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CHALLENGES OF PERFORMANCE APPRAISAL AS A TOOL FOR
PERFORMANCE MANAGEMENT OF NURSES.
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
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).
NATURE AND SCOPE OF PERFORMANCE MANAGEMENT PRACTICES
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.
THE CHALLENGES OF PERFORMANCE MANAGEMENT PRACTICES IN NURSING
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
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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