Individual performance review in hospital practice: the development of a framework and evaluation of doctors’ attitudes to its value and implementation

Abstract

IPR may have value for performance evaluation of consultants, contributing toward job planning and complementing medical appraisal. Support by their employing organisation and engagement with medical managers in design and implementation is likely to be essential.

Determining doctors’ views on performance measurement and management of their clinical practice

“…For example, a report by the UK National Audit Offi ce 3 suggested that medical and non-medical managers had diffi culty in challenging doctors' performance, and that this refl ected the absence of usable information on performance. 11 Furthermore, clinicians have expressed fears over the negative unintended consequences of the publication of such data, for example distortions of activity, gaming and perverse incentives, 4 or the potentially detrimental effects of poorly validated data. 20 This may also refl ect low levels of trust doctors have in their managers.…”

“…Such approaches are more consistent with an 'empower and facilitate' as opposed to a 'command and control' organisational culture, focusing on intrinsic as opposed to extrinsic motivational strategies. Examples of this have been developed and evaluated within the context of individual performance review 11 and performance measurement and management models 26 for senior hospital clinicians, based on the systems used in successful non-healthcare public sector, commercial sector and charity sector organisations.…”

“…9 Likewise, the introduction of appraisal and revalidation under an external regulatory body, the General Medical Council 10 was intended to maintain professional standards of practice, but involves limited use of objective data-based performance monitoring, and is considered an ineffective method of managing doctors' day-to-day productivity. 11 Furthermore, professional engagement with national initiatives to introduce performance management in the UK has been poor, 12 refl ecting resistance by clinicians, 13 which has limited implementation. 14 However, measuring and managing the productivity and quality of practice of individual clinicians remains a key strategy for improving clinical performance in the NHS including through job planning, 15 remuneration with clinical excellence and incremental pay awards, 16 and public release of clinical outcomes.…”

Managing hospital doctors and their practice: what can we learn about human resource management from non-healthcare organisations?

“…In terms of evaluating the performance of individual employees for performance improvement, there were similarities of IPR in the study organisations to clinical appraisal and revalidation in terms of the use of both tangible and intangible outcomes and objective setting [ 70 , 71 ]. However they differed in that IPR was considered as a formative, organisationally lead process undertaken by an individual line manager supported by HR and, in the event that underperformance was identified, leading to an immediate, intensive but supported objective based system of review.…”

Physician performance feedback in a Canadian academic center

“…There is limited published evidence on physician performance feedback processes and their impact on job performance and professional development. A recent review of studies relating to performance review and appraisal in commercial, public and volunteer sectors, and corresponding systems in non-healthcare systems identified the following essential domains of a performance feedback process: evaluation of performance against objectives, behavior and leadership, talent management (career development) and agreed action plan (Trebble et al, 2013). Multisource feedback tools, or 360-degree assessments, are increasingly being used as a means for physicians to obtain formative feedback (Hall et al, 1999;Sargeant et al, 2007;Overeem et al, 2009;Ten Cate and Sargeant, 2011).…”