Kinds of Formal Control

The types of formal control that a manager can use may be grouped into:
1. Pre-action Control
This is controlling by means of personal supervision and utilizing control checks
consisting of procedures for any given task or function.

2. Post-action Control
This is controlling as the task or functions being performed or may have been
performed and correcting deviations from standards or plans.

Types of Control
Controls are most effective when they are applied at key places. Supervisors can implement
controls before the process begins (feedforward), during the process (concurrent) or after it
ceases (feedback).
1. Feedforward Controls
Feedforward controls focus on operations before they begin. Their goal is to prevent
anticipated problems. An example of feedforward control is preparing all supplies and
equipments for a scheduled wound dressing or bedside lumbar tap, intravenous
insertion, among others, in order to determine what is lacking and other things to be
done. Regular maintenance feeds forward to prevent problems. Other examples
include safety systems, training programs and budgets.
2. Concurrent Controls
Concurrent controls applies to processes as they are happening. Concurrent controls
enacted while work is performed include any type of material or supplies for
therapeutic care which requires direct supervision or the use of automated systems
such as computers programmed to inform the user when they have issued the wrong
command and organizational quality programs and resources.

3. Feedback Controls
Feedback controls focus on the results of operations. They guide future planning,
inputs, and process designs. Examples of feedback controls include timely (weekly,
monthly, quarterly, and annual), reports and that almost instantaneous adjustments
can be made.

Characteristics of an Evaluation Tool

The evaluation tool should be objective, reliable and sensitive. Objectivity means that the
evaluation tool is free from bias. Reliability refers to the accuracy or precision of the tool
such that it will produce the same results if administered twice. Validity refers to the
relevance of the measurement to the performance of the employee while sensitivity means
that the instrument can measure fine lines of differences among the criteria being
measured.

Basic Components of the Control Process

The control process may be divided into the following basic components:
1. Establishment of standards, objectives and methods for measuring performance
2. Measurement of actual performance
3. Comparison of results of performance with standards and objectives identifying
strengths and areas for correction and/or improvement
4. Action to reinforce strengths or successes
5. Implementation of corrective actions as necessary

Establishment of Standards for Measuring Performance

Standards are desirable sets of conditions and performance necessary to ensure the quality
of nursing care services which are acceptable to those instrumental to or responsible for
setting and maintaining them.
There are three types of performance standards: structure, process and outcome.
1. Standards on structure are those that focus on the structure or management system
used by the agency to deliver care. They include the number and categories of
nursing personnel, their education, personal and professional qualities and
proficiencies, their function, physical facilities and equipment.
2. Process standards refers to decisions and actions of the nurse relative to the nursing
process which is necessary to provide good nursing care. These includes assessment,
plan of care and nursing intervention.
3. Outcome standards are designed to measure the results of care provided in terms of
changes in the health status of the clients served, changes in the level of their
knowledge, skills and attitudes, and satisfaction of those served including the
members of the nursing and health team.

Establishment of Objectives and

Methods for Measuring Performance
Measurable criteria or objectives specific to giving nursing care must be developed to
evaluate process and outcome. The establishment of objectives provides clear direction and
communication of expected levels of achievement. There should be full commitment in the
form of a performance contract. The greater the participation of the employee, the greater
the motivation to achieve. Agreed-upon performance objectives therefore should be
developed by everyone concerned. Objectives should be challenging but attainable.
Performance expectations must be clearly stated and should lie within the individuals scope
of control.
The most commonly used methods for measuring nursing care are task analysis and quality
control. In task analysis, actions and procedures such as written guides, schedules, rules,
records and budgets are inspected. Task analysis uses tolls as time studies and checklists.
Quality control refers to the activities and techniques employed to achieve and maintain the
quality of a product, service or process. It includes a monitoring activity but is also
concerned with finding and eliminating causes of problems so that the requirements of the
customer are continually met. In quality control, the level of nursing care provided and its
effects on the clients are assessed.

Measuring Actual Performance

Measurement of performance is an on-going, repetitive process with the actual frequency
dependent on the type of activity being measured. For example, nursing care to patient is
continuously monitored, whereas, a formal performance appraisal may be done only twice a
year.
Measurements may be scheduled in advance, may be done at periodic but unannounced
intervals or may occur at random. The purpose of measurement should be clarified and the
staff should be informed about the tasks and levels of care that need attention.

Comparing Results of Performance with Standards and Objectives

Comparing the results of performance with standards and objectives is one of the easiest
steps in the control process. If performance matches standards and objectives, managers
are assured that the needs of patients are met. However, if performance is contrary to the
standards and objectives set, then necessary action should be taken.

Reinforcing Strengths or Successes and Taking Corrective Action

as necessary
Positive feedback stimulates motivation, consistently high performance and growth of the
employee. Corrective actions are applied to improve performance.

Responsibilities of the Head/Senior Nurse

Being at the first level of supervision, the Head Nurse or Senior Nurse are in the best
position to know whether their staff nurses perform satisfactorily at work. Their influence has
an impact on promoting quality care to patients.
They have the responsibility to instruct subordinates regarding the appropriate methods and
procedures in providing nursing care. They should inform the staff of the likely causes of
errors or defects and the preventive measures necessary. They should initiate and/or
facilitate any steps necessary to improve methods, equipment, materials and conditions in
the work are for which they are responsible.
The feeling of responsibility to render quality performance must be installed in all employees
for them to follow agreed upon written procedures and use materials and equipment
correctly as instructed. Employees can also be enjoyed to draw attention to existing or
potential quality problems and report all errors, defects and wastes, suggests ways by which
risks, errors or quality problems may be reduced, and assist in training new staff particularly
by setting good example.

