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Performance appraisal has always been used in reference to perfmance management


especially within developing conuntry context. This has neglected a number of key factors


inherent in performance managment as an overarching principle which captures job appraisal


as one of the management strategies in examining job performance among nurses in Ghana.


In other words, job appriasal is a function of perfomance management.


This issue paper however, attempts to draw a clearer distinction between performance and


performance management, outlining key attributes, similarities and distinctions in the case of


examing performance among nurses.




The New York Times in 2012 reported of many writers and consultants using the term


?performance management? as a substitution for the traditional appraisal system. And that


performance management is a much broader work system that begins when a job is defined


as needed and ends when an employee leaves your organization. According to the report


performance management system includes the following practices such as (i) Develop job


descriptions, (ii) Select appropriate people with appropriate selection process, (iii) Negotiate


requirements and accomplishment-based standards, outcomes, and measures, (iv) Provide


effective orientation, education and training, (v) Design effective compensation and


recognition systems that reward people for their contributions, (vi) Provide promotional


career development opportunities for staff, (vii) Assist with exit interviews to understand why


valued employees leave the organization. While performance appraisal is a review and


discussion of an employee's performance of assigned duties and responsibilities. The



appraisal is based on results obtained by the employee in his/her job, not on the employee's


personality characteristics.


Performance appraisal has been the focus of considerable research for almost a century. Yet,


this research has resulted in very few specific recommendations about designing and


implementing appraisal and performance management systems whose goal is performance


improvement. DeNisi and Pritchard (2006) believes that a reason for this is that appraisal


research became too interested in measurement issues and not interested enough in ways to


improve performance. There is a growing literature and acceptance of performance


management event in Ghana.


Employee appraisal has been the main tool for the measurement of employee performance


especially among health worker in Ghana. Until recently, the Public Service Commission


developed a performance management policy for public services in Ghana. This was to


ensure that (1) an objective and transparent scheme of assessment of performance is in place;


(2) create a clear direction for employees by ensuring that work is aligned with the


strategic effort and direction of the public services; (3) assist employees


























and development relevant to



individual performance areas, career aspirations and longer term organisational needs;


(4) provide an equitable and transparent framework for regular and constructive


























developments, operational plans and their alignment with individual work plans, goals and


priorities; and (5) develop mechanisms for rewarding high performance and managing


unsatisfactory performance, where continuity in office of post holders in the public services


will depend on performance. Reference.


Over the last 20 years, a number of strategies aimed at improving the job performance of


health workers have been implemented in low and middle-income countries (LMIC)



(Marchal et al. 2012). The study found induction of new staff, training and personal


development, good communication and information sharing, and decentralised decisionmaking were critical in nurses performance. The study also identified three(3) additional


practices: ensuring optimal physical working conditions, access to top managers and


managers' involvement on the work floor. Teamwork, recognition and trust emerged as key


elements of the organisational climate. Each strategy has had its specific perspective and


focused on one particular issue: quality improvement, performance management, building


learning organisations, innovation diffusion, to mention but a few (Chopra et al. 2008). While


success has been reported in some cases, there is increasing acknowledgement that to


improve performance of health workers especially nurses and healthcare organisations in


general, approaches that deal with one problem, mostly fall short or obtain only short-term


results (Marchal et al. 2010). The concern about shortage of nurses and it potential effect on


quality of nursing care rendered as well as the mounted public urge on quality and excellent


performance in the health sector mandates the Human Resource Management as part of its


core function to ensure that an effective system of monitoring, measuring and evaluating


performance of health workers especially nurses is in place. This is hoped to maximise the


potential of employees and improve upon the quality of health service delivery. It is an


undeniable fact that nurses form the majority of the health sector workforce, hence the


performance of the health centers critically depends on their overall performance.


Indeed, Studies have found that when hospitals provide incentives and motivation to work


and follow a system of bonuses by competencies, there is improvement of the individual's?


performance (McKinnies, R., Collins, S., Collins, K. Sc. & Matthews, E. 2010) and this can


make a significant difference between health organization with good performance and health


organization underperforming or with a below average performance (Edgar and Geare, 2005).



