Performance Management ver 2.ppt

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Performance Management ver 2.ppt

  1. 1. Performance Management Insight September 27, 2006 The Old Mill
  2. 2. Notes <ul><li>No need to take notes This presentation and a lot more material is on these issues is available on our web site www.healthandeverything.org For more information you can write to me [email_address] </li></ul>                                                              
  3. 3. The NHS <ul><li>The Blair government created strategic health authorities (SHAs) in 2002 specifically to performance manage the newly created primary care trusts (PCTs). </li></ul><ul><li>There was thus a four year experiment with a large scale performance management effort worth looking at. </li></ul>
  4. 4. Performance Management NHS 2002-2005 Minister of Health Department of health 28 Strategic Health Authorities 180 Acute and Mental Health Trusts 200 Primary Care Trusts 1.000.0000 Employees
  5. 5. My Role <ul><li>I have been meeting semi-annually with a representative cross section of the NHS from 1990 to review the state of play and changes that have occurred </li></ul><ul><li>I consulted to a strategic health authority from 2001 to 2005 </li></ul><ul><ul><li>I met with them 4 times a year to see how they were doing and lend a hand in their efforts. </li></ul></ul><ul><li>I also consulted to a Primary Care Trust from 2001 to 2003 </li></ul><ul><ul><li>I met with them 5 times and helped with their planning efforts </li></ul></ul>
  6. 6. Introducing Performance Management in the UK <ul><li>A specific publication on performance management was prepared in 2002, but is no longer available on the internet or in hard copy </li></ul><ul><li>So I have used standard sources to give an overview of Performance Management </li></ul><ul><li>Various Outlines and Reports are available that helped to describe how it was implemented in the NHS </li></ul>
  7. 7. Performance management Performance management is the systematic process by which an organization involves its employees, as individuals and members of a group, in improving organizational effectiveness in the accomplishment of its mission and goals.
  8. 8. Employee performance management includes: <ul><li>Planning work and setting expectations, </li></ul><ul><li>Continually monitoring performance, </li></ul><ul><li>Developing the capacity to perform, </li></ul><ul><li>Periodically rating performance in a summary fashion, </li></ul><ul><li>Rewarding good performance. </li></ul>Planning Monitoring Rewarding Rating Developing
  9. 9. Employee performance management includes: Planning Monitoring Rewarding Rating Developing
  10. 10. Planning <ul><li>Set performance expectations and goals </li></ul><ul><li>Involve employees in the planning process </li></ul><ul><ul><li>help them understand goals (what why and how) </li></ul></ul><ul><li>Establish elements and standards of performance appraisal </li></ul><ul><ul><li>that are measurable, understandable, verifiable, equitable & achievable. </li></ul></ul><ul><li>Hold employees accountable as individuals </li></ul><ul><li>Plans should be flexible </li></ul><ul><li>Plans should be discussed often and not seen only when formal ratings are required. </li></ul>Planning
  11. 11. Planning in the NHS: Trust Involvement <ul><li>Introduction of 3 year Local Delivery Plans to be prepared by individual trusts </li></ul><ul><ul><li>Bottom up planning to involve all local agencies with support from the SHA </li></ul></ul><ul><ul><li>Stabilization of planning and funding over 3 year periods </li></ul></ul>Planning
  12. 12. Monitoring <ul><li>Monitor continually. </li></ul><ul><li>Consistently measure performance </li></ul><ul><li>Provide ongoing feedback on progress toward goals. </li></ul><ul><li>Compare performance against their elements and standards. </li></ul><ul><li>Change unrealistic or problematic standards </li></ul><ul><li>Identify and correct unacceptable performance quickly </li></ul>Monitoring
