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Dr Dale Thomas Director Medical Services Redcliffe Hospital

Using 360-degree feedback as part of Senior Medical Performance Review in a public hospital setting. Dr Dale Thomas Director Medical Services Redcliffe Hospital. Overview. Describe the introduction of Senior Medical Performance Review including online 360-degree feedback tool

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Dr Dale Thomas Director Medical Services Redcliffe Hospital

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  1. Using 360-degree feedback as part of Senior Medical Performance Review in a public hospital setting Dr Dale Thomas Director Medical Services Redcliffe Hospital

  2. Overview • Describe the introduction of Senior Medical Performance Review including online 360-degree feedback tool • Discuss some pitfalls and challenges in how such processes could be adopted more broadly

  3. Performance Appraisal • Well established processes for most professional groups, including junior doctors, but not for senior doctors • Assessing trainees vs expert clinicians • Permanent vs temporary employees • Maintenance of standards vs continuing professional development

  4. Clinician Engagement • Senior medical staff are a valuable resource, but not often given feedback on their performance • Doctors are competitive, high achievers • Even experts can improve their performance

  5. Senior Medical Performance Review • Clinical indicators – complications, re-admission rates, length of stay • Participation in CME/CPD/MOPS • Participation in departmental meetings & clinical audit • Records of mandatory training • 360 degree feedback summary

  6. 360 degree feedback tool • Based on a validated questionnaire 1 • Developed following extensive consultation with AMA and unions 2 • Anonymous online tool or paper survey • Ramsey PG, Wenrich MD, Carline JC, et al, Use of peer ratings to evaluate physician performance, JAMA 1993 Apr 7;269(13):1655-1660 • Johnston A, Senior medical performance review: making it happen – the Queensland experience, RACMA Quarterly 2011 Feb, accessed online http://www.racma.edu.au/index.php?option=com_content&view=article&id=301:senior-medical-performance-review-making-it-happen-the-queensland-experience&catid=21:the-quarterly-february-2011&Itemid=14

  7. 360 degree feedback tool • 9-point Likert rating scale • Clinical domain 9 questions • Team management 4 questions • Interpersonal skills 5 questions • Ethical behaviour 4 questions • Free text strengths & weaknesses • http://www.surveymonkey.com/s/SY3BTS7

  8. Implementation at Redcliffe Hospital • Pilot study in Anaesthetic Department • First cohort of 5 anaesthetists in 2010 • Second cohort of 6 consultants in 2011 • Third cohort of 5 anaesthetists in 2013 • Physician cohort of 6 consultants in 2012 • Stratified design allowing subgroup analyses

  9. Sampling methodology 1 • Allowing subjects to choose who to invite to provide feedback • Completed by consultant peers, supervisors, training registrars and nursing/support staff • Collated feedback provided to SMO/VMO for discussion with their Clinical Director

  10. Sampling methodology 2 • Consistent sample for each subject • Respondents • Supervisor/line manager • Consultant anaesthetists • Anaesthetic registrars • Nursing and allied health staff • Proceduralists – i.e. consultant surgeons, obstetricians, gastroenterologists • Optional self-assessment

  11. Response Rate • Managers 94% • Peer consultants 74% • Registrar trainees 57% • Nursing/support 76% • Proceduralists 40% • Self-assessment 81% • Total excluding self 60%

  12. 10 9 8 7 6 5 4 3 2 1 0 CULTURE INTEGRITY EDUCATION COMPASSION ACCESSIBILITY INPATIENT MGT RESPONSIBILITY COMMUNICATION OVERALL CLINICAL SKILL OUTPATIENT MGT PROBLEM SOLVING SELF MANAGEMENT QUALITY ACTIVITIES PROCEDURAL SKILLS MEDICAL KNOWLEDGE OVERALL COMPETENCE RESPECT FOR OTHERS COMPLEX PROBLEM MGT PSYCHOSOCIAL ASPECTS ACCEPTANCE OF CRITICISM INTERPERSONAL RELATIONSHIPS PUNCTUALITY AND RELIABILITY

  13. Results • Higher response rate for subjects who are Staff Specialists (72%) compared with VMO/SMO (44%) • Overall very good quantitative scores from all groups of respondents

  14. Qualitative • 75.5% of respondents provided comments • 63% of comments were positive • Negative comments can be confronting, but were considered more useful by subjects

  15. Feedback to subjects • Quantitative & qualitative results • Summary data included as part of annual PAD process • Inform professional development needs for coming year

  16. Pitfalls & challenges • Choosing your respondents • Online confidentiality concerns • Lower response rates for VMO and non-specialist SMO • Meaningful subgroup analyses • Evaluating effectiveness

  17. Questions?

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