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Back to the Performance Improvement Journal Home PageSeptember, 2003 Editor’s Notes
Guest Editorial: Working Worldwide: Differences in Work, Measurement and Evaluation in Performance Improvement
Refining Performance Improvement Tools and Methods: Lessons and Challenges Performance-Based Contracting With NGOs in Haiti Enhancing Facility-Based Care in the Eastern Cape: The Future of Performance Improvement in International Health Turning Knowledge Into Power and Productivity Sharing Knowledge Through Mentoring A Dutch Perspective on Performance Technology Executive Summaries
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Executive Summaries
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| Measurement and Evaluation in Performance Improvement in International Reproductive Health by Edgar Necochea and Alfredo Fort This article focuses on how measurement and evaluation are being applied to performance improvement in the field of international reproductive health. In international settings the standardization of care and the determination of the outcomes of improved performance, two key aspects for measurement and evaluation for performance improvement, face several important constraints. These are related to the complexity of the healthcare processes and the weak in-country institutional capacity for the incorporation of evidence-based knowledge into day-today practices. Responding to these challenges, several international health agencies have been developing and implementing practical methods and tools to measure and evaluate performance and the individual performer and organizational levels. In conducting these efforts, these organizations have gone beyond a provided-centered approach to healthcare towards a more holistic model that takes into account the points of view of different stakeholders: front-line providers and managers, clients and the community. Refining Performance Improvement Tools and Methods: Lessons and Challenges by James McCaffery, Michelle Heerey, and Kirsten P. Böse Performance improvement methods and tools have proven effective and are now widely used throughout the Americas, Europe, and parts of Asia. In the last five years, there has been increased interest and experience in applying these same approaches to health services work in low-resource settings around the globe. Recognizing that successful performance improvement processes require adaptation and tailoring in any given situation, interesting patterns of challenges and opportunities particular to health service delivery in low-resource settings are beginning to emerge. This article captures some of the knowledge gained through a growing body of field experience; in particular, it highlights a handful of tools and discusses existing challenges and opportunities for applying performance improvement methodologies in low-resource settings. Performance-Based Contracting With NGOs in Haiti by John Pollock The HS2204 Project works with a network local, service-delivery NGOs to provide efficient and high-quality primary health care services to the people of Haiti. These NGOs have established missions to provide services, and all have engaged in a process to improve efficiency and impact of services. The delivery of services was taking place, but with disparities in quality, inadequate coverage and wide variation in cost. A sub-group of these NGOs that had established essential management capacities agreed to participate in a performance-based contracting program that built in financial risks and incentives to promote performance improvement. In process, the participating NGOs have found new ways to use monitoring information and innovated new approaches to improve efficiency. They have also found ways to use the award fees to improve their programs and motivate staff. The results have been positive in relation to both the delivery of health services and in transforming the operations systems within participating NGOs to focus on efficient delivery of quality services. Enhancing Facility-Based Care in the Eastern Cape: Performance-Focused Approach Improves Clinic Services by Dan Riehle and Jedida Wachira Located in rugged country crossed by dirt roads, health care providers in rural areas of the Eastern Cape Province in South Africa needed a tool to make health care delivery and training more responsive to the needs of their communities. Under apartheid, clinics in the former “homeland” areas relied solely on centralized training sessions to improve specific delivery problems. In a country combating the spread of HIV/AIDS, sexually transmitted infections (STIs), and tuberculosis (TB), providers needed an approach that empowered them to tailor training and clinic management in order to meet localized community health needs, respond to the changing face of STIs and TB, and address performance issues in their own clinics. This article talks about a performance improvement approach that has enabled clinic supervisors and managers to tailor onsite training and create their own clinic-based solutions to improve the quality of priority primary health care services. The Future of Performance Improvement in International Health by Marc Luoma In the few years since HPT (called Performance Improvement, or PI, in this context) has been introduced to help improve public health in developing countries, some trends have emerged. From these trends we can predict what lies ahead for PI. Where human performance issues exist, the PI methodology will become endemic. No longer will a single need, such as training, be assumed. Rather, an analysis of desired and actual performance, as well as provider needs, will become a standard way of doing business. PI will also be used in combination with many other approaches, as the situation demands. The combined use of PI and other quality tools and methods will enhance the effectiveness of interventions. As needs assessment grows ubiquitous, there will be a greater demand for effective non-training interventions. Healthcare providers often have unmet needs for feedback, motivation, and supervision. Meeting these needs effectively will mean a greater reliance on non-training solutions. Creating a sustained enabling environment that allows providers to do their best will increasingly shine a spotlight on inadequate human resource systems. For our interventions to be most sustainable, they will have to become part of the regular human resource systems in the places where we work. Turning Knowledge Into Power And Productivity by Frank J. Adick, CSP, CMC Employees today are granted more freedom in the decision-making process. Organizations do this partly to encourage their staff to behave more like entrepreneurs: to be proactive, think innovatively, and take calculated risks and accept responsibility for the consequences. This greater level of freedom means that the organization is entrusting their staff to make decisions which directly effects the organization itself. Therefore, it is important to businesses that their workforces are educated and knowledgeable and receive regular education and training to maintain their skills. Only an educated and trained workforce will be capable of taking responsibility for the fate of customers, colleagues, and the organization. Successful organizations provide their employees with continuing education, to prepare them for more democratic and responsible behaviors. Our traditional education often ignores developing skills in teamwork, creativity, leadership and responsible decision-making. Instead, compliance with accepted knowledge and wisdom is rewarded. A positive learning environment is crucial to guiding employees towards entrepreneurship. When education is provided under too much control, learning shuts down. For individuals to learn effectively, they need the freedom to practice thinking for themselves, and to have the freedom to make mistakes within secure limits. Investing in infrastructure, wellness, a healthy planet, and above all, providing high quality education are essential for the quality of life for future generations. Sharing Knowledge Though Mentoring by Truls E.J. Engström, MSc A large degree of employee knowledge is tacit and personal. This knowledge is difficult to identify and define, and very complicated to share and cultivate. Engström argues that mentoring can work as an accelerator to the sharing of tacit knowledge and help build an environment with trust, openness, and willingness to share. Engström describes a study that examined informal mentoring experiences among early managers and professionals in the Norwegian Hospitality industry. Results show that respondents involved in informal mentoring report higher knowledge enabling opportunities through their careers, higher degree of workplace satisfaction, expect faster future careers, are more involved in their work and have higher salary than respondent not involved in informal mentoring. A Dutch Perspective on Performance Technology by Joep Straathof and Jolanda Botke Around 1990 Human performance Technology was introduced in the Dutch training sector. This led to a limited number of fans. Unfortunately, a broad implementation didn’t take effect. Now, almost 15 years later, the time is right for a broad implementation. Not the implementation of a copy of the United States performance approach, but of a Dutch approach in a European perspective. The Netherlands has become a knowledge economy in which the application of knowledge--technical knowledge, as well as creative knowledge--replaces capital, raw materials, and labor as the main means of production. To improve performance in a knowledge-based economy like the Netherlands, the control dogma and the self-guiding dogma need to be linked, and supported by a management style based on creation and application. |
