Assessment of Impact of Performance Appraisals on Annual

Performance of Nurses with Special Reference to Satisfaction

and Retention in CPE Institute of Cardiology Multan.
By

Sidra Dildar
Shahida Parveen
Khursheed Bibi
Khalida Yasmeen
Rizwana Bibi

A Project Submitted in Partial Fulfillment of the Requirements

for the Degree of
POST RN.BACHELORS OF SCIENCES
IN
NURSING
Multan College of Nursing, MMDC, Multan
(Affiliated with UHS (LAHORE)

We, the supervisory committee, certify that the present study “Impact of Performance Appraisals
on Annual Performance of Nurses with Special Reference to Satisfaction and Retention in CPE
Institute of Cardiology Multan” submitted by Sidra Dildar, Shahida Parveen, Khalida Yasmeen,
Khursheed Bibi, Rizwana Bibi has been found relevant and satisfactory we, gladly appreciate the
team work of the crew. We strongly recommend it for further evaluative process by External
Examiner(s) for the award of the degree.

SUPERVISORY COMMITTEE:

Principle: ----------------------------------------

Miss. Suriya Shehnaz

Member: ----------------------------------------

Miss. Naveeda Iqbal

DEDICATION
 To
Our beloved
Parents & Teachers
Certainly their untiring efforts, love,
prayers and support enable us to achieve
the goal
 ACKNOWLEDGEMENTS

All praises to Almighty God alone, the most merciful and the most
compassionate and the most perfect.

It’s a matter of great pleasure to express our humble appreciation

and gratitude to our legend kind hearted supervisor , Miss Naveeda Iqbal
for her valuable guidance, suggestions, and endless encouragement
during the entire process of this significant study.

We also indebted to our honorable teacher, Miss Suriya Shehnaz

for his effective valuable rec ommendation to shape the dissertation.

We, from the core of heart thankful to our noble families for their
care, support and financial assistance. Our Special humble thanks to our
well-wisher for their support and encouragement during our studies.

May Allah give them all long, happy and prosperous life
“Ameen”
 CONTENTS

Title page ………………………………………………………………... I

Supervisory committee ……………………………………….……….. II

Dedication ……………………………………………………..……….. III

Acknowledgements ………………………………………….…………IV

Declaration …………………………………………………………...…...V

Chapter I INTRODUCTION …………………………..…………………………....... 6

Chapter II REVIEW OF LITERATURE ……………………..……………………....….13

Chapter III MATERIALS AND METHODS ……………………………………………...16

Chapter IV IMPLICATION..…………………………………………………..……………...18

Chapter V CONCLUSION ………………………………….…………………………...…. 19

REFERANCE …………………………………..………..……………………….20
Chapter No.1

Introduction

It's difficult to judge performance as on how it's running without having many certain
governor bodies of certain standards which able us to evaluate them according to common
procedures. We make our judgments on the ambit of validity and integrity of these continue
application to follow up these progress, whether it can be (Score) by a particular standard or Commented [NI1]: Check english

through some one or a person representing these certain standard.

Organizations as in general needs to obtain an ongoing assessment process of working towards

achieving its set of goals and thus targets can’t be achieved only and unless it has a lessons from
previous experience learnt, or previous gaps of planning procedures that was not accomplished its
missions particularly in employee’s performance. They are considered as the working force and
key tools to complete the overall hospital works at any internal unit. Hospitals in general are
considered to be as the main elements of driven hidden force of economic power itself, as it seeks
to achieve certain goals along with other primary objective(Kerzner, 2002).

These goals of care and patients service are of main pillars and of higher targets of hospital
objectives, and in the presence of competitive power in simultaneously with management tasks
seeking continuously and diligently towards providing services as best efforts , so human recourses
are considered to be an ongoing achievements need to assess their performance in general and the
performance of other workers in hospital at each level of Job Titles(Forbes, Wongthongtham,
Terblanche, & Pakdeetrakulwong, 2018)

