Playing tick-box games: Interrelating defences in professional appraisal

Abstract

We here examine the introduction of appraisal for senior medical professionals. Our recent qualitative field research found four main experiences of appraisal (developmental, disappointed reflection, defensive assessment and cynical dismissal of appraisal as a waste of time), which we developed into a typology. We argue many professionals `play tick-box games' to give the impression of auditable practice while continuing to practise in a traditional way. We develop existing theory on the `audit society', social defences and `mock bureaucracy' to explain interrelating defences which occur in appraisal as a reaction to the risks and conflict experienced in professional regulation.