Abstract
BackgroundIn many healthcare systems, physicians are accustomed to periodically participate in individual performance appraisals to guide their professional development. For the purpose of revalidation, or maintenance of certification, they need to demonstrate that they have engaged with the outcomes of these appraisals. The combination of taking ownership in professional development and meeting accountability requirements may cause undesirable interference of purposes. To support physicians in their professional development, new Dutch legislation requires that they discuss their performance data with a non-hierarchical (peer)coach and draft a personal development plan. In this study, we report on the design of this system for performance appraisal in a Dutch academic medical center.MethodsUsing a design-based research approach, a hospital-based research group had the lead in drafting and implementing a performance appraisal protocol, selecting a multisource feedback tool, co-developing and piloting a coaching approach, implementing a planning tool, recruiting peer coaches and facilitating their training and peer group debriefings.ResultsThe system consisted of a two-hour peer-to-peer conversation based on the principles of appreciative inquiry and solution-focused coaching. Sessions were rated as highly motivating, development-oriented, concrete and valuable. Peer coaches were considered suitable, although occasionally physicians preferred a professional coach because of their expertise. The system honored both accountability and professional development purposes. By integrating the performance appraisal system with an already existing internal performance system, physicians were enabled to openly and safely discuss their professional development with a peer, while also being supported by their superior in their self-defined developmental goals. Although the peer-to-peer conversation was mandatory and participation in the process was documented, it was up to the physician whether or not to share its results with others, including their superior.ConclusionsIn the context of mandatory revalidation, professional development can be supported when the appraisal process involves three characteristics: the appraisal process is appreciative and explores developmental opportunities; coaches are trustworthy and skilled; and the physician has control over the disclosure of the appraisal output. Although the peer-to-peer conversations were positively evaluated, the effects on physicians’ professional development have yet to be investigated in longitudinal research designs.
Highlights
Build a foundation for a trusting relationship.2
We report on the design of an individual performance appraisal system in a Dutch academic medical center, in which this incompatibility was taken into account
Since the Academic Medical Center (AMC) was the first Dutch academic medical center to present its solution to the new Individual Functioning Medical Specialists (IFMS) requirement, the AMC offered its protocol for review to the medical registration authority (RGS)
Summary
Build a foundation for a trusting relationship.2. ConfidentialityDiscuss the purpose of the coaching session and explain the procedure.3. In response to society’s call for transparency performance appraisal has been incorporated into procedures for revalidation (UK), recertification (USA, Canada) and re-registration (Netherlands). The interlinking of appraisal and revalidation presents itself as a delicate matter, as this may cause undesirable interference of two types of goals: professional development versus accountability. Physicians may perceive these goals as conflicting, framing the appraisal process as summative (i.e. to detect and weed out bad apples) instead of formative (i.e. to raise standards and support professional development) [5, 6]. Care must be taken that the appraisal process is experienced and used as an opportunity for learning and development and is not turned into a tick-box-exercise, associated with a loss of personal investment and a disposition of compliance
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