Personnel Review

Policing performance: the ethics of performance management

Diana Winstanley, Kate Stuart‐Smith,
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Diana Winstanley, Kate Stuart‐Smith, (1996) "Policing performance: the ethics of performance management", Personnel
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 Personnel
Review Policing performance:
25,6 the ethics of performance
management
66
Diana Winstanley
Imperial College Management School, London, UK and
Kate Stuart-Smith
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British School of Osteopathy, London, UK

Introduction
This article questions whether it is possible to develop an ethical approach to
measuring and managing performance. It is argued that traditional models and
approaches to performance management generally do not succeed in meeting
their objectives, are flawed in implementation, act to demotivate staff, and are
often perceived as forms of control which are inappropriately used to “police”
performance. The article proposes that for an approach to be meaningful and
worthwhile, four ethical principles need to be built into the process:
(1) respect for the individual,
(2) mutual respect,
(3) procedural fairness, and
(4) transparency of decision making.
This article presents an alternative methodology for developing performance
objectives and managing performance particularly appropriate for professional
staff in the not-for-profit sector and where there may be dissent over both the
nature of the service being provided, and how that service should be provided.
This is explained through a case study of the development and use of performance
indicators at the British School of Osteopathy. This utilizes a stakeholder analysis
and synthesis approach, involving those affected in a dialogue over the design of
performance measures and methods for performance improvement.

Definitions of performance management and measurement

Within the realm of human resource management there is an implicit and
sometimes explicit model of the process of performance management and
measurement. This breaks down into three main processes:

Personnel Review, Vol. 25 No. 6,
1996, pp. 66-84. © MCB
University Press, 0048-3486
The authors acknowledge, with thanks, permission to reproduce Fitzgerald et al.’s “Model of
Service Performance”. This appeared in Performance Measurement in Service Businesses by L.
Fitzgerald, R. Johnston, S. Brignal, R. Silvestro and C. Voss, published by The Chartered Institute
of Management Accountants, 1991.
 (1) setting the objectives; Policing
(2) managing performance to objectives; and performance
(3) measuring performance against objectives.
These are possibly accompanied by a process of benchmarking the
performance and benchmarking the objectives externally[1], thus it has been
labelled the MBO of the 1990s[2]. 67
If we take a more holistic view of performance management and
measurement, we can draw on literature from finance, accountancy, auditing,
and public sector management. These models tend to concentrate on the setting
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of objectives and measuring performance against them, with less concern for
managing performance, although there are some exceptions (for example [3,
p. 9]).
Much performance measurement literature has focused on financial
indicators, but there is an increasing literature which shows the private sector
supplementing financial measures with softer measures of quality and
customer satisfaction. For example, Geanuracos and Meiklejohn[4, p. 6] quote
Jack Welch, CEO of General Electric Inc. as saying:
The three most important things you need to measure in a business are customer satisfaction,
employee satisfaction and cash flow.
This is in part a response to increased forces of global competition, the
pressures of recession, and the influence of “excellence” practices. In the public
sector performance measurement is linked to the application of key elements of
Thatcherite and post-Thatcherite policy, that of incorporating private practices
in the public sector, controlling the public purse, and controlling professionals
who were seen to be key obstacles in the path to greater consumer choice[5-11].
The influence of central Government is endemic in the systems of rewards and
penalties, operating in the use of appraisal systems in universities, IPR and
clinical audit in the health service, and PRP in local government, and in the use
of league tables to evaluate performance in health and education.

Five critiques of performance measurement

Despite their widespread use, performance management and measurement
systems can be criticized from at least five angles. Each criticism, in turn, can
contribute to an ethical reappraisal and make the case for a change of approach.

Traditional managerialist critiques

The first three critiques are derived from a traditional managerialist
framework. They take a functionalist stance in identifying problems which
prevent performance management from contributing to the success of the
organization, with the ultimate aim of rectifying these. They concentrate on the
mechanics and design of performance management and measurement systems
rather than their raison d’être, and provide ammunition for an attack based on
operationalization rather than on performance management per se.
 Personnel Lack of success. The first criticism focuses on lack of success in meeting
Review objectives. This may arise out of design errors, or from the unpredictability of
25,6 unintended consequences. There is no conclusive evidence that the use of
performance management systems results in improved performance. The
Bevan and Thompson study[1] and Guest and Peccei’s work[12] on evaluating
the effectiveness of human resource management demonstrate the
68 methodological difficulties in demonstrating cause and effect. Factors such as
firm size, age, culture, sector, and numerous other variables make the
relationships more complex, as do the different definitions of performance
management in existence within organizations.
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The most spirited defence of performance systems based on their

