A study of determining factors affecting the performance of nurses based on the achieve model in selected hospital of Isfahan (Iran).

BACKGROUND: The achieve uses 7 variables: ability; clarity; help; incentive; evaluation; validity; and environment, to provide leaders and staffs with the necessary tools to improve performance, and help managers to determine cause of performance problem. And create change strategy for solving those problems. We try to determine factors affecting the performance of nurses, base on this model in selected hospital of Isfahan (Iran).
MATERIALS AND METHODS: This was a descriptive-correlation survey. The population of study was 85 nurses of 9 hospitals in Esfahan. Data gathering was done via achieve questionnaire. Reliability was calculated by Cronbach's alpha (r = 0.85). Data analysis was done by using SPSS 16. RESULT: The ability and help variables were the most important factors in improving performance of nurses and validity and evaluation were less important.
CONCLUSION: [corrected] Today, staff effectiveness is one of the important problems in health care organization. In fact, performance improvement is the most important step for organization improvement.

INTRODUCTION

Human capital is not a new term in economics or organizational performance assessment and has its roots in Smith's economic theories of the eighteenth century and other economists, which focused on human contributions to the organization more as faceless commodities to be utilized until no longer of value.[1] Human capital is described as “the knowledge, skills, competencies, and other attributes embodied in individuals that are relevant to economic activity,” which embodies an outlook of human capital being a source of investment and production more than a source of use.[2] The most important knowledge capital of an organization is human resource. Knowledge investment of staff is the influence components on organizational performance.[3] Increasing staff capabilities has direct impact on improving financial results to the organization.[4] That is why human resources can be the most important infrastructure of intellectual capital.[56] Over the last decade a great deal of attention has been devoted to examining the links between human resource management (HRM) and organizational performance.[7]

Two buzz words, human productivity improvement and employee engagement have become hot topics in the world of human resources. What organization would not want to increase its productivity and thus its competitive advantage? According to fisher, Schoenfeldt, and Shaw (2006), a number of things are required by organizations to be competitive including, physical resources, financial resources, marketing capability, and human resources. The factor most likely to provide potential competitive advantage is human resources and how these resources are managed.[8] At present, all organizations, but especially those in the health-care industry, face unprecedented challenges and competitive pressures. The rising costs of health care, escalating technology, an aging society with diverse needs and care requirements, and new types of illnesses and other ailments have placed ever-higher demands on hospitals and their employees.[9] Improving health workers performance is vital for achieving the millennium development goals.[10] The human resources crisis in the health sector in low and middle income countries is receiving increased global attention.[11]

On the front lines of this difficult and dynamic landscape are the nursing professionals who must deal with increased calls for efficiency gains, cost-cutting, and improved patient care, while at the same time coping with workplace stress, fatigue, and burnout.[9]

In most health care organizations, nurses are the largest work group and play a major role in the organization's success. Hence nurses’ productivity affects an organization's success by influencing on productivity.[12] Health care organizations cannot succeed without productive nursing staff.[13] However, recent studies suggest that nurses no longer feel their work is valued and are concerned with their productivity.[14]

Nurses, as the largest human resource element of health care systems, have a major role in providing ongoing, high-quality care to patients.[15161718]

Although, nurses are concerned about declining levels of effective care and productivity, staff productivity rarely has been assessed within the health care organization of Iran and little is known about factors that affect nurses’ productivity.[19]

Paul Hersey and Marshall Goldsmith developed the achieve method for leaders to use as a performance management tool to help determine specific performance problems and understand why these problems exist. According to Hersey and Goldsmith, the use of a situational approach is an effective way to address performance management.

The achieve uses seven variables: ability; clarity; help; incentive; evaluation; validity; and environment, [Figure 1] to provide leaders and followers with the necessary tools to improve performance. By using these seven aides, management can identify performance problems and determine why these problems exist.

Figure 1

The variables of achieve model

The letter “A” represents ability and constitutes the skills, experience, etc., possessed by an employee. Managers identify skills possessed by employees and set goals and tasks based on ability information.

“C” represents clarity and is the ability of an employee to clearly understand requested tasks and possess knowledge of what must be done in order to accomplish them. Problems with clarity in a situation may result in goals that are never accomplished. It is extremely important that managers clearly state goals and objectives up front to employees.

The “H” in the third variable, help, refers to support by the organization necessary for employees to complete goals and objectives. Support encompasses anything from monetary resources to equipment resources. It is the responsibility of management to aide the employee in obtaining necessary resources.

“I” stands for incentive. This refers to the motivation of the employee to achieve a task or goal. Managers must remember that employees are motivated in very different ways and address motivational needs based on the individual situation.

“E” refers to evaluation and relates to the incentive variable discussed previously. Employees must receive periodic on-going feedback regarding their performance. Without feedback, employees “wonder” what is going on and can become unmotivated. Management should document positive as well as negative feedback.

“V” stands for validity. The validity of a situation includes the legalities of decisions by managers. Managers must consider laws and company policies when making human resources decisions. Managers should document any issues based on performance. It is the responsibility of management and human resources to ensure their decisions are valid.

