A Study On Employee Performance Appraisal in Health Care
A Study On Employee Performance Appraisal in Health Care
A Study On Employee Performance Appraisal in Health Care
ISSN: 2348-0351
ABSTRACT
Health care professional are becoming more involved in performance
management as hospital restructure to increase effectiveness. Although
they are hospital employees, they are subject to performance appraisals
because the hospitals are accountable to patients and the community for the
quality of hospital services. The purpose for having a performance appraisal
program in hospital is to monitor employees’ performance, motivate staff
and improve hospital morale. The performance of a health care professional
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may be appraised by the appropriate departmental manager, by other
professionals in a team or program or by peers, based on prior agreement on
expectations. Appraisal approaches vary. They include behavioral approaches
such as rating scales, peer rating, ranking or nomination and outcome
approaches such as management by objectives and goal setting.
Professionals should give and receive timely feedback on a flexible
schedule. Feedback can be provided one-on-one, by a group assessing
quality of care or through an anonymous survey. The British Association of
Medical Managers (BAMM, 1999) has defined appraisal as "the process of
periodically reviewing one's performance against the various elements of
one's job". This paper will describe the purpose & developmental criteria of
an appraisal program that will regularly assess the performance of hospital
employee.
Keywords: Healthcare, Performance Appraisal, Flexible schedule, Criteria.
Introduction
Performance appraisal is one of the important program is to monitor employees‟ performance, motivate
components in the rational and systematic process of staff and improve hospital morale. In the hospital,
human resource management. The information obtained monitoring employee performance requires routine
through performance appraisal provides foundations for documentation, which is accomplished through
recruiting and selecting new hires, training and completing a performance appraisal form. When
development of existing staff, and motivating and employees are aware that the hospital is mindful of their
maintaining a quality work force by adequately and performance and they could be rewarded with increment
properly rewarding their performance. Without a reliable and promotions, they will work harder. Morale is improved
performance appraisal system, a human resource when employees receive recognition or reward for their
management system falls apart, resulting in the total work. An effective performance appraisal program will
waste of the valuable human assets a company has. This is assist the hospital in achieving its goals and objectives. Not
not to argue that there should be no formal mechanisms only, training needs will be identified and addressed during
for evaluating performance but, rather, it should be a performance appraisal review, but also hidden talent can
viewed as only one of a number of mechanisms for be discovered as well. Through identifying these training
improving the quality of clinical care (Armstrong & Baron, needs, staff can perform their jobs at the highest level and
1998). Performance appraisal has been defined by DeVries be in a better position to address clients, members and
et al., (1981) as the process which allows firms to customers concerns and questions. A well- developed staff
measure and consequently evaluate an employee’s is more likely to be proactive, productive and resourceful,
achievements and behavior over a certain period of time. all of which helps give the hospital a competitive edge,
According to Briscoe & Schuler (2004) performance can be from improved customer relations to increased profits.
viewed as a combination of several variables, such as The Department of Health London (1999) in consultation
motivation, ability, working conditions and expectations. It paper “Supporting Doctors, Protecting Patients”
has been established that there are certain factors that emphasized this point by stating that it is not the primary
affect employees‟ performance more than others. These aim of appraisal to scrutinize doctors to see if they are
factors, according to Dowling et al (1999) include the performing poorly but rather to help them consolidate and
compensation package; the nature of task; support from improve on good performance aiming towards excellence.
higher management; the working environment and the In the health sector, resource availability and employee
overall corporate culture. competence are essential but are not enough to guarantee
Chandra, A. & Frank, Z.D., (2004) wrote that “performance desired employee performance (Franco et al., 2002). To
appraisal systems are designed to objectively evaluate an obtain performance on quality, cost and patient
employee's performance and then outline measures to be satisfaction dimensions, health organizations will also have
taken for improvements, which are essential for an to satisfy their physicians and employees (Griffith, 2000).
organization to move ahead. The evaluative purpose is Health care delivery is high labour-intensive (Franco et al.,
intended to inform people of their performance standing. 2002) and health sector performance is critically
The developmental purpose is intended to identify dependent on employee motivation (Amaratunga and
problems in employees performing the assigned task. Baldry, 2002, Franco et al., 2002, & Martinez and
These systems are often organization specific and health Martineau, 1998).
care organizations are no exception.” Ontario Public The ultimate aim of performance management (or
Hospitals (1992) ensured that physician performance is performance appraisal), in hospital, is to optimize the
appraised, because they are accountable to patients and quality of work and efficiency in the health system. Quality
the community for ensuring that the care delivered meets may simply be defined as fitness for purpose (Acute Care
defined standards and for quality improvement. Berwick, Hospitals, 1991). All approaches to quality assurance share
D.M. (1991) wrote that as more organizations tackle the common theme of measuring actual performance and
quality from a system-wide perspective, the philosophy its comparison with either expected or normative
underlying evaluation is shifting from a focus on the standards. Having said this, it is pertinent to note that
individual to one on the entire system, involving everyone organizations are growing more and more dependent on
but blaming no one. formal appraisals to make personnel decisions. Hospitals
Purpose of Performance Appraisal are aware that well – developed appraisal systems
In hospital, thus the primary objective of performance increase the probability of retaining, motivating and
appraisal is to improve the quality of healthcare practice. promoting productive people. The proper
The primary reason for having a performance appraisal management of human resources is a critical variable
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Asian Journal of Management Sciences 02 (03) 2014; 59-64.
affecting an employee’s productivity. So performance that the routine practice of doctors and nurses can be
appraisals are seen as an essential tool for the effective influenced by feedback from patients (Hearnshaw, H.,
management of Organizational human resource (Latham & Baker, R., Cooper, A., Eccles, M. & Soper, S., 1996).
