Performance evaluation: discussing technology for planning and managing health worforce

Abstracts

Este ensaio apresenta o produto de reflexões e análises a partir do exame de opções conceituais inerentes às metodologias de avaliação de desempenho (AD) de profissionais e sua possibilidade de aplicação na área da saúde. Estabelece uma discussão conceitual para a área, articulando e integrando conhecimentos de campos distintos - o da saúde e o da administração pública. Promove a intersecção entre a gestão do trabalho em saúde no setor público e as técnicas da administração de pessoal. Pretende gerar novas análises e estudos que possibilitem uma releitura das práticas administrativas para avaliação de desempenho utilizadas nas organizações, adaptá-las para atender às especificidades do setor saúde.

Avaliação de desempenho; Recursos humanos; Recursos humanos em saúde; Administração de recursos humanos em saúde

REFLECTION

Performande evaluation: discussing technology for planning and managing health workforce

Evaluación de desempeño: discutiendo tecnología para planificación y gestión de recursos humanos en salud

Celia Regina Pierantoni^I; Tania França^II; Marcia Silveira Ney^III; Valéria Oliveira Monteiro^IV; Thereza Christina Varella^V; Maria Ruth dos Santos^VI; Dayane Nascimento^VII

^IPhysician. Ph.D. in Collective Health. Adjunct Professor, Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro. General Collaborator of the Rede Observatório de Recursos Humanos em Saúde, Estação de Trabalho do Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro. Director of the Pan American Organization /World Health Organization Collaborating Centre for Health Workforce Planning and Information. Rio de Janeiro, RJ, Brazil. [e-mail]

^IIStatistician. Ph.D. in Collective Health. , Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro. Adjunct Collaborator of the Rede Observatório de Recursos Humanos em Saúde, Estação de Trabalho do Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro. Rio de Janeiro, RJ, Brazil. [e-mail]

^IIIPhysician. Fellow doctoral student of the Collective Health Graduate Study Program, Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro. Rio de Janeiro, RJ, Brazil. [e-mail]

^IVNurse. PhD. in nursing. Adjunct Professor, College of Nursing, Universidade Estadual do Rio de Janeiro. Rio de Janeiro, RJ, Brazil. [e-mail]

^VNurse. Ph.D. in Collective Health. Adjunct Professor, College of Nursing, Universidade Estadual do Rio de Janeiro. Researcher, Rede Observatório de Recursos Humanos em Saúde, Estação de Trabalho do Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro. Rio de Janeiro, RJ, Brazil. [e-mail]

^VIPharmacist. Ph.D. in Collective Health. Researcher, Rede Observatório de Recursos Humanos em Saúde, Estação de Trabalho do Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro. Rio de Janeiro, RJ, Brazil. [e-mail]

^VIIPsychology graduate, Psychology Institute, Universidade Estadual do Rio de Janeiro. Holder of a "Scientific Initiation" Grant - PIBIC/UERJ. Rio de Janeiro, RJ, Brazil. [e-mail]

^{Correspondence addressed to:}

ABSTRACT

This essay presents the outcome of reflections and analyses from examining the conceptual options inherent to the methodologies of employee performance appraisal (PA) and its possible application in the health area. It sets a conceptual discussion of the area, associating and integrating knowledge from different fields - health and public administration. It promotes an intersection between public health work management and personnel management strategies. It has the purpose to generate new analyses and studies that would allow for a new approach of the management practices for performance appraisals used in companies, adapting them to meet the specificities of the health sector.

Descriptors: Employee performance appraisal; Human resources; Health manpower; Health personnel management

RESUMEN

Este ensayo presenta el producto de reflexiones y análisis basado en el examen de las opciones conceptuales inherentes a las teorías de evaluación del desempeño (ED) de los profesionales y su posible aplicación en el área de salud. Establece una discusión conceptual para el área, articulando e integrando conocimientos de diversos campos - el de la salud y el de la administración pública. Promueve la intersección entre la gestión del trabajo en salud en el sector público y las técnicas de administración de personal. Pretende ser generador de nuevos análisis y estudios que permitan una relectura de las prácticas administrativas para evaluación de desempeño utilizadas en las organizaciones y adaptarlas para atender a las particularidades del sector de salud.