Quality Control
During the controlling phase of the management process, standards are set, performance is
measured and action is taken to correct discrepancies between standards and actual
performance. Employees who feel they can influence their environment have some control
over their destinies thus increasing job satisfaction and motivation. Organizations also need
some control over productivity, innovation and quality outcomes. Controlling should not be
viewed as a means of determining success or failure but as a way to learn and grow, both
personally and professionally.
This unit explores controlling as the fifth and final step in the management process. Because
the management process, like the nursing process, is cyclic, controlling is not an end in
itself; it is implemented throughout all phases of management. Examples of management
controlling functions include the periodic evaluation of unit philosophy, missions, goals, and
objectives, the measurement of individual and group performance against pre-established
standards, the monitoring of expenses and use of supplies, and the auditing of client goals
and outcomes.
Quality control, a specific type of controlling, refers to activities that evaluate, monitor or
regulate services rendered to consumers. In nursing, the goal of quality care would be to
ensure quality while meeting intended goals. For any quality control program to be effective,

certain components need to be in place. First, the program needs to be supported by toplevel administration; a quality control program cannot merely be an exercise to satisfy
various federal and state standards. A sincere commitment by the institution, as evidenced
by fiscal and human resource support, will be a deciding factor in determining and improving
quality of services. In addition, although the organization must be realistic about the
economics of rendering services, if nursing is to strive for excellence, then developed quality
control criteria should be pushed to optimal levels rather than minimally acceptable levels.
Although controlling is generally defined as a management functions, effective quality
control requires the manager to have skill in both leadership and management. To
understand quality control, the manager must become familiar with the process and
terminology used in quality assurance activities.

Quality Control as a Process

Measuring quantitative data is often fairly simple. Qualitative data are, however, more
elusive and their measurement is more difficult. Accurate assessment of qualitative data
requires managers to consistently use a specific and systematic process.
This process need not to be complex. In fact, the process when viewed simplistically can be
broken down into three basic steps:
1. The criterion or standard is determined.
2. Information is collected to determine if the standard has been met.
3. Educational or corrective action is taken if the criterion has not been met.

The first step is the establishment of control criteria or standards. Measuring performance is
impossible if standards have not been clearly established. Not only must standards exists,
but leaders or managers also must see that all subordinates know and understand them.
Because standards vary among institutions, employees must know the standards expected
of them at their organization. Employees must be aware that their performance will be
measured in terms of their ability to meet the established standard. For example, hospital
nurses should provide postoperative patient care that meets standards specific to their
institution. A nurses performance can be measured only when it can be compared with a
preexisting standard.
Many organizations have begun using benchmarking as a tool for identifying desired
standards of organizational performance. Benchmarking is the process of measuring
products, practices and services against best performing organizations. In doing so,
organization can determine how and why their performance differs from those exemplar
organizations and use these exemplar organizations as role models for standard
development and performance improvement. Many states have initiated a Best Practices
program that invites healthcare institutions to submit a description of a program or protocol
relating to improvements in quality of life, quality of care, staff development, or costeffectiveness practices. A panel of industry experts reviews the submissions and then
designates a best practice (Mitty, 1998).
The second step in the quality control process includes identifying informations relevant to
the criteria. What information is needed to measure the criteria? In the example of
postoperative patient care, this information might include the frequency of vital signs,
dressing checks, and neurological or sensory checks.
The third step is determining ways to collect information. As in all data gathering, the
manager must be sure to use all appropriate sources. When assessing quality control of the
postoperative patient, the manger could find much of the information in the patient chart.
Postoperative flowsheets, the physician orders, and the nursing notes would probably be
most helpful. Talking to the patient or nurse also could yield information.
The fourth step in auditing quality control is collecting and analyzing information. For
example, if the standards specify that postoperative vital signs are to be checked every 30
minutes for 2 hours and every 1 hours thereafter 8 hours, it is necessary to look at how often
vital signs were taken in the first 10 hours after surgery. The frequency of vital signs listed
on the postoperative flowsheet is then compared with the standard set by the unit. The
resulting discrepancy or congruency gives managers information which they can make a

judgement about the quality or appropriateness of nursing care. If vital signs were not taken
frequently enough to satisfy the standard, the manager would need to obtain further
information regarding why the standard was not met and counsel employees as needed.
Likewise, the manager should reward employees who provide nursing care that meets or
exceeds organizational standards.
The last step is reevaluation. If quality control is measured on 20 postoperative charts and a
high rate of compliance with established standards is found, the need for short-term
reevaluation is low. If standards are consistently unmet or met only partially, frequent
reevaluation is indicated. Remember that quality control should not be implemented solely
as a reaction to a problem. Effective leaders ensure that quality control is proactive by
identifying where care can be improved to maximal standards and by eliminating problems
in early stages before productivity or quality is compromised.

References:
Lydia M. Venzon, et. al. 2006. Nursing Management towards Quality Care, 3 rd Edition. P. 120126

Bessie L. Marquis, et al. 2000. Leadership and Management Functions in Nursing: Theory and
Application. 3rd Edition. P.393-396.