the lived experiences of nurses with performance reviews in a public hospital in the eastern cape

219 Pages·2017·1.73 MB·English

by  Coetzer, Rina

THE LIVED EXPERIENCES OF NURSES WITH PERFORMANCE REVIEWS IN A PUBLIC
HOSPITAL IN THE EASTERN CAPE PROVINCE: A PHENOMENOLOGICAL APPROACH

by

SIZIWE WINNIFRED XEGO

submitted in accordance with the requirements

for the degree of

DOCTOR OF LITERATURE AND PHILOSOPHY

in the subject

HEALTH STUDIES

at the

UNIVERSITY OF SOUTH AFRICA

SUPERVISOR: PROF LV MONARENG

CO-SUPERVISOR: PROF MM MOLEKI

NOVEMBER 2016
Student number: 737 203 5
DECLARATION

I declare that THE ONTOLOGICAL EXPERIENCES OF NURSES WITH CONTRACTING AND
DOING PERFORMANCE REVIEWS IN A PUBLIC HOSPITAL IN THE EASTERN CAPE
PROVINCE: A PHENOMENOLOGICAL APPROACH is my own work and that all sources that I
have used or quoted have been indicated and acknowledges by means of complete references and
that this work has not been submitted before for any other degree at any other institution.

SWXego 20 February 2017
THE ONTOLOGICAL EXPERIENCES OF NURSES WITH CONTRACTING AND
DOING PERFORMANCE REVIEWS IN A PUBLIC HOSPITAL IN THE EASTERN
CAPE PROVINCE: A PHENOMENOLOGICAL APPROACH

STUDENT NUMBER: 737 203 5
STUDENT NAME: SIZIWE WINNIFRED XEGO
DEGREE: DOCTOR OF LITERATURE AND PHILOSOPHY
DEPARTMENT: HEALTH STUDIES, UNIVERSITY OF SOUTH AFRICA
SUPERVISORS: PROF LV MONARENG
CO-SUPERVISOR PROF MM MOLEKI

ABSTRACT

Performance Management and Development System (PMDS) is a process of
harnessing human and material resources within an organisation to ensure maximum
performance to achieve the desired results of improved quality of health service
delivery.

This study explored and described the ontological experiences of nurses of all
categories with contracting and doing performance reviews in a public hospital in the
Eastern Cape Province. Purposive sampling approach was used to recruit all categories
of nurses Data was collected through unstructured, individual, in-depth interviews with
professional nurses and focus group interviews with lower categories. Techs eight step
data analysis method was employed to analyse data. Major findings were related to lack
of supervisor cooperation, shortage of resources, difficulty in calculating the scores, lack
of understanding the tool, time constraints and paperwork which results in the tool being
viewed as time consuming. Positive findings were that experiences such as improved
relations resulting from spending time with supervisors during performance review
sessions. Guidelines were developed, based on the findings, to empower both nurse
clinicians and the supervisors in the implementation of the PMDS.

KEY CONCEPTS:

Contract, experience, nurse, ontological
ACKNOWLEDGEMENTS

I thank God for the following people who made it possible for me to complete this study.
Without them I wouldn’t be where I am today in the academic field.

 Professor LV Monareng, my research supervisor, for her invaluable support,
guidance and expertise throughout the study.
 Professor MM.Moleki, my research co-supervisor, for her invaluable support,
input and expertise in the research applied in this study.
 All the participants who willingly volunteered to participate in the study.
 Doctor Nonkelela, for assisting me with qualitative data analysis.
 My family, for their support, patience, encouragement and understanding
throughout the study
 My colleagues in the hospital, who were very encouraging and supportive
throughout the journey.
Dedication

I dedicate this study to:

My late father Kaiser and my late mother Nontukunina Roselinah for their love
and value for education. My late brother Monde for his love. My late brother
Lulama for taking me to school, his love, his encouragement and support. My
husband Tembekile for being with me, motivating me during my studies. My sisters
Nomadletye, Nomaciko and Noludumo for their encouragement. My son Bakolise,
daughters Hlonela and Kumbula, my late son Bapiwe for their assistance with
typing and internet search and also their unending motivation. My grandchildren
Mila and Manyano whom I could barely give love during my studies.
i

