E .ANNAMARY.

Msc II nd year
 HISTORY:
 PERT was developed primarily to simplify the planning and
scheduling of large and complex projects. It was developed for
theU.S.Navy special projects office in 1957 to support the U.S.
Navy's Polaris nuclear submarine project.
 It found applications all over industry. An early example is when it
was used for the 1968 winter olympics in Grenoble which applied
PERT from 1965 until the opening of the 1968 Games.
 This project model was the first of its kind, a revival for scientific
management founded by Frederick Taylor Taylorism and later
refined by Henry Ford Fordism . DuPont 's critical path method was
invented at roughly the same time as PERT.
Meaning:
 PERT uses a network of activities. Each activity is represented
as a step on chart. It is an important tool in the timing of
decisions. In simplest form of PERT, a project is viewed as a
total system and consisting of setting up of a schedule of dates
for various stages and exercise of management control, mainly
through project status reports on this progress.
 The Program (or Project) Evaluation and Review Technique,
commonly abbreviated PERT, is a model for project
management designed to analyze and represent the tasks
involved in completing a given project.
 Program Evaluation & Review Technique:
 Includes:

1. The finished product or service desired

2. The total time & budget needed to complete the project
or program.
3. The starting date & completion date.
4. The sequence of steps or activities that will be required
to accomplish the project or program.
5. The estimated time & cost of each step or activity.
 Benefits of PERT:
 PERT is useful because it provides the
following information:
 Expected project completion time.
 Probability of completion before a specified
date.
 The critical path activities that directly impact
the completion time.
 The activities that have slack time and that
can lend resources to critical path activities.
 Activity starts and end dates.
 Limitations
 The following are some of PERT's weaknesses:
 The activity time estimates are somewhat subjective and depend on judgment. In cases
where there is little experience in performing an activity, the numbers may be only a
guess. In other cases, if the person or group performing the activity estimates the time
there may be bias in the estimate.
 Even if the activity times are well estimated, PERT assumes a beta distribution for these
time estimates, but the actual distribution may be different.
 Even if the beta distribution assumption holds, PERT assumes that the probability
distribution of the project completion time is the same as that of the critical path.
Because other paths can become the critical path if their associated activities are
delayed, PERT consistently underestimates the expected project completion time.
 USES OF PERT IN NURSING.
 Why should nurse managers use the PERT system for controlling?
 It forces planning and shows how pieces fit together.
 It does this for all nursing line managers involved.
 It establishes a system for periodic evaluation & control at critical points in
the program.
 It reveals problems & is forward-looking.
 PERT is generally used for complicated & extensive projects or programs
 Many records are used to control expenses and otherwise conserve the budget.
 These include personnel staffing reports, overtime reports, monthly financial
reports and others. All these reports should be available to nurse managers to
help them monitor, evaluate, and adjust the use of people and money as a part
of the controlling process.
 Modern and Philips enlists the advantages of PERT:
1. It encourages logical discipline in planning, scheduling
and control of project.
2. It encourages more long range & detailed project
planning.
3. It provides a standard method of documenting and
communicating project plans, schedules, and time and cost
performance.
4. It identifies the most critical elements in the plan, thus
focusing management attention i.e most constraining on
the schedule.
5. It illustrates the effects technical procedural changes on
overall schedules
Advantages
 It explicitly defines and makes visible dependencies
(precedence relationships) between the WBS elements.
 It facilitates identification of the critical path and makes this
visible.
 It facilitates identification of early start, late start. and slack
for each activity.
 It provides for potentially reduced project duration due to
better understanding of dependencies leading to improved
overlapping of activities and tasks where feasible.
Disadvantages
 There can be potentially hundreds or thousands of activities
and individual dependency relationships.
 The network charts tend to be large and unwieldy requiring
several pages to print and requiring special size paper.
 The lack of a timeframe on most PERT/CPM (Critical path
method) charts makes it harder to show status although color
can help (e.g specific color for completed nodes)
 When the PERT/CPM (Critical path method) charts become
unwieldy, they are no longer used to manage the project.
 Advantages and limitations
 Gantt charts have become a common technique for representing the phases and
activities of a project work breakdown structure (WBS), so they can be
understood by a wide audience.
 A common error made by those who equate Gantt chart design with project
design is that they attempt to define the project work breakdown structure at the
same time that they define schedule activities.
 This practice makes it very difficult to follow the 100% Rule. Instead the WBS
should be fully defined to follow the 100% Rule, and then the project schedule
can be designed.
 Although a Gantt chart is useful and valuable for small projects that fit on a
single sheet or screen, they can become quite unwieldy for projects with more
than about 30 activities.
 Larger Gantt charts may not be suitable for most computer displays.
 A related criticism is that Gantt charts communicate relatively little
information per unit area of display. That is, projects are often
considerably more complex than can be communicated effectively
with a Gantt chart.
 Gantt charts only represent part of the triple constraints (cost, time
and scope) of projects, because they focus primarily on schedule
management.
 Moreover, Gantt charts do not represent the size of a project or the
relative size of work elements, therefore the magnitude of a behind-
schedule condition is easily miss communicated.
 If two projects are the same number of days behind schedule, the
larger project has a larger impact on resource utilization, yet the Gantt
does not represent this difference.
 Because the horizontal bars of a Gantt chart have a fixed height,
they can misrepresent the time-phased workload (resource
requirements) of a project, which may cause confusion especially in
large projects.
 In the example shown in this article, Activities E and G appear to
be the same size, but in reality they may orders of magnitude
different. A related criticism is that all activities of a Gantt chart
show planned workload as constant.
 In practice, many activities (especially summary elements) have
front-loaded or back-loaded work plans, so a Gantt chart with
percent- complete shading may actually miscommunicate the true
schedule performance status.
A Ganttt chart created using Microsoft Project MSP.
•The critical part is in red.
•The slack is a black lines connected to non-critical activities.
• Since Saturday and Sunday are not working days and are thus excluded from a schedule,
some bars are on the net chart are longer if they cut through a weekend.
 A project is generally defined as a
program of work to bring about a
beneficial change and which has:

