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Performance Management ver 2.ppt
 

Performance Management ver 2.ppt

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    Performance Management ver 2.ppt Performance Management ver 2.ppt Presentation Transcript

    • Performance Management Insight September 27, 2006 The Old Mill
    • Notes
      • 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]
                                                                    
    • The NHS
      • The Blair government created strategic health authorities (SHAs) in 2002 specifically to performance manage the newly created primary care trusts (PCTs).
      • There was thus a four year experiment with a large scale performance management effort worth looking at.
    • 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
    • My Role
      • 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
      • I consulted to a strategic health authority from 2001 to 2005
        • I met with them 4 times a year to see how they were doing and lend a hand in their efforts.
      • I also consulted to a Primary Care Trust from 2001 to 2003
        • I met with them 5 times and helped with their planning efforts
    • Introducing Performance Management in the UK
      • A specific publication on performance management was prepared in 2002, but is no longer available on the internet or in hard copy
      • So I have used standard sources to give an overview of Performance Management
      • Various Outlines and Reports are available that helped to describe how it was implemented in the NHS
    • 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.
    • Employee performance management includes:
      • Planning work and setting expectations,
      • Continually monitoring performance,
      • Developing the capacity to perform,
      • Periodically rating performance in a summary fashion,
      • Rewarding good performance.
      Planning Monitoring Rewarding Rating Developing
    • Employee performance management includes: Planning Monitoring Rewarding Rating Developing
    • Planning
      • Set performance expectations and goals
      • Involve employees in the planning process
        • help them understand goals (what why and how)
      • Establish elements and standards of performance appraisal
        • that are measurable, understandable, verifiable, equitable & achievable.
      • Hold employees accountable as individuals
      • Plans should be flexible
      • Plans should be discussed often and not seen only when formal ratings are required.
      Planning
    • Planning in the NHS: Trust Involvement
      • Introduction of 3 year Local Delivery Plans to be prepared by individual trusts
        • Bottom up planning to involve all local agencies with support from the SHA
        • Stabilization of planning and funding over 3 year periods
      Planning
    • Monitoring
      • Monitor continually.
      • Consistently measure performance
      • Provide ongoing feedback on progress toward goals.
      • Compare performance against their elements and standards.
      • Change unrealistic or problematic standards
      • Identify and correct unacceptable performance quickly
      Monitoring
    • Monitoring in the NHS
      • Three Major agencies to monitor and assess the system
      • NICE: National Institute for Clinical Excellence
        • To review standards and improve clinical practice
      • CHI: Commission for Health Improvement
        • To consider impact on health of the nation
      • Audit Commission
        • To monitor and assess fonancial and operational management
      Monitoring
    • Developing
      • During planning and monitoring of work
        • Deficiencies become evident and can be addressed
        • Successful employees can be helped to further improve
      • Evaluate and address developmental needs
      • Increasing capacity to perform through training,
      • Give assignments to introduce new skills or higher levels of responsibility,
      • Improve work processes
      • The above encourage good performance
        • Strengthen job-related skills
        • Help employees keep up with changes in the workplace
      Developing
    • Developing in the NHS
      • Creation of the “Modernization Agency”
        • Seconded the best development officers
        • To help define the shape of the “New and modern NHS”
        • Then to identify and develop the new skills and competencies needed for the new NHS
        • To identify and deal with development issues quickly
      Developing
    • Rating
      • Organizations need to know who their best performers are.
      • Rating allows you to compare performance over time or among various employees.
      • Evaluates employee or group performance against the elements and standards
      • Assigns a summary rating of record for each employee.
        • based on work performed during an entire appraisal period.
        • has a bearing on various other personnel actions
          • granting within-grade pay increases
          • determining additional retention service credit in a reduction in force.
      Rating
    • Rating in the NHS
      • An Annual Report on the performance of individual organizations
        • Linked to the measurable targets
        • Uses a three star rating system
          • 0 stars = poor
          • to 3 stars: excellent
      • Individual Managers and organizations are rated using these performance measures at every level of the system
      Rating
    • 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
    • Rewarding
      • Recognize employees, individually and as members of groups,
      • Acknowledge contributions to the mission
      • All behavior is controlled by its consequences
        • formal and informal
        • positive and negative.
      • Informal recognition is constant and ongoing like saying "Thank you“
      • More formal rewards include cash, time off, and many non-monetary items.
      •  
      Rewarding
    • Rewarding in the NHS
      • The main group reward in the NHS is through the creation of Foundation Trusts
