An assessment of a performance-based management agreement initiative in Ghana's health service.

BACKGROUND: As part of its efforts to improve efficiency, accountability and overall performance, the Ghana Health Service (GHS) introduced annual Performance-based Management Agreements (PMAs) in the year 2013. However, no assessment of this initiative has since been made in order to inform policy and practice. This paper provides an assessment of this policy initiative from the perspective of managers at various levels of service implementation. METHODS: Mixed methods were employed. Questionnaires were administered to managers through an online survey (using Google forms). Descriptive and inferential statistical methods were used to analyze and present quantitative results while qualitative data was analyzed via thematic analysis. RESULTS: The content and objectives of the PMAs were observed to be comprehensive and directed at ensuring high performance of directorates. Targets of PMAs were found to be aligned with overall health sector objectives and priorities. The directors felt PMAs were useful for delegating task to subordinates. PMAs were also found to increase commitment and contributed to improving teamwork and prudent use of resources. However, PMAs were found to lack clear implementation strategies and were not backed by incentives and sanctions. Also, budgetary allocations did not reflect demands of PMAs. Furthermore, directors at lower levels were not adequately consulted in setting PMAs targets as such district specific challenges and priorities are not usually factored into the process. Insufficient training of staff and lack of requisite staff were key challenges confronting the implementation of PMAs in most directorates. Weak monitoring and evaluation was also observed to significantly affect the success of PMAs. CONCLUSION: There is the need to address the weaknesses and improve on the existing strengths identified by this assessment in order to enhance the effectiveness of PMAs utilization in the Ghana health service.

Views from the front line: is the NHS workforce at crisis point?

Emeritus Professor Alan Glasper, from the University of Southampton, discusses a report revealing that hospital doctors are concerned about their ability to deliver safe patient care over the next 12 months.

Is the Annual Confidential Report system effective? A study of the government appraisal system in Gujarat, India.

BACKGROUND: Effective performance appraisal systems can not only motivate employees to improve performance but also be important for the performance of organizations. However, the appraisal systems in civil services called the Annual Confidential Report (ACR) systems can be ineffective and do not contribute to employees' learning and development. With this background, the current study aimed at understanding the ACR system and assessing its effectiveness. The research aims to contribute in filling the knowledge gap in the existing literature on the need as to why the ACR system in civil services is an important human resource management (HRM) function. METHODS: The analysis is based on policy review to understand the extant appraisal-related rules and policies. Nineteen in-depth interviews with medical officers (MOs) working with the government health department of Gujarat, India, were conducted. The main objective of the research was to assess the effectiveness of the actual appraisal system called or referred to as the ACR as perceived by MOs. Thematic framework approach was used to analyze qualitative data using NVIVO 9. Themes were built around five features of an effective appraisal system, i.e., purpose, source, feedback quality, link of the ACR system with other human resource functions, and administrative effectiveness. RESULTS: The five features of the effective appraisal system studied in the current research (purpose, source, feedback quality, link of ACR system with other HRM functions, and administrative effectiveness) indicate that the overall appraisal system is ineffective. The overall appraisal system was perceived to be subjective and one directional in character by the study respondents. Furthermore, respondents perceived the appraisal system to be a ritual and where MOs hardly got to know about their performance, especially good performance. Hence, the feedback loop, an important feature for an effective appraisal system, was absent. The overall ACR system functions in isolation with no link to other HRM functions such as training and counselling, and a weak link with salary administration and promotion. CONCLUSIONS: Addressing the five features or domains of an effective appraisal system can lead to improved perceived fairness MOs have on the current appraisal system which may further influence the satisfaction and motivation positively. Improved motivation and satisfaction with the appraisal system can influence two important human resource for health-related outcomes, i.e., performance and retention.

District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study.

BACKGROUND: In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). METHODS: This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews. RESULTS: The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs. CONCLUSIONS: The incongruence in perspectives offered by members of CHMTs and mid-level providers points to deficient HRH management practices, which contribute to poor practice environments in acute obstetric settings in Tanzania. Our findings indicate that members of CHMTs require additional support to adequately fulfill their HRH management role. Further research conducted in low-income countries is necessary to determine the appropriate package of interventions required to strengthen the capacity of members of CHMTs.

How do you manage early or late clock-ins? .