  13. 13. Monitoring in the NHS <ul><li>Three Major agencies to monitor and assess the system </li></ul><ul><li>NICE: National Institute for Clinical Excellence </li></ul><ul><ul><li>To review standards and improve clinical practice </li></ul></ul><ul><li>CHI: Commission for Health Improvement </li></ul><ul><ul><li>To consider impact on health of the nation </li></ul></ul><ul><li>Audit Commission </li></ul><ul><ul><li>To monitor and assess fonancial and operational management </li></ul></ul>Monitoring
  14. 14. Developing <ul><li>During planning and monitoring of work </li></ul><ul><ul><li>Deficiencies become evident and can be addressed </li></ul></ul><ul><ul><li>Successful employees can be helped to further improve </li></ul></ul><ul><li>Evaluate and address developmental needs </li></ul><ul><li>Increasing capacity to perform through training, </li></ul><ul><li>Give assignments to introduce new skills or higher levels of responsibility, </li></ul><ul><li>Improve work processes </li></ul><ul><li>The above encourage good performance </li></ul><ul><ul><li>Strengthen job-related skills </li></ul></ul><ul><ul><li>Help employees keep up with changes in the workplace </li></ul></ul>Developing
  15. 15. Developing in the NHS <ul><li>Creation of the “Modernization Agency” </li></ul><ul><ul><li>Seconded the best development officers </li></ul></ul><ul><ul><li>To help define the shape of the “New and modern NHS” </li></ul></ul><ul><ul><li>Then to identify and develop the new skills and competencies needed for the new NHS </li></ul></ul><ul><ul><li>To identify and deal with development issues quickly </li></ul></ul>Developing
  16. 16. Rating <ul><li>Organizations need to know who their best performers are. </li></ul><ul><li>Rating allows you to compare performance over time or among various employees. </li></ul><ul><li>Evaluates employee or group performance against the elements and standards </li></ul><ul><li>Assigns a summary rating of record for each employee. </li></ul><ul><ul><li>based on work performed during an entire appraisal period. </li></ul></ul><ul><ul><li>has a bearing on various other personnel actions </li></ul></ul><ul><ul><ul><li>granting within-grade pay increases </li></ul></ul></ul><ul><ul><ul><li>determining additional retention service credit in a reduction in force. </li></ul></ul></ul>Rating
  17. 17. Rating in the NHS <ul><li>An Annual Report on the performance of individual organizations </li></ul><ul><ul><li>Linked to the measurable targets </li></ul></ul><ul><ul><li>Uses a three star rating system </li></ul></ul><ul><ul><ul><li>0 stars = poor </li></ul></ul></ul><ul><ul><ul><li>to 3 stars: excellent </li></ul></ul></ul><ul><li>Individual Managers and organizations are rated using these performance measures at every level of the system </li></ul>Rating
  18. 18. Rating in the NHS: 45 Measurable Targets Planning Thrombolysis treatment time  Methicillin Resistant Staphylococcus Aureus (MRSA) bacteraemia improvement score  Infection control procedures  Emergency readmission to hospital following treatment for a stroke  Emergency readmission to hospital following treatment for a fractured hip  Emergency readmission to hospital following discharge for children  Emergency readmission to hospital following discharge  Deaths within 30 days of selected surgical procedures  Deaths within 30 days of a heart bypass operation  Clinical Negligence  Clinical focus Staff opinion survey  Sickness absence rate  Junior doctors' hours  Information Governance  Fire, Health & Safety  Data quality  Consultant appraisal  Capacity and capability Two week cancer waits  Total time in A&E  Number of outpatients waiting longer than the standard  Number of inpatients waiting longer than the standard  Improving Working Lives  Hospital cleanliness  Financial management  Cancelled operations not admitted within 28 days  A&E emergency admission waits (12 hours)  Key target Waiting times for Rapid Access Chest Pain Clinic  Total inpatient waits  Thirteen week outpatient waits  Six month inpatient waits  Privacy & dignity  Patient complaints procedure  Paediatric outpatient did not attend rates  Outpatient A&E survey - safe, high quality, co- ordinated care  Outpatient A&E survey - clean, comfortable, friendly place to be  Outpatient A&E survey - building relationships  Outpatient A&E survey - better information, more choice  Outpatient A&E survey - access & waiting  Nine month heart operation waits  Delayed transfers of care  Day case booking  Cancelled operations  Breast cancer treatment  Better hospital food  A&E emergency admission waits (4 hours)  Patient focus
