Performance management of health professionals : an evaluation research study of health services in the subdistrict of Buffalo City in the Provincial Department of Health in the Eastern Cape

摘要

Integrative Summary In 1997 the Minister of Public Service and Administration of South Africa, Zola Skweyiya, introduced the White Paper on Transforming Public Service Delivery(Department of Public Service and Administration(DPSA,1997: 1). It was premised on what was called Batho Pele (DPSA, 1997: 9), giving effect to Section 197 of the Constitution, Act 108 of 1996 as amended. A linkage to performance management can be found from the assertion made in the White Paper that in future the Batho Pele would form the basis of any assessment of the performance of individual staff and that would contribute to improving the delivery of service (DPSA, 1997:16). Another factor that contributed to the utilisation of a performance management system was the recommendation put forward by the Public Service Commission of South Africa( PSC,2004: 16),that called for public institutions to adopt a clear, comprehensive performance management and evaluation framework for the delivery of public service. That was expected to turn around the ailing public institutions whose record of serving the public with pride and dignity was on the decline. The research aim was to evaluate the effectiveness of the performance management system in creating and resolving role conflict with health professionals employed by the Buffalo City sub-district. The research goal was divided into three objectives, namely: evaluation of the effectiveness of the performance management system as a managerial tool for health managers to manage their subordinates including both professional and support staff, evaluation of the effectiveness of the performance system from the perspective of the health professional as a subordinate and to analyze the functioning and effectiveness of the system in creating and resolving role conflict between professional conduct and organisational requirements. The respondents noted that the implementation of the system was not matched with appointment at managerial level with officials having relevant managerial capacity. Further to that resources at the coal face of service delivery continued to deteriorate and became very scarce and there is no documented proof that has been found of an effort made to check the compatibility of the system to health professionals. The literature identified negative effects that have emanated from the implementation of the performance management system. The study was conducted by interviewing health professionals from the entry level to the management level within the Buffalo City sub-district from three mini hospitals or Health Care Centres. The respondents indicated that there are positives that have been achieved by the implementation of the system, such as the skills gap identification as well as specific targets contained in annual performance contracts. These targets help motivate health professional to focus on that particular direction of activities. Unfortunately it has been clearly documented that the performance management system has also contributed to the development of role conflict in a number of professionals. It has been documented that the system has not been crafted with a health professional in mind and, as such, appears to favour quantity rather than quality of health services as advocated by the codes of practice of different health professionals. There are a number of recommendations that were put forward by the respondents to try to salvage the system and in mitigation of the identified negative factors. For the improvement of the system, the Eastern Cape Provincial Department of Health has to firstly customise the annual contracts to contain only the fundamental information. Secondly need to improve the transparency pertaining to financial pressures facing the Health Department. Thirdly the provision of essential enablers, need to be prioritised. Fourthly there is a need to upgrade the system to incorporate 360 degree feedback. Further research recommendations include a bigger sample incorporating different research methods and to also incorporate searches for measures that can be implemented to improve the system to be more relevant to health professionals. This document is organised and presented in three sections. The first section is the evaluation report with a review of literature, research methodology, findings, discussion and conclusion. The second section is where an indepth literature review is located and the last section details the research methodology.