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International
Global Centre for Nursing Executives
Identify your Gap
to Goal Tools to Conduct a Nurse Manager Time Audit and
Performance Gap Assessment
©2014 The Advisory Board Company advisory.com 2
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Global Centre for Nursing Executives
Project Director
Contributing Consultants
Managing Director
Marguerite Lucea, RN, MPH, PhD
Vanessa Orco, MPP
Patricia Wynn, MBA
©2014 The Advisory Board Company advisory.com 3
Tools to Conduct a Nurse Unit Manager
Time Audit and Performance Gap Assessment
Identify your Gap to Goal
Nurse managers all over the world tell us they’re feeling overwhelmed. They’re currently juggling multiple
competing demands and struggling to prioritise.
Even more concerning, when asked how they spend their time, nurse managers reported they were
frequently getting absorbed by time-consuming tasks such as scheduling, managing patient flow, and
budgeting. This kept them from partaking in the leadership activities their executives wanted them to
prioritise.
The Global Centre for Nursing Executives believes that organisations need to re-evaluate the role and ensure
it is fit for purpose for the new health care reality.
To restructure the role, executives should start by assessing exactly how managers currently spend their
time.
A time audit is a good place to start. Using this information, executives can then partner with managers to
understand which activities can be delegated and what support is necessary to thrive in the role.
At the Global Centre, we think that this is a worthy exercise not only to identify areas of need and gaps
between your priorities and your managers’ priorities, but also to facilitate a conversation between managers
and leaders about the priorities. You can then involve managers in the process of role re-design.
To support you in this process, we have created a set of PowerPoint and Excel tools designed for both nurse
managers and executives to complete.
©2014 The Advisory Board Company advisory.com 4
Table of Contents
Diagnose the Need for Conducting a Time Audit.........................................................................................
Assessing Where You Stand.......................................................................................................................
Orientation to the Nurse Unit Manager Time Audit and Performance Gap Analysis................................
Overview and Directions..............................................................................................................................
Diagnostic Tools: Nurse Unit Manager Time Audit and Gap Analysis.......................................................
Instructions for Worksheet #1..................................……….........................................................................
Explanation of Activity Categories...........................………..........................................................................
Worksheet #1: Daily Time Audit..................................……….....................................................................
Instructions for Worksheet #2..................................………........................................................................
Worksheet #2: Summary Page for Unit Managers.....................................................................................
Instructions for Worksheet #3..................................………........................................................................
Worksheet #3: Nurse Unit Manager Summary...........................................................................................
Determine Gap to Goal.....................................................................................................................................
Instructions for Worksheet #4..................................………........................................................................
Worksheet #4: Aggregate Nurse Unit Manager Report...............................................................................
Instructions for Worksheet #5..................................………........................................................................
Worksheet #5: Nurse Executive Assessment of Unit Manager Time Audit Allocation................................
Instructions for Worksheet #6...................................………........................................................................
Worksheet #6: Executive Summary..............................................................................................................
5
6
7
8
9
11
12
13
14
15
16
17
18
19
20
21
22
23
24
©2014 The Advisory Board Company advisory.com 5
Diagnose the Need for
Conducting a Time Audit
Section 1
©2014 The Advisory Board Company advisory.com 6
Assessing Where You Stand
Level of Executive Understanding No Yes
1. Are you very familiar with how unit managers spend their time on a day-to-day
basis?
2. Do you know where bottlenecks typically occur in the unit manager’s job at
your institution?
Nurse Unit Manager Ability to Prioritise
3. Do unit managers focus on areas that you consider top priorities?
4. Are unit managers clear as to what their primary responsibilities and desired
outcomes are?
5. Do unit managers generally know where they spend their time and, for the
most part, feel that they have accomplished something each day?
6. Do you feel that there is little or no disparity in the unit manager understanding
about senior leaders’ priorities?