      • Individual organizations that have far more independence and can increase their local rather than national reporting relationships
      • This is replicated inside SHAs and indeed inside the existing trusts
        • Successful managers move up quickly
        • A successful CEO of an SHA received a knighthood
      Rewarding
    • 2006
      • In 2006 the Ministry of Health reduced the number of strategic health authorities to 14 and radically changed the primary care trusts.
      • They merged the monitoring agencies
      • Performance Management is no longer the flavour of the month
      • How did it all go so wrong? Not that anyone admits it.
    • Planning in the NHS: Trust Involvement
      • The 3 year Local Delivery Plans (LDPs) took two years to frame
        • Local trusts did not perform well
        • The SHAs believed that they did not have the planning capacity to prepare the extensive documentation.
      • LDPs were renewed annually
      • LDPs were required top down and the bottom up was to get them done in an acceptable way
      • Annual revisions reduced the stability that was expected
      • The SHAs could not performance manage trusts adequately and were therefore largely merged into larger less directive organizations
      • What would bottom up planning be in the NHS?
      Planning
    • Planning in the NHS: Targets
      • The priority targets were largely met or fudged.
        • Some incidents of faking data
        • Some incidents of meeting stated targets but subverting the real meaning
        • Widespread hidden overspend
      • Government boasted of success in reducing all waiting times
      • Head of NHS was fired for £1Billion accumulated deficit that emerged suddenly
      • What does measurable really mean?
      Planning
    • Monitoring in the NHS
      • Three Major agencies to monitor and assess the system disagreed about the state of individual trusts that they examined
      • They functioned as largely independent and somewhat competing inspectorates
      • They disagreed about what the standards meant
      • They also overloaded individual trusts with monitoring demands
      • They were merged into one organization that is now much more hierarchically connected to the Ministry.
      Monitoring
    • Developing in the NHS
      • The Modernization Agency was disbanded in 2005
        • (The government declared it to be a success and closed it down)
      • The best development officers had been stripped from local organizations and now would not go back
      • The performance management of development issues was largely done through punitive measures at the SHA rather than the Modernization Agency.
        • Many executive level managers of trusts lost their jobs.
      • The failure to perform “old skills” like those associated with budget management was widespread
      Developing
    • Rating in the NHS
      • The Annual Report was awaited with bated breath because your job depended on it
        • Linked to the priority targets so other non-targeted areas suffered
        • Targets continue to be attacked constantly
        • The three star rating system had its downside
          • 0 stars pretty much meant that at least the CEO was fired
          • 3 stars meant that you became high profile
      • Individual Managers and organizations are rated using these performance measures at every level of the system
      Rating
    • Rating in the NHS
    • Rating in the NHS
      • Key targets
      •  
      • A&E emergency admission waits (12 hours) 
      • Cancelled operations not admitted within 28 days 
      • Financial management 
      • Hospital cleanliness
      • Improving Working Lives 
      • Number of inpatients waiting longer than the standard 
      • Number of outpatients waiting longer than the standard 
      • Total time in A&E 
      • Two week cancer waits
    • Rewarding in the NHS
      • The main reward in the NHS is through the creation of Foundation Trusts
        • There is a serious question about how these organizations link to the rest of the NHS
        • This has consequence to everything from funding flow to patient flow.
      • Individual organizations that have far more independence and can increase their local rather than national reporting relationships
      • There is much talk about the future of these organizations
      • Punishment for failure seems more in the air motivator than reward for success
      • The knighted head of the NHS Sir Nigel Crisp lost his job over these efforts
      Rewarding
    • The Law of Unintended Consequences
      • With all good intentions this massive effort to implement performance management failed
      • Does this mean that performance management will go the way of other similar management ideas?
      • Why did it fail? Can it be recuperated? Or should it simply cross the ocean to be implemented in Ontario?
      • I have some closing thoughts
    • Following a Recipe A Rocket to the Moon Raising a Child
      • Formulae are critical and necessary
      • Sending one rocket increases assurance that next will be ok
      • High level of expertise in many specialized fields + coordination
      • Rockets similar in critical ways
      • Relative certainty of outcome
      • Optimism re results
      • Formulae have only a limited application
      • Raising one child gives no assurance of success with the next
      • Expertise can help but is not sufficient
      • Every child is unique
      • Uncertainty of outcome remains
      • Optimism re results
      Complicated Complex
      • The recipe is essential
      • Recipes are tested to assure replicability of later efforts
      • No particular expertise; knowing how to cook increases success
      • Recipes produce standard products
      • Certainty of same results every time
      • Optimism re results
      Simple
    • Analysis
      • Health care organizations and systems are complex
      • Recipes won’t work and their application will have unintended consequences
      • 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