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CHALLENGES OF PERFORMANCE APPRAISAL AS A TOOL FOR

 

PERFORMANCE MANAGEMENT OF NURSES.

 

Abstract

 

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.

 

INTRODUCTION

 

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

 

performance

 


 

by

 


 

providing

 


 

them

 


 

with

 


 

training

 


 

to

 


 

improve

 


 

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

 

discussions

 


 

between

 


 

supervisors

 


 

and

 


 

employees

 


 

about

 


 

future

 


 

organisational

 


 

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,

 

2012).

 

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

 

Ghana.

 

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

 

year.

 

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.

 

CONCLUSION

 

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

 

care.

 

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.

 


 

REFERENCES

 

Aguinis, H. (2009a). ?An expanded view of performance management?. In Smitter, J. W. and

 

London, M. (Eds), Performance management: putting research into practice. Wiley,

 

San Francisco: pp.1-43

 

Aquinis, H. (2007). Performance management. Pearson Prentice Hall; Upper Saddle River,

 

New Jersey.

 

Armstrong, M. & Baron, A. (2010). Performance Management, A Strategic and Integrated

 

Approach to achieve success. Ahmedabad: Jaico Publishing House.

 

Armstrong, S.J., Rispel, L.C. & Penn-Kekana, L. (2015). The activities of hospital nursing

 

unit managers and quality of patient care in South African hospitals: a paradox? Glob

 

Health Action, 8: 26243, doi: http://dx.doi.org/10.3402/gha.v8.26243

 

Australian Nursing and Midwifery Council (2006), National Competency Standards for the

 

Midwife, Melbourne: Nursing and Midwifery Board of Australia (available on-line at

 


 

http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/CodesGuidelines.aspx#competencystandards)

 

Awases, M.H., Bezuidenhout, M.C. & Roos, J.H. (2013). ?Factors affecting the performance

 

of professional nurses in Namibia?. Curationis, 36(1), 108-116.

 

Bratton. J, & Gold, J. (2003). Human resource management: theory and practice.

 

3rd edition. New York: Palgrave Macmillan.

 

Briscoe, D.B. & Claus, L.M. (2008). Employee performance management:policies and

 

practices in multinational corporations, Performance Management Systems: A Global

 

Perspective,(Ed)PW Budwah and DeNisi,Routledge, Abingdon.

 

Brudan, A.( 2010). Rediscovering performance management: systems,learning and

 

integration, Measuring Business Excellent, Vol.14, No.1,109.

 

Boxall, P. Purcell, J. & Wright, P. (2007). The Oxford handbook of human

 

resourcemanagement. New York Oxford University Press.

 

Chopra M., Munro S., Lavis J.N., Vist G., Bennett S. (2008). Effects of policy options for

 

human resources for health: an analysis of systematic reviews. Lancet 2008,

 

371(9613):668-674.

 

Denkyira, F Opoku, (2014). Establishing Effective Performance Appraisal Practices in the

 

Ghana Civil Service. Available at SSRN: http://ssrn.com/abstract=2394578 or

 

http://dx.doi.org/10.2139/ssrn.2394578 retrieved on 20th April 2016.

 

DeNisi, A....

 

Paper#9209581 | Written in 27-Jul-2016

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