The Current State of Performance Appraisal in National Health Service - Research Proposal Example

The current state of performance appraisal in National Health Service (NHS-UK) and how it can be improved By students name Course Professors Institution Date Abstract The current state of performance appraisal for NHS-UK does not effectively meet the performance appraisal needs of public institution. The institution faces a lot of challenges in relation to performance appraisal. The appraisal challenges are further compounded by the fact that the institution is large organization and has a countrywide coverage. The aim of the study was to conduct an evaluation of the performance appraisal of a public institution (UK’s NHS). The study establishes the state of its current performance appraisal approaches; identify weaknesses and opportunities for improvement. Use qualitative study ethnography, critcalits approach, this study analyses secondary data and provide clear perspective of the appraisal systems. It compares NHS systems with suggestions from literature in order to establish the clear state of the systems. It establishes the need for such systems and establishes gaps the need improvement and provides recommendations for improvement. 1.0 Introduction (500 Words) The current state of performance appraisal for NHS-UK does not effectively meet the performance appraisal needs of public institution. The institution faces a lot of challenges in relation to performance appraisal. The appraisal challenges are further compounded by the fact that the institution is large organization and has a countrywide coverage. The institution is roughly over 720,000 people. The studio also has a large budget due to its large size. In 2016 the NHS spending plan stands at 116.574bn, approximately 18% of the countries budget. The evaluation of the performance is integral to the success of the institution. However, because the institution’s employees are far flung across the country the assessment of the institutions has been reduced to a box ticking activity. This is very dangerous since it encourages poor performance, poor use of funds and a reduction in the quality of healthcare services. For this reason, there is a need to improve the approach to appraisal of NHS in order to motive and improve its performance continuously. The aim of this study of to conduct an evaluation of the performance appraisal of a public institution (UK’s NHS) establish the state of its current performance appraisal approaches, identify weaknesses and areas that would benefit from improvements and develop and suggest or recommend improvements to the performance appraisal of the institution. 1.1 Statement of the problem Like many government and public institutions, NHS is expanding and growing in order to provide mere people with healthcare service thought the nations. Amid this growth, NHS has to provide specific service and maintain the quality of the services throughout the country. The organization’s budget is also expanding and thus the institution has to prudently use the available financial resources. To ensure all its systems (including staff and facilities) are performing effectively in delivery of services to the citizens, performance appraisal is done regularly. However, due to the changes NHS has experience over years characterized by increase in employees, coverage and budget, the institution performance appraisal approach is no longer as effective as it’s used to be. Performance appraisal did not evolve alongside the changes experienced by the institution and has been reduced into a box ticking activity and that does not effectively appraise the institutions performance. Identifying the weakness and gaps in the performance appraisal mechanism of the NHS-UK will provide information for developing solutions to these weaknesses and gaps. Finding viable solutions will facilitate development of implemental recommendations that will improve the institutions performance appraisal. 1.2 Research questions The following research questions will be addressed What methods are currently used for performance appraisal in the NHS? To what extent are the performance appraisal methods effective in improving performance in the NHS? What possible new methods can the NHS adopt to further improve its current system of performance appraisal? 1.3 Significance of the study Performance appraisals in most national institutions are outdates, while most of these institutions have experienced organic growth, their performance appraisal approaches have not evolved to meet the new and emerging appraisal needs. As a result, most of the organizations’ approaches to performance appraisal have many gaps and do not facilitate effective appraisal of the organizations. Therefore, there is a need to evaluate these organization establish the existing gaps and changes and improve the performance appraisal systems. 