 A start and an end.

 A multidisciplinary team brought
together for the project.
 Constraints of cost, time and quality.
 A scope of work that is unique and
involves uncertainty.
 OBJECTIVES OF PROJECT
 Define the project.
 Reduce it to a set of manageable tasks.
 Obtain appropriate and necessary resources.
 Build a team or teams to perform the project work.
 Plan the work and allocate the resources to the tasks.
 Monitor and control the work.
 Report progress to senior management and/or the project
sponsor.
 Close down the project when completed.
 Review it to ensure the lessons are learnt and widely understood.
Project management related to other initiatives:
Total quality management (TQM):
 The introduction of TQM aims to encourage ‘divine discontent’ in staff
and to give them the tools to achieve continuous improvements in the
way they work. Improvement projects use the principles of project
management especially when the improvements are cross functional ones.
 TQM looks critically at the operational side of the business using a
project management methodology to implement the improvements.
Performance management:
 Performance management brings together all the best practice for
managing staff to achieve their full potential. Effective project leaders use
all the principles of performance management to motivate the team but do
not have the authority of a line manager.
Business process reengineering (BPR):
BPR focuses on optimizing the processes in an organization and if necessary
redesigning them to meet the customer’s needs. In a major survey on BPR by the
Harvard Business School review of the second most significant factor in the recent
failure of BPR initiatives was a lack of project management expertise and culture. The
first was a failure to analyze and understand the process requirement. The research and
implementation should be managed as a project.
Project management methodology:
 If a project has a beginning and an end, what is its life cycle and how is it managed?
 To be effective and workable project methodologies should be appropriate to the
task and the organization.
 For simple projects in a small organization, agreed milestones, a few checklists and
someone to steer the project are all that are required.
 For complex projects in a large organization a more structured approach is needed,
to set up and approve the project, monitor and guides its progress, solve its
problems, deliver the end product (or gain) and close it down.
Roles of project manager:
The project manager will be the leader of the project team
and will be responsible for ensuring the following or
completed in a timely way
1) Gaining approval for the project aim and terms of
reference.
2) Selecting and leading the team and setting individual
objectives.
3) Ensuring a feasibility study is complete.
4) Ensuring that the project is planned in appropriate detail.
5) Allocating and monitoring the work and cost.
6) Motivating the team.
7) Reporting progress back to the organization.
8) Helping the team to solve project problems.
9) Achieve, through the team, the goals.
10)Reviewing and closing down.
Skills of project manager:
Individual skills
Team skills