Interpreting Self-Results
General Applicability Direct Indicators
Primary benefit of time audit is identifying gaps
between nurse executive and nurse unit
manager understanding of unit manager
priorities. A majority of “No” answers indicates
a potential “fit” for time audit at your institution
Members responding “No” to
questions #1 and #3 should
strongly consider conducting a
time audit
Nurse Executive Self-Test
We acknowledge that time audits are time intensive, so we created this self-assessment to help you roughly
evaluate if this would be a useful exercise for your organisation.
If you feel like you have a good sense of where your challenge areas are, a time audit may not be worth the
effort. But even if you have a good sense of the workload of managers, the results can help facilitate a dialogue
about effective prioritisation between executives and managers.
©2014 The Advisory Board Company advisory.com 7
Orientation to the Nurse Unit Manager
Time Audit and Performance Gap Analysis
Section 1
©2014 The Advisory Board Company advisory.com 8
Overview
This tool is intended to quantify how nurse unit managers spend their time and to identify differences
between nurse executive and unit manager perspectives on appropriate manager time allocation and
organisation.
With limited time to meet their many accountabilities, nurse unit managers must decide how best to allocate
their time. In many cases, these managers do not allocate their time to activities considered the highest
priority by senior nursing leaders or the executive team. The resulting gap in shared vision can lead to a
misplaced focus or misaligned priorities. This exercise aims to reduce those gaps and help nurse unit
managers and nurse executives align their priorities.
Intended Audience
Section 2 of this tool should be completed by nurse unit managers. Section 3 should be completed by nurse
executives. While we have provided PowerPoint and Excel versions of the tool, the Global Centre
recommends members use the Excel tool, because it has been designed to automate calculations.
Directions on Using Nurse Unit Manager Time Audit and Performance Gap Analysis
Section 2: Nurse unit managers use Worksheets #1 through #3 to capture data concerning time allocation
and priorities:
• Worksheet #1 Daily Time Audit: Nurse unit manager uses time audit tool to track time across 7
categories for five consecutive days
• Worksheet #2 Summary Page for Unit Managers: Nurse unit manager stores data and performs
calculations
• Worksheet #3 Nurse Manager Summary: Nurse unit manager provides aggregate data for use by nurse
executive
Section 3: Nurse executives use Worksheets #4 through #6 to record their desired time allocation and to
enter and analyse data captured by nurse unit managers:
• Worksheet #4 Aggregate Nurse Manager Report: Nurse executive compares data from all managers and
calculates institutional averages
• Worksheet #5 Nurse Executive Assessment of Manager Time Allocation: Nurse executive provides own
estimate of both actual and ideal nurse manager actual time allocation at own institution
• Worksheet #6 Executive Summary: Nurse executive uses both own estimates of manager time allocation
and manager actual allocation to identify and analyse gaps
How to Use This Tool
Nurse Unit Manager Time Audit
and Performance Gap Analysis
©2014 The Advisory Board Company advisory.com 9
Nurse Unit Manager Tools:
Time Audit and Gap Analysis
Section 2
10 ©2014 The Advisory Board Company • advisory.com
Instructions for Worksheet #1
How to Use This Tool
Overview
The purpose of this tool is to capture concrete, detailed data about how unit managers allot their time across
multiple responsibilities on a daily basis. Tracking activities across several days in real time and in small
increments is the best way to provide an accurate account of actual time allocation.
Intended Audience
This tool is intended for unit managers.
Instructions
1. Managers should first familiarise themselves with the 7 categories on the time audit by reading through
the Explanation of Activity Categories. This analysis represents a concerted effort to accurately
represent the variety of nurse manager duties, while trying to limit the number of categories. Though
what is included in the categories may not, in every instance, reflect a particular manager’s situation,
managers are encouraged to use this listing so that there is a consistency of responses within the
manager group at each institution.