My current practice has historically been very strict with hourly employees. The workday is 8:30 a.m. to 5 p.m. for most employees. They are to clock in and out at exactly those times unless overtime has been approved. (Staff working with late patients are exempt.) My business manager is constantly fighting over clock-ins 15 to 20 minutes early or late, with similar clock-outs. Staff may have a stop to make and would like to make up those 15 minutes. We do grant paid time off in an initial minimum block of 30 minutes to assist with some of this. ... The issue is not overtime, as we're well aware that we have to pay for it when appropriate. It's simply to streamline our policy and make it fair. ... I'm looking for practice policies that deal with employee variances from the 8 a.m. to 4:30 p.m. clock-ins. For example, someone wants to come in 30 minutes early in order to leave 30 minutes early for an appointment. Or someone comes in 22 minutes late due to traffic and wants either to make it up or to take the minimal half-hour paid-time-off time.

Quality allied health clinical supervision policy in Australia: a literature review.

Clinical supervision is presented as a complex set of skills that may broadly apply to any and all allied health professions. However, it is also noted that a clear understanding of clinical supervision and how to implement it in allied health is currently lacking. It is argued that there is a need to reflect upon current approaches to clinical supervision amongst allied health professionals and to gain a shared understanding about what supervision involves, what effective supervision is, and what effective implementation of clinical supervision might look like. By gaining an understanding of what high quality clinical supervision is and how it is best put into practice, it is anticipated that this will form the first step in developing an understandable and useful universal supervision policy for all allied health professionals.

Evaluating the effectiveness of performance management: A 30-year integrative conceptual review.

This integrative conceptual review is based on a critical need in the area of performance management (PM), where there remain important unanswered questions about the effectiveness of PM that affect both research and practice. In response, we create a theoretically grounded, comprehensive, and integrative model for understanding and measuring PM effectiveness, comprising multiple categories of evaluative criteria and the underlying mechanisms that link them. We then review more than 30 years (1984-2018) of empirical PM research vis-à-vis this model, leading to conclusions about what the literature has studied and what we do and do not know about PM effectiveness as a result. The final section of this article further elucidates the key "value chains" or mediational paths that explain how and why PM can add value to organizations, framed around three pressing questions with both theoretical and practical importance (How do individual-level outcomes of PM emerge to become unit-level outcomes? How essential are positive reactions to the overall effectiveness of PM? and What is the value of a performance rating?). This discussion culminates in specific propositions for future research and implications for practice. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Age and space flight.

Criteria for space flight crew and passenger selection should be based on the following three considerations: (1) freedom from impairing disease, (2) ability to perform mission requirements and (3) motivation to undertake the mission. Chronologic age of itself is not a valid criterion. Forecast life expectancy and vitality relative to mission duration are valid criteria and can be applied on an individual basis using modern assessment techniques. The good health and vitality characterizing the upper ages of today's population widens the opportunity to utilize increasingly broad fields of experience and skills in future space flights, further enhancing the odds for total mission accomplishment.

Managing temporary staffing services: selecting the right agency.

Hospitals frequently must resort to using temporary staffing agencies. As an informed client and skilled negotiator, the nurse executive can obtain the highest quality and best price possible.

The effective management of occupational health and safety: the requirement for accreditation for quality in the Health Services.

It is becoming increasingly important for providers of health care to manage the health and safety of their workforce effectively. In the competitive world of health care, organizations seeking accreditation for quality are having to allot greater importance to health and safety than in the past. The manager of occupational health services for West Birmingham Health District, which has recently applied for Trust status, explores some of the reasons for this.

Ensuring fair termination procedures.

Throughout the discharge process, it is the healthcare executive's responsibility to act in the organization's best interest while ensuring that the employee is treated fairly.

Excerpts from "Maintaining Radiation Protection Records". National Council on Radiation Protection and Measurements.

This is the last in a three-part series of articles reprinted from a report by the National Council on Radiation Protection and Measurements (NCRP). Section 5, "Workplace Records," is reprinted below. The Introduction and Section 2, "Guidance for Systemic Generation and Retention of Records Relating to Radiation Protection," were reprinted in the winter 1994 issue of Radiology Management, and Section 3, "Radiation Protection Program Records," appeared in the spring 1994 issue.