Performance Improvement Approach Orientation

The

Performance Improvement Approach

An Orientation For Project Team

By Isaac Munene

Today’s learning objectives

• Be able to define the Performance Improvement

Approach (PIA)

• Name the 5 performance factors

• Describe the steps in the PI framework

• Thirst for more!!

Introductions

• As we go around the room, say:

– Your name

– Your position

– Knowledge or experience with PI

Who Wants to Be a Millionaire?

• What is the name of the group of people who are essential decision makers in the Performance Improvement process?

Important People

Stakeholders

Presidents

Facilitators


• Which of the following is NOT a performance factor (conditions necessary for people to perform well in their jobs)?

Clear Job Expectations

Performance Feedback

Skills and Knowledge

Advocacy


• Which of the following is NOT a performance factor (conditions necessary for people to

perform well in their jobs)?

Clear Job Expectations

Performance Feedback

Skills and Knowledge

Advocacy


• What term is used to describe the difference between desired performance and actual performance in the Performance Improvement framework?

Performance hole

Performance spiral

Performance gap

Performance differential


• What is the name of the process where data is collected to assess what performance problems exist and what factors are causing them?

Performance Needs Assessment

Performance Evaluation

Training Evaluation

Performance Factoring

What is Performance?

The tasks that people do and the results

of those tasks

Effort Performance

What is the Performance

Improvement Approach?

A step-by-step methodology for finding out

what is needed to ensure good performance,

and delivering it

Factors Influencing Performance

Environment and supplies

Job expectations

Performance feedback

Motivation and incentives

Skills & knowledge

Organizational Support: Using Performance

Factors

Job Expectations

• Do providers know what is

expected of them?

– Guidelines, policies, standards,

procedures, protocols, job

descriptions

Performance feedback

Do providers know how they are doing compared to set expectations or standards?

Motivation/Incentives

• Do providers have a reason to

perform as they are asked to

perform?

• Does anyone notice when they

perform well?

Physical Environment

The infrastructure, supplies, materials, and tools necessary to do the job.

Knowledge and Skills

• Do providers know

how to do the

required job?

• Are there systems

and interventions to

address how to do a

job

Organizational Support

• Does the organization assure that all the performance factors are in place?

• Through supportive supervision, communication mechanisms, training, functioning logistics systems, developing job descriptions, updating and disseminating policies, norms, and protocols…

Benefits of PI

• Use systematic approach for finding the root cause of the performance problem

• Helps avoid making assumptions

• Data driven

• Allowing you to implement the best intervention that applies only to that root cause

• Ensures training has maximum impact

PI answers these questions

What performance do we have now? (Actual)

What performance do we want? (Desired)

What is the difference? (Gap)

Why is there a difference? (Root causes)

What should we do about it? (Interventions)

Performance Measures…

• Quality

– Does the performance match the standard?

• Provider should counsel clients on the side effects of their chosen method during FP counseling.

• Quantity

– Does the performance happen as much or as often as it should?

• Each provider sterilizes 4 sets of instruments at the beginning of each day.

• The provider should always discuss side effects of the FP method the client selects (100% of the time).

Performance Measures…

• Timeliness – Does the performance happen on time?

• The provider should be ready to see clients by 9:00 a.m., every day.

– Does the performance happen as often as it should?

• The provider should do family planning counseling with all eligible women and couples (100% of the time).

PI Framework

CONSIDER

INSTITUTIONAL

CONTEXT

MISS ION

GOALS

STRATEGIES

CULTURE

CLIENT AND

COMMUNITY

PERSPECTIVES

OBTAIN AND MAINTAIN STAKEHOLDER AGREEMENT

MONITOR AND EVALUATE PERFORMANCE

DEFINE DESIRED

PERFORMANCE

FIND ROOT

CAUSES

WHY DOES THE

PERFORMANCE

GAP EXIST?

SELECT

INTERVENTIONS

WHAT CAN BE DONE

TO CLOSE THE

PERFORMANCE GAP?