2. Best practice is to complete the time audit for five consecutive days, using one copy of the audit tool
each day. This provides at least a full week’s worth of data for analysis. The most effective way to use
the worksheets is to stop at several points during the day to note how time was spent in the past 2 to 3
hours. Time should be recorded in minutes. This means that there can be entries in multiple categories
within any given half-hour block. Approximations about time spent on a given activity are better than
omitting any activities. Time spent in meetings should be allocated to the category that most closely
resembles the topic covered at the meeting. If multiple topics were discussed, the time can be allocated
across several categories.
3. Personal time and meals should not be counted in any category. For example, a manager who takes
lunch from 12 until 12:30 should leave that row blank.
4. At the end of each day, total the minutes at the bottom of each column and transfer these numbers to the
appropriate cell in Worksheet #2.
Notes
The Global Centre has created both a PowerPoint and an Excel version of this tool. The Excel version is
available here.
©2014 The Advisory Board Company advisory.com 11
Explanation of Activity Categories
Functions Tasks
Patient Care Services Provide direct patient care (either by being included in staffing count or carrying out
other activities, e.g., vital signs, giving meds, IV therapy, responding to a code, etc.)
Ensure effective delivery of patient education
Attend ward/unit rounds with members of the multidisciplinary team
Lead discussions with doctors, nurses/midwives and allied health staff regarding
clinical care delivery
Establish a feedback process for patients and carers
Review patient feedback, identify trends, and share with staff
Manage patient satisfaction issues/complaints in a timely manner
Develop processes that ensure all patients receive adequate nutrition and hydration
Conduct patient satisfaction rounds
Establish a standardised approach to clinical handover
Support clinical decision making and patient care delivery with evidence
Facilitate critical thinking at the bedside
Ensure patients are aware of and receive their patient rights
Daily Unit Operations Monitor or coordinate patient admissions, transfer, and discharge on ward/unit
Build rosters for ward/unit care delivery
Ensure staffing levels and skill mix match patient demands/needs
Strategically anticipate long term workforce needs
Ensure appropriate equipment is available and functional on ward/unit
Fill out supply and medication orders
Manage processes for supply and medication procurement
Facilitate routine staff meetings
Business and
Financial Operations
Develop annual ward/unit budget
Collect data regarding ward/unit financial performance against allocated budget
Prepare monthly budget and productivity variance reports
Present on ward/unit financial performance against allocated budget
Draw correlations between performance key clinical indicators and financial impact
Monitor timesheets and do payroll
Service External to
Unit
Assist with hospital-level program development
Implement organisational change initiatives
Participate in activities, committees, or task force meetings outside the ward/unit
Attend hospital-wide nurse manager training sessions
Attend meetings with senior executives, nursing leadership team, department heads
The Global Centre has broken down all nurse manager functions into seven broad categories. This analysis
represents a concerted effort to accurately represent the variety of nurse manager duties, while trying to
limit the number of categories. Though what is included in the categories may not, in every instance, reflect
a particular manager’s situation, managers are encouraged to use this listing so that there is a consistency
of responses within the manager group at each institution.
Before filling out Worksheet 1, managers should familiarise themselves with this list and determine in which
category each of their responsibilities may fall.
NOTE: MANAGERS OFTEN ATTEND MEETINGS THAT HAVE MULTIPLE PURPOSES. PLEASE DO
YOUR BEST TO ALLOT TIME SPENT IN MEETINGS TO THE MOST APPROPRIATE CATEGORY; DO
NOT ACCOUNT FOR TIME TWICE.