contribution to performance has been conducted by Huselid[13]. He attempts to
establish the impact of what he terms “high performance work practices”,
including performance management, incentive compensation and certain types
of recruitment and training programmes, on corporate performance. But his
definition of high performance work practices is contentious, and the reliability
and validity of his questionnaire data is questionable, and even he admits that
extrapolation of conclusions from the regression analysis data may reflect
spurious correlation or correlation due to a non-causal relationship.
Performance management systems can also produce undesirable side effects,
including demoralization and de-motivation on the one hand, and an over-
bureaucratization on the other. These points are even more evident when the
process is linked to pay[14,15].
Problems in operationalization. The design of performance management and
measurement systems can also be criticized[1,14,16,17]. Textbooks on
performance management are geared towards explaining how such mistakes
and design problems can be overcome[18-20]. Some writers focus on the
difficulties of setting performance objectives, of their inability to reflect
intangibles, their lack of flexibility to respond to change, and the problems of
making objectives cover the whole job[21,22]. The fix for these types of
problems tends to be the advocacy of methods such as SMART objectives
(simple, measurable, agreed, realistic and timely).
Other criticisms relate to the process of appraisal itself, including lack of time
given to the process, an over-bureaucratization of the process, and lack of
perceived importance ascribed to it. Some mention the tendency for
performance management and appraisal systems to stress assessment of
performance in order to determine performance rewards, and de-emphasize
development. They also mention the difficulties of using systems for both
development and reward[23].
Impact on people: subjectivity and bias. Within the process, some authors
concentrate on the lack of fairness arising from the subjectivity and bias of the
appraiser, as well as their lack of skill[24-28], and the repercussions for equal
opportunities. Unfairness can be of two sorts, procedural unfairness, in terms
of the methods used, and outcome unfairness, in terms of the effects these have
on people. Wayne and Liden[28], for example, suggest that “impression
 management behaviour” had a significant, indirect impact on performance Policing
ratings, as did likeness or “demographic similarity”, and Bevan and performance
Thompson[1] show how this can negatively affect women’s ratings. Yet
Townley[27, p. 228] comments:
Most [appraisal] systems deny the element of judgement, depersonalising the process by
appealing to notions of a seemingly externally verifiable objectivity.
69
The issue of subjectivity lies at the heart of the disagreement between
managerialists and radicals on performance management. Where
managerialists suggest that what we need to do is weed out subjectivity, and
make appraisal as objective as possible, the radicals state that subjectivity is an
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inherent part of the process, as performance management reflects the exercise

of power.

