360 degree Feedback for Doctors

Aim
Design of a 360 degree PE for doctors in KMC

Objectives
To map current performance evaluation system for doctors
To analyze and figure out areas of improvement
To design 360 degree feedback system

Scope
The project is done for academic purpose, it needs deep
study to implement in the hospital
Literature review
360-degree feedback can be a positive force for practice improvement provided skilled
facilitators are available
to encourage reflection, concrete goals are set and follow-up interviews are
carried out
Hospitals should be aware of the existing lack of openness and absence of constructive
feedback
Consultants indicated sharing personal reflections with colleagues could improve the
quality of collegial relationships and heighten the chance of real performance
improvement.
A questionnaire based process 360-degree can be an effective means of assessing
physicians & has stimulated practice improvement
Inclusion and exclusion criteria


The instruments needed to fulfil the following criteria:
Template prepared by consultants from different specialities
Assess practising doctors
Have capacity to assess individual doctors for performance feedback and
Inclusion of facilitators

Instruments were excluded if any of the following were evident:
They assessed medical students, nurses or non physicians
They assessed purely at an organizational level and
They had not been used for individual feedback



INTERACTIONS POINTS
Nurse
Pharmacy
Lab technicians
Radiologist
Patients
Patient party
Junior doctors
Senior doctors
Interns
Post graduates
Hospital Administrator







Methodology
Personnel interviews
Nurses (2)
Doctors (2)
Pharmacist (1)
Lab technician (1)
Radiology lab technician (1)

o To understand
Current performance evaluation system
Where they can provide their inputs to evaluate doctors
How frequently they interact with doctors


Questions asked:
Is performance evaluated?
Existence of a performance appraisal system for doctors?
Number of interactions with doctors

Existing practice:




Analysis and diagnosis
Dean/MS
Senior doctors
(HOD)
Junior doctors
(Prof. or
assistant prof.)

Parameters for evaluation in KMC
Active interest
Initiatives taken
Communication
Leaves taken
Health of doctor
Diagnostic survey:
Interaction with doctors, regarding existence of a system in which the
other professionals are involved for performance appraisal

Diagnostic summary:
Performance evaluation for doctors exists
Existing system is highly hierarchical
Interactions high only with nurses & PGs/Interns
But nurses, staff or PGs/Interns do not evaluate doctors
Evaluation system is Top to bottom

Areas for development:
Involvement of other coworkers who also have a stake in
patients safety and prevention of errors
Performance reviews at regular intervals
Performance & Development planning:
Performance results What
Performance outcomes or standards from job description
Performance objectives for the next time period
Performance behavior How
Competencies, performance factors, or behavior
expectations
Development objectives: Patient centric



Design


Existing parameters


New parameters
Active interest
Initiatives taken
Communication
Leaves taken
Health of doctor

Communicating disease and
intervention
Listen to patient and taking history
Taking specific measure for patient
safety
Knowledge
Team work
Diagnostic and treatment skills
Assisting junior doctors
Diagnostic skills
Taking advice when appropriate
Daily rounds
Cross Consultation
Number of tests written

Goal setting:
Organizational goal: clinical excellence, Patient centricity & ethical practices
Feedback can be given by the co-workers, Patients as well as the Peers
Assessment: By the facilitators
The rating would be done on the basis of questionnaires with Likert scale developed
by physicians from various specialties(for patients instruments)
The facilitators would encourage reflection among the consultants ,also help in
making concrete goals
Personnel development planning:
Encouraged sharing personal reflections with colleagues that could improve the
quality of collegial relationships and heighten the chance of real performance
improvement

CRITICAL INTERACTIONS TO
IMPROVE PATIENT OUTCOME
Doctors
Co-workers
patient
Peers
Nurse
Radiologist
Lab Technician
Pharmacist
Pg/Interns
Self
evaluation
Parameters for Assessment
Nurses
Communication
Daily rounds
Prognosis
Cross Consulting
Other Soft skills
PG/Interns
Number of medication
Number of tests written
Assisting junior doctors
Diagnostic skills
Taking advice when
appropriate
Co-workers
Parameters for Assessment
Time Spend with patient
Communicating disease and intervention
Listen to patient and taking history
Daily rounds
Soft skills
Satisfied with tests and medication given
Taking specific measure for patient safety
Patients
Knowledge
Skills
Communication
Team work
Handling patients
Diagnostic and treatment skills
Peers
/
Seniors
All the employees are communicated about the performance appraisal system
as soon as they join the organization.
They are updated of the Appraisal system & the process of execution.
They all also informed about the relation between the performance appraisal &
the compensation as well as the assessment period
The employees & mangers undergo a pilot test to avoid any kind of confusion



Implementation
Evaluate performance results and behaviors
Conducted face-to-face with a written record.
While rating and ranking pros and cons would be considered, a summary rating of
each employee would be done
Reflections helped the consultants to see that improvements were needed
Examining their strengths and weaknesses in a portfolio would give them insight into
the quality of their performance
Facilitators: would gauge the accuracy of their reflections
Annual assessments (follow-up) would stimulate them to take action
Repeated exposure to improvement goals and would enhance the likelihood
of performance improvement
Operations
Contextual factors that affect
development of PM
Factors related to hospital and consultant group:
Work Load
Cultural Aspects
Lack of openness among the people
Lack of social support
Lack of management commitment: All goals should not be laid on the doctors
door
Factors related to society
Public Distrust



Thank You