DESCRIBE ACTUAL

PERFORMANCE

PERFORMANCE

GAP

IMPLEMENT

INTERVENTION

PNA

Steps in Performance

Improvement

Consider the institutional context

Stakeholder agreement

Define desired performance

Determine actual performance

Identify performance gaps

Analyze root causes

Select interventions

Develop draft action plans

Implement Interventions

Monitor and evaluate interventions

Performance

Needs

Assessment

Example-FP Providers

• Desired: 100% adherence to client-provider interaction norms

• Actual: 60% adherence to norms

• Gap: 40% of providers not adhering to norms

• Root causes: unclear expectations, lack of client provider interaction (CPI) skills, no feedback

• Interventions: CPI norms training, feedback from clients

Example-2

• Desired: counsel 100% of eligible clients

• Actual: counseling less than 25%

• Gap: 75%

• Root causes: incentives, supplies

• Interventions: incentive ($), supply chain

Let’s break the stages down one by one

CONSIDER

INSTITUTIONAL

CONTEXT

MISSION

GOALS

STRATEGIES

CULTURE

CLIENT AND

COMMUNITY

PERSPECTIVES



DEFINE DESIRED

PERFORMANCE

FIND ROOT

CAUSES

WHY DOES THE

PERFORMANCE

GAP EXIST?

SELECT

INTERVENTIONS

WHAT CAN BE DONE

TO CLOSE THE

PERFORMANCE GAP?

DESCRIBE ACTUAL

PERFORMANCE

IMPLEMENT

INTERVENTION

Consider Institutional Context

• The mission of the organization

• The goals of the program

• Strategies in use already

• Culture of the organization and the country

• Client and community perspectives

CONSIDER

INSTITUTIONAL

CONTEXT

MISSION

GOALS

STRATEGIES

CULTURE

CLIENT AND

COMMUNITY

PERSPECTIVES



DEFINE DESIRED

PERFORMANCE

FIND ROOT

CAUSES

WHY DOES THE

PERFORMANCE

GAP EXIST?

SELECT

INTERVENTIONS

WHAT CAN BE DONE

TO CLOSE THE

PERFORMANCE GAP?

DESCRIBE ACTUAL

PERFORMANCE

IMPLEMENT

INTERVENTION

Obtain and Maintain Stakeholder Agreement

• Who are stakeholders?

• Gather information from key stakeholders

• Stakeholders meet to agree on desired outcomes

• Actively participate in identifying goals, prioritizing performance problems, analyzing root causes and selecting interventions

• Ownership of process and commitment to making improvements

CONSIDER

INSTITUTIONAL

CONTEXT

MISSION

GOALS

STRATEGIES

CULTURE

CLIENT AND

COMMUNITY

PERSPECTIVES



DEFINE DESIRED

PERFORMANCE

FIND ROOT

CAUSES

WHY DOES THE

PERFORMANCE

GAP EXIST?

SELECT

INTERVENTIONS

WHAT CAN BE DONE

TO CLOSE THE

PERFORMANCE GAP?

DESCRIBE ACTUAL

PERFORMANCE

IMPLEMENT

INTERVENTION

Define Desired Performance

Definition:

What the organization would like to see happening,

Where do we want to go?

How do we want things to be?

i.e. What should the standard of FP services be?

What are the goals of the FP program?

What should providers, supervisors, and facilities be doing

to reach goals and objectives?

Defined by stakeholder consensus using

specific, measurable terms

Desired Performance Statements

Identify the performer

State accomplishments or behavior within control of

the performer

Observable

Measurable

Specific, can be agreed upon by independent

observers

Example: All FP providers should counsel FP clients on

HIV risk and prevention according to standards.

Desired Performance

Statements

Indicators Desired

Levels

Providers counsel FP clients

on side effects of their

selected method.

% of providers who tell clients about

the possible side effects of their

chosen method

90%

Providers promote male

involvement in RH/FP

services.

% of providers who encourage

women to have their spouse join

them for their FP consultation

60%

Community leaders should

talk about the benefits of FP

during community meetings.

% of community leaders who

mention FP during meetings in the

community

50%

Examples of desired performance

Practice 1—Define Desired

Performance Statements

Job: Waiter/waitress in a restaurant

Describe 2 desired performance statements

for this person

You have 15 minutes

CONSIDER

INSTITUTIONAL

CONTEXT

MISSION

GOALS

STRATEGIES

CULTURE

CLIENT AND

COMMUNITY

PERSPECTIVES



DEFINE DESIRED

PERFORMANCE

FIND ROOT

CAUSES

WHY DOES THE

PERFORMANCE

GAP EXIST?

