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The performance of staffs in an organization needs to be evaluated over a period of time on a regular basis and one of the ways to review, is by the process of performance appraisals (Mullins 2002).Performance appraisal in an important part of performance management, it is not performance management in itself but an important process in managing the performance of employees" (Cipd 2010). Performance appraisal is defined by Armstrong (2006:500) as the "formal assessment and rating of individuals by their managers at usually, an annual review meeting". Members of an organization should know what is expected of them in other to perform in line with the organizations objectives and values, as a result they need to know the yardstick by which their performance will be measured (Mullins 2002).
This study evaluates the aims and benefits of performance appraisals, analyzes the culture of NHS and how it is linked to the process of performance appraisal adopted for NHS GP, the aims of NHS appraisal process, problems encountered with the appraisal process and how to make the appraisal system work and made recommendation on how to improve the appraisal process.
1.1 Aims and benefits of performance appraisal
An objective of performance appraisal is to improve the performance of the employee which will in turn lead to the improvement in the performance of the organization (Mullins 2002). "Performance appraisal is an opportunity for the employees to discuss their performance with their line manager; it also provides a platform for clarifying the quantity of performance through feedback on both an informal and a formal basis though out the year" (Muller-Camen et al 2008). A regular performance appraisal scheme will enable the organization identify the potential of the individual and also help to identify training and development needs (Mullins 2002). Also, It's an opportunity for the employee and their line managers who are concerned with their performance to come together to discuss the employees performance in other to know the area in which the employee has developed and also to know what area the employee needs support from the manager (Cipd 2010), and an effective performance appraisal system can improve or lead to the development of the performance of the employee in the future (Mullins 2002). It is also concerned with the development of a culture in which members of the organization can participate and contribute to the goal of creating satisfying, effective jobs, and encouraging the involvement and development of people in the organization (Mullins 2002).
Muller-Camen et al (2008) cited Armstrong and Baron (2003) who point out that "appraisal system should be seen as being transparent and equitable, providing, reporting consistent and regular feedback on performance, it should be simple, straight forward, attainable, realistic and time-bound". It a process adopted in other to see how the employee has performed in relation to the organizations objectives and goals and to know what has worked well and what has not in relation to their role (The Aston centre for human resources 2008).
However, there are various benefits of the performance appraisal system which involves identifying the employees strength and weaknesses and finding the best way to utilize their strength and to overcome their weakness, appraisals can also help to reveal the areas in which the employee might be exercising weaknesses which may be restricting their progress or growth and limiting their work performance, it provides information on succession planning in other to determine who needs training or promotions and also improve communication between staffs and their manager by giving staffs an opportunity to talk about their ideas and their expectations and how well they are developing (Mullins 2002).
2.0 NHS CULTURE
NHS organizations values and culture is very important when it involves given the patient the best care, and also necessary in other to improve quality care given to patients (Bristols royal infirmary enquiry 2001). NHS, (National health service), are known to give health care service to those who need it, their culture involves their attitude, assumptions and their values and also the condition of their patients and how well they are cared for (Bristol royal infirmary enquiry 2001). Culture joins the NHS together which urges the NHS to move forward and also provides a cultural strength in which the employees are not just working they know the organization they are working for, know what is expected of them and how to make the organization work well (Corrigan 2009). The understanding of NHS culture by the employee is to understand its strength and the weaknesses and how well to address it in other to grow, develop and to perform well in other to meet the expectations of the organization (Bristol royal infirmary inquiry 2001). NHS have various strengths which includes their involvement in public service and social solidarity, also, the commitment as well as the performance of their employee serves as a source of strength to them (Bristol royal infirmary inquiry 2001). The NHS culture involves the attitude, assumptions and the values which conditions or states the way an individual works as well as the way the organization functions (Bristol royal infirmary inquiry 2001). In other to know how well NHS has managed the performance of their employee's and how their performance is linked with the organizations culture or objectives, the method of the GP's appraisal system is analyzed below.
3.0 NHS GP PERFORMANCE APPRAISALS PROCESS
"The development of clinical governance in the NHS and the proposal by the GMC (Good medical practitioners) for the revalidation of the doctors, underlined the need for a comprehensive annual scheme for GPs" (Glospct.nhs.uk 2010). "GPs (General practitioners) are seen as a group of individuals driven by their own internal standards" (Walls et al 2002). The performance appraisal process adopted by NHS to appraise the performance of the GP is the Peer review appraisal process, which is the appraisal system that is usually carried out by a colleague or a peer at work (Glospct.nhs.uk 2010). Peer appraisals is where an individual of equal rank evaluate one another, and usually this provides information that are different to some extent from those that would have been provided if the appraisal is carried out by a superior (Bohlander et al 2001).