©2014 The Advisory Board Company advisory.com 12
Explanation of Activity Categories
Functions Tasks
Staff Management and
Development
Create a vision and culture for the ward/unit that engages staff in goals
Communicate organisational and ward/unit priorities to staff
Ensure staff are aware of and utilise current policies and procedures
Ensure novice clinicians are supervised and supported as they develop their
competence
Establish processes that ensure all staff participate in mandatory trainings
Ensure all nursing/midwifery staff have current registration
Ensure that all staff are practicing within the scope of practice
Conduct audit for 100% compliance with mandatory nurse/midwife training
requirements
Develop a process for succession planning on the ward/unit
Conduct interviews and assess for candidate fit
Train and orient new hires
Deliver annual staff evaluations
Prepare and deliver disciplinary actions
Resolve staff conflicts
Mentor charge nurses or other ward/unit leaders
Coach staff as they deliver patient care
Oversee and follow up on ward/unit staff educational needs
Establish practices that enable giving and receiving feedback
Establish practices that facilitate mentoring
Quality Improvement Analyse and report on ward/unit performance
Monitor and track incidents on the ward/unit
Identify key performance improvement opportunities
Develop quality improvement (QI) projects
Write action plans related to unit-level QI projects
Obtain interprofessional buy-in for execution of QI projects
Implement QI projects
Ensure hand hygiene procedures are followed
Embed evidence-based protocols to advance key indicators
Establish checks and audits to ensure ward/unit performance is up to quality
standards
Administrative and Non-
Managerial Tasks
Develop job descriptions for vacant positions
Review resumes and set up interviews with qualified candidates
Collect data on ward/unit performance indicators
Coordinate hiring process (including obtaining work visas, needed)
Review schedule daily to assess census, call in extra staff, and deal with staffing
emergencies
Deal with process glitches, interdepartmental or ancillary problems
Perform general office and clerical duties
©2014 The Advisory Board Company advisory.com 13
Worksheet #1: Daily Time Audit
Time of
Day
Patient
Care
Services
Daily Unit
Operations
Staff
Management
and
Development
Quality
Improvement
Business and
Financial
Operations
Service
External
to Unit
Administrative
and Non-
Managerial
Tasks Time of Day
5:30a–6a 5:30a–6a
6a–6:30a 6a–6:30a
6:30a–7a 6:30a–7a
7a–7:30a 7a–7:30a
7:30a–8a 7:30a–8a
8a–8:30a 8a–8:30a
8:30a–9a 8:30a–9a
9a–9:30a 9a–9:30a
9:30a–10a 9:30a–10a
10a–10:30a 10a–10:30a
10:30a–11a 10:30a–11a
11a–11:30a 11a–11:30a
11:30a–12p 11:30a–12p
12p–12:30p 12p–12:30p
12:30p–1p 12:30p–1p
1p–1:30p 1p–1:30p
1:30p–2p 1:30p–2p
2p–2:30p 2p–2:30p
2:30p–3p 2:30p–3p
3p–3:30p 3p–3:30p
3:30p–4p 3:30p–4p
4p–4:30p 4p–4:30p
4:30p–5p 4:30p–5p
5p–5:30p 5p–5:30p
5:30p–6p 5:30p–6p
6p–6:30p 6p–6:30p
6:30p–7p 6:30p–7p
7p–7:30p 7p–7:30p
7:30p–8p 7:30p–8p
8p–5:30a 8p–5:30a
Total
Minutes
Total
Minutes
©2014 The Advisory Board Company advisory.com 14
Instructions for Worksheet #2
How to Use This Tool
Overview
The purpose of this tool is to create a summary report of the total amounts and percentages of time spent in
each category during the audit period.
Intended Audience
This tool is intended for unit managers.
Instructions
1. If unit managers have not done so previously, fill in the grid on Worksheet #2 with the end-of-day
category totals from each of the daily time audits.
2. Then, total each row in column F. After column F is filled, sum the column in the last cell of column F to
obtain the total minutes spent working during the time audit period.
3. Finally, calculate the percentage of time spent in each category by dividing each row in column F by the
total number of minutes spent working in the last cell of column F. The percentage should sum to 100
percent.
4. Transfer the data from columns F and G to columns A and B on Worksheet #3.
Notes
The Global Centre has created both a PowerPoint and an Excel version of this tool. The Excel version is
available here. The Excel spreadsheets have formulas already written into the calculation boxes. If you
make adjustments to the forms, please double check the formulas in the calculation boxes.
