Performance Management at NHS - Essay Example

Performance Management: Performance management is the measurement, analysis, and optimization of computer resources to provide an agreed-upon levelof service. The focus is on service delivery. The use of performance measures that enable aspects of health care delivered in different institutions to be compared are fraught with difficulties. However, despite inherent international concerns-about validity, comparability, and usefulness-they are here to stay. The challenge for all health systems is to find ways of using performance measures to promote real improvements in care. Questions such as whether public disclosure of comparative performance measures should be used to make external judgments-for example, in the form of league tables-or whether are they better used as tools for internal reflection to support quality improvement are the focus of active international debate. Changes in the use of performance data in any system have implications for others. The new approach to be implemented in the UK will therefore be watched with interest. Performance Management Spectrum Managing performance is not a black or white process (you do it, or you don't), but rather a series of what the Gartner Group calls maturity levels as follows: Chaotic - No consistent use of performance tools. Reactive - Event consoles are used. Proactive - Performance monitoring and historical tools are used. Service - Capacity planning practices are followed. Value - An IT/business metric is established (performance is managed with a direct link to revenue). Each of these levels builds on the one before, adding more management and control of the underlying systems, and providing more benefit back to the business. Start by developing the infrastructure to be reactive, move towards the proactive level, and build further over time. The key attributes that distinguish different change processes are: - Speed (faster or slower) and - Source of energy for the change (more from the top, or more from the whole organization) The appropriate speed depends on the time available to respond to or shape the forces of change. There are a number of situations in which speed is critical. In rapidly deteriorating or crisis situations a fast response is essential to save the business. Rapidly closing windows of opportunity, like first mover advantages in new markets, also require a fast reaction if the opportunity is not to be lost. Similarly, fast change may be needed to save market share and deal with moves by competitors. And regardless of the external forces of change, the leader may want to speed up the change process to avoid complacency, or to outpace competition. NHS: Since the 1980s Performance Indicators have been used to examine and compare performance across NHS organisations. These indicators have focused on areas such as length of stay, costs per episode of patient care and number of staff employed. While these type of indicators focus on efficiency others have been developed to examine clinical performance Wales has introduced a new approach to performance management in the NHS. "The Performance Improvement Planfor NHS Wales" takes a holistic view of the services provided by an NHS organisation to its patients and the public, providing a: Structured approach to focusing on an organisation's strategic and annual performance objectives Mechanism for accurately reporting organisational performance Way of ensuring accountability for results Way of ensuring responsibility for performance improvement is shared Way of addressing quality and safety issues as well as those of activity and cost The 'Balanced Scorecard' plays a key role within the framework. The NHS Wales Scorecard looks to answer4 basic questions: How well do we meet the needs of the public, patients, government and industry (Stakeholder perspective) What must we excel at (Internal perspective or our management processes) Can we continue to improve and create value (Innovation and learning processes) Are we using money, equipment, staff and buildings effectively (Resource utilisation perspective) Regional Offices have the lead responsibility for monitoring the performance of the NHS in Wales and will operate the new Performance Improvement Framework The recently published 10 year plan for the NHS contained an initiative that has profound implications for both performance management and quality of care. The NHS performance assessment framework (PAF) already makes comparative indicator data publicly available, including clinical indicators such as readmission rates and preoperative mortality rates. The annual publication of these performance indicators by the NHS is about to be supplemented by a new "traffic light" grading system for NHS organisations. On the basis of a selection of performance measures all organisations will be categorised as "red", "yellow", or "green". This approach is taking the use of league tables to another level. Organisations categorised as green will be "meeting all core national targets and will score in the top 25% of organisations on the PAF". Yellow organisations will be meeting "all or most national core targets", while red organisations will reflect "poor absolute standards of performance". Green organisations will have access as of right to development funds, with a lesser degree of regional and national monitoring, greater freedom to