The impact of a professional
evaluation system in primary
healthcare
Luis Velez Lapão1
Márcia Silveira Ney2
Celia Regina Pierantoni3
Context
The 2005 Primary Care Reform introduced a performance-based management system in Portugal. This study aims
at analyzing the Integrated Management System and Evaluation of Public Administration Services (SIADAP)
implemented for this purpose. The objectives were to analyze the general context and the implementation of the
Professional Evaluation System, identify the facilitating and limiting factors of management process, recognizing
the tools used for monitoring and assessing the managers perception on the framework usability.
Methods
We use an exploratory, descriptive, and narrative research using a qualitative approach. It was performed a
document review and scientific literature. Data collection was conducted through an applied questionnaire
addressing managers at Groups of Health Centers (ACES) in Lisbon. Respondents were divided into various
categories: Family Health Units (FHU) Coordinators, members of Clinical Councils and Management Support Units
(UAG) managers. The questionnaire addressed the process of implementation of SIADAP for professionals,
monitoring and evaluation of professional practices and their relationship with the contracting process targets in
FHU.
Figure 1. Conceptual framework in performance management
Results
The SIADAP was institutionalized by
the government for all Portuguese
Public Administration in 2007, however,
it
still
not
includes
all
health
professional
categories,
such
as
physicians or nurses.
The process of performance evaluation
is applied once a year including both
technical and administrative services.
The
indicators
and
assessment
objectives are to be defined and
negotiated beforehand with head
superiors. As limiting factors to the
process have been described: the
extensive workload; the effort to
perform the monitoring; lack of
protocols for the assessment of
technical skills. The absence of an
integrated information system is also a
barrier, not allowing the reach of
objectives achieved by professionals
with established by the department.
As positive points it was emphasized:
a greater involvement of professionals
to the organization's goals; greater
accountability for the staff activities; an
opportunity for career advancement
and; encouraging learning for the
improvement of services.
Primary health care reform
Groups of health centers
(ACES)
Performance
evaluation
(SIADAP)
Performance
management
Objectives
Performance
rating
Contratualization
Indicators/targets
Products/results
Financial incentives
Discussion
In the ACES organization the management processes directed to
the professional performance is showing very positive evolution,
however is still fragile, by the fact that it does not include all team
members and is still not inserted into the organizational culture.
The healthcare teams activities are planned in meetings where
agreed targets for the indicators are also defined, and the absence
of a performance evaluation for all professionals makes it
impossible for a systematization in order to improve management
processes and get a better services quality.
1 - Health Management Professor , WHO Collaborating Center for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine (IHMT),
Universidade Nova de Lisboa, Portugal.
2 - Medical, Doctoral Student of Public Health at Institute of Social Medicine/UERJ, Brazil and Institute of Hygiene and Tropical Medicine (IHMT),
Universidade Nova de Lisboa, Portugal.
3 - Medical. PhD in Public Health. Associate Professor of IMS / UERJ. General Coordinator of Network Observatory of Human Resources in HealthWorkstation at IMS / UERJ. Director of the Collaborating Centre PAHO / WHO for Planning and Information Workforce for Health.