Technical skills

Tools and techniques

Verifiable objective setting

Brainstorming

Work breakdown structures

Main roles and responsibilities:
There are three key roles in the management of projects whether they are
service development projects, Organizational change project, TQM Projects,
or facilities projects.
Top management:
Setting the conditions and culture such that the business can select and
implement appropriate projects to support the business.
Middle management:
Ensuring that all projects are selected, allocated, steered and closed down
satisfactory relief. Ensure that projects that are not approved are not worked
on.
Operational staff
To use the tools and techniques to manage projects effectively.
Definition:
“MBO is a comprehensive managerial system that
integrates many key managerial activities in a systematic
manner, consciously directed toward the effective and
efficient achievement of organizational objectives”.
“MBO is a result centered, non-specialist, operational
managerial process for the effective utilization of material,
physical and human resources of the organization by
integrating the individual with the organization and
organization with the environment”.
Objectives of MBO:
1) To measure and judge performance.
2) To relate individual performance to organizational goals.
3) To clarify both the job to be done and the expectations of
accomplishment.
4) To foster the increasing competence and growth of these
subordinates.
5) To enhance communication between superior and subordinates.
6) To serve as a basis for judgment about salary and promotion.
7) To stimulate subordinates motivation.
8) To serve as a device for organizational control and integration.
Characteristics of MBO:
 MBO is an approach and philosophy to management and not merely a technique.
 On the other hand, MBO is likely to affect every management technique. MBO employees several techniques
but it is not merely the sum total of these techniques. It is a way of thinking about management.
 MBO is bound to have some relationship with every management technique. Certain degree of overlapping is
there. In fact often MBO provides the stimulus for the introduction of new techniques of management and
enhances the relevance and utility of the existing ones.
 The basic emphasis of MBOs is an objectives. MBO is also concerned with the determining what these results
and resources should be. This MBO tries to match objectives and resources.
 The MBO is characterized by the participation concerned managers in objective setting, the performance
reviews, and his performance.
 Periodic review of performance is an important feature of MBO.
 Objectives in MBO provide guidelines for appropriate systems procedures.
Steps in process of MBO.
1) Setting of organizational purpose and objectives.
2) Identify the key result areas.
3) Establishment of the objectives of the supervision.
4) Recommending objectives for the subordinates by the superiors.
5) Setting subordinates objectives.
6) Periodic review of the performance of the subordinates.
7) Review of the Performance by the superior.
8) Final review of performance by the superiors.
9) Performance appraisal by superiors
10) Providing feedback to the top level.
 Benefits of MBO:
1) Better management of organization.
 Clarity of objectives

 Role clarity.

 Feedback of performance.

 Participation by managers in the management process.

 Realization that there is always hope for improvement of performance in

every situation.

2) Clarity in organizational action.

3) Personal satisfaction.
4) Basis for organizational change.
 Limitations of MBO:
 Time and cost
 Failure to teach MBO philosophy.
 Problems in objective setting.
 Emphasis on short term objectives
 In flexibility
 Frustration
 Prerequisites for installing MBO program:
1. Purpose of MBO.

2. Top management support.

3. Training for MBO.

4. Participation

5. Feedback for self-direction and self-control.

6. Other factors
 Implementing MBO at lower levels.

 MBO and salary decision.

 Conflicting objectives.
 Venture planning:
It is not about writing a business plan. Sometimes a business plan is not needed.
Venture planning does not require detailed funding, source analysis, professional
opinions, entity formation or detailed market analysis venture planning is
development of a means of comparing various business models, usually through
financial modelling to answer the following questions.
 Which venture concept produces a most sales, the best margins, the highest net profit
and the lowest break even?
 Which model requires a least investment by entrepreneurs and others which concept
requires equity as opposed to debt financing?
 Which produces the highest return on investment and the best liquidity? Which model
requires entrepreneur to give up the least equity
Identify and quantify the risks involved with execution of each model.
 Venture formation involves all of the
following stages.
 Idea- concept.
 Development- venture development
 Monitoring- progress
 Initiating- new changes
 Venture feasibility- analysis.
 Business or operational plan
 Budget vs actual- new plans.
 There are 11 keys to a good first venture
1. Founders’ alignment with the mission