Care coordination is foundational to the health care reform goals of improving the quality of care
for individuals and populations via the efficient and effective use of resources. The increased
complexity of care, growing numbers of patients with chronic disease, and exploding health care
costs heighten the need for better integration of care without increased expenditures(Robinson,
2010). Very convincing evidence indicates that uncoordinated care greatly increases health care
costs, but there is still a need to identify “best practices” and describe models and interventions
that achieve patient-centered, high-quality care(McGinnis, Olsen, & Yong, 2010).
 Despite the challenges of measuring the cost effectiveness of care coordination, addressing
care gaps, and avoiding service duplication, there is consensus around the need for a designated
health professional to provide patient/family-centered care coordination(Brown, 2009). Care
coordination is a professional competency of all registered nurses (Trevillion et al., 2012). In
numerous studies and analyses, registered nurses, in partnership with other providers, have integral
roles that improve patient care quality through care coordination across health care settings and
populations(Manderson, Mcmurray, Piraino, & Stolee, 2012).

The American Nurses Association (ANA) position statement, The Nurse’s Essential Role
in Care Coordination (2012), affirms that registered nurses are integral to the achievement of care
coordination excellence. This white paper describes the roles and benefits of nursing in the care
coordination process and provides evidence of the centrality of registered nurses to health care that
is patient centered, high quality, and cost effective(Association, 2012).

Since the start of the Joint Learning Initiative (JLI), in 2003, the human resources crisis in
low-income countries (LICs) has received global attention, particularly the crisis in sub-Saharan
Africa. In some countries less than 50% of the required staff is available to serve rural populations,
while at times care is provided by non-qualified staff (Hongoro & Normand, 2006; WHO, 2006).
This situation seriously compromises the health status of the communities, particularly the poor.

Although there is no conclusive evidence concerning the relationship between health

outcomes and the number of human resources (HR) available for health care, it is clear that
qualified and motivated human resources are essential for adequate health service provision, but
also that HR shortages have now reached critical levels in certain areas. The World health report
2006 has given another important boost to the global agenda of human resources for health
(HRH)(WHO, 2006).

Finally, at all levels, policy- makers and planners are starting to realize that attaining the
Millennium Development Goals (MDG) is simply not possible if the HR crisis is not more
effectively addressed, despite the increase in financing for health care through debt release and
specific programmes such as GAVI (Global Alliance for Vaccines and Immunization) and the
Global Fund (Global Fund to Fight AIDS, Tuberculosis and Malaria).
 One of the key elements to success in staff retention and improvement in performance is
to develop approaches that are evidence-based, to inform policy-makers as to which interventions
are successful under which circumstances and for which groups of staff (Buchan, 2002). However,
as mentioned by other authors little has been written on what works and what does not. This report
therefore intends to contribute to lessons learnt in the field of retention and performance
improvement of health workers1 and is primarily written for health policy-makers, planners and
managers in low-income countries(Dussault & Franceschini, 2006; Lehmann & Zulu, 2005).

Performance appraisal is a formal system of review and evaluation of individual or task

performance. A critical point in the definition is the word formal, because in actuality, managers
should be reviewing an individual performance on a continuing basis performance appraisal is
especially critical to the success of performance management. Although performance appraisal is
but one component of performance management, it is vital, in that it directly reflects the
organizational strategic plan(Aswathappa, 1997).Although evaluation of team performance is
critical when teams exist in the organization, the focus of performance appraisal is most firms
remains on the individual employee. There are many purposes of performance appraisal but the
primary and most important purpose is to provide constructive feedback to the employees. A good
performance appraisal system is used to provide information to the staff members that what is
expected from them regarding job tasks. A good performance appraisal system is used for staff
development and staff satisfaction. When satisfaction increases the retention of staff in that
organization also increases. By using performance appraisal the employee increased their salaries
and promotion(Deepa, Palaniswamy, & Kuppusamy, 2014; Hammen, Henry, & Daley, 2000).

There are several principles which are used in appraisal system and that are
nondiscriminatory. Information is shared with employee during performance appraisal. The
performance appraisal is done in written form and carried out for at least once a year. The focus
of performance appraisal is always on behavior and not on personal traits such as attitude,
initiative. The employee appeal regarding the result of performance appraisal(French, 2003).

There are two types of system which is used in performance appraisal. The one is result
oriented and the second is behavior oriented system. In result oriented performance appraisal
system the employee is known already that what is expected from them and how they achieve their
objective and in behavior oriented system the focus is exactly on what the employee
done(Cleveland, Murphy, & Williams, 1989).

