Every three years, hospitals go through an accreditation review, in which they’re assessed against a set of national standards, both by external experts and by the hospitals themselves.
HR development and management is an important element of that accreditation, along with patient care and delivery of service, information management and governance.
In its latest accreditation review two years ago, Mount Sinai Hospital in Toronto was lauded for a number of HR initiatives, including recruitment and retention, human rights, workplace behaviour and diversity programs.
However, the hospital was urged to improve its performance management process to ensure that staff receive regular feedback. With that prompting, and with support from employee surveys, the hospital has rolled out an automated performance management system.
“I wanted something progressive that would move the organization forward on the human resources front and support our balanced scorecard measurement system,” says Debbie Fischer, senior vice-president, organizational development and strategic projects at Mount Sinai.
“The scorecard goes beyond standard financial measures to look at outcomes in the four key areas of efficiency and growth, safety, patient and family-centred care, and learning and innovation.”
The hospital had been using paper-based performance management systems that were specific to each department and introduced on an ad hoc basis. Hence, incomplete record-keeping resulted, and in employee surveys, staff said they needed better communication and more skills development. They said they wanted a performance review process that was regular, fair and consistent.
Fischer is impressed with the advantages of going online. With a single click on the computer, managers can have access to everything from previous appraisals to comparisons among employees to ensure fairness. Senior managers can compare performance results by area of competency or by work group. Reporting is easy for any number of items including needs assessments, competency gaps, training plans and department roll-ups.
There is also the potential for future initiatives such as 360-degree feedback. It can also link to a job evaluation project, a parallel activity now underway.
“We want to be known as a top employer dedicated to continuous learning,” says Fischer. “Our strategic goals include being a leader in the use of technology. This performance management system is user-friendly, and intuitive for a diverse population with a variety of IT abilities. It involves employees in their own performance assessment and learning needs.”
Mount Sinai is using Halogen’s eAppraisal Healthcare. The hospital chose this over others because it’s easy to use and has the sought-for reporting capacity. The software is based on the cascading of goals from the high-level mission statement, through department goals to group goals and individual activities. The timetable for appraisals can be annual, tied to an employment anniversary or a common date, or programmed to shorter intervals to meet probation requirements or performance improvement targets.
Donna Ronayne, vice-president of marketing and business development at Halogen Software in Ottawa, says the software automates processes as they exist.
“Every organization has its own fingerprint for culture and values that should be reflected in an employee appraisal. No system can think for you. It takes human intervention to define the role of the department and the individual in realizing the corporate goals.”
Ronayne says that the workflow is automated so that the right documents and the right forms are sent to the right people at the right time. The system contains reminders at all stages in the process, including training dates. Once a task is completed, the next person is notified as to what needs to be done. The system can be programmed to inform the next level of supervision in the event that responses are overdue.
Appraisals can be numerical or anecdotal, or a combination of both, depending on the nature of the work. Some areas may not need a score. Any competency can be weighted and rolled up through the organization. The system is compatible with most HR information systems. A flat file can be imported or exported, linking employee information, job descriptions and payroll.
The system has the capacity to incorporate ratings from multiple sources. This is useful when the manager does not work in the vicinity of the employee or needs more information on what is being done. It also makes it easy to gather information to do a 360-degree review, should the hospital want to introduce it later on. Through anonymous responses, an individual can find out how they are viewed by peers, subordinates and the executive. Managers can be encouraged to collect feedback as part of their own learning plans.
Trent Dark, director of organizational development at Mount Sinai, says since the arrival of the software last fall, the hospital has introduced it in a pilot phase to 1,100 employees — one-third of the workforce. These include managers, administrators and technical specialists, such as social workers and physiotherapists.
The system uses the hospital’s balanced scorecard to set out high-level goals, says Dark, who oversees the pilot. These are then converted into departmental and individual goals.
“There are metrics and benchmarks for the different categories. In addition to clinical competencies, the system tracks such behavioural competencies as teamwork, leadership and change management. We see the behavioural competencies as very important in how you achieve the goals. There are also milestones for specific activities such as training,” he adds.
Employees begin with a self-evaluation in which they provide examples of what they have done during the review period. This goes to the manager, who works with the employee to develop a learning plan.
Dark says the initial self-assessment is taking more time than he expected.
“Some people have never had an assessment before and they are spending time in coming up with examples. In another round, we will probably have less writing on the forms.”
Fischer says the technology has proved to be a challenge as not everyone has access to a computer. To address privacy concerns and time constraints, the hospital has terminals in the library and in HR, and portable kiosks on the floor. “Some employees prefer to work on it at home.”
Fischer points out that the automated system does not replace the personal interaction between managers and employees. “The automated system is only a way to record information. It does not take away from the personal approach. I would prefer that people spend more time talking and less writing.”
Starting out with a large pilot group allows the HR department to gather broad feedback and follow up with improvements or training, says Fischer.
“There has been 100-per-cent compliance in some areas. In others, as you would expect, there are growing pains,” she adds, referring to comments from some managers about the time involved.
The hospital aims to roll out the system across the board within three years.
Evelyn Dean, strategic HR consultant with E. Dean Associates in Meaford, Ont., has considerable experience in supporting hospital accreditation. She says that although the health-care sector is strong in defining medical competencies related to professional licensing requirements, it’s “not known for having strong performance management processes, or for relating long-term goal-setting to day-to-day operations.”
Mount Sinai is taking exactly the right steps to link goals to individual performance, she says. “Performance management doesn’t work if you start without a strategic framework.”
In Dean’s experience, an organization has to build up trust in the tool. “The best way to start in a health-care environment is with training and development plans. Hospital employees value learning and professional development.” A focus on development helps win union support as well, she adds.
Emphasizing development “gives you a few years to train managers on how to coach employees, and to encourage employees to take charge of their own careers. The major source of failure is to move too quickly to link performance and pay.”
Fischer says this is an exciting opportunity for Mount Sinai to take a leadership position in using top-of-the-line systems, processes and procedures for more sophisticated performance feedback.
“As for lessons learned, we have found you have to do a lot of training when you introduce a new process and new technology. Communications are important throughout the process. You have to listen to feedback from staff and their concerns, and make changes as soon as you can. And certainly, you have to have buy-in from the top of the organization.”
Susan Singh is a Toronto-based freelancer.