Radical critiques
The exercise of power and control. One view of performance management
suggests that performance management is a new form of “Taylorism”. Control
through specification of contracts (performance objectives and measures), and
checks to ensure that performance meets that required performance evaluation,
places performance management at the centre of the process for controlling the
labour process in the public sector.
This has become viewed as a form of “boundary control”, or arms’ length
regulation[11,29]. Carter[30], for example, questions whether the use of
performance indicators is actually “backseat driving or hands-off control”.
Where organizational hierarchies continue to exist, behavioural selection
criteria, appraisal and performance related pay are part of the process for
substituting direct with indirect forms of control[31].
Is such an approach to managerial control more or less ethical than other
forms? It can be argued that it enables more discretion over how the work gets
done, but in the perception of the “appraised” it can become akin to a police
state, where the control occurs through the collection of documentation and
evidence, a dossier on an individual. Instead of standing over ones’ shoulder,
supervision becomes more a matter of spying through keyholes.
Townley[27], drawing on the work of Foucault[32], views appraisal functions
as equivalent to an “information panopticon” using the Foucaultian metaphor
of a prison, where:
The central tower was to house the administrative functions of management, the policing
functions of surveillance, the economic functions of controlling and checking, the religious
functions of encouraging obedience and work; from here all orders would come, all activities
would be recorded, all offences, perceived and judged.
Barlow[29] also examines some of the latent functions of appraisal in relation to
the perpetuation of power. In Townley’s schema, power, instead of descending
(as in the framework of managerial control), ascends and becomes constructed
and articulated, using bureaucratic and institutional processes to legitimate it
as “rational”, “neutral” and “objective”.
 Personnel Another way to theorize power and performance management and
Review measurement is to see it as a tool in the battle between conflicting interests, a
25,6 good example of which is in the Government’s assault on professional
autonomy for doctors and teachers, with the institution of peer evaluation being
paradoxically both a confirmation of, and a form of resistance to, managerial
practices and political control. This is evident in the case of clinical audit. By
70 turning our attention away from employers and towards other groups within
the organization, this leads us away from unitarist views of the organization to
pluralist ones.
Unitarist framework. A problem with much of the managerialist literature
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cited above is that it assumes a unitarist view of the organization, and that view
is the employer’s. The transcendence of the employer’s view above others is part
of the constructed rhetoric of contemporary organizations. A power model of
the organization assumes a pluralist view. Here, design problems which are
viewed as solvable from the managerialist framework become more intractable
from a pluralist one. People can play the system, being rewarded for meeting
performance objectives, while still undermining performance overall.
One example is where one professional body recommended that members
filled in performance activity data incorrectly to prevent the system becoming
operable. Another is the notorious case of the member of the Kent Constabulary
who encouraged those charged with offences to confess to others which they
had not committed in order to “improve” the clear-up rate[21]. If the wellbeing
of an organization is not the abiding interest of individuals within it, then
meeting objectives can become part of a game of cat and mouse, where an
individual’s own interests, for example to get performance rewards, are more
important than the organization’s.
One set of responses has been to suggest we should widen out the framework
of who does the appraising or judging away from a top-down process. Upward
or reverse appraisal[33] is one such way of doing this, and the concern to
involve as many stakeholders and viewpoints as possible in the process has led
to the notion of 360-degree appraisal in human resource management[34]. A
similar rationale underlies recommendations of “the balance scorecard”[35] and
the Baldrige or European Quality Award assessment schedule[36], which draw
on the needs of customers, team mates and peers and other employees in
assessing performance.
It is ludicrous to suggest that multiple or upward appraisal redresses the
power balance. As Redman and Snape[33] show, for upward appraisal to work
it usually requires anonymity of appraisers, and thus feedback through a third
party, often a consultant; it is always conducted as one part of a multiple
process, where subordinates’ views are tempered by those of others; and it is
mainly used for development rather than pay. The structural power inequality
between manager and subordinate does not change significantly.
 Ethics and a stakeholder approach to performance management Policing
Arising from the critiques above, a number of ethical concerns are surfaced. performance
First the managerialist critiques identified ethical problems of subjectivity and
bias of performance management systems. This identifies the need for
procedural fairness to limit adverse impact on individuals. This should be
backed by opportunities to scrutinize the basis for decision making and an
appeal against those decisions which are believed to be unfair. For this 71
transparency to be effective, those criteria used for performance evaluation
need to be clearly communicated. However, building in fairness and
transparency in the performance management process still maintains a fairly
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passive role for the appraisees, whereby they can check that the system works
fairly, but not question the fundamental design of the system per se.
Performance management is still something which is largely “done to” the
individual.
Another ethical appraisal of performance management would concern itself
with the rights of the individual, or its effects on the individual. In Kantian
terms, there is the question as to whether individuals in the process are treated
as “ends in themselves”, or merely “means to other ends”. One of the problems
that has dogged performance management systems is that they have generally
led individuals to feel that the latter is the reality.
Using a rights framework, it is possible to identify individual rights in
performance management, the right to privacy over some personal information,
and the right to comment on the appraisal review findings. Using a
contractarian view of rights[37], performance management processes are a
basis for identifying a person’s institutional duties, with objectives setting the
outline of duties, and appraisal the evaluation of whether the contractual duties
have been met. This does not go far enough in protecting individual rights, and
ignores the right to participate in the design of the management process.
Radical critiques of performance management highlight ethical concerns
over those performance systems and practices which reinforce modes of
intrusive control and lead to passive or resistance roles for individuals. From an
ethical viewpoint, the desirability of utilizing systems which incorporate
stakeholders in their design and not just execution leads to a wider role for the
individual, as a “creator” rather than “victim” of performance management.
This would fit in with much of the human relations approaches to humanizing
work, going back over 30 years to the work of Herzberg, for example [38],
whereby involvement, participation and even workplace democracy are viewed
as ethical constructs in the management of people at work.
A note of caution here is provided by the radical critique of performance
management which identifies pluralism as being endemic in organizations. In
this case it may not be possible for all parties to agree on what performance
measures would be appropriate and how such systems should operate. This
requires some mechanisms to ensure that it is not just the power holders whose
voice is heard, and to ensure that where consensus exists it can be built on, but
where it does not, dissenters are not silenced. Again, procedural fairness is
 Personnel needed for there to be effective mediation between competing claims, and
Review information provision is needed to explain the reasons for those which cannot
25,6 be addressed.
If we view the organization as a community of interests, more akin to
Aristotelian views of the organization[39] then we need to examine the basis for
“virtue ethicality”. Solomon proposes six ingredients:
72
(1) community;
(2) excellence;
(3) role identity;
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(4) holism;
(5) integrity; and
(6) judgement.
Through community, we find identity and meaning, and this assumes a more
bottom-up socially constituted, rather than top-down economic driven, view.
However, this is still predominantly unitarist in perspective, and our view is
that it is necessary to go further into the concept of organizations as
communities of interests to address the pluralist concerns. A stakeholder
synthesis approach enables this to be done.
Freeman[40, p. vi] a founder of “stakeholder theory”, defines stakeholders as:
Any group or individual who can affect, or is affected by, the achievement of an organization’s
purpose.
Stakeholder analysis is becoming popular as an approach to strategic
management and development[41,42]; stakeholder involvement and
incorporation is emerging as a key theme in organizational effectiveness[43];
and stakeholder agency theory is becoming a dominant paradigm in finance
economics[44]. At another level, stakeholder analysis is also being used as a tool
for research into management[45], and a vehicle for obtaining different
perspectives on a situation.
Goodpaster[46] makes a critical distinction between stakeholder analysis
and stakeholder synthesis: “the strategic approach uses stakeholder analysis to
pay attention to stakeholders as to factors that might affect economic interests”,
whereas a “multi-fiduciary stakeholder synthesis” goes beyond an assessment
of their effect on strategic implementation to incorporate their view in the
strategic intent of the organization. To take the example of multiple appraisal
processes which are identified above as one way of securing more views in
performance assessment, these are “stakeholder analysis” rather than
“stakeholder synthesis”, namely, stakeholders’ views are gained to see how they
affect business strategy, rather than to incorporate their views in its design. We
suggest that an ethical framework would address more directly the power
inequalities, and we suggest an alternative that incorporates more “synthesis”.
The approach taken for performance management below attempts to use
 “multi-fiduciary stakeholder synthesis” to involve key stakeholders in the Policing
development of performance objectives. performance
The case study
The study to identify performance measures for the British School of
Osteopathy Clinic is an action learning project attempting to tackle the
traditional and radical critique of performance management and measurement 73
by designing a methodology which is both practically robust and ethical, using
stakeholder synthesis. The British School of Osteopathy (BSO) is both the
oldest and the largest osteopathic teaching establishment in the UK. The BSO
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clinic is a central part of the school’s teaching of osteopathy and comprises 39

