1. APPROACHES TO
PERFORMANCE
MANAGEMENT SYSTEM

2. The GROW Model

3.  The GROW model was developed by Graham
Alexander and John Whitmore.
 The name is an acronym, with each letter
standing for a different phase of the model.
 GROW stands for:
 G - Goal
 R – Reality

4.  O – Option
 W – Way forward
 Goal:
 Goal refers to the objective or target for the
team.
 This is not just a list of goals that you give them – it
should be a mutually agreed-upon vision of the
future for that team member.

5.  This conversation helps them understand exactly
what their objectives should be.
 Certainly, you could address some of their
present or recent past behaviour, but you should
focus on where the employee should be going
from this point forward.
 The individual employee might not be able to
express exactly what goals they have for
themselves in the future.

6.  You can help tem by exploring their personal
goals, which can provide some interesting
information for you.
 It also gives you a chance to reinforce the
benefits of a performance management process
as a way to help them achieve those goals.

7.  Some questions you might ask the employee
regarding their key performance measures
include:
 What do you want to achieve in this area?
 When do you hope to achieve it?
 What would success in this area look like to you?
 What would be indicators that you are having
problems in this area?
 How can I help you avoid those problems?
 If I were to coach you exactly in the way you would
like to be coached, what would that look like?

8.  But the goal set can go beyond the employee’s
performance in their current position.
 You can also explore what they aspire to in the
long-term with the organisation or in their
professional life in general.
 Some questions that might help you with this goal
conversation are:

9.  What would you like to have achieved in this
position or organisation in a year from now? Two
years from now? Five years from now?
 Are there any opportunities in the organisation
that you know are available but that you haven’t
taken advantage of yet that you would like to
pursue in the coming year?
 Are there any work skills that you know would like
to develop more in the coming year that I can
help you with?

10.  Just having these conversations can lead to a
new level of motivation for your employees.
 Imagine you learn that one of your employees
whishes they were better at public speaking.
 Perhaps you could find opportunities for him or
her to practice by training other employees on a
new product or service.

11.  When you show employees that you want to
help them achieve their own goals in addition to
achieving the goals required of them, you will
find that your employees trully become your
partners in managing their own performance.

12.  Reality:
 Reality means taking an inventory of where you
are now in relation to where your employee is
now in relation to the goals that you have
identified together.
 This helps you to ascertain exactly what you
need to complete the journey ahead.
 Reality can be a deceptively simple concept.
 in the sense of employee performance, they may
have completely different ideas of where their
performance level is at this point.

13.  They could feel that they have either performed
at a higher level or below expectations.
 In that case, you need to discuss and explain
your perspective on their current performance
levels before you can begin planning for their
movement towards the goals.
 There may be miscommunication,
misunderstanding, or some other unresolved
barrier to being on the same page when it
comes to identifying the reality of the current
situation.

14.  Additionally, you should be able to identify how
their performance level got to the current point.
 What actions have you as coach taken that
have contributed to their current point.
 What actions have you not taken?
 Before you ask the same questions of theirs, be
sure that you have considered the answers to
them about your own role.

15.  OPTIONS.
 Then you can start considering some options to
move you from reality to goal.
 During this step, you look at the gap between
where we are and where we want to go, and
look at what alternatives we have to get there.
 Some of the options could be:
 Training
 More Coaching
 Mentoring – the team member could be the mentor
or mentee

16.  Personal reading or research.
 Increasing education level.
 Increasing experience level.
 Job enhancements such as increasing responsibility.
 These are just a few examples – the exact options
you choose will depend entirely upon the
employee you are working with and the goals
you have come up with together.
 When you have determined what options you
feel would be best, you are ready to go to the
last step of the GROW model.

17.  Way forward:
 This step is when you and the team member
come up with an action plan for exactly how the
chosen options will be implemented.
 During this process you will need to agree on:
 Specific timelines and deadlines
 Detailed deliverables and expectations
 Resources that will be provided or made available
 What level of help and supervision the coach will
provide
 When and how progress will be communicated.

18. The OUTCOMES Models
 There are some similarities between the OUTCOMES model and the GROW
model, though the former is more detailed.
 OUTCOMES stands for:
 O – objectives
 U – understand
 T – Take stoke
 C – Clarify
 O – Options generation
 M – Motivation to action
 E – Enthusiasm and encouragement
 S – support.

19. Objectives
 This is a step similar to the G in the GROW model.
 In this stage you are working to understand what
the team member is trying to achieve.
 You will attempt to get an idea of what
specifically the person is trying to achieve from
either the coaching session or their objectives.
 Again, this is a conversation and a learning
process, not just a directive.

20. Understand
 Understanding the reasons behind wanting to
achieve the identified objectives is what is
required during this step.
 More often than not, employees either ‘ under-
stretch’ or ‘over-stretch’.

21. Take stock
 This step is similar to reality step in the GROW
model.
 Your goal is to take stock of the current situation.
 It’s important to spend time analysing the present
situation so that the manager can establish a
performance ‘baseline’.
 And then from that baseline, you have
something to measure change in performance
by.

22. Clarify
 Clarify refers to clarifying the gap between
where the team member is now and where they
need to get to in order to achieve their
objectives.
 By clarifying, you make sure that you are both in
agreement as to exactly what the change,
progress, or development is that needs to
happen.

23. Options generation
 Similar to options in GROW.
 In this step the goal is generating all the possible
options for moving forward.
 The pros and cons of each option need to be
discussed.
 This stage can take time and many managers just
go through the motions, or worse, manipulate their
employees with leading questions that enable the
person to come up with the options the manager
wants to hear.
 Instead, take your time and allow the person to
generate their own options.