The Peer appraisal for the GP can be very effective because colleagues and peers are in a better position to identify the leadership and interpersonal skills acquired by their colleagues and also identify their strength and weaknesses, they are also in the best position to know how effective and how well their colleagues have been performing in their duties and how committed they are to the organization, to their job and to their patients, as a result of this, they produce a more accurate result than the superior (Bohlander et al 2001). Performance appraisal system is to help the doctor assess their performance and to reflect on their work in other to know what they need to improve on in other to do better and where their effectiveness can be improved in other to meet the goals and objectives of the organization (Glospct.nhs.uk 2010). The content of the NHS appraisal process in which the GP's performance is appraised is usually based on the GMPD (Good medical practitioner document) core headings, which are the consideration of the GPs relationship with patients, their working conditions with their colleagues, how well they have maintained good medical practice, good clinical care and good health, which is usually reviewed against the NHS corporate objectives to know if the GP is performing well (Glospct.nhs.uk 2010).
Also, the peer review appraisal system provides an opportunity for the employee that is being appraised and the appraiser to have an honest conversation about the individuals past performance and also identify the needs of the individual and it also link the individuals aspirations and development to the needs of the patients as well as the organization (Wall et al 2002).
3.1 Who carries out the appraisal?
The appraisal scheme is usually carried out by another GP in other to be able to appraise the individual well because he/she has knowledge of the working condition (Glospct.nhs.uk 2010). The appraiser will have a good knowledge of the work pattern of the GP who is being appraised, be aware of the environment in which the doctor works, the performance of the GP and the services that are provided by the GP (Glospct.nhs.uk 2010). This will encourage an easy conversation between the employee that is being appraised and the appraiser, which will increase the effectiveness of the appraisal system which is meant to be a collaborative process as a result of both partners engaging in a skilled conversation (Wall et al 2002). Also, it gives the GP a chance to confide in another colleague on personal and professional issues as well as developmental needs (NHS professionals 2006). However, the appraiser must have undergone an efficient appraisal training program in other to be able to carry out an effective appraisal review exercise so also the GP, for caring out appraisal and also participating in it fully (Glospct.nhs.uk 2010).
4.0 THE AIM AND OBJECTIVES OF NHS PERFORMANCE APPRAISAL SCHEME FOR THE GP
"The primary aim for NHS appraisal scheme is to identify personal and professional development and educational needs with the ultimate aim of improving clinical performance and patient care" (London Deanery 2008) which is the culture and value of NHS, to ensure that their patients are well cared for (Bristol royal infirmary inquiry 2001). It aims to ensure that the doctors are professionally available towards given the right care to their patients and also increasing the quality of care given to the patients by analyzing their performance with the patients, how well they work with their colleagues and how well they maintain good clinical and health care (Walls et al 2002). Another primary aim of the NHS appraisal scheme is to help the GP identify and to improve on their good performance in other to achieve excellent outcome, and as also identifies areas in which development is most needed (Glospct.nhs.uk 2010).
The appraisal system is to improve the performance of the GP but there are a number of other purposes they serve which includes improving the motivation and the morale of the employee, determining reward, improving communication, identifying training and development needs and opportunity, managing careers, counseling, discipline, setting goals and targets and selecting people for promotion (Bratton and Gold 2007). It also helps NHS see ways of improving health, by ensuring that GPs are sensitive to the patients needs, provide effective and timely care in other to manage resources, and to also be able to provide fair access to health service in relation to peoples need in respective of their ethnic or geographical location (Chang et al 2002).
Appraisals can be very effective in increasing the effectiveness in the medical practice and also be seen as a part of the professional development imperative of clinical governance (NHS professionals 2006). It helps the employee and the employer recognize and identify the areas in which the employees is experiencing a reduction in their performance or the areas in which the employee might need help with, it also, help to develop a reflective culture within service and culture and provide GPs with an opportunity to demonstrate the evidence for revalidation (Glospct.nhs.uk 2010).
Some of the aims of the NHS appraisal scheme are;
to review the GPs performance on a regular bases by reviewing data from local, regional and national sources;
to consider the GPs contribution to the quality and improvement of services delivered locally;
to increase the use of skills and resources in other to achieve a good delivery of personal and general medical service;
provides a situation whereby the GP can discuss or seek for support on how to improve their performance in other to participate in activities for a wider NHS;
and to set out personal developmental needs to ensure that the plans are met (Glospct.nhs.uk 2010).