A classic example can be drawn from nurses performance in the public health center and


private health where there is a sharp contrast between performance [reference]


Performance management is now widely recognised and accepted as a basic management


system which greatly influences the general levels of productivity, service delivery and the


image of an organisation [reference]. For an organization such as the health sector to improve


its image as efficient and highly performing field attracting highly qualified health


professionals including nurses, there is the need for an effective performance management


system to motivate staff. Until recently, most of our nurse leaders and managers have no


education or career development in nursing management, so the question is, how is the


performance of Ghanaian nurses managed? What are the challenges that come with


performance management in nursing? This paper seeks to address these issues.


Within Performance management literature, there abounds a number of definition; Fowler


(1990) defines performance management as the organization of work to achieve the best


possible result. From this simple definition, performance management is not a system or


technique. It is the totality of day to day activities of all managers. Fowler?s definition is


similar to that of Mullins (2010) who sees performance management as a process of


management which includes continuous judgment of the skills, behaviours, activities and


contributions of staff.


There is however, a general notion that performance management should be carried out by


the human resource department of the health facility. However, Foot & Hook (2011, p 250)


define it as a ?shared process between managers, individuals and teams?. They indicated that


the term should not be understood as a tool for monitoring and disciplining the staff


especially nurses but rather viewed as a tool for the organization to achieve the strategic


objectives by motivating and engaging it employees.



Performance management is described by Armstrong & Baron, (2010) as an integrated,


strategic continuous process which involves teamwork to achieve targets of performance that


are set in line with the organization's vision, mission and objectives, which is similar to


Performance management (PM) is essentially about measuring, monitoring and enhancing the


performance of staff, as a contributor to overall organisational performance. Similarly,


Aguinis (2007) reiterate that Performance management is a systematic link between


organizational strategies, resources, and processes towards the achievements of corporate


objectives. He further define Performance management as a ?continuous process of


identifying, measuring, and developing the performance of individuals and teams and


aligning performance with the strategic goals of an organization? (Aguinis, 2009a: p.3). It is


worth noting the key elements of performance management in the definitions that is a


continuous process and that individual performance should be aligned with the goals of the


organization, unlike instances where annually or quarterly nurses fill a form with the


supervision of their nurse managers or unit head as a human resource requirement for


promotion, which is how nurses performance has been evaluated in Ghana over the years.


Performance management thus comprises the process of assessing and managing the


difference between expected performance and actual performance within the work setting.


A positive gap is created when actual performance exceeds expected performance.


Nevertheless, this gap can be negative when actual workplace performance falls short of


required standards (Shaw & Blewett, 2013). Therefore a good performance management


process should include the six related components: prerequisites, performance planning,


performance execution, performance assessment, performance review, and performance


renewal and recontracting (Aguinis, 2007).





Mandishona (2003) explicated that the presence of establishment and good service delivery is


contingent on how workers think about how performance within the whole system is


managed. Organisations therefore need to make sure that employees? benefits are tied to


performance.According to Lawler (2008), an effective performance management system


needs to accomplish four things. First, it needs to define and produce agreement on what


performance is needed. The groundwork of any performance management system should be


focused on what needs to be done and how it should be done. Without a clear definition of


what kind of performance is desired, it is impossible to improve and motivate individuals


who meet or exceed performance standards. It also is key to guiding the performance of


individuals so that it supports the organization?s strategy and plans. Second, it needs to guide


the development of individuals so that they have the skills and knowledge needed to perform


effectively. Third, it needs to motivate individuals to perform effectively. This will even make


the best talent to perform at an extraordinary level. When it comes to performance, high


levels of both talent and motivation are needed. Finally, it needs to provide data to the


organization?s human capital information system. It needs to serve as the primary source of


information on how individuals are performing and what skills and knowledge exist in the


workforce. This information is a critical input to talent management as well as to strategic


planning, the system has to be regarded as fair and just by the employees. Hence Performance


management is the system through which organization set work goals, determine


performance standards, assign and evaluate employee's work, provide performance feedback


to employees, determine training and development needs and distribute rewards to employees


(Briscoe & Claus, 2008).


