Performance appraisal communication 76 14

The results of the Public Service Employee Survey PSES are presented according to the numerical order of questions, grouped by section theme as they appeared in the questionnaire. Results are not shown when there is no historical comparison, or when there is an insufficient number of responses. Note: Due to rounding, percentages may not add to Results have been adjusted for non-response to better represent the target population. Therefore, percentages should not be used to determine the number of respondents within a response category. The results for "Most positive or least negative answers" and "Least positive and most negative answers" are calculated by removing the "Don't know" and "Not applicable" responses from the total responses.

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Performance appraisal communication 76 14

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Content:

• O. Reg. 191/11: INTEGRATED ACCESSIBILITY STANDARDS
• Feedback time: performance appraisal and management
• Performance Appraisal and Innovative Behavior in the Digital Era
• SA Journal of Human Resource Management
• Truth or consequences: politics and performance appraisals
• Performance Evaluation for the Sustainable Supply Chain Management
• Performance Appraisal: A Tool for Practice Improvement

WATCH RELATED VIDEO: The performance appraisal interview - getting it right

O. Reg. 191/11: INTEGRATED ACCESSIBILITY STANDARDS

Existing performance management approaches in health systems in low-income and middle-income countries are generally ineffective at driving organisational-level and population-level outcomes. They are largely directive: they try to control behaviour using targets, performance monitoring, incentives and answerability to hierarchies. In contrast, enabling approaches aim to leverage intrinsic motivation, foster collective responsibility, and empower teams to self-organise and use data for shared sensemaking and decision-making.

The current evidence base is too limited to guide reforms to strengthen performance management in a particular context.

Further, existing conceptual frameworks are undertheorised and do not consider the complexity of dynamic, multilevel health systems. As a result, they are not able to guide reforms, particularly on the contextually appropriate balance between directive and enabling approaches. This paper presents a framework that attempts to situate performance management within complex adaptive systems. Building on theoretical and empirical literature across disciplines, it identifies interdependencies between organisational performance management, organisational culture and software, system-level performance management, and the system-derived enabling environment.

It uses these interdependencies to identify when more directive or enabling approaches may be more appropriate. The framework is intended to help those working to strengthen performance management to achieve greater effectiveness in organisational and system performance.

The paper provides insights from the literature and examples of pitfalls and successes to aid this thinking. The complexity of the framework and the interdependencies it describes reinforce that there is no one-size-fits-all blueprint for performance management, and interventions must be carefully calibrated to the health system context.

This is an open access article distributed in accordance with the Creative Commons Attribution 4. Performance management approaches in many low-income and middle-income country health systems are largely directive, aiming to control behaviour using targets, performance monitoring, incentives, and answerability to hierarchies. The complex, dynamic, multilevel nature of health systems makes outcomes difficult to control, so directive approaches to performance management need to be balanced with enabling approaches that foster collective responsibility and empower teams to self-organise and use data for shared sensemaking and decision-making.

This paper sets out a conceptual framework that identifies the factors that determine the appropriate balance between directive and enabling approaches to performance management in a given context. To accelerate progress towards Universal Health Coverage and the Sustainable Development Goals at a time of constrained resources, global health actors have increasingly focused on the performance of healthcare providers 1 and approaches to managing that performance.

A recent evidence gap map on performance management in primary healthcare in low-income and middle-income countries LMICs suggests the existing approaches—and interventions to support them—are often unsuccessful at driving organisational and population-level outcomes. This aligns with its framing within the public management literature. For example, Pollitt 8 identifies three components of the cyclical translation of targets into performance outcomes:. Incentive systems: positive rewards and negative sanctions that incentivise individuals within the organisation to work towards goals.

Performance measurement, feedback, and sensemaking: the processes through which performance data are collected, monitored, synthesised, and analysed. In this conceptualisation, the cyclical nature of performance management relates to how performance results are fed back to healthcare providers and facilities to inform process and service improvements, as well as in the longer term to support organisational learning effects such as new strategies and services.

