Monitoring the monitors: Assessing the implementation of performance management change after institutional reorganization in a health promotion agency

Monitoring performance management within a health promotion organization can be complex. This observational case-study demonstrates the use of methodological pluralism in assessing monitoring and evaluation.  Concurrent with institutional reorganization, performance management changes included using the principles of RE-AIM (reach, effectiveness, adoption, implementation and maintenance) to plan and evaluate initiatives under a shared accountability framework. A series of workshops was held involving a quarter of agency program staff with two objectives: to achieve a common understanding of the principles of performance management, and develop their institutional indicators with cross-department input. These indicators were used to populate a summary framework of successes, challenges, opportunities, risks and evaluation (SCORE) to convey progress concisely to management monthly. Post-workshop survey found that >90% of respondents felt the objectives were achieved, with the educational component being found useful by the majority. Thematic analysis of survey responses indicated that simultaneous participation by key decision makers was crucial to finalizing indicators. Participant observation brought out that concurrent restrategizing in various departments was holding back commitment to specific targets, in particular due to delays in communication between key agents both along and across hierarchies. In conclusion, establishing a common language for performance management that was understood as relevant for public health was crucial in organizational change. Strategic capital residing in senior managers is critical to creation of inter-departmental networks.  Iterative improvements rather than a static monitoring plan may be a more realistic solution to a dynamic intra-organizational Bourdieusian field.