24. Motivation and action
 Once the options have been discussed and the
best way forward agreed, the manager must
check the motivation of the person to move on
the actions.
 Are they agreeing to actions because that is
what they think the manager wants to hear or
are they really motivated to move on the
actions?
 The manager must have the ability to check this
and challenge any signs of demotivation.

25. Enthusiasm and
encouragement
 This stage and the one that follows are the ones
that continue through the rest of the coaching
process.
 The manager must at all times show enthusiasm
for the objectives ahead and encourage the
person to do as best they can.
 If you falter in your enthusiasm and
encouragement, you risk the team member
becoming demotivated very easily.

26. Support
 The manager must always shoe support for the
team member in the tasks agreed upon and
must also ask if there is any support that they
need in order to assist the team member.

27. PERFORMANCE AND
QUALITY IMPROVEMENT
MODEL.
 The PQI process was designed to assist
organizations in achieving desired institutional
and individual performance.
 The approach offers simple, user-friendly tools to
assist in performance management and relies on
the participation of key stakeholders from all
levels of the service delivery system and the
community to define and achieve quality in
services and behaviors.

28. Steps in the performance and Quality
Improvement Model
Find Root Causes
Knowledge
Why does the
performance gap
exist?
Desired
performance
state
Monitor
and
Evaluate
Performanc
e
Actual
performance
state
Intervention
Implementation
Performance
Analysis
Intervention
Selection
Cause
Analysis
Business
Analysis
What can be done to
close the gap?
GAP
•Mission
• Goals
•Strategies
•Culture
•Client and
community
perspectives
C
H
a
n
g
e
M
a
n
a
g
e
m
e
n
t

29. Defining Desired
Performance
 The first step in the PQI process is to bring
together incountry stakeholders to define desired
performance standards based on input from
national policies and priorities, service delivery
guidelines, service providers and community
members.
 Both providers and clients are stakeholders in this
process and must be involved in the
development of performance standards.
 Once the performance standards are defined,
they become the basis of assessment tools that
are used to assess and monitor the quality of
services and community performance.

30. Describing Actual
Performance
 To determine actual performance (as compared
to desired performance), each institutional teams
use their assessment tools at service delivery sites
to establish a baseline for each site being
assessed.
 These tools provide a quantitative measure of
how much actual performance deviates from
desired performance (i.e., the gap in
performance).

31. Finding Root Causes
 Once teams have compared actual
performance to desired performance, they work
with staff and community members to determine
the reasons for any performance gaps.
 This cause analysis, rather than serving as a
punitive measure for poor performance, is
intended to motivate staff and community
members to identify their own weaknesses and
offer solutions that will improve performance and
quality

32. Selecting and Implementing
Interventions
 An intervention is an activity, process, event, or
system that is designed to improve performance by
closing the gap between desired and actual
performance.
 Many institutions use a variety of service delivery,
policy and finance, and behavior change
interventions to address needs identified in the root
cause analysis stage of the PQI process.
 Given the wide range of possible interventions and
the likelihood that problems will exist in more than
one area, the most urgently needed interventions
and those that will have the greatest impact are
given the highest priority.

33. Monitoring and Evaluating
Performance
 Monitoring changes in performance is an ongoing task
that allows stakeholders to understand the impact of
interventions.
 Monitoring systems focus on measurable changes and on
gathering information that can be used to modify
interventions.
 To evaluate whether interventions are closing the
performance gap, teams typically use the same
assessment tool that was used to establish their
performance baseline.
 Information from these evaluations is used to guide
further analysis of performance gaps and causes for those
gaps, and it can also signal service providers, clients, and
community members that services and community
support of maternal and newborn healthcare are getting
closer to the desired level of quality.

34. The Model for Improvement
A simple way to frame, organize, execute
improvement work.
 Useful for testing great ideas, trying things that
have worked for others, implementing ripe ideas
or actions, and disseminating positive
improvements throughout organization

35. Three Fundamental
Questions for Improvement
1. What are we trying to accomplish?
2. How will we know that a change is an improvement?
3. What changes can we make that will result in
improvement?

36. What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Model for Improvement
Act Plan
Study Do
Aim
Measures
Ideas
Act Plan
Study Do

37. Question 1:
What Are We Trying to
Accomplish?
Aim:
 A written statement of the accomplishments
expected from each pilot team’s improvement
effort.
 Everyone on team has the same goals and
expectations

38. Aim:
What Are We Trying to
Accomplish?
Your team’s aim statement should be
consistent with the mission of the improvement work
and include:
 What is expected to happen
 The system to be improved
 Specific, numeric, stretch goals
 Time frame
 Guidance for activities, such as strategies
for the effort, or limitations

39. Question 2: How will we
know a change is an
improvement?
 Requires measurement
 Can collect qualitative & quantitative data
 Test small first
 Test under a wide variety of conditions to make
sure idea is robust enough

40. Types of Measures
1. Outcome Measures
 Results – system level performance
 How is the health of the patient affected?
2. Process Measures
 Inform changes to the system
 Are key changes being implemented in the
system?

41. Question 3: What Changes Can We
Make That Will Result in Improvement?
 Use change concepts, models, literature, shared
experiences to develop specific changes.
 Test: good ideas, ready for use or ready for adaptation to
your environment

42. The Cycle for Learning and
Improvement
Act
• What changes
are to be made?
• Next cycle?
Plan
• Objective
• Questions and
predictions (why)
• Plan to carry out the cycle
(who, what, where, when)
• Plan for data collection
Study
• Complete the
analysis of the data
• Compare data to
predictions
• Summarize
what was
learned
Do
• Carry out the plan
• Document problems
and unexpected
observations
• Begin analysis
of the data

43. Use the Cycle for:
 Helping to answer the first two questions of the Model for
Improvement
 Developing a change
 Testing or adapting a change idea
 Implementing a change