2.0 Literature review (1200 words) Purpose of performance evaluation Literature reports the intention of performance evaluations in healthcare. According Geddes & Gill (2012) literature evidence has many reasons why performance evaluation is important. The performance evaluation represents the quality health care measurements. It has different roles such as healthcare improvements and administrations among others. According to Nuti, Seghieri & Vainieri (2013) evaluation’s vital target is to make an improvement towards the health sector. This evaluation plays a significant role in ensuring improvements are done. Besides, it assists in the recognition of successful practices. After their identification, approaches can be made for enhancement of required targets. Besides, for quality in healthcare, different reasons support the performance evaluation. There classification is primarily on the stakeholders’ perception. According to practitioner view point, estimation of performance is crucial in enhancing skills among other things (Geddes, & Gill, 2012). Besides, it is helpful in identification of professional development requirements, as well as the fulfillment of important obligations. According to Geddes & Gill (2012) this kind of evaluation is also crucial at a consumer level. It becomes easier when it comes to choice of a health care provider. This aspect enhances improvement of healthcare. For the executives’, performance evaluation is crucial in reaching all required standards (Geddes & Gill, 2012). Other enhancements can be leadership development among others (Geddes & Gill, 2012). Lastly, performance evaluation can be very significant in the formulation of approaches in both the regional and national level. The figure below gives a summary of the functions of the evaluation (Beyan & Baykal, 2012). A number of steps are identified from the outlook of the literature for a successful evaluation system. The important steps were summarized by different articles (Beyan & Baykal, 2012). Areas for performance assessment prioritization Since performance evaluation consumes much time, selection of clinical area for the evaluation can be important for its meaningfulness. From the literature, particular criteria’s on the selection of suitable performance evaluation are selected. These aspects will involve areas that have a sturdy financial impact, are rated to have increased risks for patients, as well as those areas that have a possibility to bring a change to the healthcare delivery among others. Setting assessment targets The primary principle of an excellent performance evaluation is the in equivocal development of the planned measurement targets. Particular domains such as accessibility, continuity and effectiveness are improved among others (Beyan & Baykal, 2012). The performance evaluation targets on different dimensions, with its primary agenda being to attend to the needs of the stakeholders. Selecting measures A performance measure is also referred to as an indicator. Its applications are evident in evaluation and monitoring of quality of critical governance and the management among others. It is useful in determining when the set targets are achieved. First of all, there must be an articulation between the performance measure to the goals such as acceptability, and appropriateness among others. Its determination is basically on what health systems are under evaluation. The development of performance measure from the targets which should articulate with one’s works duties and strategic objectives of the organization (Geddes & Gill, 2012). Facilitation of the interim planning between the manager and practitioner is enhanced by joint establishment of goals. Considering an organization level, there should be a link to the performance measures and the strategic planning of the organizations standard. Secondly, there is a relation of performance measure and structure, as well as process and results. These ideas are applicable in performance evaluation of studies. The evaluation of systems utilized by the health system is done by the structure measure. According to Beyan & Baykal (2012) staffing, equipment and infrastructure among other thing are considered to be structural measures. The examination of the articulation between consumers and service providers is done by the ‘process’ measure (Beyan & Baykal, 2012). There is more consideration of diagnostic and rehabilitation activities among others. It becomes easier to assess the work of the practitioner towards the patient. The outcome measure scrutinizes the shift in the status of health of a patient. Besides, it gives an accreditation to how effective the treatment is (Beyan & Baykal, 2012). Thirdly, the performance measures depend on values of care. It is determined by the different practitioner in the health department. Also, the measures must be able to meet certain standards such as validity, reliability among others (Vasset, Marnburg, Furunes, 2011). Besides, the application of multiple measured is essential for effective outcomes in healthcare. Where single measures are applied, the utility to relevant stakeholders is reduced. Deducing on sources of information Performance evaluation should access data from multi-feedbacks. This aspect improves the assessment performance (Kilbourne, Keyser, & Pincus, 2010; Nuti, Seghieri, & Vainieri, 2013). The specific shareholders should be involved depending on the level of health system being evaluated. Information can be obtained from reports and surveys among other sources. Catecoriaio of the data is primarily clinical, patient based as well as administrative (Beyan & Baykal, 2012). Conducting the assessment During undertaking of performance evaluation, there should be precise identification of the target groups and materials for proper documentation. A schedule for evaluation that articulates with the