treatment rooms at the school’s London premises. Upwards of 700 patients are
treated per week in the clinic by students who are supervised by registered
osteopaths.
The BSO clinic incorporates conflicting groups of stakeholders with
differing objectives, and exhibits a public service orientation as a charitable
organization. These features make it particularly appropriate for a stakeholder
approach to performance management. The clinic aims to be:
(1) a learning environment,
(2) a treatment unit; and
(3) an income generating centre.
This study aimed to explore whether there are inherent conflicts between its
three objectives and, if so, whether it is possible to produce measurable
performance targets which reflect an acceptable balance between the objectives,
from which performance can be monitored and managed. The research also
explored the theoretical issue of essentially contested concepts and indicators
within a small service organization. Are some key problems in the BSO
produced by irresolvable ideological, theoretical and structural differences; or
are they simply disagreements that debate can resolve? This goes to the heart
of the radical critique of performance management, namely that it operates
within a unitarist paradigm and is not able to treat organizations as pluralities
of interests. This is made more difficult by the fact that clinical staff represent
some of the archetypes of professionals working within organizations; they are
“potentially highly mobile, and not easily controlled by non-specialist
managers or administrators”[47].
We also aimed to address the issue of stakeholder involvement in the process
of developing performance objectives, and the design of the research reflects
our view that one must examine holistically the performance management
processes, and not just the human resource processes in isolation. The aim,
therefore, was to identify appropriate performance measures for the clinic and
to establish a process, based on consensus, which would embed the measures
within the aims and culture of the school, in such a way that stakeholders would
 Personnel both be motivated by the process itself, and support the measures finally
Review identified.
25,6
The method
The approach described below incorporates the views of the stakeholders
including students, employees and clinic staff, as well as senior management
74 and customers (i.e. patients). We believed that one cannot assume a consensus
within a stakeholder group, rather one should explore individual scripts to see
whether consensus emerges. To avoid dominant individuals from biasing
output we used the Delphi technique[48,49], where individuals can comment on
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the views of others on an individual basis and with anonymity of attribution for
all concerned. Part of the the document generated by this technique is given in
the Appendix. This process accords with Burgoyne’s[45, p. 191] view that a
“stakeholder is a grouping with a relatively consistent experience and point of
view”; one therefore has to think carefully about at what level it is appropriate
to aggregate the views. He suggests that “identifying the coherent sets of
interest … can emerge in the process of collecting data in stakeholder analysis”.
We also felt it necessary to build in stakeholder synthesis and not just
stakeholder analysis to the process. Phases 1-5 of what follows accords with
Goodpaster’s[46] definition of stakeholder analysis, and Phase 6 with that of
stakeholder synthesis, although synthesis was also inherent in the triangulation
occurring in phases 1-5. We used triangulation in association with the Delphi
technique for consensus building and validation of the objectives, measures and
assessment of performance for the clinic. “Triangulation”as a concept has been
well used in social science qualitative research[50-52] where the accounts of
respondents are validated by others, and reflected back for confirmation.
The stakeholder process used for identifying performance measures at the
BSO is set out below.

