In a demonstration of effectiveness, public services – including maternity – are facing increasing pressure to show how well they perform (Seldon and Sowa, 2011). As a result, performance management is an essential part of measuring and monitoring effectiveness and is undertaken annually within maternity services for all employees through an individual performance review (IPR).
Primarily, the aim of the review and personal plan is to ensure that the individual develops and maintains the knowledge and skills for effective working by identifying learning needs so the manager can facilitate training and education. Performance management can also be seen as a platform for recognising excellence within the service, though in reality the term has negative connotations as it is a precursor to the more usual management of poor performance and underachievement.
Already used successfully in the private sector, research suggests that a good performance management system includes indicators of organisational performance (Elzinga et al, 2009), effectively aligning them with organisational strategy and business plan goals (Lawson et al, 2003). Due to the multifaceted nature of public sector work, however, and especially in maternity practice, there is a challenge to develop effective indicators of measurement (Peng et al, 2007). Based on activity where measurement is difficult, there are still suggestions that expected improvements in performance, accountability, transparency, quality of service and value for money have not yet materialised in many areas of the public sector (Fryer et al, 2009).
In a bid to provide consistency, the Knowledge and Skills Framework (KSF) implemented within the NHS in 2004 is applied in our maternity department. It advertises a single, comprehensive and explicit guide to good people management and promotes equality and diversity for all staff (DH, 2004). With core performance indicators aligned with organisational goals, dimensions are added to further individualise the plan, making it more meaningful.
For a band 6 midwife, this alludes to the completion of nine dimensions, designed to demonstrate the provision of a high-quality midwifery service. While generic dimensions allow for individual interpretation, without specific guidance the review can often lack the consistency it sets out to promote. Since each area within the service requires different approaches towards completion, staff and managers often see the review as only a ‘tick-box’ exercise, considering too many targets as detrimental to performance and quality (Moxham and Boaden, 2007).
Van Sluis et al (2008) believe that an individual, personalised scorecard would encourage employee ownership, with between seven and nine key measures to provide motivation to deliver the target performance. This personal measurement would ensure a unique development plan for each employee in contrast to the ‘one-size-fits-all’ approach, which is unlikely to be effective (Gunawardena, 2011) but is more commonly used within organisations. Advocating that performance management systems are not static but mature as the management style and organisational culture evolves (Bititci et al, 2006), this system would make sense in the ever-changing world of health care, perhaps even challenging the current KSF competencies and questioning the need for a comprehensive overhaul.
The general declining compliance in the completion of annual reviews indicates that any initial enthusiasm of the performance management initiative has waned and been replaced with scepticism and cynicism, which could undermine attempts to enhance organisational performance (Townley et al, 2003).
In the private sector, it could be argued that reward and recognition is used to increase motivation in the form of financial incentives and bonuses. Although deemed unethical within the public sector, it is still a tactic employed by commissioning bodies as a remit to improve patient care through Payment by Results and, adversely, penalties where targets are not met. Caution is advised (Deci et al, 2001), however, about the use of rewards for motivation, and Thomas (2001) strongly suggests that more intrinsic rewards, such as sense of meaning, sense of choice, sense of progress and sense of competence, lead to more engaged and committed employees.
I suggest that this sits more comfortably with the ethos of public sector organisations including maternity – for both ethical and financial reasons – although even the provision of intrinsic rewards requires a change of culture and the requirement of the hierarchical managers to ‘buy in’ and support the process. Effectiveness of any performance management also depends on employee involvement (Verbeeten, 2008), with benefits including increased motivation, job satisfaction and commitment.
For maternity services, the rewards could include improved communication, a clearly articulated culture, improvement of work performance and possibly better employee retention, but support from senior management would be required to ensure resources were available for effective measurement (de Waal, 2007).
In reality, the instrumental value of performance measurement cannot be guaranteed (Halachmi, 2011) and is often dysfunctional, with a loss of credibility among users within the service. The question is whether change can occur within performance management.
I strongly believe it needs to, and that there is no better time than now, as managers are given the green light to take on more HR activities. Instead of employing performance management systems that are imposed on them from the hierarchy within their organisation (Zigan et al, 2008), the potential is there to learn from past behaviour in order to do better in the future.
Performance management has an important part to play in any maternity service. Used effectively, it can increase understanding of the organisational and departmental vision, as well as raise awareness of the constraints and operational challenges faced by the trust. To accomplish this, however, changes are required to the current practice so that it can improve the productivity and efficiency of the service.
The definition by the Chartered Institute of Personnel and Development (CIPD, 2009) encapsulates the true meaning of performance management, in that it is ‘a process that contributes to the effective management of individuals in order to achieve high levels of organisational performance’.
I believe a personalised developmental plan can empower employees to think ‘outside the box’ and encourage the imagination to meet any goals and targets set. Adopting different methods of measurement could make staff motivated and enthusiastic, instead of viewing the HR process as a paper exercise. Reviews and appraisals will be a continuous process of learning and development that will benefit both the individual and the organisation, rather than an annual interview.
For our maternity services, further research is required, as is the acknowledgement that commitment is needed to gain an understanding of the current practice of performance management. Though interactive communication is essential, an understanding of the purpose and impact of performance management (Radnor and McGuire, 2004) will result in changes that can only enhance the maternity services within our organisations.
Deputy head of midwifery, matron and supervisor of midwives, Macclesfield Hospital Illustrations: Brett Ryder References
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