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Re: Health’s sector in Cuba: looking better performance.

Dear Editor

Cuba represents an important alternative example where modest infrastructure investments combined with a well-developed public health strategy have generated health status measures comparable with those of industrialized countries (1). However the economic crisis which began in 1991 after the withdrawal of the Soviet Union wreaked havoc on many aspects of Cuban society. Although the impact on health indices was relatively modest and now are recovering, the Cuban’s health care system is still suffering the consequences of a very long period of severe shortage. Perhaps less evident is the crisis’ impact on professional performance where a number of causes are involved and include limited resources, lack of technical discipline and particularly, poor mechanisms of evaluation/compensation. Taking into account this situation the health system in Cuba is working, at the same time with the recapitalization of their technology, in new mechanisms to achieve the performance of their enormous work force and health’s infrastructure.

The first experience on performance’s management began in 1999 at the University Hospital in Cienfuegos, an institution located on the central and south region of Cuba. After a redefinition of the hospital’s vision and mission a task force was created to define a set of core performance indicators for each group from professionals to simple workers. As result of a comprehensive and participative consultation process a new standards were generated which are improving year by year and include: work quantity, quality and results; knowledge; communication skill; human relationship; behavioural attitude towards postgraduate studies; personal image; creativity, attendance, and working hours efficiency; fulfilments of the established regulations and level of patients satisfaction. Individual performance assessment results of each employee were analysed in private meetings with the participation of the evaluated worker and his/her supervisor. The final marks in those individual interviews included a positive agreement between two different points of view: on one side, previous self evaluations of workers and, on the other side, the evaluator’s criteria. This open procedure, face to face, helpfully solved the distress frequently reported in other types of performance assessment (2).

Cienfuegos´s hospital is now a top-ranking Cuban hospital although its main strength is not the technology. Undoubtedly the management of poor performance, such as has been described by Mayberry (3), has played a crucial role. The next step is using this evidence to introduce the pay for performance in order to achieve an adequate balance between process and results and between results and tangible incentives, a new policy that Cuba needs to implement.

References:

1.Cooper R, Kenelly J, Ordúñez P. Health in Cuba. Int J of Epi 2006; 35:817–824.

2.Alvarez FC, Ordúñez PO, Espinosa AD. Introducción de la evaluación del desempeño individual en un hospital cubano. Metodología y resultados. Rev Calidad Asistencial.. 2006; 21(2): 102-110.