Soon after beginning work at athenaHealth in 2015, I was introduced to the performance management program. A 90-day “pulse check,” was scheduled with my supervisor, my “business goals,” became due, and as a manager, I was required to attend a course on people management. At the pulse check, I compared my self-assessment of my performance with my supervisor’s assessment, and identified areas of ‘opportunity’ to work on during the subsequent period of time. My business goals were measurable, weighted, aligned with corporate objectives, and evaluated at year’s end. If I ‘met’ expectations, I received a bonus. Approximately 15 percent of the company will be evaluated as ‘below’ expectations, and 15 percent will ‘exceed’ expectations, and their bonus will reflect it. Mid-way through the year, I, along with all senior employees, went through a 360-degree evaluation, where we received written feedback from colleagues above, below, and lateral to us in the management hierarchy. Over time, these quantitative and qualitative assessments formed a transparent record of achievement and failure that directly determined whether I was promoted, singled out for leadership opportunities or deficit-coaching, or dismissed.
The goal of this time-intensive performance management program is to identify leaders, find deficits, and work with employees to become more effective and successful. Another goal is to create a multi-touch, semi-redundant system of evaluation that is transparent and reasonably objective, rapidly accumulating the information that allows the company to improve its workforce. The trend in business, in fact, is toward frequent, subjective, and objective opportunities for evaluation.[1]
If your experience in clinical medicine is anything like mine, this approach to human resources will sound entirely foreign. I was occasionally shown data on my clinical productivity. Negative comments on patient satisfaction surveys were brought to my attention. Adverse-event reviews sometimes identified clinical errors I had made. That was the extent of it.
In an era when team-preparedness for clinical obstetric crises is ubiquitous, patient safety is paramount, and we are seeing a rise in team-based care models, it seems surprising that so little attention is paid to performance management of physicians, who are arguably the most important contributors to a high-quality, successful, obstetrics and gynecology service. A search of the clinical literature using Pubmed reveals no articles on this topic in obstetrics and gynecology.
There is ample evidence from the business literature that performance management improves corporate outcomes and the success and effectiveness of both managers and individual contributors.[2,3] It seems counterintuitive to think that these data do not apply to physicians.
Obstetrics is not without experience in evaluation. Many residency programs have organized systems of trainee evaluation, although these are often focused on procedural competency, and not on cohort performance as professionals. There is even a precedent for comprehensive physician performance evaluation – The Cleveland Clinic incorporates careful evaluation into their employment model.[4] Many successful healthcare organizations have incorporated comprehensive performance evaluation into their corporate culture, although typically not for their clinical physician employees.
Imagine a competency-based model of evaluation with broad acceptance from a physician staff that was assiduously completed twice-annually (or more frequently) and allowed for the identification of evidence-based practice, collegiality, teamwork, as well as the promotion of shared values and ideals. A model could include clinical productivity as well as patient satisfaction. 360-degree feedback that included administrative, nursing, and student involvement would provide unique perspective. Such a system would identify singularly successful clinicians who might be good candidates for leadership coaching that would propel them into roles where they would advance their institution and their own career. Similarly, such a system would show opportunities to help clinicians improve one or more domain of their skill-set, and if, after repeated interventions failed to accomplish remediation, would provide more than sufficient grounds for termination.
As the stewards of complex organizations reliant on highly-trained individuals who are entrusted to come together to provide a critical set of services to women, it may be time for healthcare institutions to learn from their business counterparts and apply evidence-based management techniques to human resource practices for physicians.
Bibliography
[1] P. Cappelli and A. Tavis, “The Performance Management Revolution,” Harvard Business Review, pp. 58-67, October 2016.
[2] M. Huselid, “The impact of human resources management practices on turnover, productivity, and corporate financial performance,” Academy of Management Journal, vol. 38, no. 3, pp. 635-872, 1995.