practice is recommended. Other factors such as evaluator training are considered to be crucial. Proper instructions are to be given to the evaluators for unique outcomes. Reporting the findings Giving the reports of the results should be based on performance evaluation system (Nuti, Seghieri, & Vainieri, 2013). Results give the feedback to the practitioners which boost the entire activities within the particular organization. Besides, motivation is also encouraged. While useful information can be provided with health care organizations that stand alone, comparative data is also crucial. Tools for evaluating performance Different reviews support in the provision of important tools for evaluation (Geddes & Gill, 2012; Koch, Breland, Nash, & Cropsey, 2011). Factors influencing the choice of a tool include the participant’s target. The figure below gives a clear impression on various performance evaluation tools. Audit is the practice done to the performed data collected. This issue greatly assists in their comparison. The level of performance is defined by the standards and also gives what the consumers can expect from the practitioners. The practitioner tools consist particular things such as interview with the practitioner, the peer review appraisal and chat stimulated among others. The patient-focused tools include the application of outcome measures to gather information on health status (Duncan & Murray, 2012). These measures are used to determine the change in patients over a period of time. Barriers to implementation of performance evaluation While there are important advantages related to performance evaluation, the challenges and the barriers are also highlighted by the literature. A summary of the literature was taken. A report shows different barriers within the performance evaluation (Geddes & Gill, 2012). Different aspects such as financing, manpower and time that are required to help performance evaluation are limited. Difficulty in encouraging personnel is a major issue that causes a barrier to performance evaluation. 3.0 Methodology (500 words) This study will use a qualitative research design to study performance appraisal in NHS. Qualitative usually aims at creating an understanding of the information or available data. In this design, unlike other the study starts with the understanding that is to be tested and the hypothesis of the study usually dictates the amount of data to be collected. The other designs usually preempt the approach of looking at the research study. On the other hand, qualitative study designs do not preempt what is under study. The researcher models the research rather than dictate it. The design is also molded by the context and does not try to dictate it. This makes it applicable in numerous contexts. Qualitative studies can help generate a lot of ideas. For these reason qualitative studies have been consistently seen as a precursor to quantitative research. However, this does not have to be the case since qualitative studies have the ability to examine phenomena and provide adequate information about the phenomena. In this case qualitative research design is applied to the study of performance appraisal of NHS. The qualities research design used secondary day to perform an evaluation of performance appraisal of NHS and use the information available in literature to provide new approaches to tackling the challenges present in the appraisal approach. The decision to use secondary data follow the need to conduct the study within a limited amount of time and the challenges of gating the possible people who can give information such as the staff at NHS to participate in the study. The qualitative research design is an ethnographic study and will approach the issue using criticalist approach. This approach will facilitate adequate analysis of identification and collection of critical data from secondary data sources. Criticalist approach usually seeks to avoid being entrapped with a single idea or a certain perception of the truth (Dharamsi, & Charles, 2011). This approach is chosen instead of the empiricism or interpretivism because it questions the underlying basis of the status quo at this public institution. Secondly this methodology is selected because it is the only feasible way the researcher could sufficiently address the research question. A research based on gathering primary data would require the researcher to interview senior managers in the public sector organization. This is impossible because of the time allotted for the research and also the senior managers might not have time to entertain my research questions. A criticalist methodology makes use of existing literature written by credible researchers. The secondary data will was collected from a variety of sources which will include institutional documents and reports, new paper reports, books, research articles, press release, journal publications and government publications. The sources of secondary data had to contain information about performance management and appraisal in NHS. A systematic exploration and selection of the sources focus on identifying credible and recent sources of data. Based in the recommendations by Hallebone & Priest (2008) the analysis involved going through the collected data identifying various arising themes in these literature performance appraisal of the NHS. The themes ware separate and critically analyzed to provide the accurate information about the current appraisal challenge at NHS and also identify opportunities for improvement. 