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3 things to avoid when doing physician performance reviews

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It’s everyone’s favourite time of the year – physician performance review season for hospitals!

Kidding. No one likes this time of year.

If you are a Chief of Staff or Chief of Department, performance review season is challenging. Time is short. You may have a long list of physicians to meet. Recipients will take your feedback to heart and because of human nature, will focus on anything negative you have included. In short, the conversations can feel either superficial or tough slogging.

Here are my top 3 things to avoid this season:

Skipping over the positive

This is the toughest tip.  Many Chiefs have to spend the majority of their time managing problems. So it is not uncommon for physicians to receive little to no positive reinforcement over their careers if they are productive and positive members of the team.  Yet, we know how important it is that physicians  receive ongoing career development support and recognition.

Tip 1: Accept the fact that performance review season is not the time to go deep into the positive. Instead, take the time to provide positive reinforcement throughout the year. As a physician leader, you set the tone for the team.  Share compliments from patients and families as they arise.  Acknowledge individuals in meetings or for outstanding contributions to hospital culture in the moment throughout the year. Make a note of all of these accomplishments to their file (sending an email to yourself works). At the performance review time, you can offer tangible highlights of the positive aspects of what was noticed through the year. This kind of detailed feedback is noticed and reverberates through the team. You are seen as a leader who looks for greatness and supports achievements.

Tip 2: When meeting with physicians who are struggling or who have behavioural or competency challenges, ensure you acknowledge the positive aspects of their practice when you highlight the negative. Doing so underscores that your assessments are objective and fair.

Skipping over the negative

I cannot tell you how many times I have heard from hospital leadership that a physician has been a chronic behavioural problem for years (decades even) and when I ask to see the physician’s file, the performance reviews tell a very different story. Either the file is empty or the performance reviews were  templated reviews that include statements like “Thank you so much for your excellent contributions to the Professional Staff. It is because of physicians like you that we are able to meet our hospital mission of <insert mission statement>”.

Minor issues have a way of escalating to major irritations. If leaders have failed to raise chronic issues of concern in the past, it can be difficult to take immediate action in accordance with the principles of due process required under the Public Hospitals Act.

I find that hospital leaders are usually very good at capturing and addressing egregious behaviour or serious issues of concern about competence. Usually the mistake happens with failing to call out low lying behavioural issues or minor complaints. The cumulative effect of low lying negative interactions on the team and patients and their families can be as problematic as acute flare-ups. If there are problems, they have to be documented.  I would not recommend overstating such issues – but where a pattern of behaviour or concern has arisen – that theme needs to be captured in writing and shared at performance review time.

Tip 3: A single instance of rudeness or lateness or a minor complaint is usually more appropriately addressed verbally and does not need to be reviewed at performance review time. However, if a second instance arises, that needs to be noted as with any additional examples. Fairness dictates that individuals are told when they are not meeting organizational expectations of skill or behaviour.

Waiting until performance review season to raise issues of concern for the first time 

A formal performance review is not the time to raise issues of concern for the first time, unless a situation recently occurred and the performance review meeting was the next naturally scheduled appointment.  Due process dictates that Professional Staff members should be afforded an opportunity to hear and address issues as they arise. It is not appropriate to wait until performance review time to explain a year’s worth of problems.

Tip 4: It is appropriate to summarize the year’s activities during the performance review so long as those activities had been raised and addressed through the year. In fact, if there have been issues of concern peppered throughout the year, those should be acknowledged during the annual review (as discussed above).  It is possible that an otherwise unrecognized theme arises when the cumulative picture is reviewed. So it is possible that a remediation plan or disciplinary consequences may be necessary to address issues that took place over the course of the privileging year.

Want to read a great resource? The Ontario Hospital Association’s Professional Staff Credentialing Toolkit is now free online.  Review Chapter 8 on Performance Evaluations and Progressive Management for practical tips.

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