Performance Management Process

Introduction

The primary goal of performance management is to ensure that organizational goals and objectives are achieved in a manner that is efficient and effective. The implementation of performance management processes can be deployed at various levels of the organization such as individual, department, the entire organization, and specific organizational processes that facilitate quality delivery.[1] Through performance management processes, a firm is able to align the organizational resources, employees and systems with its strategic priorities and objectives. Performance management systems play an instrumental role in helping employees to improve their efficiency, and ultimately that of the organization. In nursing, performance management offers nurses with valuable feedback and how well the healthcare organization is meeting the needs of families, patients and the community that it serves. Besides providing quality care, healthcare organizations have several strategic objectives, which can only be achieved if appropriate performance management processes are put in place and efforts to monitor the progress are initiated.[2] The goal of this paper is to develop a performance management process for nurses working in a Hospital for Special Surgery (HSS). The performance management process takes into consideration the economic environment and business needs as well as the job descriptions of nurses. This paper also justifies the necessity of the steps proposed in the performance management process and how they fit to the needs of the organization and specific job requirements. In addition, the paper also proposes the performance appraisal methods and their respective justifications and the personnel responsible for each step of the entire process.

Phases of the Performance Management Process within a HSS

The proposed graphical representation of the proposed performance management process is shown on the figure below. The HR manager will be responsible for overseeing entire performance management whereas the line supervisor will be responsible for the individual phases.[3]

The following are the strategic goals of the HSS to be addressed with this proposed performance management process:

Focus on patient-centered care in order to ensure better clinical outcomes, improve the health status of patients and increase the patient volumes;
Curb rising healthcare costs by using resources efficiently, enhancing coordination, and increase the capacity for care delivery.
Figure 1: Model for the performance management process

Phase 1: Planning

During the planning phase, the supervisor or the nursing leader will explain to the members of the staff the purpose and details regarding the performance management process, outline the job requirements for nurses, answer the nurses’ queries regarding the performance management process, and discuss with nurses about the performance standards and their commitment towards the performance standards.[4] Fundamentally, the planning phase entails informing the nurses what the process will entails, why the firm uses the performance management process, how it works and what is expected of them, and when their performance will be evaluated.

During the planning phase, the team leader/supervisor will discuss with other nurses the aspects that make up accountabilities and tag them as crucial for the firm’s success; this is often done after employees have been informed of the fundamental aspects of the performance management process. In the case of HSS, accountabilities will be derived from the job descriptions, whereby each specific job task constitutes an element of accountability. The other facet of accountability entails the performance standards, which specifies what constitutes a good work.

The planning phase also entails establishing the performance standards for each of the accountabilities/roles identified for the registered nurses working at the HSS. Performance standards will help the supervisor to review the nurses’ performance relative to the established performance standards. Performance standards will take into consideration the variables of quality, which defines how well the task is performed; quantity, which defines how many of the results have been performed; timeliness, which defines how fast the result has been produced; manner, which denotes the style which the task was performed; method, which refers to the policies and technical considerations applied to execute the task; and cost, which denotes effective resource utilization. Furthermore, activities are classified as either critical or important during the planning phase. Using the framework discussed above, the following is the list of the accountabilities for registered nurses in a HSS.[5]

Table 1: Accountabilities Form

Accountabilities (Tasks and performance standards Does not meet standards Needs improvement Meets standards Exceeds standards
Undertaking daily treatment plans according to the instructions issued by the doctor or surgeon in a timely manner [critical]

Deploying staff aptly, as needed for effective resource utilization;
[critical]

Monitoring and overseeing the management of medication and making sure that patient’s medication is administered safely and correctly;
[critical]

Administer medication and follow up on patients’ cases and make reports according to the directives of the doctor in charge
[critical]

Demonstrate the ability of meeting patient’s needs;
[critical]

Identifying opportunities for improving the quality of healthcare;
[important]

Demonstrating the application of superb clinical skills in diverse areas like care planning and emergency response;
[critical]

Phase 2: Coaching

Coaching refers to activities undertaken with the aim of aiding an employee to improve their performance. In this context, it is proposed that coaching will be conducted in the form of brief discussions with team members, and will be undertaken on a regular basis in order to track the process regarding to the achievement of goals established in the planning phase. Fundamentally, coaching is used in ensuring that team members execute their tasks as specified in the accountabilities section. It is imperative to note that coaching does not act as a formal performance appraisal; rather, it helps in tracking the progress and identifying problems in a timely manner so that corrective measures can be adopted. The HR line supervisor will be responsible for the coaching activities.[6] An important element of coaching is the gathering of coaching information, which will be done through direct observation and notes from patients. Since coaching is mostly informal, there is no need for much preparation. Coaching can be based on a review the employee’s accountabilities. During an ongoing coaching session, the supervisor should:

Appraise the accountabilities;
Assess what is anticipated regarding the progress on accountabilities;
Schedule follow ups to track the progress of team members; and
Acknowledge gradual performance improvements
In cases of performance deficiencies, which refers to gaps between results and anticipated, it is the responsibility of the supervisor to help team members get back on track. Performance deficiencies can stem from lack of skill, obstacles and unwillingness. In cases of poor performances and non-performance, supervisor should try to explain to the team members about the significance of the activity, the outcomes of non-performance, and embark on formal counseling.[7]

Phase III: Review

This is the final phase of the performance management process, whereby the supervisor and team members evaluate the accountabilities and discuss about how well the team members did regarding the job and finalize the evaluation process by completing the performance management process form. During the review phase, the supervisor should take into account the errors and biases such as general bias errors, halo effect, logical rating error, central tendency errors, proximity errors, and rating inflation. In addition, the accountabilities are rated as either Exceeds standards, meet standards, needs improvement, or do not meet standards, as indicated earlier in the accountabilities form (table 1).

An important process during the review phase is the overall accountability rating, which will somewhat serve as the overall performance rating for registered nurses in HSS. The following are the guidelines to be used:[8]

If all the accountabilities are rated as meets standards or below, the overall accountability rating cannot be stated to be exceeds standards;
If any of the critical accountability does not meet the standards, the overall rating for accountability cannot be stated as exceeding standards;
If any three accountabilities are does not meet standards or needs improvement, the overall rating for accountability cannot be stated as exceeds standards.

Bibliography

Begun, James, Flemming Fallon, and William Riley. Managing Health Organizations for Quality and Performance. New York: Jones & Bartlett Publishers, 2012.

Cognos Corporation. Performance Management in Healthcare. Burlington, MA : Cognos, 2008.

Office of Personnel Management, State of Oklahoma. The Performance Management Process. Oklahoma: Office of Personnel Management, 1998.

Walburg, Jan. Performance Management in Healthcare. New York: Routledge, 2006.

[1] James, Begun, Flemming Fallon, and William Riley. Managing Health Organizations for Quality and Performance. New York: Jones & Bartlett Publishers, 2012.

[2] Ibid.

[3] Jan, Walburg. Performance Management in Healthcare. New York: Routledge, 2006.

[4] James, Begun, Flemming Fallon, and William Riley. Managing Health Organizations for Quality and Performance. New York: Jones & Bartlett Publishers, 2012.

[5] Office of Personnel Management, State of Oklahoma. The Performance Management Process. Oklahoma: Office of Personnel Management, 1998.

[6] Cognos Corporation. Performance Management in Healthcare. Burlington, MA : Cognos, 2008.

[7] James, Begun, Flemming Fallon, and William Riley. Managing Health Organizations for Quality and Performance. New York: Jones & Bartlett Publishers, 2012.

[8] Cognos Corporation. Performance Management in Healthcare. Burlington, MA : Cognos, 2008.

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