Performance Management In Healthcare

According to Fowler (1990), performance management is very crucial and remarks accountability of the organization's mission, aims, and values. Following this the organization's objectives are identified and these need to be intrinsically linked to, and support the firm's mission. These objectives should be cascaded down the organization with strong links to the objectives of the various managers and individual employee. In particular, the healthcare industry mission to provide quality care to all individuals of different age, sex, caste, and demographic variation are deployed with objectives of service quality and customer satisfaction. These values are potentiated by healthcare providers (professional and other employees) managed well by the organization, who satisfy employee personal needs and promote service oriented environment in the organization.

The basic concern for promoting service oriented organization requires enhancing employee performance. The employee's competence, skills, and education contribute high level of performance standards in a knowledge based organization. Therefore performance management has positioned the process of performance appraisal for individual employee. There are two main perspectives of the performance appraisal process; one is evaluative, and the other is developmental (Anderson, 1992; Harris, 1995). An evaluative appraisal process procure judgment of individual employee performance evolved after examining employee's behavioral, social, and technical aspects of the job, and compared with previously established objectives or fore mentioned operational items on the job description. This type of appraisal links to the allocation of extrinsic rewards, such as pay. A developmental appraisal emphasis need to identify potentials of an employee, develop his knowledge and skill, and initiate career uplifts, which together lead to management success.

A number of different performance appraisal techniques or methods available, such as written report, critical incidents, graphic rating scales, forced choice appraisal, field review techniques, 360 degree feedback, and others. These methods elaborate and linked with the behavioral traits of the employees, and depend upon the subjective judging scales of human resource managers.

1. Written report: - The appraiser writes a narrative about the strengths, weakness, previous performance and potential of the employee and remarks suggestion for improvement.

2. Critical incident: - Under this method, the appraiser highlights incidents or key events that occur during the performance of the job, and rates appraiser's behavior as exceptionally good or bad relevant to the given situation. The characteristics of employees are grouped by categories, such as co-operation, timeliness, and attitude.

3. Graphic rating scales:- The performance is evaluated based on job related characteristics ( such as skill variety, task identity, task significance, autonomy, and feedback) and knowledge of job ( quality of work,technical knowledge).The scores are tabulated through the set of factors rating them, for example, on scale 1 to 5 where the highest number would denote the best rating.

4. Forced choice appraisal: - This type of technique consists of a list of paired 9or larger groups of) statements that may both be positive or negative, or one could be positive and the other negative. An example of a pair of statements might be "always on time" and "never on time". By incorporating several question that test different levels or degrees of the same behaviors, evaluators are able to generate an accurate representation of the individuals learning ability, interpersonal competence, etc.

5. Field review techniques: - under this method, the managers ask question to the human resource specialist or the coworkers about an employee's performance, his work progress, his strengths and weakness, promotion potentials, etc. He then evaluates the report and approves for rating.

6. 360 degree feedback: -Depending upon the employee's job, feedback on the employee's performance may be solicited from patients, family, physicians, vendors, community organization's as well as co-workers. The disclosure /feedback model of awareness known as the Johari window, named after Joseph Luft and Harry Ingham represents four panes: open, hidden, blind, and unknown.

Know to self Unknown to self

Open Blind

Hidden Unknown

Known to others

Unknown to others

To access potential within us, the open pane could be expanded, hidden pane can be reduced by self-disclosure, and feedback received from others mitigate blind pane. Feedback provides an opportunity to disclose personal beliefs, values and attitudes, and to know about how others see us. 360 degree feedback perceives developmental perspective to review progress towards goals, identify training need, and reach mutual agreement on job expectations.

For healthcare professionals, General Medical Council (2003) regards appraisal as "a process to provide feedback on disease performance, chart their continuing professional development, and identify their developmental needs", and revalidation as a doctor retaining his/her license to practice.

To improve practice, appraisal needs to be seen as part of the whole professional development, and includes critical self-reflection, development and support for the individual doctor. The CMO Sir Liam Donaldson (2006), recommend in his report, those relevant to NHS (National Health Service, UK) that Re-licensure (relates to the renewal of full registration and therefore a generic license to practice) and re-certification (relates to renewal of a doctor's specialist certification) is required and remain the responsibility of the individual doctor. Effective revalidation needs to be based on a valid and reliable assessment of a doctor's everyday practice to judge the safety of their practice and about the extent to which quality is embedded in their everyday work. Indications for good medical practice (www.gmc-uk.org) envisage seven areas, such as good clinical care, maintaining good medical practice, working with colleagues, relations with patients, teaching and training, probity, and health. The report seems to hope that appraisal will be the main mechanism, but also proposes a review of many methods that are used in other countries, including credentialing; use of stimulators; regional, national, and international audits; and primary care detection schemes.

Healthcare organizations are knowledge-based and service oriented, that make necessary to provide accurate and timely information for evaluating problems and achieve better performance. The process of performance management based on the evidence of performance and practice are functioned through clinical audit, clinical assessment, and clinical surveillance formulated and governed by medical regulatory bodies.

1. Clinical Audit: - Clinical audit is the process of setting explicit standards, measuring areas of medical practice against these standards and implementing any change necessary to improve patient care. Recent development in clinical audit have been the encouragement of multidisciplinary project work and projects which follow the path of the patient across the primary and secondary care interface.

2. Clinical Assessment: - A clinical assessment sometimes refers to as a health assessment, is a documented process that is used to evaluate, diagnose, and treat individuals. These assessments provide results that only take into account the individual that is being evaluated, rather than evaluating individuals based on data that is compiled from multiple sources. It helps to determine the nature, cause, and potential effects of a patient's injury, illness, or health. Some clinical assessments are mandated by federal agencies to ensure safe medical practices, or to disburse related health benefit payments.

3. Clinical Surveillance: - A clinical surveillance (or syndrome survey)refers to the surveillance (systematic collection, analysis, and Interpretation) of health data about a clinical syndrome that has a significant impact on public health which is then used to drive decisions about health policy and health education.