Evaluation/ PA is a responsibility of nurse managers which help to improve the quality of nursing care in clinical area, it requires appropriate methods in order to be effective in clinical setting (Ghasemi et al., 2007). The purpose of evaluation is to provide feedback to employee on its performance according to the set standards/objectives (Parkin & McKimm, 2009).
On the base of the literature review they mention that there are three methods to evaluate PA 1) Absolute standards, 2) relative standards, and 3) objectives (Jafari, Bourouni, & Amiri, 2009). On the other hand, a study conducted about performance assessment methods in healthcare providers demonstrate eight methods of evaluation among healthcare professionals out of which seven methods are directly used to evaluate nursing performance in different institutes (Hamilton et al., 2007).
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It was clear from the both studies mentioned above that there no any single method of evaluate clinical performance of nurses. Therefore, the first purpose of this essay is to review the evaluation method used at workplace in terms of its effectiveness, advantages, and disadvantage but this essay will focus only two methods like three hundred sixty degree feedback/ Multisource Feedback (MSF) and the other one is Objectives/ Management by Objectives (MBO). Secondly, discuss a change plan on the base of’ nurses’ knowledge and technical & interpersonal skills. However the last part will highlight the evaluation criteria used to evaluate PA.
Methods to evaluate PA
Appraisal/Performance review, supervision, reflection, process review, MSF, observation, supervision, and standards are the methods illustrated by Hamilton and colleagues (2007) but, this essay will review only MSF and MBO in the following paragraphs.
360-Degree/MSF Evaluation
As defined by Lockyer “360 degree employee evaluation is a questionnaire-based assessment method in which ratees are evaluated by peers, patients, and co-workers on key performance behaviors” (2003, p.4). By others it is also known as multi-rater feedback, MSF (Lockyer, 2003), or 360-degree assessment (Lelliott et al., 2008). Since the feedback comes from all around of an employee. 360 degree refers a circle; the center of the circle is individual being evaluated. Feedback is provided by juniors, colleagues, patients/customers, seniors and also through self-assessments (Palmer et al., 2007; Lelliott et al., 2008). So MSF is opposite to a traditional PA where the employees are evaluated by their managers only.
MSF is a survey based-method and in United States and in Alberta, Canada and UK it requires as a tool for maintenance of certification program and revalidation because 360-degree assessment is a requirement for relicensing and this method will give a significant outcome (Lockyer, 2003; Lelliott et al., 2008). However, it is also a valuable instrument to evaluate behavior of National Health Service (NHS) staff (Palmer, Rayner, & Wall, 2007). Proper utilization will help individuals and managers make decisions about career progression and promotion (Palmer et al., 2007; Lelliott et al., 2008).
MSF gives a rich evaluation of performance from different angles and is also psychometrically tested by several researchers in terms of reliability, validity, feasibility and acceptability especially for those who work in large multiprofessional institutions. It also covers two of the seven domains that required for good medical practice in UK 1) relationship with patients and 2) working with colleagues) which include good communication, being open and honest, and quality of relationship with patients’ family and friends, effective team working, respect for colleagues and appropriate sharing of information (Palmer et al., 2007; Lockyer, 2003; Lelliott et al., 2008).
It is useful for individuals to increased self awareness, performance and skill improvement, improved self perception accuracy, promotion, and improved attitude towards work. Moreover, it is recognized as a useful method which supports in employee decision making and quality improvement. Similar finding are discussed in their review that it helps to assess behaviors, performance and potential, develop insight into strengths and weaknesses, enhance team effectiveness, assess training needs, and enhance culture change within the organization, (Palmer et al., 2007). It has also high educational impact and is used to provide feedback and future performance guidance (Lockyer, 2003).
MSF is mostly used for Executive, management and leadership development programs in institutions as formal evaluation to promote, compensate, succession of plan, and other administrative reasons because, its main objective is to enhance a leader’s awareness of him/herself so that in different situations they may, improve how to see and deals with raters or those people he/she communicates everyday. Increased self-awareness can help them focus on their strengths as well as weaknesses. Moreover, evaluation collected from multiple sources is admired more extensive than from one traditional method. This gives more insight to effective leadership, as many researchers have proven its effectiveness (Palmer et al., 2007; Lockyer, 2003).
Management by Objectives (MOB)
As discussed in many studies in this PA method employee are evaluated against their objectives. Employees are evaluated on how well they have achieved a measured set of objectives that have been determined to be successful in completion of their job. This method is usually known as MOB (Halpern & Osofsky, 1990; Chandra & Franklin, 2004; Spaulding, Gamm, & Griffith, 2010).
MOB is also a process in which organizational objectives are transformed into individual objective to be evaluated by leaders/managers. Jafari add colleagues have divided into goal setting, action planning, self-control and periodic reviews (2009). The role of each employee is important for the effectiveness of this approach (Spaulding et al., 2010). However, as stated by them “rounding and multiple forms of feedback ensure a greater exchange of perspectives in multiple settings between leaders and followers” (Spaulding et al., 2010, p.6).
The basic purpose of MBO for employee to understand the roles and responsibilities in order to, understand how their works relate to the achievement of the organization’s objectives. MBO also places importance on fulfilling the personal goals of each employee. Some of the important advantages of MBO are:
Firstly, according to Chandra and Frank it gives encouragement and motivation as employees are involved in the objective/goal setting its ultimately, increases their empowerment which leads to employees’ job satisfaction and commitment with the institution. Not only this, it also provides frequent communication and Coordination between superiors and subordinates to have good relationships within the unit to solve many problems (2004).