The evidence base is insufficient to guide what incentive systems, implementation support strategies, and sensemaking strategies should look like in a particular context.

Evidence is largely limited to studies on the effects of a narrow subset of implementation support strategies such as in-service training and financial incentive systems such as pay-for-performance on immediate individual outcomes such as provider knowledge. In particular, the framework is agnostic regarding the main debate in the public management and organisational behaviour literature: should performance management be more enabling or more directive?

In contrast, enabling approaches treat workers as stewards, 19 and assume that workers have intrinsic motivation aligned with health system goals and need to be encouraged and developed rather than measured, incentivised and coerced. Under such conditions, performance emerges if workers have agency and an enabling environment. Directive vs enabling is a continuum, 11 and a contextually appropriate balance is required.

Health systems are complex and adaptive: performance outcomes arise from interactions between many interconnected system actors and their ability to adapt to pressures for change. Such conditions make health systems inherently non-linear and unpredictable. Despite literature examples of how performance management interfaces with these and other dimensions of complexity, to the best of our knowledge no existing conceptual framework situates health performance management within complex adaptive systems.

The framework presented in this paper aims to characterise the elements within a performance management system and their interdependencies, particularly with the actions of system-level actors who themselves undertake management tasks.

Supported by documented examples of success and pitfalls in the literature, we aim to provide a basis for informing the design of performance management reforms and guiding decision makers on achieving a contextually appropriate balance between directive and enabling approaches. This is consistent with the uses of complexity theory in public administration 12 and health services 26 ; it also addresses some concerns.

To develop the framework, we first undertook an integrative literature review. This is an appropriate method to critically review and synthesise the literature on emerging topics to reconceptualise an issue and generate new frameworks. Data on how complexity had been conceptualised was abstracted, along with findings from empirical studies. This was synthesised into a reconceptualised framework. As a starting-point, the framework took the traditional organisational performance management cycle model of Pollitt 8 and others 32—34 —and its adaptation to multilevel systems 28 —from the public sector management literature.

Given the intention to motivate the practical understanding of the framework, seven purposively selected, unpublished empirical case studies were developed that covered a range of directive and enabling performance management systems and approaches, to show how they affected different elements and interactions of the framework and provide examples of pitfalls and successes.

This includes three examples of internationally recognised performance management systems in high-income countries UK, Sweden and Italy and four on performance management interventions in LMICs results-based financing in Nigeria, performance accountability mechanisms in India, a supranational performance management intervention in El Salvador, and district governance mechanisms in South Africa.

The findings from these case studies, along with examples from the broader empirical literature reviewed, are used to illustrate the framework below. The framework is visualised in figure 1. Individual performance occurs if individuals have the required MMO. Conceptual framework for performance management in complex adaptive health systems.

System change is hypothesised to be multilevel, with performance emerging from relational interactions between individuals, connections within organisational boundaries, and networks of system elements.

This makes system outcomes non-linear and unpredictable. Within this, the framework visualises three interactions between the performance management cycle and the broader health system. Their implications for the balance between directive and enabling approaches are discussed in detail below. System actions influence the organisational performance management cycle by triggering organisational motives. Adequate resources, decision space and data—as part of an enabling environment—provide opportunities and means to undertake performance management.

The impact of the performance management cycle on individual MMO and therefore performance is mediated by organisational culture, itself influenced by system-level actions and the broader sociopolitical, cultural and governance context in which they are embedded. To achieve system-level goals, system agents undertake performance management of organisational units within them.

In most LMICs, this is undertaken through directive, audit-style approaches. Most systems operationalise this through centrally set targets.

Potential pitfalls arise from how performance targets are set. First, targets are often unrealistic given the resources and decision space available to teams, creating incentives to game the system and manipulate data. Directive approaches have also been criticised when top—down targets do not respond to local priorities or fail to create opportunities for the emergence of collaborative work among health system actors.