decide local organisation of services, and will be used as beacons or exemplars with the ability to take over persistently failing red light organisations. Their staff will act as advisors on the Modernisation Board and on a National Independent Panel to advice on contested NHS changes. They may also be deployed to help failing trusts or even take them over. In contrast, red organisations that are seen to be "failing" will be subject to review every two years from the Commission for Health Improvement. Action will be instigated to ensure a baseline of minimum acceptable performance throughout the NHS. While there will still be access to performance funds for red organisations, these will be carefully controlled and monitored. Furthermore, there will be a rising scale of intervention to reflect the level of perceived problems. Red organisations whose performance calls for "special measures" will have to produce detailed recovery plans and, if they fail, as a last resort they can be brought under the control of new management teams or taken over by other organisations. Yellow organisations, who are meeting all or most national standards, will have access to funds but will be required to draw up plans for further improvement with their regional office. NHS Policies Emphasizing Performance management: Responsibilities of the Line Manager Line Managers have a responsibility to ensure: That the employee attends the Trust induction and also has a local induction in their work area, including details of staff support, occupational health, the "Buddy" service, mentoring, and supervision. The job content is applicable to the job description, person specification and the Knowledge and Skills Framework Outline. The expectation of work performance is realistic. Advice and supervision is available Responsibilities of Individual Employees Individual staff has a responsibility to: Raise concerns about performance issues Attend induction training Attend agreed mandatory training and other development opportunities appropriate to their role Actively participate in the Personal Development Review process Participate in managerial/clinical supervision as appropriate Personal Development Review Process The appraisal process is a system for regularly reviewing and recording the Performance, potential and development needs of an employee. The PDR will ensure that employees are clear about what is expected of them and how they will be supported. The process is two-way and provides an opportunity to help identify and reveal problems which may be restricting progress and causing poor work performance. It is a continuous process and not limited to a formal review once a year. It is essential where work performance problems arise they are addressed at the time, rather than waiting for the annual review. Prior to proceeding to invoke the Capability Policy and Procedure it is expected that line managers will have used the processes to the appropriate point as described in the Trust's Knowledge and Skills Framework Gateway Policy. If the Capability Policy and Procedure is invoked no progression through pay Gateways will occur until performance has reached a level which meets that described within the Knowledge and Skills Framework Outline for the post. Conclusion: The NHS faces a challenging time ahead for performance management. Our concern would be that many of the positive developments in the performance management framework-including a shift from concentration on efficiency alone to more apposite measures of quality-could be undermined by crude and poorly conceptualized populist approach. Nonetheless, what happens as a result of this policy in the UK is likely to have important lessons for other systems internationally. Furthermore Health care itself has examples of similar effects. Thus, the initial publication of the Patient's Charter standards in the UK included the percentage of patients seen in A&E within five minutes as a key indicator. This led to the wide adoption of the pejoratively entitled "hello nurse" in A&E departments to ensure that patients were seen quickly, leading to good performance against this measure and probable improvements in public perception. However, this was not reflected in the quality of clinical treatment. References 1. Lally J, Thomson RG. Is indicator use for quality improvement and performance measurement compatible In: Davies HTO, Tavakoli M, Malek M, Neilson AR, eds. Managing quality: strategic issues in health care management. Aldershot: Ashgate Publishing, 1999: 199-214. 2. www.nhs.uk/nhsplan/default.htm 3. www.doh.gov.uk/nhsexec/nhspaf.htm 4. www.doh.gov.uk/nhsperformanceindicators/index.htm 5. Hartz AJ, Kuhn EM. Comparing hospitals that perform coronary artery bypass surgery: the effect of outcome measures and data sources. Am J Public Health 1994;84:1609-14. 6. Goldstein H, Speigelhalter DJ. League tables and their limitations: statistical issues in comparisons of institutional performance. J R Stat Soc 1996;A159:385-443. 7. Davies HTO, Lampel J. Trust in performance indicators Quality in Health Care 1998;7:159-62. 8. Burrow J, Tarling R, Mackie A, et al. Review of police forces' crime recording practices. London: Home Office Research Study 204, 2000. 9. Edhouse JA, Wardrope J. Do the national performance tables really indicate the performance of accident and emergency department J Accid Emerg Med 1996;13:123-6 Read More