There are some barriers which difficult performance appraisal for conducting on annual
basis. Manager doesn’t know the employee. Managers are not trained properly for conducting
performance appraisal interview. Performance appraisal creates negative relationship between
manager and employee. Performance appraisal is a time consuming method when manager do not
have any knowledge about conducting performance appraisal interview. Communication which
is used in performance appraisal is one way. Anxiety and stress are created through performance
appraisal atmosphere(Larsen, 2009).

There are some potential performance appraisal problems which the manager to know
before conducting performance appraisal interview. These are leniency error, regency error, halo
error, ambiguous evaluation standard and written comments problem. The manager overrates each
employee leniency error. The manager considers recent events in evaluating performance not
consider the whole year performance. The potential barrier called the regency error. The manager
not differentiates the employee performance in different fields of nursing or different nursing task.
The potential barrier called the halo error. First of all the manager assess performance of employee
and if the manager consider that there is a problem than the manager provide solution to this
problem. If problem is skill related than the managers provide education, coaching, simplify the
task, reassign the task, replace if time does not warrant other techniques. If the problem is
motivation related than the manager provide clarify expectation, determine obstacles and remove
them, remove punishment, determine employee values regarding rewards and ensure equitable
treatment Ontario Public Hospitals (1992) ensured that physician performance is appraised,
because they are accountable to patients and the community for ensuring that the care delivered
meets defined standards and for quality improvement. More organizations from a focus on the
individual to one on the entire system, involving everyone but blaming no one(Featherstone &
Baldry, 2000)

1.2 Significance of study

The study emphasize that performance appraisal have direct impact on satisfaction and
retention rate of employees in any organization. Performance of employees is judge
 through performance appraisal on monthly and annual basis. Certainly performance
appraisal is an integral part of success of any organization because the factor of
performance appraisal play a vital role to motivate the employee to done their job with
stern faith and dedication, which ultimately enhanced their integration and solidarity to
their organization. Appraisal performance factor second the role of nurses in the name of
certification, bonus, increments and promotion. The appraisal phenomenon validates the
performance and satisfaction of the nursing crew. The basic thematic approach of the study
was to focus on the employee satisfaction and retention in an organization against appraisal
performance. The study will absolutely helpfully in providing the statistical data for the
human resource, organizational managers and to the researchers also to lay down the true
foundations to enhance level of satisfaction and rate of retention of the nursing crew in the
hospital. It also may be helpful in reducing the performance evaluation errors.

Research Questions
?????????????????????????????????????????????????????????????
????/

1.3 Objectives:

The specific objectives of study are :

1. To study the performance appraisal system of CPE Institute of Multan.

2. To study the impact of performance appraisal on staff retention and satisfaction.

1.4 Hypothesis:

H1: There is significant association between performance appraisal and staff retention and
satisfaction.

H0: There is no significant association between performance appraisal and staff retention and
satisfaction.
1.5 Purpose of Study:

It is an ongoing process of obtaining, researching, analyzing, and recording information about the
worth of an employee. The main objective of performance appraisal is to measure and improve the
performance of the employee and increase their future potential and value to the company.

The purpose of performance appraisal is to achieve a better work performance from employee.
Chapter No. 2

Literature Review

(Acee et al., 2003), at their article "Performance evaluation and compensation feedback messages:
An integrated model". Assured a theoretical model is developed which looks at both performance
evaluation and compensation decisions as feedback messages. Underlying and critical to the model
is the role of causal attributions made by both the supervisor/source and recipient of feedback
about the causes of the recipient's performance. Specific hypotheses are generated which account
for discrepancies between supervisor and subordinate about these causes of performance. In
addition, the presence and impact of external organizational constraints on feedback recipients'
perceptions and performance are discussed.

Kerr, Norbert L and R. Scott (2004) on "Group Performance and decision making"(Kerr &
Tindale, 2004)

Focuses on research on group performance and decision making, discussion on brainstorming;

Group process losses and gains; Cognitive centrality of group members(Kerr & Tindale, 2004).

