In the last two decades, the world has witnessed remarkable improvements in health, particularly in many low-income countries, towards ensuring availability of accessible, equitable, and quality essential healthcare to populations [1]. Despite these improvements, in low-income countries, significantly high number of mothers, neonates and children are dying due to preventable causes. Hence, as part of the Sustainable Development Goals (SDGs), 180 countries have committed to further reducing these deaths. According to the SDG pledges, by the year 2030, five of the seventeen SDGs will contribute to better health outcomes through strategic implementation of innovations that enhance good health and wellbeing for people, ensure quality education, expand decent work and economic growth, and further reduce inequalities [2].
The ability of a country to meet its goals depends largely on its existing performance management practices, organizational culture, and a high performing primary healthcare entity [3]. An organization’s culture defines the agreed norms within the organization. It is characterized by employees’ perceptions and behavior in an organization [4]. Well-functioning health leaders develop and shape subordinates through sharing values, beliefs, and assumptions [5]. Building organizational culture needs continuous effort and innovations [6].
The Ethiopian Health Sector Transformation Plan (2020- 2025) strategizes to achieve five major agendas, namely: quality and equity, information revolution, motivated competent and compassionate health workforce, health financing, and leadership [5]. The Ministry implements the Ethiopian Health Center Reform Implementation Guidelines (EHCRIGs) as minimum standards that categorize primary healthcare unit excellence [7]. EHCRIGs are expected to be implemented in all health centers in Ethiopia. Development partners also provide technical and financial support through promoting commitment, responsiveness and accountability at primary health care level.
USAID Transform: Primary Health Care project institutionalizes performance management innovations [8]. It strives to improve work environment and management systems through building visible leadership, enhancing culture of quality, availing client focus services, and exercising transparency and accountability in the health system. The project supports the health system on the cyclic implementation of performance management initiatives within the primary healthcare entities. In addition, placing performance management dimensions at the center, its technical support has four clustered components which consist of: (1) introducing minimum standards, (2) performance measurement, (3) developing quality and performance improvement projects, and (4) reporting on progress. This is because performance management innovations help the health system to enhance organizational culture and achieve organizational excellence [9].
There is empirical evidence of the influence of organizational culture and its four traits: involvement, consistency, adaptability, and mission on higher performances of several business entities [3] [6] [10]. Currently, there is no clear information on the contribution of performance management innovations on building organizational culture and primary healthcare unit excellence in Ethiopia. Therefore, this study aimed to compare the influence of performance management innovations on building organizational culture and primary healthcare unit excellence in Ethiopia.
In the last two decades, the world has witnessed remarkable improvements in health, particularly in many low-income countries, towards ensuring availability of accessible, equitable, and quality essential healthcare to populations [1]. Despite these improvements, in low-income countries, significantly high number of mothers, neonates and children are dying due to preventable causes. Hence, as part of the Sustainable Development Goals (SDGs), 180 countries have committed to further reducing these deaths. According to the SDG pledges, by the year 2030, five of the seventeen SDGs will contribute to better health outcomes through strategic implementation of innovations that enhance good health and wellbeing for people, ensure quality education, expand decent work and economic growth, and further reduce inequalities [2].
The ability of a country to meet its goals depends largely on its existing performance management practices, organizational culture, and a high performing primary healthcare entity [3]. An organization’s culture defines the agreed norms within the organization. It is characterized by employees’ perceptions and behavior in an organization [4]. Well-functioning health leaders develop and shape subordinates through sharing values, beliefs, and assumptions [5]. Building organizational culture needs continuous effort and innovations [6].
The Ethiopian Health Sector Transformation Plan (2020- 2025) strategizes to achieve five major agendas, namely: quality and equity, information revolution, motivated competent and compassionate health workforce, health financing, and leadership [5]. The Ministry implements the Ethiopian Health Center Reform Implementation Guidelines (EHCRIGs) as minimum standards that categorize primary healthcare unit excellence [7]. EHCRIGs are expected to be implemented in all health centers in Ethiopia. Development partners also provide technical and financial support through promoting commitment, responsiveness and accountability at primary health care level.
USAID Transform: Primary Health Care project institutionalizes performance management innovations [8]. It strives to improve work environment and management systems through building visible leadership, enhancing culture of quality, availing client focus services, and exercising transparency and accountability in the health system. The project supports the health system on the cyclic implementation of performance management initiatives within the primary healthcare entities. In addition, placing performance management dimensions at the center, its technical support has four clustered components which consist of: (1) introducing minimum standards, (2) performance measurement, (3) developing quality and performance improvement projects, and (4) reporting on progress. This is because performance management innovations help the health system to enhance organizational culture and achieve organizational excellence [9].
There is empirical evidence of the influence of organizational culture and its four traits: involvement, consistency, adaptability, and mission on higher performances of several business entities [3] [6] [10]. Currently, there is no clear information on the contribution of performance management innovations on building organizational culture and primary healthcare unit excellence in Ethiopia. Therefore, this study aimed to compare the influence of performance management innovations on building organizational culture and primary healthcare unit excellence in Ethiopia.
Operational definitions
Involvement: is an internal organizational factor in developing organizational culture and is signified by transparent communication, employee-focused leadership, and strong interpersonal relationships within the organization [10].
Consistency: is an internal organizational factor in developing organizational culture and refers to the level of cohesion, integration, or agreement around values and norms [10].
Adaptation: is an external factor in maintaining an organizational culture that reflects an evolutionary approach to organizational culture and suggests that cultures develop and persist because they help an organization to survive and flourish [10].
Mission: is an external factor in maintaining an organizational culture that provides purpose and meaning by defining a social role and external goals for the organization [10].
Performance management innovation: includes team-based training of health workers on minimum standards, use of data for decision making, and strategic problem-solving tools. In addition, the project assigned health systems strengthening expert who closely provided technical support on continuous measurement of performances, development of do-able projects, and organization of experience sharing events and performance review meetings [4] [9].