Descriptores: Evaluación del rendimiento de empleados; Recursos humanos; Recursos humanos en salud; Administración del personal en salud

INTRODUCTION

Recently, the media reported a crisis in the Brazilian Symphony Orchestra caused by the decision of the conductor Marcelo Minczuck to implement a system of employee performance appraisal (PA) for the musicians aimed at achieving excellence and higher technical degrees. The measure was not accepted by part of the body of musicians integrating the orchestra, taking the fact to law courts. The controversy regarding the case raised enthusiastic debates both for and against the conductor's management.

In fact, while the topic performance appraisal gains space of discussion over the management of the public sector personnel, it also causes controversy among managers and employees. The challenge is to promote a reflection about the subject according to a theoretical review that encourages the intersection between public health work management and personnel management strategies. In the Brazilian health system, the setting and definition of solutions for the major problems existing in the work field have required appraisal processes that involve the local and organizational contexts in which they occur.

The field of work and education management involves: the selection, distribution and staffing of personnel in work positions, with the required qualification. It also comprehends the offer of possibilities of education and qualification that meets the needs for the development of competences for quality health care, mediated in the work regulation field by the interfaces with professional corporations and with the educational market ⁽¹⁾.

A recent study⁽²⁾ indicates that there is space for the analysis and reflection of the conditions in which the management practices are developed in a field that is still under construction. The results point to a low capacity in the use of management tools such as information systems, mechanisms of work negotiation, instruments of institutionalization of the career and capacity of education and qualification of the employees.

The national project designed with the National Policy in Health Innovation, Technology and Sciences (Política Nacional de Ciência, Tecnologia e Inovação em Saúde - PNCTIS) and the National Agenda of Priorities in Health Research (Agenda Nacional de Prioridades de Pesquisa em Saúde - ANPPS) searches for initiatives to adapt the mechanisms of work management to the actions and services of the Single Health System, which are being contemplated in the line of health work management. The proposals of investment in research for the development of methodologies to evaluate the mechanisms of incentive to the productivity and performance appraisal in the various levels of complexity of the SHS confirm the gaps of knowledge in these areas^(3-4).

It is fundamental to adopt models of professional performance appraisal that support both the demands of the services and the protection of the professional exercise and, especially, protect the user of these services with qualified and risk-free actions.

Supporting the need to establish a regulation on the procedures adopted for the performance appraisal in the public service, the federal government published the Decree no. 7.133 in 2010, which presents the criteria and general rules for the execution of the performance appraisal in the public service. This process has been used as an instrument to provide subsidies for the payment of performance rewards to the employees of the federal executive department, including health professionals. The innovation in the process consists of the fact that the employee is appraised not only by the immediate leader, but also by the work team in which he/she is inserted ⁽⁵⁾.

This essay intends to encourage the reflection and generate new analyses and studies that may provide an updated and humanized approach of the administrative practices for the performance appraisal used in companies, aiming at the political and social development of the employees and, in particular, of the health sector, articulating and integrating the knowledge from different fields: health and public administration.

DISCUSSION

The health sector is characterized by complex interventions and situations inherent to the processes for promoting health, preventing aggravations, caring and recovering people, thus, producing constant challenges to the managers and employees. Public services are the target of discussions with focus on the care quality, access, attention and on the resolution of problems⁽⁶⁾.

The consensual aspect of the term appraisal is its characteristic of value attribution. In the perspective of the performance appraisal, it must be understood as an instrument of the work process, allowing indicatives of improvement and adaptation for the production of health care. Considering its classificatory character, the performance appraisal may represent an instrument that favors the employee, the manager and the service, by indicating adjustments, qualification needs and work conditions. The appraising process works as one of the mechanisms for transformations in the functional scope of the public organizations, and may be used in order to investigate deficiencies and provide policies for professional development.

