Performance management
Efficient performance of tasks is an essential element to strengthening health systems. Monitoring productivity is well established in the industrial sector and in some areas of public services as well. Analysing performance provides managers and policy makers with important information to make appropriate health workforce decisions.
Productivity among nurses and midwives in Botswana highlights the importance of educational factors over economic incentives in the performance of the nursing and midwifery staff. The study provides information not only about the level of existing performance but also provides guidance on how to carry out further interventions aimed to improve the productivity of health workers.
A study by Manzi et al, exploring the influence of workplace trust over health worker performance at primary care level, was conducted in Tanzania and South Africa in 2003. Reasons for poor performance and motivation included staff shortages, low salaries, and poor working conditions. Respondents also cited lack of transparency in human resource management practices, limited supervision and monitoring, weak disciplinary procedures and limited and slow opportunities for promotion. The authors conclude that, although salary levels were seen to be important, they were not necessarily the most important issue.
Performance management helps organisations achieve their strategic goals. It reminds us that being busy is not the same as producing results. It also influences the motivation of health workers. In Mali, operational research was conducted to identify the match between motivation and the range and use of performance management activities. The results showed the importance of adapting or improving upon performance management strategies to influence staff motivation.
With the need to improve the operational performance of health systems, there is a growing acceptance that assessing the performance of health systems needs to extend beyond a purely clinical performance focus and include managerial performance. In other words, setting goals for the efficiency, effectiveness and equity of the health system is a legitimate focus for health service policy making. In order for managers to meet these goals methods must be developed to set realistic achievement targets, to measure progress towards these targets and, ultimately, for managers to be held accountable for their actions in achieving targets.
Chapter 3 of the JLI Report presents a framework for managing performance. This framework outlines a number of human resource intervention that focus on workforce coverage, motivation and competence. The framework also outlines how these will improve health systems performance and result in better health outcomes.
The authors of the JLI outline how the elements of the framework are interactive and can be complex. For instance, coverage is determined not just by the number of workers but also by their skill mix, geographic placement, available resources and support, and social compatibility with patients. Many countries that have large numbers of workers are still unable to generate full coverage because of skill misfits or geographic imbalances. Similarly, a lack of health workers may highlight the need for a stronger educational infrastructure for training doctors and nurses. It could also be a sign of inappropriate production targets, where there should be shorter training for more auxiliary workers.
Introducing performance management in national health systems: issues on policy and implementation uses preliminary research results from 15 case studies to examine the prerequisites for successful introduction of performance management systems which are appropriate for developing country situations. The key message and conclusion is that it is important to measure and value staff performance, but that this requires levels of organisational management and an external policy environment that are often not in place in a developing context.
Guidelines for introducing human resource indicators to monitor health service performance, written by Peter Hornby and Paul Forte from the Centre for Health Planning and Management, outlines why and how to develop and use health workforce performance indicators to improve management. It is aimed at policy makers and managers in national health systems.
Further reading on performance management
Productivity among nurses and midwives in Botswana highlights the importance of educational factors over economic incentives in the performance of the nursing and midwifery staff. The study provides information not only about the level of existing performance but also provides guidance on how to carry out further interventions aimed to improve the productivity of health workers.
A study by Manzi et al, exploring the influence of workplace trust over health worker performance at primary care level, was conducted in Tanzania and South Africa in 2003. Reasons for poor performance and motivation included staff shortages, low salaries, and poor working conditions. Respondents also cited lack of transparency in human resource management practices, limited supervision and monitoring, weak disciplinary procedures and limited and slow opportunities for promotion. The authors conclude that, although salary levels were seen to be important, they were not necessarily the most important issue.
Performance management helps organisations achieve their strategic goals. It reminds us that being busy is not the same as producing results. It also influences the motivation of health workers. In Mali, operational research was conducted to identify the match between motivation and the range and use of performance management activities. The results showed the importance of adapting or improving upon performance management strategies to influence staff motivation.
With the need to improve the operational performance of health systems, there is a growing acceptance that assessing the performance of health systems needs to extend beyond a purely clinical performance focus and include managerial performance. In other words, setting goals for the efficiency, effectiveness and equity of the health system is a legitimate focus for health service policy making. In order for managers to meet these goals methods must be developed to set realistic achievement targets, to measure progress towards these targets and, ultimately, for managers to be held accountable for their actions in achieving targets.
Chapter 3 of the JLI Report presents a framework for managing performance. This framework outlines a number of human resource intervention that focus on workforce coverage, motivation and competence. The framework also outlines how these will improve health systems performance and result in better health outcomes.
The authors of the JLI outline how the elements of the framework are interactive and can be complex. For instance, coverage is determined not just by the number of workers but also by their skill mix, geographic placement, available resources and support, and social compatibility with patients. Many countries that have large numbers of workers are still unable to generate full coverage because of skill misfits or geographic imbalances. Similarly, a lack of health workers may highlight the need for a stronger educational infrastructure for training doctors and nurses. It could also be a sign of inappropriate production targets, where there should be shorter training for more auxiliary workers.
Introducing performance management in national health systems: issues on policy and implementation uses preliminary research results from 15 case studies to examine the prerequisites for successful introduction of performance management systems which are appropriate for developing country situations. The key message and conclusion is that it is important to measure and value staff performance, but that this requires levels of organisational management and an external policy environment that are often not in place in a developing context.
Guidelines for introducing human resource indicators to monitor health service performance, written by Peter Hornby and Paul Forte from the Centre for Health Planning and Management, outlines why and how to develop and use health workforce performance indicators to improve management. It is aimed at policy makers and managers in national health systems.
Further reading on performance management
- How can we achieve and maintain high-quality performance of health workers in low-resource settings?
- The health and family planning manager’s toolkit
- Validating a work group climate assessment tool for improving the performance of public health organizations
- Ghana case study: staff performance management in reforming health systems
- Testing how management matters in an era of government by performance management
- Recognising, understanding and addressing performance problems in healthcare organisations providing care to NHS patients
- Productivity amongst nurses and midwives in Botswana
- ( K. Balogi; T. Fako; N Forcheh / African Sociological Review , 2002)
- This study, published in the African Sociological Review, analyses the productivity of nurses and midwives in Botswana. The authors found that productivity was 70 per cent productive, based on the fre...
- The match between motivation and performance management of health sector workers in Mali
- ( M. Dieleman; J. Toonen; H. Touré; T. Martineau / Human Resources for Health , 2005)
- This article from Human Resources for Health reports on research conducted into motivation and performance management among health workers in Mali. This research found that healthcare staff can be bet...
- Human resources for health: overcoming the crisis
- ( World Health Organization , 2004)
- This report presents the findings and recommendations of the Joint Learning Initiative (JLI). The report highlights major global challenges in human resources for health. These include: global short...