TABLE OF CONTENTS
CHAPTER 1 ............................................................................................................................... 1
ORIENTATION AND OVERVIEW OF THE STUDY ................................................................... 1
1.1 INTRODUCTION ...................................................................................................... 1
1.2 PHASES OF THE STUDY ........................................ Error! Bookmark not defined.
1.3 BACKGROUND AND RATIONALE ABOUT THE RESEARCH PROBLEM .............. 2
1.3.1 The source of the research problem ......................................................................... 2
1.3.2 Background to the research problem ........................................................................ 3
1.3.2.1 Implementation of the PDMS .................................................................................... 3
1.3.3 Research problem statement ................................................................................. 13
1.4 AIM OF THE STUDY.............................................................................................. 14
1.4.1 Research purpose .................................................................................................. 14
1.4.2 Research objectives ............................................................................................... 14
1.4.3 Research question/s .............................................................................................. 15
1.5 SIGNIFICANCE OF THE STUDY ........................................................................... 16
1.6 DEFINITIONS OF KEY CONCEPTS ...................................................................... 17
1.7 FOUNDATIONS OF THE STUDY .......................................................................... 20
1.7.1 Meta-theoretical assumptions ................................................................................. 20
1.8 RESEARCH DESIGN AND METHOD .................................................................... 22
1.9 SCOPE OF THE STUDY ....................................................................................... 24
1.10 STRUCTURE OF THE THESIS ............................................................................. 24
1.11 CONCLUSION ....................................................................................................... 26
CHAPTER 2 ............................................................................................................................. 28
LITERATURE REVIEW ............................................................................................................ 28
2.1 INTRODUCTION .................................................................................................... 28
2.2 PERFORMANCE MANAGEMENT AND DEVELOPMENT SYSTEM
(PMDS) TOOL........................................................................................................ 29
2.2.1 Historical background of performance management .............................................. 29
2.2.3 Performance management and its importance ....................................................... 30
2.3 EFFECTIVE PERFORMANCE FEEDBACK: MANAGER’S ROLE ......................... 32
2.3.1 Creation of a positive work environment ................................................................. 32
2.3.2 Performance assessment and rating ...................................................................... 33
2.4 Performance outcomes and their management ...................................................... 35
2.5 Management of sub-standard performance ............................................................ 37
2.6 EMPLOYEE TRAINING AND DEVELOPMENT ..................................................... 38
2.6.1 Employee orientation.............................................................................................. 39
2.6.2 Mentoring and coaching: a performance management function ............................. 39
2.6.3 Management of satisfactory performance ............................................................... 44
ii

2.6.4 Remuneration of nurses ........................................................................................ 45
2.7 BENEFITS OF PERFORMANCE MANAGEMENT AND DEVELOPMENT
SYSTEM ................................................................................................................ 49
2.7.1 Patients benefits ..................................................................................................... 49
2.7.2 Supervisor benefits ................................................................................................ 51
2.7.3 Employee benefits .................................................................................................. 52
2.7.4 Organisational benefits ........................................................................................... 53
2.8 PERFORMANCE OBSTACLES ............................................................................. 53
2.8.1 Staff shortage ......................................................................................................... 55
2.8.2. Shortage of equipment ........................................................................................... 56
2.8.4 Lack of motivation to perform ................................................................................. 57
2.9 Practice competencies of nurses ............................................................................ 58
2.9.1 Competencies of nurses ......................................................................................... 58
2.10 Performance Improvement Plans (PIP) .................................................................. 66
2.11 Theories and Models of motivation related to performance management ............... 66
2.11.1 Goal setting theory ................................................................................................. 67
2.11.2 Path-goal theory- .................................................................................................... 69
2.11.3 Expectancy theory .................................................................................................. 69
2.12 CONCLUSION ....................................................................................................... 70
CHAPTER 3 ............................................................................................................................. 71
RESEARCH DESIGN AND METHOD ...................................................................................... 71
3.1 INTRODUCTION .................................................................................................... 71
3.2 RESEARCH SETTING ........................................................................................... 72
3.3 RESEARCH DESIGN ............................................................................................. 75
3.3.1 Phenomenological philosophical base .................................................................... 76
3.3.2 Qualitative paradigm .............................................................................................. 79
3.3.2.1 Attributes of qualitative research. ........................................................................... 79
3.3.3 Explorative design .................................................................................................. 81
3.3.4 Descriptive design .................................................................................................. 82
3.3.5 Contextual design .................................................................................................. 82
3.4 RESEARCH METHOD ........................................................................................... 83
3.4.1 Population .............................................................................................................. 83
3.4.2 Sample and sampling ............................................................................................. 85
3.4.3 Sample size ........................................................................................................... 86
3.4.4 Sampling procedure ............................................................................................... 87
3.4.6 Gaining entree to the research site ......................................................................... 87
3.4.7 Preparation of venue for interviews ........................... Error! Bookmark not defined.
3.4.8 Data collection........................................................................................................ 87
iii