The task to appraise the performance is presented as an activity with a double dimension: politics, because appraising is analyzing based on the generation of value judgments for the introduction of institutional, organizational and management innovations and changes; and the technical-operative, because it requires the production of gauging methods and instruments. Therefore, the appraisal is a result from the combination of political intention and execution capacity⁽⁷⁾.

The practices of the PA are not new. The Society of Jesus, founded by Saint Ignatius Loyola, used an appraisal system for the activities and potential of each one of its Jesuits. In the course of time, other institutions ended up implementing the process of performance appraisal, such as the Federal Public Service of the United States, which implemented, in 1842, a system of annual reports to appraise the performance of its employees; the American Army, which adopted the same process in 1880; the General Motors, which developed an appraisal system for its executives in 1918. However, it was only after the Second World War that the performance appraisal gained space in the organizations⁽⁸⁾.

The human performance should be not only planned but also appraised and oriented towards common objectives⁽⁷⁾. Considered the precursor in the appraisal of employees, Taylor developed studies regarding the techniques of work rationalization, defending the application of scientific methods to the management to guarantee their objectives from maximum production to minimum cost⁽⁹⁾.

The historical journey of the appraisal actions starts at a first stage centered in the measure of the phenomenon analyzed for the focalization of the ways to achieve results, evolving to the judgment of the interventions and, currently, to a process that tends to the negotiation between the parts involved in the intervention to be appraised⁽¹⁰⁾.

Appraising means, in synthesis, to compare the achieved results to those expected (planned) so that only the work previously planned is the appraisal object. This fact presupposes not only the comparison between what is expected from the subject in terms of achievement (expected result) and effective execution (executed work), but also the existence of a monitoring mechanism that allows to correct deviations to assure the execution corresponding to the planning⁽¹¹⁾.

The appraisal may contribute to the feasibility of activities of internal and external control, by public institutions and by the society, taking more transparency and responsibility to the government actions. Therefore, one of the main characteristics of the appraisal must be the simultaneous integration to the entire management cycle, since the initial moment of the problem identification⁽¹²⁾.

The use of the concept of competence in the organization of the services implicates the review of the appraisal procedures of the employees. Through the actions of performance monitoring, each subject is aware of which result must be reached and how it can be reached. The competences are the base for the language to define the necessary behaviors that allow the performance improvement and execution.

The concept of competence involves directly the subject inserted in the work team, his practical activity and daily routine, in a constant know/learn process. The subject must be able to take the initiative and to assume responsibilities in face of the professional situations to which he is exposed. The responsibility is, undoubtedly, the counterpart of the autonomy and decentralization of the decision-making. Thus, a person or a team, by accepting/assuming responsibilities, accepts to be judged and appraised according to the results they are accountable for. They compromise and explicitly owe the results of their activity⁽¹³⁾.

This concept concerns a set of three interdependent dimensions necessary to achieve a certain purpose: knowledge, abilities and attitudes. In other words, the technical questions, the cognition and the attitudes related to the work: knowing what and why; knowing how and finally the desire to do, the identity and the determination^(13-14).

Once characterized the individual and collective competences, through the performance appraisal in the organization, it is possible to identify potential innovators, qualify and manage their employees. The management by competences is a practice that aims to increase the global performance of the institution through the increase of the individual performance of its employees. The performance management based on competences considers the character of complementarity and interdependence between competence and performance, since both the management of performance and that of competences presume a process that considers the connection among the actions of planning, monitoring and appraising⁽¹³⁾.

Supported by the same presupposition, the competence or performance of the employee has influence over the services, forming consensus on an integrative view in which the appraising processes contemplate both the development of the employee and the development of the service. From this perspective, appraising represents a powerful management instrument as it can and must be used during the entire management cycle: once characterized by extremely technical, bureaucratic and rational environments, it currently faces renovation demands.

