Performance Improvements Plan (PIP) in Healthcare


Performance improvement is the process of measuring the output of a particular process or procedure in an organization and then modifying the process or procedure to increase output, increase efficiency, and/or effectiveness of the process or procedure. Performance improvement in healthcare (discussed extensively here  ) is done routinely in healthcare organizations in order to improve clinical outcomes and patient experiences while reducing costs.

Performance Improvement Plan

Performance improvement initiatives sometimes tend to fail or not produce the desired results when the organization does not have an appropriate plan in place. A performance improvement plan (PIP) also referred to as performance action plan, helps healthcare organizations plan out a performance improvement initiative from start to end ensuring goals are met, tracking milestones and improving on the ongoing process. There are steps that can be followed to set an effective performance improvement plan. Some of these steps are:

  • Document Performance Issues
  • Develop an action plan
  • Review the performance plan
  • Meet with employees
  • Follow-up and Feedback
  • Performance improvement conclusion


Document Performance Issues

The first step in making a performance improvement plan is documenting the areas of performance that needs improvement. This documentation must be accurate, objective and free from sentiment. The documentation should also be standard and uniform across all employees for transparency purposes and to eliminate any suspicion of bias. The format of a performance improvement plan documentation varies from organization to organization but the standard should include the following components:

  • Employee information.
  • Relevant dates.
  • Description of performance discrepancy or gap.
  • Description of expected performance.
  • Description of actual performance.
  • Description of consequences.
  • Plan of action.
  • Signatures of the manager and the employee.
  • Evaluation of the plan of action and overall performance improvement plan.

Develop an action plan 

The next step is developing an action plan which is best done when it’s in collaboration with employees. Having employee input in developing the action plan increases the chances of having a successful action plan. The action plan should be specific, measurable, accurate and time bound (SMART). The action plan should set performance expectations and the consequences of not reaching those goals. Though it is important for a plan to be flexible, it is very important that the consequences of not reaching a goal are not purely on paper. If the plan is not carried out to the tee including punishment for not reaching goals, it will weaken the validity of the plan and undermine the performance improvement process.


Review the performance plan

Before presenting the performance improvement plan to employees, the plan should be properly reviewed by preferably a third party to check for bias, sentiments, and discrepancies.


Meet with employees

Depending on the type of performance plan as well as other factors, the employees should be met one on one in private or in a group. Sometimes both are required for effectiveness.


Follow-up and Feedback

Regular follow-up meetings should be set in other to get feedback from the employer to the employee(top-down) and from the employee to the employer(down-up). During these meetings, the employee can express concerns about the plans, ask for clarifications or further guidance. These follow-up meetings also help ensure the PIP has not lost momentum or direction.

Performance improvement conclusion

This is at the end of the performance improvement initiative. If the employee is unable to meet expectation action has to be taken. This action doesn't always have to be termination or suspension. It could be taking a different approach to help an employee or department. The different actions to take depending on outcomes of performance improvement initiatives should be stated in the plan at the beginning and the plan should consider all possible scenarios.

In conclusion,  a Performance improvement plan should

  • Clearly and objectively set out where the employee is failing
  • Set out the improvement expected for the employee using measurable objectives
  • State whether support or training will be provided
  • Provide for the time and frequency of reviews
  • Make clear what actions need to be taken for improvement