A realist evaluation of NHS managers' experiences of managing staff poor performance.

Managing staff underperformance is one of the most difficult things that a manager is required to do and is often avoided. The management of staff underperformance has not previously been explored from the managers' perspective.This study examines NHS managers' experiences of managing staff underperformance using a realist methodology in order to deal with the complexity of research in a social situation and to offer explanations of the described events. Seven NHS managers that had managed staff underperformance using the Trust's 'Managing Employee Performance Policy' were interviewed using a semi structured interview format. The interviews covered 21 cases. The interviews were recorded and analysed to identify specific case studies, features and themes associated with their experiences. Further literature searches were carried out based upon these themes and the case studies and the themes discussed in relation to the literature, and realist explanatory theories proposed.The main themes were that: there was no organisational culture of performance management (which included a lack of training for managers in how to manage staff underperformance and staff not knowing how to respond to critical feedback on performance); the performance management process was time consuming, took longer than was necessary and was expensive; and more time and resources were devoted to supporting non-compliant than compliant staff. The time and financial costs of managing underperformance had not been previously described.The management of underperformance hinges on the delivery of negative feedback to staff which can trigger one of three responses; i) acceptance, ii) overt (explicit) rejection or iii) covert (hidden) rejection of the feedback; these require different management strategies to deal with them. Covert rejection of feedback has not been previouslydescribed in the literature; consequently managers fail to recognise covert rejection and do not manage it appropriately.Managing underperformance had the potential to have a large emotional impact on the manager especially when staff members rejected feedback. The emotional impact on managers from their perspectives was not described in the available literature. Avoidance of the emotional impact played a large part in managers not managing underperformance.Twenty one interacting theories were proposed relating to performance management as a change management process, staff responses to negative feedback, the staff contexts that led to these responses, manager training and credibility, the impact of managing or not managing performance on the managers and on the organisation. These theories were refined with the addition of information from secondary literature searches and two were discounted as there was a lack of corroborating evidence or it was felt that the theory could be explained by an alternative means.It is intended that this thesis may offer useful theories that inform organisational change with respect to performance management of staff, the training of managers and organisational norms and form the basis for future research.