The management of the public service personnel has assumed the principles of the strategic management, understanding people as a determinant resource for the organizational success. The competitiveness imposed to the organizations, in general, refers to the need to count on highly qualified professionals, who are able to confront the threats and opportunities. Considering this logic, the appraisal works as one of the mechanisms for transformations in the functional scope of the public institutions, and it may be used in order to investigate deficiencies and provide policies of professional development.

In Brazil, the first guidelines for the plan of classification and appraisal of performance in the public administration were presented through the Law no. 284 from 28/10/1936 - Legislation, which treats the readjustment of the staffing and payments of the civil public employees of the Union, named law of the adjustment⁽¹⁵⁾.

The guidelines for the process of salary negotiation and reorganization of the model of human resources management, defined in 2007 by the Department of Human Resources of the Ministry of Planning, established criteria like the consolidation of the use of objective indicators for the performance of employees, teams and organs and the systematic redefinition of the performance appraisal, which will guide the management policy with effects in the salary composition of the employees⁽¹⁶⁾.

In the health public sector, the reform process is set on the debate among the public/private, the decentralization and the reform of the public service, the management of performance and the retention of personnel. Adjustments to the workforce in the long term and a redefinition of roles of the health professionals in the provision of care must occupy an important place in the workforce planning, in which processes of systematic and consistent appraisal remain recommended in order to subsidize the public management⁽¹⁷⁾.

FINAL CONSIDERATIONS

The subject performance appraisal leads to the reflection about the fact that the attitude of appraising is inherent to the human being. People are always in a position to make judgments: if someone watches a theater play, he/she forms an opinion about the content and performance of the actors, when watching a soccer game, the performance of the players and the coach is judged, and so on. However, these are informal exams made routinely about all the aspects of our lives.

The institutional appraising processes demand more formal and strict criteria, which transform subjectivity into objectivity, through detailed, perceptive and systematized judgment⁽¹¹⁾. Innovations in the management processes are characterized by the horizontality of the management functions and the resignification of the human resources management to a broader concept that involves the work management. It demands the employees to search for new attributes through the broadening of their knowledge and functional polyvalence, in order to guarantee space in a world that is presenting less and less employment opportunities⁽¹⁸⁾.

The decentralization of the health management approaches the human resources management of the real operations, increasing the pressure on the users that demand actions from the managers that guarantee a qualified performance. The principle would be simple: explicit objectives and purposes guide the individual performance, articulating them to the objectives of the service and the organization. Once the performance is quantified regarding these objectives, it is possible to promote the behaviors wanted through financial incentives and others.

However, according to studies from the World Health Organization⁽¹⁷⁾, there are few evidences that the systems of formal management of performance really affect the quality or the results for the customers.

Nevertheless, it would be ingenuous to attribute to the performance management the solution for the problems that the planning failed to solve and disregard the fact that, for the establishment of a management culture that incorporates the effective use of PA of employees, some challenges should be overcome, such as the establishment of parameters for appraisal; appraisal organizational culture; broadening of the use of appraisal beyond the salary policy; the expansion of the process generally limited to a person from a higher hierarchic level; the use of more precise and objective multiple instruments, among others⁽¹⁹⁾.

REFERENCES

Received: 09/19/2011

Approved: 10/13/2011

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• ³
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Correspondence addressed to:

Celia Regina Pierantoni

Universidade do Estado do Rio de Janeiro

R. São Francisco Xavier, 524 - 7º andar - Bl. E - Sl. 7010 - Maracanã

CEP 20550-900 - Rio de Janeiro, RJ, Brazil

Publication Dates

• Publication in this collection
  24 Jan 2012
• Date of issue
  Dec 2011

History

• Accepted
  13 Oct 2011
• Received
  19 Sept 2011