  19. 19. Rewarding <ul><li>Recognize employees, individually and as members of groups, </li></ul><ul><li>Acknowledge contributions to the mission </li></ul><ul><li>All behavior is controlled by its consequences </li></ul><ul><ul><li>formal and informal </li></ul></ul><ul><ul><li>positive and negative. </li></ul></ul><ul><li>Informal recognition is constant and ongoing like saying &quot;Thank you“ </li></ul><ul><li>More formal rewards include cash, time off, and many non-monetary items. </li></ul><ul><li>  </li></ul>Rewarding
  20. 20. Rewarding in the NHS <ul><li>The main group reward in the NHS is through the creation of Foundation Trusts </li></ul><ul><li>Individual organizations that have far more independence and can increase their local rather than national reporting relationships </li></ul><ul><li>This is replicated inside SHAs and indeed inside the existing trusts </li></ul><ul><ul><li>Successful managers move up quickly </li></ul></ul><ul><ul><li>A successful CEO of an SHA received a knighthood </li></ul></ul>Rewarding
  21. 21. 2006 <ul><li>In 2006 the Ministry of Health reduced the number of strategic health authorities to 14 and radically changed the primary care trusts. </li></ul><ul><li>They merged the monitoring agencies </li></ul><ul><li>Performance Management is no longer the flavour of the month </li></ul><ul><li>How did it all go so wrong? Not that anyone admits it. </li></ul>
  22. 22. Planning in the NHS: Trust Involvement <ul><li>The 3 year Local Delivery Plans (LDPs) took two years to frame </li></ul><ul><ul><li>Local trusts did not perform well </li></ul></ul><ul><ul><li>The SHAs believed that they did not have the planning capacity to prepare the extensive documentation. </li></ul></ul><ul><li>LDPs were renewed annually </li></ul><ul><li>LDPs were required top down and the bottom up was to get them done in an acceptable way </li></ul><ul><li>Annual revisions reduced the stability that was expected </li></ul><ul><li>The SHAs could not performance manage trusts adequately and were therefore largely merged into larger less directive organizations </li></ul><ul><li>What would bottom up planning be in the NHS? </li></ul>Planning
  23. 23. Planning in the NHS: Targets <ul><li>The priority targets were largely met or fudged. </li></ul><ul><ul><li>Some incidents of faking data </li></ul></ul><ul><ul><li>Some incidents of meeting stated targets but subverting the real meaning </li></ul></ul><ul><ul><li>Widespread hidden overspend </li></ul></ul><ul><li>Government boasted of success in reducing all waiting times </li></ul><ul><li>Head of NHS was fired for £1Billion accumulated deficit that emerged suddenly </li></ul><ul><li>What does measurable really mean? </li></ul>Planning
  24. 24. Monitoring in the NHS <ul><li>Three Major agencies to monitor and assess the system disagreed about the state of individual trusts that they examined </li></ul><ul><li>They functioned as largely independent and somewhat competing inspectorates </li></ul><ul><li>They disagreed about what the standards meant </li></ul><ul><li>They also overloaded individual trusts with monitoring demands </li></ul><ul><li>They were merged into one organization that is now much more hierarchically connected to the Ministry. </li></ul>Monitoring
  25. 25. Developing in the NHS <ul><li>The Modernization Agency was disbanded in 2005 </li></ul><ul><ul><li>(The government declared it to be a success and closed it down) </li></ul></ul><ul><li>The best development officers had been stripped from local organizations and now would not go back </li></ul><ul><li>The performance management of development issues was largely done through punitive measures at the SHA rather than the Modernization Agency. </li></ul><ul><ul><li>Many executive level managers of trusts lost their jobs. </li></ul></ul><ul><li>The failure to perform “old skills” like those associated with budget management was widespread </li></ul>Developing