Stakeholder analysis
Phase 1: identifying the key stakeholders. There were five key stakeholder
groups in the BSO: senior management of the school – the principal, board
members, the finance manager and the course team (responsible for educational
content and delivery); clinic tutors; clinic reception staff; students; and patients.
Phase 2: semistructured interviews with senior stakeholders to agree strategic
objectives of the organization. Six senior stakeholders were interviewed to bring
out the strategic concerns of the senior management team, using standard
models for analysing the attractiveness of opportunities and sources of threats
facing an organization and for identifying sustainable strategies, for example
using SWOT and PEST analysis, Porter’s five forces of competition analysis,
and work on differentiation and quality[53,54].
Phase 3: using the Delphi technique, identify consensus and conflict among
employees. The lack of effective communication and co-ordination between staff
attending the school on different days produces many challenges for the
organization, and influenced the research design.
 Statements made by interviewees in Phase 1 were listed, unattributed, on a Policing
sheet, which asked all respondents to score their agreement or disagreement performance
with the statements on a scale of one to five. This approach is similar to the first
round of the Delphi method[48,49]. This was given to all the initial interviewees
and to a wider sample of employees involved in the clinic. The questionnaire’s
purpose was to:
75
• allow the original interviewees to reconsider their original statements;
• allow them an opportunity to agree or disagree with the views of others;
• elicit individual views;
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• establish areas of consensus among individuals and stakeholder groups;

• establish areas of conflict between individuals and stakeholder groups;
• generate support for the project.
An example of the data from this process is in the Appendix.
Using descriptive statistics on the mode for each statement and group of
stakeholders, the difference between modes for each group, the mean for each
group, and the standard deviation on all scores for each statement it was
possible to identify areas of conflict and consensus.
The statements were grouped under the following headings:
• General agreement: mode 4-5, mean 4 and above.
• Some agreement: mode 4-5, averages 3.5-4.
• Little agreement: mode 4 and below, averages 3.4 and below.
• Complete division: standard deviation of 1.3 and more.