2. Guaranteed or qualified customers.

3. Lifestyle of high profit smaller business.

4. Routine concept.

5. Available product.

6. Advantageous cash flow.

7. Supportive local environment.

8. Neutral state and federal environment.

9. Equity control.

10. Relevant experience.

11. Low overhead.

 A nurse manager’s function include the following.
 The nurse administrator needs to know the plans and programs of the health facility
administrator and of other departments in which personal contribute to the joint effort of
providing healthcare services.
 Should be a participatory, voting member of all committees of the institution including those
dealing with budgeting, planning, credentialing, auditing utilization infection control, patient
care, improvement library or any other committees concerned with nursing services, nursing
activities nursing personnel.
 Should develop a marketing operational plan based on the overall view of the agency
problems and activities.
 Marketing plan should be gathering and analysis of data related to product or service.
 Operational plan consists of pinpointing possible strengths, weaknesses, problems and
opportunities.
 Before launching a venture, a control plan is made to measure performance of
implementation of venture within a time frame.
 Selected and trained personnel will be assigned to compare expected results with actual
results for making corrections in all elements of plan and its implementation and future.

 PLANNING FOR CHANGE:
 Change occurs over time, often fluctuating between
intervals of change then a time of settling and stability.
 Change management entails thoughtful planning and
sensitive implementation, and above all, consultation
with, and involvement of, the people affected by the
changes. If you force change on people normally
problems arise.
 Change must be realistic, achievable and measurable.
These aspects are especially relevant to managing
personal change.
 Planning: "Planning refers to thinking ahead of time and formulation
of preliminary thoughts".
 Planned change: "Planned change entails planning and application
of strategic actions designed to promote movement towards a desired
goal".
 ◆ "Planned change is a change that results from a well thought out
and deliberates effort to make something happen. It is the deliberate
application of knowledge and skills by a leader to bring about a
change".
Tappen, 1995.
 Change agent: "A change agent is one who generates ides,
introduces the innovation, and works to bring about the desired
change".
 Change agent:
A change agent is someone who deliberately tries to bring
about a change or innovation, often associated with
facilitating change in an organization or institution.
 To some degree, change always involves the exercise of
power, politics, and interpersonal influence. It is critical to
understand the existing power structure when change is
being contemplated.
A change agent must understand the social, organizational,
and political identities and interests of those involved; must
focus on what really matters: assess the agenda of all
involved parties; and plan for action.
 The change agent should have the following qualities;
 The ability to combine ideas
 The ability to energize others
 Skills in human relations
 Integrative thinking
 Flexibility modify ideas
 Persistent, confident and has realistic thinking
 Trustworthy
 Ability to articulate a vision, and
 Ability to handle resistance.
 Assumptions regarding change:
 Change represents loss. Even if the change is positive, there is a loss of stability. The
leader of change must be sensitive to the loss experienced by others.
 The more consistent the change goal is with the individual’s personal values and
beliefs, the more likely the change is to be accepted. Likewise the more difficult the
goal is from the individuals personal values the more likely it is to be rejected.
 Those who actively participate in change process feel accountable for the outcome.

 Timing is important in change. With each successive change in a series of changes,

individual's psychological adjustment to the change occurs more slowly and for this
reason the leader of change must avoid initiating too many changes at once.
 Strategies for planned change
 In general, three categories of change models exist:
 Empirical-rationale,
 power-coercive, and
 Normative- educative model. (Bennis, Benne and Chin
[1969], The planning of change)
 Normative- re-educative:
 Types of changes
 Hohn (1998) identified four different types of change. Change by exception,
Incremental Change, Pendulum Change and Paradigm Change.
 Change by Exception: This occurs when someone makes an exception to an
existing belief system. For instance, if a client believes that all nurses are
bossy, but then experiences nursing care from a much modulated nurse, they
may change their belief about that particular nurse, but not all nurses in
general.
 Incremental Change: A change that happens so gradually, that an individual
is not aware of it.
 Pendulum Changes: Are changes that result in extreme exchanges of points
of view.
 Paradigm Change: Involves a fundamental rethinking of premises and
assumptions, and involve a changing of beliefs, values and assumptions about
how the world works.
 Change Theories in Nursing: Change theories are used
in nursing to bring about planned change. Planned change
involves, recognizing a problem and creating a plan to
address it. There are various change theories that can be
applied to change projects in nursing. The characteristics
of change theories are
1) Problem identification
2) Plan for innovation
3) Strategies to reduce innovation
4) Evaluation plan
 General considerations for planning change
 Secure and maintain commitment to change
 Define and communicate desired end state
 Identify critical success factors
 Establish targets and prioritize activities
 Develop a theme
 Understand why the change is desired/ required
 General considerations for planning change
 Secure and maintain commitment to change
 Define and communicate desired end state
 Identify critical success factors
 Establish targets and prioritize activities
 Develop a theme
 Understand why the change is desired/ required.
 Nurse Leader (manager) as role model for planned
change:
 Implement a comprehensive and coordinated change
management program: Discover, Develop, Detect.
 Identify change agents and engage people at all levels in
the organization.
 Ensure the message comes from the top and executives and
line managers are walking the talk.
 Make change visible with new tools and or environment.
 Ensure clear, concise, and compelling communication.
 Integrate change goals with day to day activities, example
recruiting, performance management, and budgeting.
MISTAKES BY A LEADER MANAGER.