4.0 Presentation of Results and Discussion The need for performance appraisal in NHS Base on literature it was important to establish the need for appraisal of NHS. In 2002, NHS felt the need to improve its performance and thus turned to business approaches in order to improve its performance. The first tool of choice to improve performance was reshaping performance management in the health body. Thus a rage of managerial tools was adopted to see this through. Of these changes performance appraisal had to change and become an annually activity the appraisals were deemed necessary because they were a tool for establishing whether the institution meat it its performance management objectives. The need for appraisal has not changed. Performance appraisal is necessary to identify whether the NHS delivers quality service or not. It is also necessary to determine whether the institution uses finances prudently. Furthermore, appraisal is necessary for the institution to identify and reward satisfactory performance, identify opportunities for improvement and improvement its practices. For instance, appraisal can help identify infrastructure development needs and employee professional development need and thus the institution can plan on how to improve its current facilities as well as seek for training program from higher in collaboration with learning institutions to improve the training of its staffs. Similarly, the institution can effectively establish whether its personnel are motivated and find ways of motivating them in order to improve their performance. In delivering its service NHS has set its service provision objective that it hopes to achieve in its service delivery. According to the NHS Performance Appraisal Framework (2015), the institution needs appraisal to establish whether employee not the institutions objectives, know how this objectives are to be achieved and have to competencies necessary to achieve the objectives. Second the appraisal is also necessary to establish whether the employees or personnel are on line with the organization mission. For success employee objectives and mission have to be in line with those of the organizations. Third, appraisal aims at helping intergrate values with mission and vision into the core competencies. The Elements of NHS appraisal systems The performance appraisal approaches adopted by NHS uses several key performance indicators. The appraisal are done ensure that the personnel, management service delivery and other activates meet the set key performance indicators. There are key performance indicators for every section of the organization. For instance, there are key performance indicators for the quality of service delivered to patients, safety, for completion with competitors, for responsiveness to partners, for quality of staff and for technology. Under each of these areas there are several key performance indicators and way of calculating them (Key Performance Indicator Scorecard, 2014). Score computed for data collected during appraisals are compared the target scores of each sub-key performance indicator in an a group and the overall key performance indicators In every appraisal, a team of appraisers are used to conduct the appraisals. However, no individual appraiser can conduct appraisals at the same place three successive times. Professional appraisers can appraise personnel and determine the skills, knowledge and performance; quality and safety; partnership, team work and communications; and trust maintenance (Appraisal for medical staff, 2014). According to Ambrose (2013) staff appraisal can also be done through appraisal meetings which are organized by the healthcare institutions and are attended by appraisers. According to Williams & Burton (2011) appraisals are also done using customer feedbacks. This involves customer comments and remake on services as well as customer complaints. NHS also tends to use target for performance improvement. However when it comes to use of targets it is very easy to fall short of proper service delivery. NHS meets most of the targets it sets. The downside of this target is that they distort clinical priorities present a challenges to appraisals. For targets, the target is either met or not met (Have targets improved NHS performance? 2010). This can lead to institution concentrating on maintaining the target while ignoring important performance areas. Evaluation of the NHS appraisal system NHS appraisal framework meets the appraisal produces suggest by literature. There is prioritization, setting goals, selection of measures and indicators for evaluation, stipulating of source of information and processes of undertaking evaluations and reporting of the results. However, despite having all these elements in place they are not effectively implemented. There are weaknesses in prioritization of performance appraisals, there are limited sources of information for appraisal and the reporting of these findings of the appraisals is also poor. Recommendations Prioritization is important because it determine the areas that should be appraised. NHS as not effectively prioritizes the areas of performance evolution. It is necessary the institution revises its prioritization and stops