Recent studies of ?global human resources for health? conclude that all countries can advance


(regional) health through more strategic investments and management of their nursing staff


(Sermeus, Aiken, Van den Heede, Rafferty, Griffiths, Moreno-Casbas, et al. 2011).



In addition, according to Veld (2012), a vital factor in addressing the challenges for hospitals


encompasses managing human resources in the healthcare sector. The management of the


workforce within a hospital can make the difference between high performance and poor or


average performance which ultimately has an influence on the quality of healthcare (Veld,




According to Wright (2006), performance appraisal has given ground to performance


management. She states that performance management is a broader process in which


organisational aims and objectives are used as a starting point for the setting of objectives, for


divisions, departments, teams and individuals. Bratton & Gold (2003) define performance


appraisal as a process that provides an analysis of a person's overall capabilities and potential,


allowing informed decisions to be made for particular purposes. They argue that more


emphasis is placed on assessment, whereby data on an individual's past and current work


behaviour and performance are collected and reviewed. Performance appraisal serves two


main objectives, which are evaluative and developmental objectives (Grobler et al 200).


Boxall, Purcell & Wright (2007) point out that what distinguishes performance management


and performance appraisal is that the former is an ongoing process, whereas the latter is done


at separate time intervals. This could be annually or quarterly in some instances, de[ending on


the organization. Performance appraisal is consequently not a substitute to performance


management or vice versa, but should be seen as being a part of the performance


management process. Attainment of institutional goals and improving service delivery is the


main focus of performance management. It is a holistic approach to performance


incorporating other management tools to ensure improvement in an organization's? service


delivery as well as having a competitive edge over its competitors. Performance appraisal, on


the other hand, is more concerned about the assessment of the individual?s past and current


performance with the purpose of evaluation and developmental plans.



In terms of the importance of performance management (PM) to nursing, the Report on


Continuing Professional Development of Staff Nurses and Staff Midwives (National Council


for the Professional Development of Nursing and Midwifery 2004) asserted that 90% of


nurses only receive feedback on their performance from relatives and patients. The


Commission on Nursing and Midwifery (Government of Ireland 1998) also asserted that ?the


quality of care and public satisfaction with the health service is primarily determined by the


quality of nursing services?. Therefore a true measurement of actual performance would be of


value to the field of nursing as well as the healthcare sector in Ghana.


The goal of performance management therefore is to improve service delivery through


effective and efficient use of resources.




Managing the performance of the employees is one of the toughest challenges faced in many


organizations today as this is completely influenced by employee?s commitment, competence


and clarity of performance(Brudan, 2010). Performance management system can function as


an important tool for employee motivation and development If managed efficiently through a


well-planned reward practice and feedback mechanism. African countries find it as a major


challenge to improve the productivity and performance in order to enhance efficiency in


health interventions of health care workers (Awases et al., 2013).


Some health challenges and needs identified that have negative influence on performance


include timely and efficient health care services; poor human resource management, poor


performance management policies and systems for staff evaluation resulting in poor quality


of services (Marchal et al. 2010). Others are negative attitudes and low motivation of health


care workers and a general feeling of despondency amongst healthcare workers due to limited


opportunities for career advancement and performance reward systems (World Health


Organization, 2005). A study conducted by Karunhanger & Werner (2013) revealed that



major challenges impacting Performance Management Implementation (PMI) in universities


in Uganda could be categorised as: lack of a formal performance management environment;


limited employee engagement/communication problems; institutional systems and structural


constraints; and institutional governance challenges. Among the enlisted challenges the


specific items on which respondents had the highest level of agreement are: limited


motivation and staff morale; limited and uneven cash flows; and poor physical infrastructure.