"The appraisals are concerned with the doctor's professional development within his or her working environments and the needs of the organization for which the doctors work (Glospct.nhs.uk 2010). It also aims to help the employee improve their performance and to work towards achieving a better performance as a result of them receiving feedback of their performance appraisal review (Glospct.nhs.uk 2010). It is believed that people work better, learn better and achieve more when they get feedbacks on their performance, have set goals they are aiming to achieve which is line with the organizations objectives and are involved in the setting of task and goals (Mullins 2002). Through feedback the employee will acknowledge that there is a need for change and should also recognize excellence and see the appraisal process as one that supports competent practice (NHS professionals 2010). However, Colon (2003) cited by Wall et al (2006) argues, an effective appraisal will not only improve the quality of care for the patient but also serve as a catalyst for continuing personal development and learning.
5.0 PROMBLEMS ENCOUNTERED WITH THE APPRAISAL SYSTEM
Although, the appraisal system are used to analyze the performance of employees, it is believed that appraisal systems are ineffective and do not have much impact in developing the performance of the individual in the future, rather, they are used as an administrative exercise (Torrington et al 2005). Rather than the appraisal system pointing out the developmental needs of the GP it points out the performance need of the organization (Bristol royal infirmary enquiry 2001).
The performance appraisal is usually used to review the performance of the organization and not just the performance of the individual, they turn the strategic goal of the organization into operational goals rather than using the appraisal system help the individual to see how their contributions adds value to the organization as a whole (Price 2004). The NHS peer appraisal scheme affects the relationship between the appraisee and the appraisal which will in turn affect the result of the appraisal process which should have being an objective process, the individual may be reluctant to admit to failure because of fair of being denied of promotion, and also, the appraiser may withhold some vital information that may have pointed out how poorly the individual is performing as a result of them being colleagues which may not be the case if the appraisal scheme was the 360 degree process (London deanery 2008). London deanery (2008) cited the work of Handy (1993) who points out that, NHS idea of combining managerial demand, performance review linked to pay and reward, given feedbacks, planning personal and job objectives in one appraisal is not a wise thing to do.
Also, if the appraiser is not well trained or the GP being appraised is not given adequate notice this can lead to failure of the appraisal scheme because neither the appraiser nor the appraisee are well informed (Walls et al 2002). Most performance appraisal process do not motivate individuals nor does it effectively guide the behavior of the individual, it is believed that besides compensation, rewards, and development, only a few effect of positive appraisal system has been seen (Smither 1998).
6.0 HOW SUCCESSFUL THE APPRAISAL SYSTEM HAS BEING
For an appraisal to be successful it has to be well prepared for in advance, the NHS make sure that both the appraiser and the GP undergoing appraisal has a reasonable advance notice of the date of the appraisal meeting and also have sufficient time to prepare.(Glospct.nhs.uk 2010). The appraisal system of NHS over the years has helped the organization to develop the performance of the GP by revealing the areas in which the GP's performance needs developing, and also, it has made the GP to be aware of the organizations corporate objectives by working in line and being appraised in line with the organizations culture and values, also, by giving them feedback on their performance they tend to work harder and develop the areas in which their performance need to be develop and also improve patients care (NHS 2009).
7.0 HOW TO MAKE THE APPRAISAL SCHEME WORK
The success of the performance appraisal scheme depends on both the appraiser and the appraisee, having sufficient time to prepare and given their contribution some thoughts before carrying out the appraisal (NHS professionals 2006). The performance appraisal scheme will be very effective if those involved the appraiser and the appraisee, have a clear knowledge on what the scheme is all about and what is expected of them in their various roles and also undergo proper training (Torrington et al 2005).
The appraisers need to undergo training in other to know how appraisal is done and on how to conduct interview and also the GP being appraised also need to go on training (Torrington et al 2005). They also need to agree on a personal development plan for the appraisee in other to meet the organizations objectieves (NHS 2009). An excellent appraisal system is of no use if the appraisee does not have the knowledge on how to use or execute it (Torrington et al 2005).
NHS corporate objective involves providing their patients with the best care and in other to do this their employees performance and operation needs to be in line with the organizations values, in other to make sure this happens the performance of the GP needs to be assessed or appraised in other to know how well they have performed or how bad and find ways to improve their performance (NHS 2009).
I believe that NHS should adopt the 360 degree feedback appraisal process and if they are to use the peer review appraisal process they should create a situation whereby three separate colleagues review each other's appraisal so that no one can favor the other,
They should create a culture of openness between the superiors and those that work for them,
The appraisal system should not be to judge an employee or to punish them but to improve their performance,
And the GP must be well informed on what the appraisal is meant in other to prevent them from withholding vital information.