focusing on staff alone. In addition to staff skills and competence, it is necessary to also focus on other areas that affect the quality of service delivery such as the facilities, information available to patients on where to seek service, understanding of staff and patients o weather the quality of service should be. It should also prioritize, financial planning and usage as one of the areas that must be critical appraised frequently. There is need to expand the sources of informant for appraisal. Currently the appraisal information sources seem to be limited to patient feedback, observation of the personal by appraisal teams, and interviewing the personal during appraisal comments. This should change and the appraisal source should expand to include personnel reports on daily and weekly reports. It should also include information from private and institutional conducted research on issues affecting NHS service delivery such as patients’ satisfaction, employee satisfaction and facilities. Reporting is yet another challenge faced by the NHS appraisal approaches. The reports do not reach all stakeholders and some stakeholder such as patients only have to rely on media reports. This challenge also faced this study since it was hard to find information on performance evaluation or appraisal at NHS. Therefore, NHS needs to develop an effective way of reporting information on performance evaluation. NHS should stick to developing SMART goals since these are easy to monitor and manage through performance management approaches. They are also easy to appraise as compared to use of target, which derail service delivery improvement. 5.0 Conclusions The current study aimed at conducting an evaluation of the performance appraisal of a public institution (UK’s NHS) establish the state of its current performance appraisal approaches, identify weaknesses and areas that would benefit from improvements and develop and suggest or recommend improvements to the performance appraisal of the institution. NHS is continuously expanding but its performance appraisal approaches have not expanded at all. There is need to review the performance appraisal approaches of the institution and improve them since they are yet to respond to the organic growth the institution has experience. Performance appraisal is important because it has various benefits. As Geddes & Gill (2012) assert literature evidence has many reasons why performance evaluation is important. The performance evaluation represents the quality health care measurements. It has different roles such as healthcare improvements and administrations among others. Performance appraisal is necessary to identify whether the NHS delivers quality service or not. It is also necessary to determine whether the institution uses finances prudently. Furthermore, appraisal is necessary for the institution to identify and reward satisfactory performance, identify opportunities for improvement and improvement its practices. Using qualitative research design criticalist approach, this study used secondary sources to establish the state of performance appraisal. The source included reports from healthcare institution in the country as well as reports from NHS. The findings indicated that the NHS appraisal framework meets the appraisal produces suggest by literature. There is prioritization, setting goals, selection of measures and indicators for evaluation, stipulating of source of information and processes of undertaking evaluations and reporting of the results. It also indicated that despite having all these elements in place they are not effectively implemented. There are weaknesses in prioritization of performance appraisals, there are limited sources of information for appraisal and the reporting of these findings of the appraisals is also poor 6.0 References Dharamsi, S. & Charles, G. 2011, Ethnography: traditional and criticalist conceptions of a qualitative research method, Can Fam Physician. 57(3): 378–379. Hallebone, E., & Priest, J. 2008, Business and Management Research: Paradigms and Practices, Basingstoke: Palgrave Macmillan. Smith, P. C. 2002, Performance Management In British Health Care: Will It Deliver? Health Aff, 21(3), 103-115. Key Performance Indicator Scorecard. 2014, Available from http://www.clch.nhs.uk/media/154790/board_kpi_definitions_sheet_july_2014.pdf Appraisal for medical staff. 2014, Available from http://www.uhs.nhs.uk/Education/Informationforstaff/Doctors/Appraisalforseniormedicalstaff/AppraisalforSeniorMedicalStaff.aspx Ambrose, J. 2013, Appraisal and Performance Review Framework, Available from http://www.enhertsccg.nhs.uk/sites/default/files/documents/Mar2015/ENH%20CCG%20Appraisal%20and%20Performance%20Framework_0_0.pdf Performance Appraisal Framework 2015. 2015, Available from http://www.nhsla.com/Pages/Performance-appraisals.aspx Williams, J. & Burton, J. 2011, Southampton University Hospitals NHS Trust, Annual Complaints Report 2010/11, Available from http://www.uhs.nhs.uk/Media/TBFiles/TBSept11/EncJAnnualcomplaintsReport2010-11.pdf Have targets improved NHS performance? 2010, Available from http://www.kingsfund.org.uk/projects/general-election-2010/key-election-questions/performance-targets Geddes, L & Gill, C, 2012, Annual performance appraisal: one organization’s process and retrospective analysis of outcomes. 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