For example, in Sweden, the 21 districts tailor the national performance management system at the regional level. Performance targets are expected to form the basis of an accountability relationship, giving organisations the motive to perform. Hierarchical and transactional accountability relationships may exacerbate the risk of unintended consequences arising from performance targets. For example, in India, punitive treatment of staff in facilities that did not meet system-mandated targets, such as salaries being withheld, led to coordinated and systematic falsification of data.

Performance-based financing PBF is commonly used to operationalise accountability. Performance management requires organisations to have the opportunity to perform, with sufficient agency over outcomes.

Otherwise, improvements may be limited to efficiency gains and performance management approaches are more likely to be unrealistic, incentivising gaming.

In addition, the health systems literature identifies that organisations often have insufficient decision space, lacking autonomy in health planning, budget allocation and HRM. Measurement and data are key for organisations to undertake performance management. For higher-order learning and whole-system improvement to occur, practical and tacit knowledge needs to flow among system actors and organisations, thus leveraging the power of networks and social connections eg, learning exchanges and communities of practice.

In El Salvador, the highest-performing teams share experience and know-how with the entire community of team leaders, thus turning routine supervision meetings into strategic opportunities for learning and collective sensemaking. The literature also emphasises the importance of appropriate leadership and management capabilities. The capacity of managers—particularly at the sub-national level—to diagnose problems, identify and implement solutions, and manage performance is increasingly emphasised as crucial to better health system performance.

The health systems literature emphasises the importance of organisational culture, 61 including intangible software dimensions 35 such as power dynamics and shared norms and values, on team and individual behaviour. Conducive culture—manifested through high levels of teamwork, recognition, and trust, and individuals feeling they receive organisational support and reciprocity 62 —is crucial for enabling approaches to performance management that require collective organisation.

The complex web of relationships within facilities, underpinned by formal and informal power dynamics, can also subvert directive performance management approaches, for example through quid-pro-quo behaviour and political connections undermining management controls. Performance management approaches can in turn influence organisational culture. For example, micro-practices of social sensemaking within enabling approaches have been shown to improve motivation and collective commitment.

In the context of the limited effectiveness of existing performance management approaches in LMIC health systems, and the sparse evidence base and lack of a system-based framework to guide reforms, this paper has presented a framework attempting to situate performance management within complex adaptive systems.

Building on theoretical and empirical literature across disciplines, this framework has identified interdependencies between organisational performance management cycles, organisational culture, system-level performance management, and the system-derived enabling environment.

In particular, the framework has been used to consider the strengths and weaknesses of directive and enabling approaches in different contexts. Directive approaches seeking to control behaviour based on targets and accountability relationships may be more effective where workers are primarily extrinsically motivated, in less complex systems where there is higher certainty over how outcomes should be achieved, where there are sufficient resources and decision space, and where informal relationships do not subvert formal management levers.

Enabling approaches promoting self-organisation and collective sensemaking may be more effective in contexts of higher complexity and uncertainty and where there are higher levels of trust, teamwork, and intrinsic motivation, as well as appropriate leadership.

The literature indicates a degree of complementarity: directive approaches can fuel short cycles of innovation and improvement, but enabling approaches are necessary for long-term strategic renewal and change.

It also explicitly promoted social interactions, fostered multidirectional feedback and learning loops that built trust, and delegated the decision space on achieving targets to semi-autonomous teams.

The SMI is also a good example of a comprehensive intervention targeting system-enabling factors, with strong data systems and the use of organisational financial incentives as untied funds to alleviate resource constraints.

This is an important reminder of the need to facilitate the emergence of an enabling environment for performance management alongside optimising performance management systems. Failing to engage with context can contribute to well-meaning interventions not having their anticipated effects.

This complexity makes strengthening performance management in health systems extremely challenging. Through categorising the interdependencies between system elements, the framework is intended to support those designing performance management reforms to systematically consider the range of factors that are critical in determining optimal approaches and identify complementary interventions that may be required.