Phase 4: focus group interviews with clinic tutors and customers (students). In
addition to filling in the questionnaires for Phase 3, two separate focus groups
of clinic tutors were convened[55]. They explored what they felt to be important
about the clinic and what made it, or would make it, successful. Information
from Phase 2 was also used to compare the views over BSO objectives and to
establish areas of conflict and consensus.
Three groups of students were interviewed to establish the extent to which
the school was satisfying their needs, where the school’s objectives matched
their own, and where they saw improvements could be made.
Phase 5: questionnaire and depth interviews with customers (patients). The
patient profile of the school was assessed and a patient questionnaire was
devised to obtain systematic data about their experience at the BSO. This used
Fitzgerald et al.’s[56] dimensions of service performance (see Table I), although
some new categories of performance related specifically to the business in the
clinic were also identified. This was filled in through face to face interviews in
the clinic reception with a broadly representative sample of 23 patients, in terms
of age, gender, new/regular patients, paying full/reduced fees. From this sample
 Personnel Dimensions of performance Types of measures
Review
25,6 Results
Competitiveness Relative market share and position
Sales growth
Measures of the customer base
76 Financial performance Profitability
Liquidity
Capital structure
Market ratios
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Determinants
Quality of service Reliability
Responsiveness
Aesthetics/appearance
Cleanliness/tidiness
Comfort
Friendliness
Communications
Courtesy
Competence
Access
Availability
Security
Flexibility Volume flexibility
Delivery speed flexibility
Specification flexibility
Resource utilization Productivity
Efficiency
Table I.
Fitzgerald et al.’s Innovation Performance of the innovation process
model of service Performance of individual innovations
performance Source: [56]

five patients were selected to take part in unstructured depth interviews, which
were taped, and analysed in more detail.

Stakeholder synthesis
Phase 6: establishing performance measures. At each stage there was an
inductive process whereby the performance measures each group felt to be
appropriate for the activities of the clinic were discussed. The findings were
related back to the principal, members of the course team and the finance
committee to establish a consensus about the performance indicators which
should be adopted. Areas of conflict were also the subject of further discussion.
This activity enabled the organization to produce a number of key objectives,
each of which had identifiable actions and measures associated with them.
 Findings from BSO study Policing
Surprisingly, it was found that there was much more consensus than had been performance
expected, and the process revealed considerable agreement about what the
school ought to achieve, in terms of shared values and objectives. There was
broad agreement that the school “represented a passionate belief in osteopathy”
and that it was “committed to improving the standards of the osteopathic
profession”. There was also agreement that the school should establish a 77
“learning community”.
There was agreement that the BSO’s most important business was “helping
people to learn”, and broad agreement that the changes in the NHS internal
market and the force of “patient power” open up opportunities for osteopathy,
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while the changes in student funding patterns in higher education present a