©2014 The Advisory Board Company advisory.com 15
Worksheet #2: Summary Page for Managers
A B C D E F G
Categories Total Minutes per Day
Total Minutes
for Week
(sum columns A
through E)
Current
Percentage
(divide column
by total in
column F) Day #1 Day #2 Day #3 Day #4 Day #5
1 Patient Care
Services 0
2 Daily Unit
Operations 0
3
Business and
Financial
Operations 0
4 Staff Management
and Development 0
5 Quality
Improvement 0
6 Service External
to Unit 0
7
Administrative
and Non-
Managerial Tasks
Total 0 100%
©2014 The Advisory Board Company advisory.com 16
Instructions for Worksheet #3
How to Use This Tool
Overview
The purpose of this tool is to create summary of each individual manager’s time audit findings for their nurse
executive. Additionally, Worksheet #3 asks managers to identify their ideal time allocation; this will help
nurse executives understand individual managers’ priorities.
Intended Audience
This tool is intended for nurse unit managers.
Instructions
1. Transfer the minute totals from each category from column F on Worksheet #2 to column A on
Worksheet #3, and the calculated percentages from column G on Worksheet #2 to column B on
Worksheet #3. Again, check to make sure column B sums to 100 percent.
2. The questions at the bottom of the form provide an opportunity to describe any unusual circumstances
about a specific time audit.
3. Managers should use columns C and D to identify areas in which they would like to allocate more or less
time. Do so by placing a check in the appropriate column.
4. Column E asks unit managers to identify their ideal time allocation. In a perfect world, how would time be
allocated across the same 7 categories? If managers prefer not to spend time in one area, answer “0%”.
5. Upon completion of the audit, unit managers should turn in all worksheets to the person leading the time
audit project.
Notes
The Global Centre has created both a PowerPoint and an Excel version of this tool. The Excel version is
available here. The Excel spreadsheets have formulas already written into the calculation boxes. If you
make adjustments to the forms, please double check the formulas in the calculation boxes.
©2014 The Advisory Board Company advisory.com 17
Worksheet #3: Nurse Manager Summary
A B C D E
Categories
Total Minutes for
Week
(from Worksheet
#2 column H)
Current
Percentage
(from Worksheet
#2 column I)
Allocate More
Time?
Allocate Less
Time?
Ideal
Percentage
1 Patient Care
Services
2 Daily Unit
Operations
3 Business and
Financial
Operations
4 Staff Management
and Development
5 Quality
Improvement
6 Service External
to Unit
7 Administrative and
Non-Managerial
Tasks
Reflection Questions
1. Do you think this is an accurate reflection of how you spend your time? Yes______ No_______
Comments:
_______________________________________________________________________________
_______________________________________________________________________________
2. During the time audit period, were there any circumstances that resulted in an unusual time
allocation? Yes______ No ______
Comments:
_______________________________________________________________________________
_______________________________________________________________________________
©2014 The Advisory Board Company advisory.com 18
Nurse Executives Tools:
Determine Gap to Goal
Section 3
©2014 The Advisory Board Company advisory.com 19
Instructions for Worksheet #4
How to Use This Tool
Overview
The purpose of this tool is to calculate the average time allocation among managers at each institution.
Intended Audience
This tool is intended for nurse executives.
Instructions
1. Once managers have completed Worksheets #1-3, use the data from column A of Worksheet #3, to fill in
the total minutes in each category for each manager. There is space for data from only five managers,
so multiple copies of this form may be needed (if this is the case, do not calculate averages on each
page, just the final page).
2. Once all of the data is entered, calculate the sum of each row in column F. Next, add up column F. This
is the total number of minutes spent by all managers over the course of the audit process.
3. Finally, calculate the average percentage of time spent by managers in each category by dividing the
total minutes for each category in column F by the total number of minutes for all categories in total cell
in column F. Enter the result for each row in column G. Column G should sum to 100 percent.
Notes
The Global Centre has created both a PowerPoint and an Excel version of this tool. The Excel version is
available here. The Excel spreadsheets have formulas already written into the calculation boxes. If you
make adjustments to the forms, please double check the formulas in the calculation boxes.