Anne (2010), Stressed on her research work entitled" Performance appraisal applied to leadership",
Performance appraisal is a measurement process of how well an individual is doing her or his job.
In most organizations, this appraisal is an annual event. Generally, it is done to encourage job
performance, to flag areas that need attention, to inform both parties as to expectations. Much of
the literature speaks to this process in terms of the performance appraisal of the employee.
However, the leader's performance is as important to the success of an organization as the
employee's. This article provides comment on actual use of a survey on leader performance. In so
doing, the article highlights how a process, performance appraisal, can be responsible for
undesirable consequences when results and actions taken are not necessarily aligned (Jefferson,
2010).

Radhakrishnan, Phanikiran Arrow, and others, (1996)," Hoping, Performing, learning, and
Predicting: Changes in the Accuracy of Self-Evaluations of Performance". Had tested and
examines the prediction in the accuracy of self-evaluations of performance. Determination of the
work performance standards; Basis of self-appraisals, judgments and decision making;
Specifications of the integrated hypothesis(Radhakrishnan, Arrow, & Sniezek, 1996).

Harris et al.,(2011),"A rapid equity focused health impact assessment of a policy implementation
plan: An Australian case study and impact evaluation", noted that This paper presents a case study
of a rapid EFHIA that was conducted in Australia on a health promotion policy implementation
plan. It briefly describes the process and findings of the EFHIA and evaluates the impact on
decision-making and implementation. Methods: The rapid EFHIA was undertaken in four days,
drawing on an expert panel and limited review of the literature. A process evaluation was
undertaken by email one month after the EFHIA was completed. An impact evaluation was
undertaken two years later based on five semi-structured interviews with members of the EFHIA
working group and policy officers and managers responsible for implementing the plan(Harris-
Roxas, Harris, Harris, & Kemp, 2011).

Cost estimation was conducted by the EFHIA working group. Findings: The EFHIA made both
general and specific recommendations about how the health equity impacts of the policy
implementation plan could be improved. The impact evaluation identified changes to development
and implementation that occurred as a result of the EFHIA, though there was disagreement about
the extent to which changes could be attributed solely to the EFHIA. Those responsible considered
the recommendations of the EFHIA in the next versions of their ABHI implementation plans.
Factors that influenced the impact of the EFHIA included consolidating understandings of equity,
enabling discussion of alternatives, and differing understandings of the purpose of the EFHIA
(Iyengar, 2016).

Erwin, Paul Campbell & others,( Apr2011),"The Association of Changes in Local Health
Department Resources With Changes in State-Level Health Outcomes", they explored the
association between changes in local health department (LHD) resource levels with changes in
health outcomes via a retrospective cohort study(Erwin, Greene, Mays, Ricketts, & Davis, 2011)

As they measured changes in expenditures and staffing reported by LHDs on the 1997 and 2005
National Association of County and City Health Officials surveys and assessed changes in state-
level health outcomes with the America's Health Rankings reports for those years. They used pair
wise correlation and multivariate regression to analyze the association of changes in LHD
resources with changes in health outcomes. Increases in LHD expenditures were significantly
associated with decreases in infectious disease morbidity at the state level (P=.037), and increases
in staffing were significantly associated with decreases in cardiovascular disease mortality
(P=.014), controlling for other factors(Erwin et al., 2011).

Mishra, Badrinarayan & others ,( Jan2011),"Evaluation of Work Place Stress in Health University
Workers: A Study from Rural India" ,as they focused on healthcare providers being over-worked
and under staffed are prone to poor mental health. Unhealthy work place compounds it further.
The study aimed to assess the mental health status of a medical university employee with special
reference to work place stressors. Settings and design: A cross-sectional study was designed and
carried out at a Rural Health University. Materials and Methods: Both the General Health
Questionnaire (GHQ) and Scale were used to evaluate 406 participants. The main result was
doctors were the highest stressed group (P ≤ 0.04). Prominent work environmental stressors were
poor departmental reorganization, lack of cohesiveness in department, difficult superiors and
juniors (P ≤ 0.001, Pearson correlation). Stressors associated with work organization and work
nature were: noninvolvement in departmental decision making and lack of proper feedback; along
with; work load, lack of clarity in job, and a erratic work schedule (P ≤ 0.001 on Pearson
correlation). Harassment, favoritism, discrimination, and lack of self-expression (P ≤ 0.003) were
other factors responsible for work dissatisfaction. The study concludes: 1- A high stress level was
detected in the study population. The principal stressors were work environment related. Poor work
culture was found to lead to job dissatisfaction among majority(Mishra et al., 2011).
Chapter No. 3

Methodology

Performance appraisal is directly impact on annual performance of nurses on satisfaction and

retention in Institute of Cardiology Multan. Performance of employees is judge through
performance appraisal on annual basis.