threat to the school. The threat to the school from short courses in osteopathy,
or cheaper courses, could only be offset if the BSO could assure the quality of its
own education and so influence and lead the standards for the profession in
general.
There was agreement among all stakeholder groups that the clinic was a
“centre of excellence” and should be promoted as such. Other aspects of
agreement are covered in the ten BSO objectives areas which were developed as
a strategy document for the BSO.
In addition, different groups had different emphases. The clinic tutors
highlighted issues relating to employee satisfaction, staff development, pay,
power and influence. The focus of the student stakeholder interest was on the
quality of teaching they received, the fairness of assessments, the quality of
their working environment, and the variety of patient conditions they were able
to treat.
An inherent structural contradiction and conflict emerged between
maximizing each of the clinic’s principal objectives: student learning, high
quality treatment for the patient and revenue generation. It was generally
agreed that maximizing the revenue from the clinic inputs, namely physical
resources, students and patients, would compromise the learning objectives of
the clinic. Students need time to “reflect”, patient appointments are therefore
lengthy, and both students and tutors felt that at least one 40-minute
appointment in each student’s four-hour clinic session should be left free for
reflection.
However, through consensus, it was agreed that the key performance
indicator (KPI) for the clinic should reflect the balance of educational, patient
care and financial requirements. The KPI is a measure of the optimum capacity
of the clinic, which allows maximum patient throughput and student “reflective
learning” while not jeopardizing the care of the patient.
There was some concern about whether the objective of “high quality care”
for patients was ever compromised in the interests of student learning. An
example of this conflict was the lack of “continuity of care”. In an educational
clinic, where timetables dictate which student may treat a particular patient at
any time, patients may not always receive treatment from the same student
 Personnel practitioner. This was felt by most institutional stakeholders to be regrettable,
Review but an inevitable consequence of the system. It was agreed by consensus that
25,6 the school should measure the extent to which it fails to deliver continuity of
care as a key indicator of patient satisfaction. Some patients interviewed were
concerned about the lack of continuity, although in general the patients were
satisfied with the quality of the care they received, and it was rather some
78 aspects of the quality of service delivered they felt could be improved.
The most significant debates that emerged both between and within
stakeholder groups had to do with definitions of “learning”, models of
education and the notion that the quality of care and the treatment of patients
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could be measured. This was not surprising, given that both health and
education are essentially contested concepts[57]. As one respondent said:
I am assuming that people can be “educated” in a learning community, your definition may be
different to mine.
Another one said in response to the statement that “the BSO is interested in
finding the most beneficial way of educating students”:
Yes academically, but there are more problems in the clinic.
This reflected the perceived problem of teaching students at the same time as
they are delivering a treatment to patients. For example, the “reflective
practitioner” model of learning for the student could ultimately undermine
patient care, if the student was allowed totally unfettered to learn through trial
and error and reflection on mistakes and successes.
The research sought to identify how stakeholders would define quality of
teaching in the clinic. Some clinic tutors felt that students learn in proportion to
the numbers of patients they treated, and that this was the most important
influence on their learning. Others felt that learning had far more to do with the
quality of the tutor’s intervention. Some tutors defined the quality of staff as
relating directly to their length of experience, both professionally and as tutors.
Students, however, while they felt it important to see large numbers of patients,
produced a list of qualities which the excellent tutor would possess. The list did
not encompass long service in the clinic, instead the qualities were: academic
knowledge, approachability, encouragement, fairness, interest, helpfulness, and
the defining quality – enthusiasm.
The project not only clarified which objectives the stakeholders felt the
school should be pursuing, and what priority they attached to them, but also the
extent to which they believed it already achieved those objectives. This
provides an invaluable guide to the management of the school. In addition, each
stakeholder group identified their pre-eminent concerns, for which appropriate
measurements were agreed.
While the KPI of capacity for the clinic was agreed, it was evident that
stakeholders required that it be balanced by other measures to ensure that
students had sufficient time to learn. Agreement about this KPI was achieved
 on the basis that it should be revisited frequently, and tested for its continued Policing
appropriateness. As Kettner[58, p. 31] observes: performance
Ideally, the outcome of discourse will be a rational consensus. However, any particular
consensus as the product of a concrete, historically situated and hence limited community of
communication is fallible. Hence in principle it must be open for revision.
The process also identified structural weaknesses in the management of the 79
school, and enabled the definition of new job outlines. As a result, a clinic
manager was recruited to set up appropriate information systems and improve
operating efficiency of the clinic. It set an agenda, not only for the future
development of the clinic itself, but also in setting key organizational objectives,
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for which specific measurements were agreed. Ten specific BSO objectives were
identified, each with associated measures and actions to form the core of the
BSO strategy. For example, one of these objectives was “To deliver a
consistently high quality education”; the measures and actions associated with
this objective are given in Table II.
However, from the discussion above, some conflict remains about the
direction of the school. Kettner[58] suggests that where there are “conflicting
interests”, these need to be transformed into “competing claims”. Where the
balanced view of objectives is adopted, and transparent to all, then these
contested interests become no longer pressed at the expense of other areas, and
stakeholders can see the fairness in the checks and balances used, as part of

BSO objectives Measures Actions

Deliver a high Target dates for induction and Induction programmes

quality education teaching programmes
– Set QA standard Numbers of days of teacher
for the profession training taken by each clinic
tutor
Student assessment of tutors’
teaching skills
Student assessment of the use
of formative assessment
programmes
Student and tutor assessment
of enough time to reflect and
learn
Measure allocation of patients
on clinic systems to ensure:
Students see wide variety
Fair allocation of chronic
patients
Fair allocation of patients
between teams
Teaching programmes
Staff appraisal: feedback
Integrity of teaching standards
between days
In clinic:
Improve fairness of formative
assessments
MOT for tutor staff –
demonstration of clinical
competence
Student assessment of:
Academic knowledge
Approachable
Encouragement
Enthusiasm
Fairness
Interest
Helpfulness
Improve clinic systems for Table II.
providing quality assurance data An example of a BSO
Look at student mentoring systems performance objective
 Personnel being a “community”. Although the organization is like a living organ full of
Review mutual inter-dependencies, at the same time there are many sub-communities or
25,6 “sub-cultures” where differing concerns dominate. The likelihood that such a
dialogue will take place is highly dependent on there being the conviction from
the top that this is desirable, and the mechanisms to enable it to take place. This
is perhaps one of the key challenges that remains, and enabling this exchange
80 of views to take place in a positive way must be part of the new role outlined for
the clinic manager.

