Performance Improvement (PI) is a method for analyzing performance problems
and setting up systems to ensure good performance. PI is applied most effectively
to groups of workers within the same organization or performing similar jobs.
While PI principles are relevant to workers in any field, this publication focuses
on primary providers of family planning and reproductive health (FP/RH) care
Overview of Performance Improvement
Performance refers to the way people do their jobs and the results of their
Organizations seeking to solve a performance problem frequently implement a
specific intervention, such as training, without fully understanding the nature
of the problem or determining whether or not the chosen intervention is likely
to succeed. Just as often, professionals with a high level of expertise in a
specific intervention area see every problem as an opportunity to ply their
trade. As Abraham Maslow once said, To the person who only has a hammer
in the toolkit, every problem looks like a nail. In fact, there are a
number of methods for improving the performance of organizations, teams and
individuals. Organizational development, industrial engineering, training and
development, quality assurance, and human resources development address performance
gaps in particular ways. Performance Improvement differs from these approaches
by using a systematic methodology to find the root causes of a performance problem
and then implement an intervention (or fix) that applies to that
specific performance deficit.
The PRIME II Performance Improvement Approach (PIA) is not a new intervention.
Nor is it intended to replace other successful interventions or programs such
as USAIDs Maximizing Access and Quality (MAQ) initiative, EngenderHealths
Client-Oriented Provider-Efficient (COPE) services, Quality Assurance, Situation
Analysis or Whole Site Training, one or more of which may already be in place
when PI is implemented. Rather, the PI methodology offers a set of tools that
can be used independently or in conjunction with other interventions to improve
the accessibility and quality of FP/RH services.
Too often, FP/RH interventions have failed to build the capacity of organizations
to sustain improved services or even to improve services at all. PI helps to
ensure that selected interventions are supported and sustained by involving
a stakeholder group from the outset and ensuring that an organizations
staff participates actively in every step of the process.
Factors That Affect Performance
Certain factors need to be in place for workers to be able to perform well
on their jobs:
- Clear job expectations
- Clear and immediate performance feedback
- Adequate physical environment, including proper tools, supplies and workspace
- Motivation and incentives to perform as expected
- Skills and knowledge required for the job.
Successful organizations support their workers by instituting and sustaining
these performance factors. This support can be provided by a supervisor or emanate
from a variety of other sources. For example, feedback can come from clients
and incentives from a peer group. But no matter the source of these performance
factors, it is the responsibility of the organization to make sure that a system
is in place to deliver them.
When a performance factor is missing and a gap in performance has occurred,
a solution, or intervention, usually becomes clear. For example, if workers
lack information about what is expected of them, obvious interventions would
include implementation of written policies, job descriptions or verbal directions.
The PI facilitator considers the entire human performance system by looking
at the desired performance of workers and the organizations they work for. This
approach does not presuppose any particular type of intervention; rather, it
allows the PI facilitator and the stakeholder group to choose appropriate interventions
once the problem is clear. Often, the PI practitioner will not have expertise
in a needed intervention but will call on other professionals for that expertisefor
example, bringing in instructional designers if training is required.
The PI Process Framework
The following graphic illustrates the typical PI process:
Click to enlarge
Following is a more detailed discussion of each of the stages in the
Consider Institutional Context
Before taking the first steps in the PI process, the facilitator must understand
the institutional context within which performance improvement will take place.
The facilitator must be aware of the goals of the larger organization and maintain
a consistent direction when defining performance targets. Familiarity with organizational
goalsfrom the very top down to the level at which the main interventions
will take placehelps to ensure the sustainability of the interventions.
In a given project, for example, the facilitator and the stakeholders may need
to know the goals of the ministry of health, the safe motherhood program and
the postabortion care initiatives going on nationwide. (Jump
to this stage.)
Obtain and Maintain Stakeholder Agreement
A client initiates the PI process by asking for assistance with problems or
performance situations. In the initial stage, the PI facilitator, the client
and the stakeholders meet to discuss and define the desired outcomes of the
During the discussion, this group also addresses some or all of the following
- How will the activity and its objectives fit within the goals of the organization?
- Who are the relevant stakeholders?
- Who are the PI team members?
- What steps need to be taken to determine the performance gaps?
- Are there any known impediments to proceeding with the activity?
This dialogue is important as it creates a collaborative working relationship
that will continue for the life of the project. Throughout the PI process, the
facilitator will ensure that there is common understanding and project agreement
among the stakeholders. (Jump to this stage.)
Define Desired Performance
The stakeholder group creates verbal statements that define desired performance
in specific, observable and measurable terms. These statements of desired performance
address the quality, quantity and timeliness of performance (i.e., how well,
how many, when?). The group then sets initial and final target levels of performance.
This cooperative work to define desired performance is vital for building consensus
among the stakeholders and achieving the desired outcome of the project. (Jump
to this stage.)
Describe Actual Performance
Once desired performance is described to everyones satisfaction, current
levels of performance are assessed using the same indicators developed to describe
desired performance. Typically, describing actual performance levels necessitates
baseline data collection. (Even though the data will not be used until the root
cause analysis stage, it is usually most efficient to gather information
about the presence or absence of performance factors at the same time you gather
the baseline data.) While the description of actual performance usually follows
the definition of desired performance, in some cases the order may be reversed.
(Jump to this stage.)
Describe Performance Gaps
Once the desired and actual levels of performance have been defined, identifying
the performance gaps becomes a simple matter of comparing the two levels. The
gap should be described using the same indicators that were employed to describe
desired and actual performance. The gap description shows, in objective terms,
the difference between current performance and the performance the client wants
to achieve. This stage usually involves prioritizing which performance gaps
to address, as more than one will likely be identified. Discussions are also
necessary to make sure the gaps that are identified are important enough and
wide enough to merit further work. (Jump to this stage.)
Find Root Causes
Once performance gaps have been described, the next step is to determine the
cause of those gaps. Using the performance factors as a starting point, the
stakeholder group participates in a root cause analysis to uncover the environmental
factors that are impeding good performance. Any of the proven root cause analysis
techniques (e.g., fishbone diagram, why-why analysis) will serve here. In PI,
the analysis that concludes with the finding of root causes is frequently called
a Performance Needs Assessment (PNA).
Note: When applying PI to new performance (e.g., a job that has never been
done before), some of these steps might be eliminated, as the focus will be
on setting up an enabling system rather than solving an existing problem. (Jump
to this stage.)
Select and Design Interventions
The stakeholder group next selects interventions that will address the root
causes discovered during the previous stage. Each intervention or set of interventions
must address at least one root cause. During this stage, the team consults experts
in each possible intervention area and plays a major role in designing and developing
the selected interventions. (Jump to this stage.)
During the implementation stage, the team recruits additional expertise as
needed, assures organizational readiness, applies the interventions, and helps
enable and monitor organizational change. (Jump to this
Monitor and Evaluate Performance
Through monitoring and evaluation, the team measures the change in the performance
gaps identified during gap analysis. Monitoring happens on an ongoing basis
so that changes in implementation can be made as needed. Whenever possible,
the team develops an evaluation method that can be integrated into workplace
processes and remain in the workplace after the interventions as a feedback
device for workers and managers. The final evaluation should remeasure the performance
gaps and assess the extent to which they have closed as a result of the interventions.
(Jump to this stage.)