Managing performance and development

Maintaining a happy, competent and confident work team will involve continued feedback and education as the practice grows and changes. Set up a system for feedback and review on a regular basis. Note, however, that performance assessment is an ongoing process and at the annual review the staff members should not get any surprises.

Performance review meetings need to answer these important questions:

• Is the person fulfilling the requirements of the position as set out in the job description?
• Is the organisation providing the necessary time and resources to enable the employee to complete their job?
• What areas of development can be addressed to improve the person’s quality of work and job satisfaction?

Performance management may be required when staff are not performing as well as they should. This can be caused by personal issues such as relationship problems, difficulties with personal finances, issues with personalities at work, or other work-related issues. Performance problems need to be managed well to ensure that you don’t lose a good employee and that your practice maintains its financial and commercial viability.

Performance issues should be discussed as soon as they become apparent. Most problems can be resolved by having a quiet and confidential chat with the person in question. However, there may be times when a more formal approach is required. Where an employee fails to respond to one-on-one discussion, it may be necessary to counsel the employee.  Maintaining documentation of any formal counselling is advisable as it will be of particular assistance if the situation deteriorates.

Above all, talk to the staff on a regular basis about their work. This, more than anything, will stop issues coming to a head.

Remember - Praise in public; reprimand in private.

All medical, nursing and administrative staff require ongoing access to education and training to allow them to do their job in a professional and efficient manner. Work demands are changing as technology grows in importance, and compliance and accreditation become integral parts of health care practice management.

For medical, nursing and administrative staff alike, continuing development and training can make the difference between confident and competent staff members and an efficient practice, or something less desirable. Access to professional development courses can also be seen as a reward for effort and application.

Remember, there are vicarious liability issues if staff are inadequately trained. (see HR and staff recruitment ).

Development can sometimes be completed on site under the guidance of an experienced staff member. At other times, you may find it preferable to use the services of an outside provider who is an expert in a particular field. You may also access seminars, conferences or formal education courses provided by others.

There must be a clear audit trail of all education provided. For some positions such as practice managers who are Certified Practice Managers or Fellows of the Australian Association of Practice Managers and nurses, there is a requirement to document professional development including annual mandatory training (e.g. first aid training).  In legal proceedings, it is often vital to have documents which demonstrate the training and education undertaken by the staff member. In recording all staff education in their individual file, it can be encouraging to see the additional skills and education development that can add to their CV and improve their performance and attitude.

Medical practitioners are required to undertake Continuing Professional Development (CPD) over the designated triennium in order to maintain their Vocational Registration (VR) entitlements.

General practice accreditation requires documented evidence of training undertaken by all members of the practice team. Most healthcare professionals have to meet some form of continuing professional development requirement.

Workplace assessments can be performed to identify gaps in staff competencies and the processes to meet these gaps must be documented.

It is important to provide a formal performance management and review program for the practice based on the relevant position descriptions and competency standards, to ensure regular feedback is provided to all staff members on an ongoing basis.

The process of performance appraisals should aim to identify, evaluate and develop each individual staff member’s work performance and productivity to more effectively achieve organisational goals and objectives and to provide reward, recognition, feedback, support and career guidance to staff members, where necessary.

There are a number of benefits for both the practice and staff members in the implementation of an effective performance appraisal system that may include:

• strengthening of the working relationship by allowing communication and discussion to take place concerning both work-related and personal issues.
• differentiating between satisfactory and unsatisfactory staff members.
• obtaining information and feedback from staff members that may improve productivity or identify potential problems or safety issues within the organisation.
• identification of training and development needs, or the potential of staff members for future management positions, promotions or transfers.
• maintaining performance standard levels that aid in the identification of poor performance so that corrective action can be taken immediately.
• encouraging staff members to use their own initiative in developing and improving their job performance.

Both the practice and staff members should be aware that when either good or bad issues arise, they should be addressed immediately, and not left to the scheduled performance appraisal to be discussed. The practice manager should also have their own performance appraisal and this can be undertaken with input from staff, practitioners and the principal/s.

Above all, performance management is an ongoing process. This means that there should be no major surprises at an annual performance review.

Decide how frequently performance should be reviewed. It usually occurs on an annual basis.

Design a performance management system to facilitate discussion of:

• individual performance.
• impact of the individual on the rest of the organisation.
• impact of the organisation on the individual’s performance.
• issues or concerns on the part of the staff member, management or other staff, where relevant..
• rewarding individuals for performance which is acceptable or exceeds expectation..