©2014 The Advisory Board Company advisory.com 20
Worksheet #4: Aggregate Nurse
Manager Report
A B C D E F G
Categories
Total Minutes per Day Total
Minutes for
Week
Current
Percentage
(must add up
to 100%) Manager
#1
Manager
#2
Manager
#3
Manager
#4
Manager
#5
1 Patient Care
Services
0 0.00%
2 Daily Unit
Operations
0 0.00%
3 Business and
Financial
Operations 0 0.00%
4
Staff
Management
and
Development 0 0.00%
5 Quality
Improvement
0 0.00%
6 Service
External to Unit
0 0.00%
7
Administrative
and Non-
Managerial
Tasks 0 0.00%
Total 0 0.00%
21 ©2014 The Advisory Board Company • advisory.com
Instructions for Worksheet #5
How to Use This Tool
Overview
The purpose of this tool is to capture concrete, detailed data about how managers allot their time across
multiple responsibilities on a daily basis. Tracking activities across several days in real time and in small
increments is the best way to provide an accurate account of actual time allocation.
Intended Audience
This tool is intended for nurse executives to complete during the time that nurse managers are conducting
time audit.
Instructions
1. Explanations of each of the 7 time audit categories can be found in the Explanation of Activity
Categories. This analysis represents a concerted effort to accurately represent the variety of nurse
manager duties, while trying to limit the number of categories. Though what is included in the categories
may not, in every instance, reflect a particular hospital’s situation, executives are encouraged to use this
listing so that there is a consistency of responses within each institution.
2. Once familiar with the 7 categories, in column A record how the nurse managers at your institution
actually spend their time.
3. In column B, create your ideal time allocation, considering in which categories you would like managers
to spend more or less time.
4. The percentages in each column should sum to 100 percent. If any of the categories do not apply to a
particular institution’s managers, “0%” may be entered in that category.
Notes
The Global Centre has created both a PowerPoint and an Excel version of this tool. The Excel version is
available here. The Excel spreadsheets have formulas already written into the calculation boxes. If you
make adjustments to the forms, please double check the formulas in the calculation boxes.
©2014 The Advisory Board Company advisory.com 22
Worksheet #5: Nurse Executive
Assessment of Manager Time Allocation
A B
Categories Current Percentage Ideal Percentage
1 Patient Care
Services
2 Daily Unit
Operations
3
Business and
Financial
Operations
4 Staff Management
and Development
5 Quality
Improvement
6 Service External
to Unit
7
Administrative and
Non-Managerial
Tasks
Total 100% 100%
©2014 The Advisory Board Company advisory.com 23
Instructions for Worksheet #6
How to Use This Tool
Overview
The purpose of this tool is to identify gaps between managers’ and nurse executives’ understanding about
manager priorities and time allocation.
Intended Audience
This tool is intended for nurse executives.
Instructions
1. Transfer managers’ data from column G on Worksheet #4 to column A and the executive’s data from
column A on Worksheet #5 to column B.
2. Subtract the columns to identify gaps between the managers’ current allocation and the executive’s
expectations. Gaps greater than 10 percentage points (plus or minus) should be analyzed to discover if
additional support or training could bring managers closer to expectations. This exercise can also be
performed for individual managers using the data from column B of an individual’s Worksheet #3.
Notes
The Global Centre has created both a PowerPoint and an Excel version of this tool. The Excel version is
available here. The Excel spreadsheets have formulas already written into the calculation boxes. If you
make adjustments to the forms, please double check the formulas in the calculation boxes.
©2014 The Advisory Board Company advisory.com 24
Worksheet #6: Executive Summary
A B C
Categories Manager
Percentage
Executive
Percentage Gap
1 Patient Care
Services
2 Daily Unit
Operations
3
Business and
Financial
Operations
4 Staff Management
and Development
5 Quality
Improvement
6 Service External
To Unit
7
Administrative and
Non-Managerial
Tasks
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