The HSE’s performance management system

“The HSE’s performance management system is a process for establishing a shared understanding about what is to be achieved and how it is to be achieved and an approach to managing people that increases the probability of achieving success”, Mr. Paddy Duggan, HSE General Manager, Performance Management & Management Information, told the HMI South Forum in Cork.  Maureen Browne reports.

“The HSE’s performance management system is a process for establishing a shared understanding about what is to be achieved and how it is to be achieved and an approach to managing people that increases the probability of achieving success”, Mr. Paddy Duggan, HSE General Manager, Performance Management & Management Information, told the HMI South Forum in Cork.

He said this required a genuine commitment to this process that achieved clarity on role reporting relationships, priorities and responsibilities and provided personal development opportunities, guidance and support to employees; without this genuine commitment it would become dishonest annual ritual.

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It was a value based system, underpinned by assumptions that individuals were capable of continuous development, that they wanted to be included and that managers had a “linking pin” role and influence performance.

Mr. Duggan said that details of the new performance management system had been rolled out to the regional management teams and he was now progressing through the directorates.  Regional teams would carry out workshops and roll it out to area management levels.

It was a value based system, underpinned by assumptions that individuals were capable of continuous development

He said that the first phase of implementation will encompass managerial positions down to Grade 8s and comparable clinical grades and functional/service heads. “We want to get to the management cadre first because the research shows that if it is not implemented at the top, you can forget about it.” If it doesn’t work at senior level then it will not work lower down the organisation.

Then the next phase will be for structures below grade 8s and comparable clinical grades and teams.

The HSE Performance Management System is grounded in the need for engagement, and has four components

  1. A performance review cycle (PRC) consisting of:
    • An initial meeting based on the business plan and which looks at performance planning and personal development
    • Ongoing discussions and feedback with a formal mid cycle review
    • A cycle end performance review and developmental evaluation.
  2. The performance improvement plan provides a supportive approach to addressing underperformance.
  3. HR and professional practices within the organisation with emphasis on developmental programmes, PDP, and CPD.
  4. Relevant performance measures.

The compliance reason for implementing performance management was that we had all signed up to it in the Croke Park Agreement but the best reason was that we should be doing it because it was a very good thing to do, good management practice and good employee practice. We need to do it if we were to understand the people who work for us, the challenges they faced and we needed it to see if we were bringing to fruition the tasks which we had been charged to do.

The compliance reason for implementing performance management was that we had all signed up to it in the Croke Park Agreement but the best reason was that we should be doing it because it was a very good thing to do, good management practice and good employee practice

He said that in drawing up the system, the HSE had met with the various groups and disciplines in the service and asked them ‘what would a performance management system look like for their profession or service?’ From all the discussions they had come up with a system, which might not be what individual groups wanted but included most of the points which were important for the health services.

Mr. Duggan said that the process itself was to a great extent self assessment with the staff members sitting down with their managers at the beginning the year and discussing what they thought was their job and their priorities and then repeating the process mid way through the year when they might see things slightly differently.

“The purpose of the performance review cycle is to provide a systematic process for managing the cycle of activities associated with their service delivery and the process whereby the organisation and individuals achieve agreed performance and development outcomes.

Managers could either be barriers or enablers to engagement, so it was up to managers to turn the process one way or the other

“The process requires engagement and meaningful discussing between managers and their direct reports on performance expectations, resource availability, utilisation, training and developmental needs, appropriate recognition of personal contribution, achievement and early identification of performance problems.

“Engagement is about creating opportunities for employees to connect with their colleague managers and the wider organisation. It is also about creating an environment where employees are motivated to want to connect with their work and really care about doing a good job. This engagement enables an adult two way relationship between leaders and managers and employees where challenges can be met and goals achieved, whether it be improved patient care, higher quality production or more satisfied customers.