• Provide development opportunities for those who need new skills or knowledge, or who need help to reach the desired level of performance.
• Set new objectives for the following period at each performance review.

Be sure to follow a few simple rules:

• Don’t ‘let matters lie’. If there is a performance issue, address it. Lack of follow-up gives the message that the matter is not important.
• Make notes of all staff meetings regardless of their informality. Staff records are as important as patient clinical records. They enable you to keep track of staff matters.
• If an employee is given a warning, ensure you clearly advise them that continued breaches may result in termination of employment.
• Seek legal advice from an industrial relations adviser before terminating any employee’s appointment or going down this path.
• Beware of the risks of employing staff under a casual arrangement in an attempt to avoid unfair dismissal legislation. 

A significant element of the performance appraisal process is the setting of appropriate performance standards and ensuring that the staff member is aware of them.

• Consideration should be given to the following when setting the performance standards:
• Stipulate actions, behaviour and results to be achieved by the staff member that are within the control of the staff member being appraised. 
• Assist the staff member in successfully performing in the position. 
• Provide feedback (both positive and negative) to the staff member and outline the level of performance expected. 
• Have a standard that is realistic.
• Base the performance standard upon documented and work-related observations. 

Once the performance standards have been completed, the following stages comprise the performance appraisal process:

The performance appraisal form has been based on a three-point rating system.

• 2 = above average performance
• 1 = meets performance standards
• 0 = unsatisfactory performance (specific warning issued)

Agreed goals

It is recommended that a maximum of four or five goals (that are realistic and measurable) are set for each employee in one review period.

Example of an achievable goal:

‘Conduct a safety audit by 28 February and action remedial strategies by 31 March.’

Example of a goal that is not within the control of the individual:

‘Ensure that no one gets hurt.’

Present job requirements

It is not essential that each staff member is assessed on all of the points identified here, as they may not all be relevant to the particular position. What is important though, is the staff member’s achievement of the agreed goals. The points on the form may be modified, or additional points included, if and where necessary.

Leadership

This section is only relevant to managers or supervisors when their work performance is being assessed.

Overall rating

The appraiser has the authority to decide on the recommended overall appraisal rating. It is important to note that the staff member signs the form only to signify that they have been involved in the performance appraisal process. The staff member’s signature however, does not necessarily signify their agreement with the recommended overall rating.

Agreed performance goals for the next review period

This section deals with future events and is used to record agreed performance goals and completion dates for the next review period. The goals that are set should be challenging but achievable. The goals must be expressed in realistic and measurable terms and be within the control of the employee (see also Agreed goals). There is also a section in which any training or development activities required by the staff member, that have been identified through the performance appraisal process, can be recorded.

Once the form has been completed and signed by both the employee and manager, it needs to be retained in the staff member’s personnel file.

There are a number of ways you can increase your skills in the people management area. Many companies offer short courses in management and leadership.

1. Most states have branches of the Australian Institute of Management, which runs courses in management and leadership concepts and skills. They may be anywhere from one to four days in duration. You will find contacts for the AIM office in your state on their website - Australian Institute of Management  
2. UNE Partnerships in association with AAPM have been involved in education for practice managers and staff of healthcare practices for many years. They have developed a specific Professional Practice Management Development Program for healthcare practices. The current nationally accredited Practice Management qualifications available from UNE Partnerships are:

Certificate 111 in Business Administration (Medical) (BSB31112)

Certificate 1V in Professional Practice Management ( 91482NSW)

Diploma of Professional Practice Management (91483 NSW)

The details of these courses are available on the UNEP and the AAPM web sites.

1. Business Enterprise Centres (BECs) also offer a number of services and educational workshops which are designed to help small business people. Some, but not all, BECs have websites. These can be found by searching ‘business enterprise centres’. Otherwise, your local centre will be listed in the phone directory. Staff at these centres can be a good starting point for consultation on the set-up and ongoing management of your practice.
2. Ask colleagues, other professionals and business people what resources they have used.
3. AAPM
4. UNE Partnerships , the education and training company of the University of New England, offers education programs in medical administration, practice management and business administration. Go to UNE Partnerships   for more information.
5. Technical and Further Education (TAFE) institutions may offer courses which are of use to yourself and your staff. Contact your local campus for details.