SELECT

INTERVENTIONS

WHAT CAN BE DONE

TO CLOSE THE

PERFORMANCE GAP?

DESCRIBE ACTUAL

PERFORMANCE

IMPLEMENT

INTERVENTION

Methods for assessing actual performance

Use existing data!

Direct observation of performance

Facility audit

Provider interview

Clinic record review

Focus groups with community members

Client exit interview

Household survey

• Self-assessment

Actual Performance

Statements

One for each desired performance statement

Desired and actual performance are

measured with same indicators

Desired Performance

Statements

Actual Performance

Statements

90% of providers counsel FP clients

on side effects of their chosen

FP method

60% of providers counsel FP clients on

side effects of their chosen FP

method

60% of providers encourage women

to have their spouse join them for

their FP consultation

20% of providers encourage women to

have their spouse join them for


50% of community leaders mention FP

during meetings in the community

0% of community leaders mention FP

during meetings in the community

Examples of actual performance statements

CONSIDER

INSTITUTIONAL

CONTEXT

MISSION

GOALS

STRATEGIES

CULTURE

CLIENT AND

COMMUNITY

PERSPECTIVES



DEFINE DESIRED

PERFORMANCE

FIND ROOT

CAUSES

WHY DOES THE

PERFORMANCE

GAP EXIST?

SELECT

INTERVENTIONS

WHAT CAN BE DONE

TO CLOSE THE

PERFORMANCE GAP?

DESCRIBE ACTUAL

PERFORMANCE

IMPLEMENT

INTERVENTION

What is a Performance Gap?

Desired Performance — Actual Performance

Desired Performance

For example:

50% - 10% X 100 = 80% Gap

50%

X 100 = GAP

Desired Performance

Statements

Actual Performance

Statements

Performance

Gaps

90% of providers counsel

FP clients on side effects of

their chosen FP method

60% of providers counsel

FP clients on side effects of

their chosen FP method

33% of providers do NOT

counsel FP clients on side

effects of their chosen FP

method

60% of providers

encourage women to have

their spouse join them for


20% of providers




67% of providers do NOT




50% of community leaders

mention FP during

meetings in the community

0% of community leaders

mention FP during meetings

in community

100% of community

leaders do NOT mention

FP during meetings in the

community

Examples of Performance Gaps

Prioritize Performance Gaps

• Cannot work on every performance gap at once – Resources are limited

– Need to focus the efforts for greater success

• How to prioritize gaps? Largest gaps

Critical area of performance

• Can select via democratic voting process or other method

• Place in priority order (i.e. highest number of votes to lowest number)

Practice 2—Performance Gaps

• For each desired performance statement discuss and agree on actual performance based on your experience eating out

• Determine the size of the gap for each performance statement

• You have 3 minutes.

CONSIDER

INSTITUTIONAL

CONTEXT

MISSION

GOALS

STRATEGIES

CULTURE

CLIENT AND

COMMUNITY

PERSPECTIVES



DEFINE DESIRED

PERFORMANCE

FIND ROOT

CAUSES

WHY DOES THE

PERFORMANCE

GAP EXIST?

SELECT

INTERVENTIONS

WHAT CAN BE DONE

TO CLOSE THE

PERFORMANCE GAP?

DESCRIBE ACTUAL

PERFORMANCE

IMPLEMENT

INTERVENTION

Root Cause Analysis—Multiple Whys

Why?

Why?

Why?

Root Cause Analysis Technique

For each gap, ask “why is this happening?”

For each answer, ask “why” again?

Record all responses as they come up

Keep asking “why?” until there are no more reasons

Stop when you say “I don’t know”

The root cause is the lowest-level cause that something can

be done about.

Gap: Supervisors are not making appropriate number of supervision visits

Root Cause Analysis Example

Did not know how many visits were expected No transport

No one told them Have no job

description No funds

No one developed a

Job description

No one’s job

to tell them Did not request funds

Did not know how to complete

the funding request form

Were not trained

Have no supervisor

No support system for them

Not in their

training

Example: Ghana,

2000

Why? Why?

