• Editors' Summary
• Credits

1. Overview
2. Getting Started
3. Define Desired Performance
4. Describe Actual Performance
5. Measure/Describe Performance Gaps
6. Find the Root Causes
7. Select Interventions
8. Implement Interventions
9. Monitor and Evaluate Performance
10. Managing Change

• Figures
• Tables
• Side-bars
• Bibliography

• PI approach offers many benefits
• Pilot project holds lessons
• Helping people do their best
• Burkina Faso: Assessing needs
• India: PI helps private providers
• Using the “Why Tree” in Ghana

• POPLINE
• Media/Materials Clearinghouse
• Other issues
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Published by the Population Information Program, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA

Measure/Describe Performance Gaps

Using the definitions of desired performance and the information about actual performance, the PI facilitators: (1) measure or describe the performance gaps, (2) help stakeholders select the gaps that they would like to address, and (3) rank the selected gaps in order of importance. This preliminary selection avoids further analysis of gaps that stakeholders do not want to pursue. The performance gap is the difference between desired and actual performance, often expressed as a difference of percentages. It can also be expressed as a ratio of the achievements of exemplary performers to those of typical staff members (48).

A common mistake at this stage is to list causes as performance gaps. For example, if providers are not counseling clients well, PI facilitators may mistakenly define the gap as inadequate knowledge and skills rather than the difference between the desired performance, which could be 100% of providers following the counseling protocol, and the actual performance, perhaps 20% following the protocol. Analysis of the root cause—the next step in the PI process—is not part of the description of the performance gap but rather explains the performance gap.

Stakeholders themselves select performance gaps for further attention based on criteria that they choose. For example, they may select gaps because they are large, because they are important to the organization or to top management, or because they can be solved quickly or their solution will have an obvious impact.

In meetings and interviews the PI facilitators collect ranking information with questions such as: What is the impact of this typical (or unsatisfactory) performance on reproductive health services? and How does this performance problem compare with other performance problems we have discussed?

Catherine Murphy, PRIME II Project In Yemen a community midwife at a Performance Improvement workshop describes performance gaps in supervision. A key part of the PI process is for stakeholders to measure performance gaps, select the gaps to address, and rank them in order of importance.

In general, the larger the performance gap, the greater the opportunity for performance improvement. In the Tanzania project, for example, the facilitators considered gaps of over 20% large enough to pursue with root cause analysis and solutions (135).

Ranking the selected gaps helps stakeholders decide the order in which they should be addressed. In the Nigeria needs assessment, for example, PI facilitators ranked the clinic performance gaps based on a consensus of the stakeholders. In order, the gaps dealt with problems in: (1) the supply of contraceptives, (2) clinic records, (3) treatment of clients, (4) infection prevention, and (5) accessibility in rural areas (46, 88). In some cases, however, the most important gaps have to wait until other, less important performance problems are solved. In the IDSS project, for example, gaps in counseling were ranked highest, but logistics problems, which were ranked fourth among five, had to be solved first so that providers would have contraceptives to give to clients (101).