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Appraisal and Performance Indicators

Appraisal and Performance Indicators. Good or bad science?. Plague of Tick Box Appraisals: Driven by lawyers?. My Background Spine surgeon with a trainee (“apprentice”) Course principal MSc T&O, Brighton 5 th year sub dean, Brighton Medical School

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Appraisal and Performance Indicators

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  1. Appraisal and Performance Indicators Good or bad science?

  2. Plague of Tick Box Appraisals: Driven by lawyers? My Background • Spine surgeon with a trainee (“apprentice”) • Course principal MSc T&O, Brighton • 5th year sub dean, Brighton Medical School • RCS Regional Advisor, SE Coast (4 milllion population) • Approximately 35 consultant appointment committees annually • Orthopaedic tutor RCS • HST Training Programme Director • SAC • 39 assessments per week • How can appraisal be meaningful after minimal exposure to the appraisee? • What is the secondary affect on the individual • Many trainers do notfulfil a meaningful assessment- “I’ll just sign it” • No Medical School Curriculum is Comprehensive. • All graduates are vulnerable in some key clinical areas

  3. Changing World • Revalidation 2013 • Dr Foster Intelligence 2007 • PROM’s 2005 • Hip fracture database 2005 • National Joint register 2002 • Annual appraisal 2001 “Transparency” Sequel of Dr Shipman, Bristol, Mid Staff’s etc + spiralling cost of healthcare BIG BROTHER IS WATCHING How smart is he?

  4. Funnel Plots and Outliers • Anxious surgeons are declining higher risk cases for fear • of falling out of the funnel – patient neglected • Many colleagues focus on point scoring more than practice • Outliers may be the innovators – IS INNOVATION AT RISK?

  5. Problem? Health Service Industrial Action • Canada (Saskatchewan) 23days 1962 • UK January to March 1976 November Ambulance+Nurses 1980 • Israel 1968 1984 2011

  6. Outcome:NationalRegister of B M D

  7. No doctors: Death rate reduced! • CABG • Bowel Resection • Joint Arthroplasty • Complications • Medical Error Given that all people will eventually die, would we serve patients better by stopping work ?

  8. Cape Horn Weather for NHS

  9. Evidence Based Medicine Difference between proper medicine and quackery? Medicine is founded on rigorous scientific method Treatments are based on the evidence Would that it were entirely true! Witness the Cochrane library A culture of responsible scientific enquiry must be instilled

  10. NHS Performance assessment:Mission Statement • Raise Standards • Apply Scientific method • Evidence based practice • Guidelines Avoid confounding factors Reflect and respond

  11. Scientific Method • Question • Background research • Construct Hypothesis • Test Hypothesis by Experiment • Analyse Data • Communicate Result

  12. Scientific Method • Question • Background research • Construct Hypothesis • Test Hypothesis by Experiment • Analyse Data • Communicate Result Raising standards Saving treasury funds Confounding factors: Data collection Transcription Confounding factors: Knowledge of analysts BBC Tabloid press Politics

  13. UNA’S TITS, 2,451ftLe Maire channel, Antarctica

  14. DATA:South Coast SHA Observatory Paediatric Surgery Spine Surgery Vascular Surgery 2012, for: operation numbers, staffing levels, referrals Never less than 100% wrong, and usually far more Reason • Recording by hospital staff lacking knowledge • Downloaded by hospital coders lacking knowledge • Transcribed at SHA by clerical staff lacking knowledge • INTERPRETED BY PERSONNEL WITH LITTLE KNOWLEDGE

  15. Measuring tools-a plethora • Must be repeatable among observers • Must be capable of discriminating • Must correlate with other instruments PERFORMANCE ASSESSMENT CAN BE COMPARED WITH PEER PERFORMANCE CLINICAL ASSESSMENTS MUST BE RECORDED PRE AND POST INTERVENTION TO INDICATE CHANGE

  16. Flat spirals of progress Lessons from the past • Each generation wishes to assert itself – out with the old, and in with the new • In the panic to achieve this result, previous sound science is discarded, only to be rediscovered later, and then discarded again

  17. Clinician’s StrategyMedical student to Retiring Physician • Construction of inner confidence coupled with Humility. • Everything can be taught and learned -Nothing is impossible • Maintain Highest Principles of Good Medical Practice • Maintain healthy cynicism. Always question AFFECT is the biggest determinate of performance Unsound appraisal can be destructive to self esteem

  18. Conclusions • The present art of performance assessment falls far short of good science • It is important to be aware of the deficiencies. • Constant re-evaluation of methodology is essential • Most of the faults are fixable The future desperately needs technical innovation. Contemporary NHS culture risks stifling, rather than embracing real advance.

  19. Thankyou!

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