Why? Why?

Why? Why?

Why?

Why? Why?

Why?

Why?

Why?

Why?

I don’t

know

I don’t

know

I don’t know I don’t know

Why?

Why?

Why? Why?

Practice 3—Root Cause Analysis

• Discuss and select the priority performance gap that is most important to work on first

• Use the multiple whys technique to uncover the root cause (s) for that 1 gap

• You have 15 minutes.

CONSIDER

INSTITUTIONAL

CONTEXT

MISSION

GOALS

STRATEGIES

CULTURE

CLIENT AND

COMMUNITY

PERSPECTIVES



DEFINE DESIRED

PERFORMANCE

FIND ROOT

CAUSES

WHY DOES THE

PERFORMANCE

GAP EXIST?

SELECT

INTERVENTIONS

WHAT CAN BE DONE

TO CLOSE THE

PERFORMANCE GAP?

DESCRIBE ACTUAL

PERFORMANCE

IMPLEMENT

INTERVENTION

Steps to select interventions (1)

• Define intervention criteria

• Make a list of criteria for judging possible interventions, some examples include:

• Affordable

• Feasible (considering resources)

• Time bound (i.e. completed within 1 year)

• Culturally appropriate

Steps to select interventions (2)

• Brainstorm possible interventions – Generate as many possibilities as you can

• Prioritize and select interventions – Compare each intervention to criteria list – Cross out those that do not meet the criteria

• Select the best intervention to fix the root cause—aim for 1 intervention per root cause

• Develop action plan for each intervention: – Activities/steps/tasks – Person responsible – Timeframe

Intervention and Action Plan Format

Performance

Gap

Root

Cause

Intervention Activity/

Steps

Person

Respon-

sible

Time-

frame

Clinical

officers,

midwives, and

nurses are not

performing

IUCD insertion

Lack of

knowledge

and skills

Training of

health workers

Identify

training

sites

Identify

trainees

Identify

supplies

Conduct

training

District

director

District

Nurse

District

health team

District

trainers

30-03-05

30-03-05

30-04-05

30-04-05

Design Interventions

• Form and convene a design and development team

– Involve potential implementers

• Develop a workplan for the design and development team

• Design and develop interventions

• Field test where appropriate

• Identify input, process and output indicators

CONSIDER

INSTITUTIONAL

CONTEXT

MISSION

GOALS

STRATEGIES

CULTURE

CLIENT AND

COMMUNITY

PERSPECTIVES



DEFINE DESIRED

PERFORMANCE

FIND ROOT

CAUSES

WHY DOES THE

PERFORMANCE

GAP EXIST?

SELECT

INTERVENTIONS

WHAT CAN BE DONE

TO CLOSE THE

PERFORMANCE GAP?

DESCRIBE ACTUAL

PERFORMANCE

IMPLEMENT

INTERVENTION

Implement Interventions

• Develop an implementation plan and a monitoring and evaluation plan

• Identify and mobilize resources

• Carry out interventions

• Foster and document organizational change process

CONSIDER

INSTITUTIONAL

CONTEXT

MISSION

GOALS

STRATEGIES

CULTURE

CLIENT AND

COMMUNITY

PERSPECTIVES



DEFINE DESIRED

PERFORMANCE

FIND ROOT

CAUSES

WHY DOES THE

PERFORMANCE

GAP EXIST?

SELECT

INTERVENTIONS

WHAT CAN BE DONE

TO CLOSE THE

PERFORMANCE GAP?

DESCRIBE ACTUAL

PERFORMANCE

IMPLEMENT

INTERVENTION

Monitor & evaluate performance

• Monitor the implementation and make adjustments as

necessary

• Repeat the baseline data collection exercise using the same

indicators and instruments

• Compare baseline to final results

– Make statements about the extent to which the gaps closed

• Where goals were met, celebrate!

• Where goals were not met, analyze and cycle through PI

process again

What questions or comments do you have?

Performance Improvement Approach Orientation

Documents

Transcript of Performance Improvement Approach Orientation