  26. 26. Rating in the NHS <ul><li>The Annual Report was awaited with bated breath because your job depended on it </li></ul><ul><ul><li>Linked to the priority targets so other non-targeted areas suffered </li></ul></ul><ul><ul><li>Targets continue to be attacked constantly </li></ul></ul><ul><ul><li>The three star rating system had its downside </li></ul></ul><ul><ul><ul><li>0 stars pretty much meant that at least the CEO was fired </li></ul></ul></ul><ul><ul><ul><li>3 stars meant that you became high profile </li></ul></ul></ul><ul><li>Individual Managers and organizations are rated using these performance measures at every level of the system </li></ul>Rating
  27. 27. Rating in the NHS
  28. 28. Rating in the NHS <ul><li>Key targets </li></ul><ul><li>  </li></ul><ul><li>A&E emergency admission waits (12 hours)  </li></ul><ul><li>Cancelled operations not admitted within 28 days  </li></ul><ul><li>Financial management  </li></ul><ul><li>Hospital cleanliness </li></ul><ul><li>Improving Working Lives  </li></ul><ul><li>Number of inpatients waiting longer than the standard  </li></ul><ul><li>Number of outpatients waiting longer than the standard  </li></ul><ul><li>Total time in A&E  </li></ul><ul><li>Two week cancer waits </li></ul>
  29. 29. Rewarding in the NHS <ul><li>The main reward in the NHS is through the creation of Foundation Trusts </li></ul><ul><ul><li>There is a serious question about how these organizations link to the rest of the NHS </li></ul></ul><ul><ul><li>This has consequence to everything from funding flow to patient flow. </li></ul></ul><ul><li>Individual organizations that have far more independence and can increase their local rather than national reporting relationships </li></ul><ul><li>There is much talk about the future of these organizations </li></ul><ul><li>Punishment for failure seems more in the air motivator than reward for success </li></ul><ul><li>The knighted head of the NHS Sir Nigel Crisp lost his job over these efforts </li></ul>Rewarding
  30. 30. The Law of Unintended Consequences <ul><li>With all good intentions this massive effort to implement performance management failed </li></ul><ul><li>Does this mean that performance management will go the way of other similar management ideas? </li></ul><ul><li>Why did it fail? Can it be recuperated? Or should it simply cross the ocean to be implemented in Ontario? </li></ul><ul><li>I have some closing thoughts </li></ul>
  31. 31. Following a Recipe A Rocket to the Moon Raising a Child <ul><li>Formulae are critical and necessary </li></ul><ul><li>Sending one rocket increases assurance that next will be ok </li></ul><ul><li>High level of expertise in many specialized fields + coordination </li></ul><ul><li>Rockets similar in critical ways </li></ul><ul><li>Relative certainty of outcome </li></ul><ul><li>Optimism re results </li></ul><ul><li>Formulae have only a limited application </li></ul><ul><li>Raising one child gives no assurance of success with the next </li></ul><ul><li>Expertise can help but is not sufficient </li></ul><ul><li>Every child is unique </li></ul><ul><li>Uncertainty of outcome remains </li></ul><ul><li>Optimism re results </li></ul>Complicated Complex <ul><li>The recipe is essential </li></ul><ul><li>Recipes are tested to assure replicability of later efforts </li></ul><ul><li>No particular expertise; knowing how to cook increases success </li></ul><ul><li>Recipes produce standard products </li></ul><ul><li>Certainty of same results every time </li></ul><ul><li>Optimism re results </li></ul>Simple
  32. 32. Analysis <ul><li>Health care organizations and systems are complex </li></ul><ul><li>Recipes won’t work and their application will have unintended consequences </li></ul><ul><li>Performance management like many other flavours of the month can be useful but should be applied with great care and foreboding while carefully considering the complexity of local conditions </li></ul>
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