3.4.8.1 The unstructured individual interviews .................................................................... 90
3.4.8.2 Focus group interviews .......................................................................................... 91
3.4.8.3 Direct observations ................................................................................................ 92
3.4.8.4 Field work and field notes ....................................................................................... 93
3.4.9 Data analysis ......................................................................................................... 94
3.4.10 Reflexive journal ........................................................ Error! Bookmark not defined.
3.5 ENHANCING TRUSTWORTHINESS ..................................................................... 95
3.5.1 Credibility ............................................................................................................... 97
3.5.2 Dependability ......................................................................................................... 99
3.5.3 Confirmability ....................................................................................................... 100
3.5.4 Transferability ...................................................................................................... 102
3.5.5 Authenticity .......................................................................................................... 102
3.6 ETHICAL CONSIDERATION ............................................................................... 102
3.6.1 Protection of the rights of the institutions .............................................................. 103
3.6.2 Protecting the rights of participants ...................................................................... 103
3.6.3 Scientific integrity ................................................................................................. 109
3.7 CONCLUSION ..................................................................................................... 109
CHAPTER 4 ........................................................................................................................... 110
PRESENTATION, ANALYSIS AND INTERPRETATION OF THE RESEARCH FINDINGS .... 110
4.1 INTRODUCTION .................................................................................................. 110
4.2 SAMPLE DEMOGRAPHIC DATA ........................................................................ 111
4.2.1 Observations during data collection ........................................................................ 93
4.3 DATA ANALYSIS PROCESS ............................................................................... 113
4.3.1 Language ............................................................................................................. 116
4.3.2 Understanding and Heidegger’s being-in-the-world .............................................. 118
4.3.3 Gadamer’s fusion of horizons. ................................... Error! Bookmark not defined.
4.3.4 Hermeneutic circle ............................................................................................... 118
4.4 THEMES AND SUB-THEMES THAT EMERGED ................................................ 120
4.5 DATA PRESENTATION ....................................................................................... 120
4.6 THEME 1: CHALLENGES IN IMPLEMENTATION OF THE PMDS ...................... 121
4.6.1 Busy work schedule ............................................................................................. 121
4.6.2 Lack of supervisor cooperation ............................................................................. 122
4.6.3 Difficulty in calculating the scores ......................................................................... 123
4.6.4 Shortage of resources .......................................................................................... 124
4.6.4.1 Time constraints and paperwork .......................................................................... 126
4.7 THEME 2: LACK OF UNDERSTANDING OF THE PMDS PROCESS ................. 128
4.7.1 Obligation ............................................................................................................. 129
4.7.3 Performance enhancement versus monetary benefits .......................................... 130
iv

4.8 THEME 3: NEGATIVE EXPERIENCES................................................................ 133
4.8.1 Frustration ............................................................................................................ 133
4.8.2 High level of stress ............................................................................................... 134
4.9 THEME 4: POSITIVE EXPERIENCES ................................................................. 137
4.9.1 Enhanced relations .............................................................................................. 137
4.9.2 Learning experience ............................................................................................. 138
4.9.3 Skills development ............................................................................................... 140
4.9.4 Knowledge acquisition and self-development ....................................................... 141
4.9.5 Clarification of the PMDS process ........................................................................ 142
4.10 CONCLUSION ..................................................................................................... 144
CHAPTER 5 ........................................................................................................................... 146
DEVELOPMENT AND PRESENTATION OF GUIDELINES FOR IMPROVEMENT OF
CONTRACTING AND DOING PERFORMANCE REVIEWS .................................................. 146
5.1 INTRODUCTION .................................................................................................. 146
5.2 GUIDELINES ....................................................................................................... 147
5.2.1 Characteristics of guidelines................................................................................. 147
5.2.2 Types of guidelines .............................................................................................. 147
5.2.2.1 Standard guidelines ............................................................................................. 148
5.2.3 Principles for the development of guidelines ........................................................ 148
5.2.4 Target group ........................................................................................................ 149
5.2.5 Purpose for the development of guidelines ........................................................... 150
5.3 METHOD FOLLOWED TO FORMULATE THE GUIDELINES .............................. 151
5.3.1 Context inductive reasoning ................................................................................. 151
5.4 FORMULATION OF GUIDELINES TO FACILITATE PERFOMANCE
APPRAISAL COMPLIANCE IN THE NURSING CONTEXT ............................... 152
5.4.1 Description of the guidelines ................................................................................ 152
5.5 Concluding statements ......................................................................................... 162
5.6 CONCLUSION ..................................................................................................... 164
CHAPTER 6 ........................................................................................................................... 165
CONCLUSIONS, RECOMMENDATIONS AND LIMITATIONS OF THE STUDY .................... 165
6.1 INTRODUCTION .................................................................................................. 165
6.2 CHALLENGES RELATED TO PDMS CONTRACTING AND DOING
PERFORMANCE REVIEWS ................................................................................ 166
6.2.1 Monetary incentives ............................................................................................. 168
6.3 VIEWS OF PARTICIPANTS ON PDMS CONTRACTING AND DOING................ 168
6.3.1 Positive experiences ............................................................................................ 169
6.3.2 Impact of PDMS on relationships ......................................................................... 169
6.4 RECOMMENDATIONS ........................................................................................ 170