Research Design

Qualitative research method used to collect the data from Nurses of CPE institute of Cardiology,
Multan.

3.1 Sample size

Sample size of the research based on 30 Nurses of CCU, ICU and Emergency Ward of CPE
Institute of Cardiology Multan. Commented [NI2]: Why 30
reference???????????????????

3.2 Sampling Technique

Convenient Sampling Technique has been used for data collection. Commented [NI3]: Will be

3.3 Tools for Data Collection

After drawing the sample and designed the appropriate research technique data collected through
self-administered structured questionnaire as a research instrument. Questionnaire formulated on
the basis of information drawn from the review of literature and knowledge of the indicators.
Structured questionnaire added for observing the predetermined response of the respondents. The
questionnaire prepared in English.

3.4 Pilot Study

Before collecting the actual data, in order to check the validity of questionnaire, pilot study was Commented [NI4]: Use will instead of was

necessary in the same population, ten questionnaires filled to check the validity. During the pilot
study some question did not provide the proper answer, hence they were modified. After pilot
study the questionnaire was improved for data collection.

3.5 Data Collection

In the present study, the data collected with the help of questionnaire, which asked from the
respondent in a face to face situation.

3.6 Data Analysis Commented [NI5]: Spssss used to analyse data

Data collected, arranged, organized and interpreted statistically through histogram.

 Implications
Caring is the essence of nursing and is the basic factor that distinguishes between nurses and other
health profession. The concept of caring in nursing studies has been defined in different ways as
‘’ caring includes knowledge, performance and the results’’. An insecure condition occurs for most
of patient’s satisfaction and treatment outcome. The staff is not only a source for patient
information but also they are most important source of support and comfort. The scientific method
is used to collect the data and information. In the research methodology, such techniques are to be
used as in the literature survey. Sample size for this study was 30. The study shows that high
patient workload also has adverse effect on nurse’s health as well as on their behavior and result
in fatigue, stress, injury and job dissatisfaction.

Performance assessment is the basic component of the management of health institutions. In fact,
it is the formal system of evaluation of the nursing staff's performance to encourage constructive
feedback and further improve the level of satisfaction and retention of health workers in under-
serviced areas. The study emphasizes the value and effectiveness of performance assessment on
the annual certification, admiration and retention of role and performance of respected nursing
staff, which ultimately favor the prestige of CPEIC Multan, which offers the healing cardiac
facilities. The scientific methodology adopted for data collection while literature review clearly
substantiated the effectiveness of the study. The current project shows statistical correlation
between the performance assessment and satisfaction and retention among nurses. Overall impact
on annual performance.
 Conclusion
Performance appraisal is a process of how well staffs perform their duties during a specific period.
This process includes assessing needs and setting goals, establishing the objectives, assessing the
progress and evaluating the performance. In order to achieve the performance appraisal purpose
both organization context and evaluation system should be appropriate. The findings of this study
reveal that the nurse performance appraisal system confronts various problems. Some of these
problems are related to organizational context while the others are concerned with structure,
process and outcomes of the performance appraisal system. Unfortunately, evaluation and
judgments are often based on opinions, preference and inaccurate or partial information. The
subjective and biased appraisal and poor communication between raters and managers and
employees create unfavorable feelings in users. To achieve high quality patient care as the final
goal of performance appraisal, it is necessary to make revisions and modifications in various
dimensions of the appraisal system. The findings of this study will help nurse managers take action
for solving the problems of the appraisal system. A better way for solving these problems might
be nurse’s participation of proper solutions. Commented [NI6]: At least one page

where is tool Commented [NI7]: Structured questionaire

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