Wexley, 1994). A previous study reported that the method of selecting
Major Performance Appraisal Issues peer or patient raters (by the physician, by the
Assessment is usually thought of as the measurement of investigators, or at random from lists of associates or
the performance of an individual against a predefined patients) does not influence ratings (Ramsey, P.G., Carline,
standard. The vast majority of doctors are working J.D., Blank. L.L. & Wenrich, M.D., 1996). Physician must
independently as consultants or principals. In general ensure that standards established by the team are met;
practice they do not encounter any form of formal both the nursing manager and physician would provide
assessment (of knowledge, skills or performance) from feedback to the nurse in question. Responsibilities of the
the time that they take up their appointment until department head, also called the chief of service.
retirement. Even with the adoption of total quality Generally, the department head is responsible for
management the developmental and motivational assessing the clinical expertise and ensuring compliance
functions of performance appraisal will continue to be with expectations; however, many hospitals have not yet
important for the organization's continued existence. fully implemented such a system.
What makes judging another person's performance so What Performance Will Be Appraised?
difficult? Performance appraisal involves important The nature of the performance to be evaluated is
aspects of people's sense of who they are and what ambiguous. In many cases the appraisal considers the
they can accomplish – their competence and practitioner's decisions about when individual practice
effectiveness. (Mohrman, A.M., Jr. Resnick-West S.M. & patterns take precedence over practice guidelines. The
Lawler, E.E. III, 1989). Fisher (1994) explained that the jury is out on how to develop expectations for practice, but
design and structure of the performance appraisal system to assess the quality of a department's service such
is important to staff and management and of equal expectations must be developed. Health Services Research
importance to the actual appraisal interview. In the Group (1992) wrote an article in CMAJ and reviewed the
appraisal of performance it is important to consider who challenge of developing standards, guidelines and clinical
will conduct the appraisal, what performance will be policies as well as defining "quality" in relation to
appraised and how and when it will be appraised. performance. Performance measures often include both
Who Will Appraise Performance? process expectations (how the work gets done) and
Physicians, nurses, social workers, clinical pharmacists and outcome expectations (the results of the process). Simon,
other professionals often work interdependently to care L. (1992) suggested the following criteria to assess the
for patients; but during performance appraisal, they have performance of department head in the hospital: quality of
formal input into each other's appraisals. As hospitals service in the specific department, operational efficiency
increasingly focus on care delivery processes, physicians and effectiveness, and budget responsibility and
may be appraised by other professionals who share the accountability.
responsibility for patient care and outcomes. Ensuring the Acute Care Hospitals (1991) decided that in addition to
quality of medical care is the responsibility of both evaluating clinical performance of the hospital employee,
regulatory bodies and hospitals. The way an organization is appraisers also take into account that employee are
structured has a direct bearing on who conducts the expected to work effectively with other staff; respect
appraisal. Hospitals generally use a combination of bylaws, regulations, policies and procedures; and
functional and, team or program approaches. In a participate in committees, staff development activities and
functional approach, professionals focus on performing continuing education. The College of Physicians and
their own functions under the direct supervision of one Surgeons of Alberta (1995) established the Physician
boss. Teams or programs comprise individual professionals Performance Advisory Committee to establish a process to
who also belong to traditional functional departments. In evaluate physician performance.
this case, however, professionals may have two Extensive discussions within the committee generated six
supervisors - one in the department and one in the team broad categories of physician performance attributes -
or program. medical knowledge and skills, attitudes and behavior,
The peer review program of the College of Physicians and professional responsibilities, practice improvement
Surgeons of Ontario showed that the office records of activities, administrative skills and personal health.
randomly selected physicians tended to improve after Moorhead and Griffin (1992) described that the process will
defects were pointed out (Norton, P.G., Dunn, E.V., evaluate work behaviors by measurement and comparison
Beckett, R. & Faulkner, D., 1998). A British study suggested to previously established standards, recording the results,
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Asian Journal of Management Sciences 02 (03) 2014; 59-64.
and communicating them back to the employee. It is an instruments that validated by Ramsey et al (1993), which
activity between a manager and an employee. General could be used to assess working relationships with
Medical Council, London & Royal College of Physicians and colleagues‟, they are yet to be implemented widely.
Surgeons of Canada wrote the seven key roles, which are There are various approaches to assessing performance.
being expected from specialist physician in the hospital as Table - 1 outlines the most common ones.
a permanent employee, in their reports. So any physician Performer–oriented approaches:-
can be evaluated on the basis of these roles. o Traits
The seven key roles of physician in the hospital (Fig–1) o Skills
Behaviour – oriented approaches:-
o Critical incidents
o Behaviorally anchored rating scales
o Mixed – standard scales
o Forced – choice scales
Results – oriented approaches
o Management by objectives
o Goal setting
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