The final letter “E” stands for the environment variable. Environment refers to all external factors that may affect performance. Some of these include suppliers, market changes, etc., Employees can only perform as their environments allow.[20]

Haghi[21] identify affecting factors on human resources productivity, motivation, performance feedback (evaluation), organizational support are three factors that considered most effective. Ability is the most important factor and evaluation is the less important factor there is a meaningful correlation between ability, clarity, help, incentive, evaluation, validity, environment with gradation of productivity. Pour Sadegh[22] is express numerous factors effective on the manpower productivity, the most important ones are: motivation, education, human resources communication, management and workplace management. SirusMehr[23] show that Equal rights and benefits, promote culture of organization, ergonomic, comfortable and decent working environment with good facilities, friendly and intimate partners, promotion and upgrading improve human resources performance. alamalekishow that, physical condition, motivation, organizational structure, training, job skills, employees tend to raise their awareness and supervision affect on increase and improve the performance of human resources.[24] Some researchers reported that employees with higher levels of job satisfaction and job skills had significantly higher productivity.[25]

Another study revealed that practices such as performance appraisal had a strong effect on productivity.[26] In addition, training programs for new employees increased their productivity[27] A number of researchers have assessed factors affecting nurses’ productivity.[282930] While Grosskopf, Margaritis and Valdmanis (2001) evaluated effects of teaching on hospital productivity.[31] This paper aimed to study the factors affecting the performance of nurses based on the achieve model in selected hospital of Isfahan.

MATERIALS AND METHODS

This was a descriptive–correlation survey. Study population was the nursing in selected hospitals of Isfahan University of Medical Sciences. We used questionnaire for gathering information this questionnaire was made based on Hersey and Goldsmith Achieve model by authors. The questionnaire contains five selection questions according to Likert spectrum. Questionnaire was given to several professors in the fields of nursing and management for validity. Reliability was calculated via Cronbach's alpha (r = 0.85), this number shows our questionnaire is very permanent. Data analysis was done by SPSS software version 13. In this research we selected 85 nurses from nine hospitals through the application of random sampling method. For determining the number of sample from the statistic society we use Morgan's table. This study has done during 2010.

RESULTS

Preliminary analysis of the data revealed that the mean number of performance improvement factors among nurses of selected hospitals is 41.2 ± 16.4.

Nurses who had more job experience (over 25 years) give the highest score to motivation. The nurses who were post graduated (Master degree and PhD) give the highest score to ability.

Men give highest score to help. Among the factors that effect on nurses performance are ability and help had a highest mean score and clarify and validity had the least [Table 1].

Table 1

Mean score of factors affecting the performance of nurses

Based on the findings of Table 2, according to pearson test, all 7 factors effective in nurses performance improvement.

Table 2

Effective of variable of achieve model on nurses’ performance

Based on the findings of Table 3, there is a significant relationship between performance and sex (t = 4.50, P = 0.02) according to t- test. Also, there is a significant correlation between performance and job experience (F = 3.87, P = 0.00) and level of education (F = 2.7, P = 0.00) based on ANOVA test. But there is no significant correlation between performance and age (F = 0. 061, P = 0.80) based on ANOVA test [Table 2 and Figure 2].

Table 3

The relation of performance improvement with demographic factors in nursing managers

Figure 2

Radar chart for determine factors impact on nurses’ performance

DISCUSSION

Nurses managers must use their authority and influence to ensure that their employees are working creatively to accomplish the goals for the organization, which in the health sector would be to deliver the most effective and efficient services to the patient. Managers need to promote a staff that is competent and that works hard. Motivation is directly effort on the quality of work. In fact motivation is a basic factor in performance improvement

If the nurses are not motivated then they will not perform their jobs correctly. Managers should make it a daily goal to ensure that their employees are continuously applying their skills and abilities.

Managers everywhere in every organization have been trying to figure out what promotes performance. There is no one standard procedure, every entity is different, so the manager must find what works for his or her workforce. For some employees, their job and career are very important to them, for others they look at their career as just a job and seek no motivation. At all, Effective human resource management in the organization must recognizing and acting on what Improve performance of staff.

The results of this study suggest that the ability and Help, was the most important factors in improving performance of nurses and validity and evaluation were less important. This indicates that nurses ability are the most important factors in high-performance in nurses. Study done by Tabibi show that incentive, help and evaluation have most effect on improving human resources function.[18] This study has similar results too. Pour sadegh in his research indicate that evaluation, intensive and staff ability effective in human resources function.[22] This study has similar results too. Some studies observed that skills and experience is effective on staff productivity.[131520] This study has similar results too at ability factor. the ability in this study means: skills and experience and etc., On the other hand, the systematic evaluation effective on employee productivity.[21] This study has similar results too.

CONCLUSION

Eventually can be proposed that one of the most important tasks of human resources managers in hospitals is improve performance in staff and recognized and organization on specialty factor for gradation of human productivity.