Management and Change: The design and implementation of performance management against goals and objectives
Performance Management in the NHS
Authored by Piers Simey, Specialist Public Health Trainee, Greenwich PCT (2006). Updated by Claire Beynon (2017)
Definition: Performance Management has been defined as: 'a process which contributes to the effective management of individuals and teams in order to achieve high levels of organisational performance. As such, it establishes shared understanding about what is to be achieved and an approach to leading and developing people which will ensure that it is achieved' (Armstrong & Baron, 2002).
The drive to improve the quality of healthcare performance has been a consistent theme for several decades. Performance managing the health and social care system helps involve staff in raising standards and ultimately provides taxpayers with proof of progress in areas that matter most to them. In the UK the difficulties of performance managing such complex systems have been compounded by the adoption of too many national targets, leading to criticisms of excessive central control and skewed local service priorities. Recent developments have focused on setting fewer targets, with greater freedom for local systems to respond to local needs.
Performance Management is a tool that can be used at an operational and strategic level. It is used to set goals and monitor goals at an individual level that should contribute to wider organisational or corporate goals. At the corporate level strategic goals should be identified. All personal performance goals should link back to these goals in some way. Individual performance management should include regular reviews against progress and regular communication with the line manager on the progress against the ambitious goals set.
Performance Management is a systematic process of aligning individual activity to the wider strategic goals. This should encompass developing accurate job descriptions, the selection processes, and exit interviews. In addition the key elements of performance management is providing continuous monitoring and support to deliver the required level of performance, identifying appropriate training and development opportunities for staff as well as holding regular performance meetings to assess progress against each goal at individual, team and strategic levels.
Performance management outside of the public sector often includes financial rewards for those who meet their objectives. In the public sector other forms of recognition are used, such as ‘employee of the month’.
In summary, performance management is seen as a proactive method of managing staff in an organisation to focus on the delivery of the wider strategic goals. It links each individual in the organisation to delivery.
The Balanced Scorecard (BSC)
Definition: The BSC is briefly defined as a management framework that:. . . 'translates an organisation's mission and strategy into a comprehensive set of performance measures that provides the framework for a strategic measurement and management system' (Kaplan and Norton, 1996).
In the early 1990's Dr. Robert Kaplan (Harvard Business School) and Dr. David Norton devised a new approach to business strategy and the measurement of overall 'performance' in organisations. They called their new system the 'balanced scorecard' and it has since become increasingly used in organisations, private and public, across the globe.
The balanced scorecard is not simply a measurement system, it is a management system - a system that helps organisations to clarify their vision and strategy and, importantly, translate these into action. The Scorecard provides feedback around both the internal business processes and external outcomes so as to enable organisations to continuously improve their strategic performance, their business outcomes. It has been said (The Balanced Scorecard Institute) that when fully deployed, the balanced scorecard 'transforms strategic planning from an academic exercise into the nerve center of an enterprise'.
Theoretically the Balanced Scorecard encourages us to view the organisation from four perspectives, and to develop measurements, collect data and analyse it in each of the four undernoted perspectives:
- The Learning & Growth perspective
- The Business Process perspective
- The Customer perspective
- The Financial perspective
For further information on balanced Scorecard use http://www.balancedscorecard.org
How the BSC is used in the Health and Social Care Sector
- As a measurement tool against the defined targets
- As a traffic light system for health and social care providers to identify progress
- The health service does not always use the BSC in a 'balanced holistic' way to develop its business from the four perspectives identified above.
- It is used in a way that it is difficult to balance progress with success e.g. if at 6 months smoking cessation target are below 50% that does not mean that the target will not be met, but it will highlight areas of concern.
- There is a degree of self assessment which is often subjective.
Many organisations are now using different tools to assess performance progress. To find out what the organisation you work for uses, look at the Board reports for the organisation. Most health and social care organisations report on performance quarterly.
Partnerships: shared goals and mutual performance management
In England the Health Act (1999) and the Health and Social Care Act (2003) and the revised Health and Social Care Act (2012) all established and furthered the statutory requirements for health organisations and Local Authorities to work together on improving healthcare. In each of the countries across the UK there is different legislation affecting the health and social care system. What is common however is the need to work closely together with partners to deliver integrated services to the service users.
- Armstrong M, Baron A. Performance Management: the new realities. Institute of Personnel and Development: London, 1998.
- Kaplan RS, Norton DP. The Balanced Scorecard. Harvard Business School Press: Boston, Massachusetts, 1996
- UK Parliament. The Health Act, The Stationery Office: London, 1999
- UK Parliament. The Health & Social Care (Community Health & Standards) Act, The Stationary Office: London, 2003
- UK Parliament. The Health and Social Care Act. The Stationery Office: London, 2012
© K Enock 2006, C Beynon 2017