Conclusions
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We have shown the benefits of bringing together organizational, group and

individual concerns for performance measurement into one framework. The
resulting performance system may be viewed by those in human resource
management as not being about managing performance at all. We argue that
the policing concepts and activities that have become known as performance
management in the area of HRM need to be seen as outdated as Taylorism itself,
at least for the management of professional activity. In this paper we have tried
to distil out some of the problems with performance management, and to
highlight the areas of ethical concern. We have suggested that three ethical
principles in particular can shed light on how a more ethical approach to
performance management could take place.

Respect for the individual

Our first ethical point concerns respect for the individual and giving “voice” to
all stakeholders in the organization. This process involves both stakeholder
analysis, and stakeholder synthesis. Thus the views of all stakeholders at the
BSO were incorporated in defining organizational objectives and strategy.
Although there are clear benefits for strategy formulation by involving
stakeholders in the process, there are also benefits for the individuals concerned
in terms of being better informed, having access to more reliable information,
improved communication, and having a chance for that communication to be
upward and not just downward. This is helped considerably by using the
Delphi technique.

Mutual respect
Our second ethical point is the requirement for a shift away from seeing
organizations as purely economic constructions to serve the profit motive, and
towards viewing them as communities of interests, which may sometimes
conflict. Organizations constitute a plurality of interests. We raised the
possibility that it may not be possible to incorporate these divergent
stakeholder interests easily because they may be irreconcilable. The approach
tried to encapsulate a principal of mutual respect, by establishing communities
of interest, and by reconciling conflicts which were a product of poor
communication. In the case study organization there was less conflict than
 anticipated once the mechanisms had been put into place to enable Policing
communication between the groups. performance
Procedural fairness and transparency of decision making
Where genuinely different interests exist, for example where the clinical tutors
had vocal interests in specific forms of skill development, we suggest that the
ethical concept of procedural fairness is relevant. Kettner[58] suggests one 81
needs to “transform conflicting interests into competing claims”, so that the
requirements of each group are put forward and a process developed where
they can be viewed collectively against resources and other claims. If this is
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done then decisions can represent a balance of these interests. The openness of
the process in the BSO engaged support and understanding for its conclusions,
because of its perceived fairness. Where genuine conflicts of interest were
identified they were represented as “balanced measures”. Here the performance
management process becomes not a prison for capturing dissenters but a
vehicle for expressing their views.
There are still some challenges that remain. We agree with Kettner[58, p. 31]
that this activity must be part of an ongoing dialogue, continually open for
revision and re-negotiation. For performance management to be useful as a
communication tool, to enable people to make sense and meaning out of their
working lives, the focus must move away from measurement, judgement and
“skilled incompetence”[59] towards developing understanding and building up
trust to allow a genuine dialogue to take place.

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84
25,6
Review

Table AI.
Personnel

document used for

generating consensus
Extract from the delphi
Score agreement/disagreement with the following
statements on a scale from 1 total disagreement Mode Mode Mode Diff Diff AverageAverage
to 5 total agreement all c team tutor CT/CS Tut/CS SD Count Cum Tutor Dir
Appendix

1.00 What do you think is important about the BSO?

What values does it represent?

1.29 The BSO should value an ability to disagree 5 5 5 0 0 0.44 20 4.80 4.77 5
1.16 The BSO is interested in finding the most
beneficial way of educating students 5 5 4 0 1 0.66 22 4.67 4.14 5
1.18 The BSO’s purpose is to educate students 4 5 4 0 1 0.70 22 4.50 4.07 5
1.19 The BSO’s purpose is to establish a learning
community 5 5 5 –1 –1 0.73 22 4.83 4.29 4
1.30 The BSO’s education of students represents a
move away from rote learning 5 5 5 0 0 0.84 22 4.33 4.21 5
1.10 The BSO represents a passionate belief in
osteopathy 5 5 5 0 0 0.91 22 4.17 4.43 5

1.34 The BSO gives students a wide range of

opportunities 4 3 4 2 1 0.99 22 3.67 3.64 5
1.12 The BSO values fairness 5 4 3 1 2 1.08 21 3.83 3.62 5
1.17 The BSO’s interest in the most beneficial way of
educating students can create a dilemma as to
whether this approach is always for the best 5 3 4 2 1 1.11 22 3.83 3.64 5
1.38 The BSO is committed to improving the
standards of the osteopathic profession 5 5 5 0 0 1.13 22 4.83 4.00 5
1.32 The BSO is concerned to counter any narrow
mindedness of the osteopathic profession 5 4 2 1 3 1.18 22 3.67 3.29 5
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