These are not different from those experienced by employee of the various hospitals in




In Australia, the capabilities needed for effective performance management for all nurses and


midwives are consistent with the National Competency Standards for Nurses and Midwives


(Australian Nursing and Midwifery Council, 2006). On the other hand, in African countries


such as Namibia, McCourt and Awases (2005) found no performance appraisal system in


place for nurse managers. However, the nurses expressed a sense of professional pride and


motivation to work. In South African hospitals, Armstrong, Rispel and Penn-Kekana (2015)


found that nurse managers experienced numerous interruptions and distractions hence do not


have adequate time to assess and evaluate performance of their staff in order to identify


performance gaps and assist in improving those areas. They spent 25.8% of their time on


direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on


education, 13.4% on support and communication, 3.9% on managing stock and equipment,


11.5% on staff management, and 11.8% on miscellaneous activities. Pillay (2010) also


noticed lack of management capacity within the health sector in South Africa.


One facet of performance management is performance appraisal which is the most commonly


used approach in the public sector organizations. In most public hospitals in Ghana,


monitoring employee performance is monitored, and a routine documentation is required, this


is accomplished through completing a performance appraisal form. This helps one to be able



to determine the gap between actual performance and expected performance (Lewis,


Linganiso & Karodia, 2015). The appraisal system as a tool for performance management is


not without challenges.


In Ghana, a study conducted by Denkyira (2014) on effective performance appraisal


practices in the Ghana civil service adopting a case study and a descriptive survey found that


the current performance appraisal system in the Civil Service does not fulfil the aspirations


of the employees, because it is characterized by certain flaws, which need to be addressed.


Employees believe that the current performance appraisal system (PAS) cannot help achieve


organizational strategic goals and objectives; there is a negative general perception about the


PAS; performance monitoring and feedback is poor; results from the appraisals are not


judiciously used; performance is not linked to rewards and sanctions and finally, employees


are hugely dissatisfied with the current PAS. Consequently, employees cannot be sufficiently


motivated to put in their best. All these factors have worked against the effective


implementation of the performance appraisal system in the Ghana Civil Service.


An interaction with Nursing Administration and Human Resource management in charge of


assessing and evaluating performance (performance management of nurses) in some


hospitals, revealed certain challenges with the current performance management practice. It


was indicated that teaching hospitals have not developed their own performance management


policies or guidelines, they have over the years relied on the borrowed policy from Ghana


Health Service. Currently the staff performance appraisal system is the main tool in use, the


nursing administration have introduced quarterly assessment of nurses? performance, and


these documents are kept on individual files at the unit level and are collated at the end of the




At the unit level, nurse managers assess their staff performance based on their output at work


and other methods which are sometimes considered too subjective. Personal observation



shows that some of the data on nurses? performance are incomplete and full of biases.


Anecdotal evidence shows that most nurse managers rose to their leadership rank due to long


service within their various institutions and they do not receive any formal managerial


training to equip them in their duties, they have little understanding of the appraisal tool and


hence this influence effective implementation of the tool and utilization of the results. Some


nurse managers only appraise their subordinates only when they are due for promotional


interviews. The present appraisal form also does not adequately evaluate the actual


performance of the nurse and is subject to bias by nurse managers.


A critical examination of this appraisal system shows that it does not have clearly defined


objectives. There is no link of the process to an enforceable reward and sanctions mechanism


and staff development, thus training and career development. There is also lack of effective


monitoring and annual reporting and feedback mechanisms compared to a performance


management system.




Performance management can be regarded as a proactive system of managing employee


performance for driving the individuals and the organizations towards desired performance


and results. It?s about striking a harmonious alignment between individual and organizational


objectives for accomplishment of excellence in performance. Nurses play a vital role in the


health sector and their performance has a correlational effect on the overall performance of


the of the healthcare facility, by recognizing and rewarding their achievements, you make


nurses feel more appreciated and more willing to go that extra mile thus promoting quality




Health sector in Ghana is facing challenges in the implementation of performance


management system for effective assessment and evaluation of the performance of nurses and



to minimize these challenges, there is the need for training and education on performance


management, since the success of any performance management system is dependent on the


managers and staff of the organization.


Performance management is a concept that is required to sustain any organization and the


nation at large.





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DeNisi, A....


Paper#9209581 | Written in 27-Jul-2016

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