They should consider the existing balance between directive and enabling approaches against the degree of uncertainty over how targets should be achieved, the current levels of accountability in the system, the sources of motivation of workers, the decision space and hardware resources available, and the organisational culture, data systems and leadership skills that exist.

By considering each factor and their interdependencies, actors can minimise perverse unintended consequences while attaining a contextually appropriate balance between directive or enabling approaches. Contributors Each author contributed to the conceptual development of the framework presented and were jointly responsible for manuscript preparation. Provenance and peer review Not commissioned; externally peer reviewed.

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Feedback time: performance appraisal and management

Supply chain SC activities transform natural resources, raw materials, and components into various finished products that are delivered to end customers. A high efficient SC would bring great benefits to an enterprise such as integrated resources, reduced logistics costs, improved logistics efficiency, and high quality of overall level of services. In contrast, an inefficient SC will bring additional transaction costs, information management costs, and resource waste, reduce the production capacity of all enterprises on the chain, and unsatisfactory customer relationships. So the evaluation of a SC is important for an enterprise to survive in a competitive market in a globalized business environment. Therefore, it is important to research the various methods, performance indicator systems, and technology for evaluating, monitoring, predicting, and optimizing the performance of a SC. A typical procedure of the performance evaluation PE of a SC is to use the established evaluation performance indicators, employ an analytical method, follow a given procedure, to carry out quantitatively or qualitatively comparative analysis to provide the objective and accurate evaluation of a SC performance in a selected operation period. Various research works have been carried out in proposing the performance indicator systems and methods for SC performance evaluations.

Performance Appraisal and Innovative Behavior in the Digital Era

Human Resources for Health volume 9 , Article number: 22 Cite this article. Metrics details. Previous research in performance appraisal PA indicates that variation exists in learning and job motivation from performance appraisal between occupational groups. This research evaluates the potential effect of job motivation, learning and self-assessment through performance appraisals for health personnel. This article focuses on goal-setting, feedback, participation and training in performance appraisals in municipal health services in Norway; and job motivation, learning and self-assessment of performance are the dependent factors. Factor analysis and regression analysis were run in SPSS The study suggests that respondents learn from performance appraisal. Nurses experienced some higher job motivation from performance appraisal than auxiliary nurses. All subordinates perceived higher job motivation after performance appraisal than managers. Useful feedback, active participation and higher education are fundamental elements of discussion in performance appraisal, as well as the role of increasing employees' job motivation.

SA Journal of Human Resource Management

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Truth or consequences: politics and performance appraisals

When employees have goals, they tend to be more motivated if they also receive feedback about their progress. Feedback may occur throughout the workday, but many organizations also have a formal, companywide process of providing feedback to employees, called the performance appraisal. A performance appraisal is a process in which a rater or raters evaluate the performance of an employee. Then, when it is time for a performance appraisal, these observations are documented on a form. The rater usually conducts a meeting with the employee to communicate performance feedback. Even though performance appraisals can be quite effective in motivating employees and resolving performance problems, in reality, only a small number of organizations use the performance appraisal process to its full potential.

Performance Evaluation for the Sustainable Supply Chain Management

Try out PMC Labs and tell us what you think. Learn More. Yours may be among the many oncology practices without an appropriate performance review system in place. Lack of an effective evaluation system increases the risk of inefficiency, poor office morale, and high turnover rates. Within 30 days, physicians we recruit know specific changes they should make to succeed with our practice.

Performance Appraisal: A Tool for Practice Improvement

Existing performance management approaches in health systems in low-income and middle-income countries are generally ineffective at driving organisational-level and population-level outcomes. They are largely directive: they try to control behaviour using targets, performance monitoring, incentives and answerability to hierarchies. In contrast, enabling approaches aim to leverage intrinsic motivation, foster collective responsibility, and empower teams to self-organise and use data for shared sensemaking and decision-making.

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