He said that managers could either be barriers or enablers to engagement, so it was up to managers to turn the process one way or the other. Staff must know what was expected of them. A reluctance to engage could mean fear that it would mean relinquishing command and control style of leadership in favour of a relationship based on mutuality. Other barriers are inconsistent management style, lack of communications and knowledge sharing, low visibility management and an obsession with targets which often affected managers’ behaviour and detracted from their ability to interact effectively with their staff.

Where leadership engagement was concerned, engagement on the rational level was not sufficient “We have to stop saying it is the budget and we must do it.  This will not work, we must invest time and offer clarity and coaching and appreciate positive feedback, treat people as individuals, fairly and with respect  and make sure that the work is designed efficiently and effectively,  that  processes and systems can solve issues and create interesting, challenging and rewarding work. He said that it was also possible to discuss possible knock on implications from decisions. Just don’t say ‘close down 10 beds’ and then fail to listen to the fall out from this.

Performance management is not a single project, not an isolated event but an agenda for change, change of culture, greater engagement,  a push to a different way of behaving for not only managers but for all employees

“People management practices are a better predictor of company performance than strategy, technology and research and development. It also leads to better financial performance and better outcomes in public organisations.

Mr. Duggan said that UK reports suggested high engagement organisations scored better on risk management than those with low engagement and engagement levels could be a predictor of sickness absence with engaged employees taking 2.7 days off a year and disengaged employees 6.2 days.

Employees who worked for engaging organisations got an organisation for which they felt proud to work, managers who were more likely to listen and care for them, leaders who listened to an inspired them, more opportunities for personal growth and teams that supported each other.

UK reports also suggested engaged employees were enthusiastic, cheerful and optimistic while those who were not engaged tended to feel miserable, worried and depressed. For most people their work was a key determinant of self worth and with family esteem

The Performance Improvement Plan is designed to be a supportive process aimed at addressing a underperformance. “In this we have to be brave. If somebody is not performing the way we would like, we should address this between the two of us. By managing the process within the department we can focus on the substantive issue in a constructive manner. If our first reaction is to involve third parties the original issue and desired outcome could go pear shaped as the agenda, focus and desired outcomes change. This process is between the manager and the individual. It is a supported process and if it doesn’t work, we go somewhere else, but it is initially between the two of us.

Mr. Duggan said that one school of performance management focused only on metrics which looked at the degree of targets met.

“In my view, the whole focus here is actually on the consequences of actions but by the time you look at these, it is too late.  Some performance management systems have been critised because the results were considered to be too high, because they did not fit the statistical distribution of a normal population. These statistical measures can sometimes be the outcome of a dishonest annual ritual, and other times you do not have a normal population in statistical terms, like the HSE.

”Some multinational believe that in performance management the top third should get a big bonuses, the middle third should get a cost of living increase and the third should get a new job.  This approach may be suitable for for-profit organisation but may not a positive contributor to quality in service organisations.

“Performance management in service organisations needs to place the emphasis on behaviours that affect outcomes.  Especially in health it is down to the individual and the focus is on behaviour first, as the consequences of this behaviour can contribute to the service being better or worse.

Quoting P Senge (1990)  he said “Because service quality is intangible there is a strong tendency to manage service businesses by focusing on what is most tangible, such as the number of customer’s services, the costs of providing a service and the revenues generated. But focussing on what is easily measured leads to looking good without being good – to have measurable performance indicators that are acceptable yet not providing quality service means that work gets done but at a steadily poorer standard of quality. For example one surgeon might do three procedures in a particular timeframe while another might do ten, but they could be of very different complexity.

“We need to move back from consequences through behaviours to antecedents and it is antecedents where this performance management system wants to get. There isn’t an quantitative appraisal the end of the year where you are told ‘you’ve got a four, sign here and go off happy, but a requirement to engage, to individual assess our performance and be prepared to discuss and implement performance  improvements and personal development activities for the benefit of patients and service users.

Performance management is not a single project, not an isolated event but an agenda for change, change of culture, greater engagement,  a push to a different way of behaving for not only managers but for all employees, it is a challenge that encompasses us all irrespective of profession, employee category or level in the organisation.