Comparably, where it helps in the clarity of goals set for the individual in relation to department and organization it also provides opportunity for employees to become more committed in the accomplishment of objectives they have for themselves which built autonomous, and they can assess their own needs for continuing professional development (Hamilton et al., 2007). On top of everything managers can make sure that objectives of the employees are knotted to the institution’s objectives consequently, MBO methods based PA could increase the quality of nursing care (Ghasemi et al., 2007)
Advantages, Disadvantages and effectiveness of PA methods
As discussed above in light of studies, every approach used to evaluate PA has advantages and disadvantages therefore, combination of several methods to achieve goal is consider a best way. The leader should keep in mind organization’s goals, objectives as well. Not only this, an effective appraisal method should be reliable, trustworthy and free of error (CP & Schuwirth, 2005; Hamilton et al., 2007).
Change Plan/Re-evaluation
Recently a literature reviewed by Glenn finds that today hospitals are facing so many changes because of major developmental changes in the clinical practice as result of this change where employee experiences feeling of loss, doubt, stress and impulsiveness in the same time they feel sense of accomplishment and pride. The role of leader becomes more vital in the change process to become a change agent and help the subordinates especially in this situation of uncertainty (2010)
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The strategy used for this change process were on the base of previously used “theory of change” given by Lewin in the mid of 20th century and Roger a decade ago however, in the light of this change she mentioned that the role of leader to whom she called “clinical supervision” is to provide support and guidance to administer safe and effective care for patients. And the method of this change agent’s style is given the name of transformational leadership and a normative-re-educative (Glenn, 2010).
“Transformation is defined as a process of so fundamentally changing individuals and organizations that they more fully resonate with their own goals and demands for the future, calling for a new expectations, behaviours, and organizational performance” (Porter-O’Grady & Malloch, 2007 P.66). This requires awareness of leader for permanent and endless need for the changing environment. The components of transformation are: Creativity, innovation, new behaviors, new goals, deeper understanding, renewal, reenergized purpose. However, as discussed before it is a duty of the leader to translate change to the subordinates, finds meaning in the translation, and gets essential assistance and investment to start change.
A decade ago it was highlighted that the ways and instruments doctors and nurses work are change/different from the information technology (Simpson, 1998). Recently, a research about current knowledge and future training requirements of nurses in information and computer technology highlighted that the organization should pay more attention to train them. They emphasized on government and institutions to develop appropriate policy to compete with the change (Eley, Fallon, Soar, Buikstra, & Hegney, 2008). Conversely, in their study the use of information system have change the routines of work but it also provides chance to improve quality (Vartak, Crandall, Brokel, Wakefield, & Ward, 2009).
Conversely, another study shows that newly graduate nurses and registered nurses can enhance professional development in term of communication and practical skills, and learn to work with the teams as they work in the different department as a clinical rotation and through taking part in RN to BSN degree programs (Hunter, 2010; Stuever, 2009). The objective is to help employee to change their behaviors to improve technical performance skills, communication, work planning and timeline so, it is important to follow some steps to follow some standards to evaluate performance (Porter-O’Grady & Malloch, 2007).
Therefore, it is very important for the leader to arm nurses and him/her self to meet the challenge of the innovations and set criteria against which the standard of this change can be measured.
Evaluation Criteria
“There is no such thing as the reliability, the validity, or any other absolute, immanent characteristic of any assessment instrument” (CP & Schuwirth, 2005, P. 310). Their study was to develop taxonomy of performance behaviours based on a theoretical model of job performance and to assess the performance of nursing groups or individuals. Additionally, it is also useful in examining the links between nurse and patient outcomes.
Specifically, by using performance taxonomy that adequately covers the eight domains of task performance (i.e. technical care, information provision, coordination of care and emotional support) and contextual performance (i.e. interpersonal support, job task support, compliance to organizational rules and volunteering for additional duties). The components of this scale are same used to measure nursing performance in the past. For example, the Slater 84 items rating scale. Task and contextual performance used in the past was also the part of this pilot study in order to the convergent validity of the nurse performance taxonomy.
Below are some examples that help nurse manager set/develop a criteria on different scale against which he/she can evaluate the performance of their staff: these lines are taken from of their article
Example 1) ‘My unit achieves the objectives of the job’; strongly disagree (1) to strongly agree (7). Fifteen items adapted from Motowidlo and Van Scotter was used to measure contextual performance.
Example 2) ‘How likely is it that nurses in your unit would comply with instructions even when supervisors are not present’. Items were rated on a scale ranging from not at all likely (1) to extremely likely (5). These two scales were reliable with studies, respectively.
Example 3) Overall job performance was measured by asking nurses to rate the nurses in their unit on three 7-point scales from high, medium, and low ranges.high (6-7) ¼ exceeds standards for job performance, moderate (3-5) ¼ meets standards for job performance, and low (1-2) ¼ does not meet standards for job performance (Greenslade & Jimmieson, 2007).
Conclusion
As stated by Parkin and McKimm “Appraisal is a structured process for improving future clinical, managerial and educational performance while reviewing past performance” (2009, p. 528). Depending on usage any methods have its utility (Hamilton et al., 2007). There is no single method which is suitable and used as a standard to evaluate clinical performance of nurses because every method has advantages and disadvantages to assess the clinical performance of nurses. However, as discussed earlier that MSF and MBO are reliable and valid tools and can be used to evaluate the PA in clinical setting.
Although, it is a responsibility of the team leader to change the plan or methods according the need of person and organization in case if there is Creativity, innovation, new behaviors, new goals, deeper understanding, renewal, reenergized purpose. But there should be some criteria against which leader can measure these objectives and this tool should be valid and reliable and the task and contextual criteria used to evaluate nursing performance is reliable and valid tool.
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