1. Fail to provide visible support and reinforce the change with other
managers.
2. Do not take the time to understand how current business processes
would be affected by change.
3. Delayed decision making which leads to low morale and slow
project progress.
4. Are not directly or actively involved with change project.
5. Fail to anticipate the impact on employees.
6. Underestimates the time and resources needed.
7. Abdicate ownership of the project to another manager.
8. Fail to communicate both the business reasons for the change and
the expected outcome to employees and other managers.
 Introduction:
 Change is a natural social process of individuals, groups,
organizations and society. The source of change originates
inside and outside health care organizations.
 Change today is constant, inevitable, pervasive and
unpredictable, and varies in rate and intensity, which
unavoidably influences individuals, technology and
systems at all levels of the organization.
Sources of innovation
Seven sources for innovative ideas have been identified by (Drucker 1992)
Four sources are found internally within the institutions are:
1. Unexpected outcomes: Situation presents themselves that require
different methods to be adopted. Knowing what is happening in an
institution allows an individual to prepare for the impending changes
2. Incongruous circumstances: Disruptions occur that require change to
b made discrepancies exists between the reality as it is and reality as it
is assumed to be.
3. Innovations made on the process needs: Procedures and policies need
to be altered to respond to the new regulations, policies or law.
4. Changes in structure: Organizational changes require changes in
method of the operations.
 Concept of innovation.
 To share with others, collaboration with
regulatory bodies, and partnership with
practitioners to enhance clinical
experiences. It is a process of transforming
the existing services and also involves
ways of doing things, approaches,
technologies, and various developmental
processes or interventions to create new
ones by using the knowledge and
innovative ideas. Successful innovation
depends upon human creativity, culture,
and skills and talents nurtured and
developed through education.
Need for Innovation
Change is necessary for the following:
• Continuous improvement in nursing
• Fulfilling the growing demand for health services
• Rendering holistic and high-quality care
• Advancement in communication, education, and technology
• Compensating shortage of workforce
• Replacing traditional methods of teaching and practices
• Adapting change and facing competitions with other organizations
. Coping with the changing needs of clients
• Maximizing globalization sharing
• Solving work related problems.
Components of innovation:

Innovation has main three elements innovation individual or team creativity, and
environment. All these three components are interdependent of creating and
implementing changes in an organization.

1. Innovation: Changes can be accounted for by implementing new ideas or creating

new technology tools or products policies, services, procedures, or devices. Clients
should adapt and customize and innovation based on their individual need.
2. Individuals or innovators: Individuals or innovators comprise individuals or groups
of people who solve the problems or create well accepted technology, tools, products,
or intervention of novelty.
3. Environment environmental structural support is critical to give shape to innovation.
It constitutes the culture physical, and social and psychological and organizational
atmosphere essential to facilitate and support creative
BARRIERS TO INNOVATION:

The two barriers to innovation are barriers related to education and

practitioners. Following shows further subdivisions of each barrier

a) Barriers related to education:

 Traditional and comfortable pedagogy.
 Fear of mistakes
 Students deficient in clinical experience.
 Lack of organizational support.
 Incompetent nurse educators.
 Lack of in service training.
 Limited exposure of student nurses in the clinical areas
 Fearing liability to practice by student nurses
 Non cooperation between educators and practitioners
 Isufficient preparation of the student for problem solving and caring patients.
Barriers related to practitioners:
 Lack of nursing policies and standard operative
procedures
 Lack of uniformity in practice
 Incompetent nurse practitioners
 Lack of support for nurses in practice areas
 Nurses role conflict and undefined job descriptions
 Lack of workforce
Dissatisfaction and lack of motivation among nurses