360-Degree Performance Reviews Provide Greater Feedback in Healthcare

Healthcare organizations have a unique set of challenges, particularly when it comes to measuring performance and understanding development needs. Some are strong at measuring clinical or functional skills. Yet few are equally adept at assessing the non-clinical skills that are so important to overall success in a healthcare organization. 360-degree feedback can play a significant role in understanding the other side of performance, those skills that are not directly tied to day-to-day, job specific ability.

Rather than relying on the perceptions of one individual, 360-degree feedback takes into account multiple perspectives. This is especially important when one person (i. e. , the employee’s manager) does not have the opportunity to observe all areas of the employee’s performance. Those working alongside the employee, along with the supervisor, are generally able to provide a more comprehensive look at the employee’s behavior and/or performance.

Introduction

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Performance of individual employees is central to the long-term success of an organization. Healthcare organizations have a unique set of challenges, particularly when it comes to measuring performance and understanding development needs. Some are strong at measuring clinical or functional skills. Yet few are equally adept at assessing the non-clinical skills that are so important to overall success in a healthcare organization. Clinical, or functional, ability is at the base of healthcare performance.

However, possessing these skills does not always ensure success. Unfortunately, many organizations ignore “soft side” skills like communication and relationship management, viewing these interpersonal and behavioral skills as “nice to have” qualities. Yet lack of interpersonal performance is something that generally cannot be compensated for by even the strongest of clinical skills (Maylett, 2009).

Expectations of the Consumer

Issues of performance and productivity are continuously being scrutinized by the leaders of healthcare organizations. Although cost is urrently the driving force for health care system reform, there is still great concern for the quality of the health care provided. Consumers of healthcare services are now asking “How can I get the best care for the least amount of money? ” This means that for an organization to gain competitive advantage, they must make sure that not only is the quality of care high, but the cost must also be reasonable when compared to other providers of similar services. Equally important for the healthcare organization to recognize is that the definition of quality performance is not “value-neutral”.

Standards are continuously evolving to reflect changes in values, new scientific findings, new technology, changes in regulatory requirements and laws and changes in the healthcare market place. The changes in these standards reflect the differences between the purchaser and the patient. The healthcare purchaser is concerned how effectively their dollars are spent and getting the most care for their money, while the patient expects the healthcare provider to be responsive to their individual needs (Popovich, 1998).

Currently, the Joint Commission requires accredited healthcare organizations to assess, track and improve the competence of all employees (Fried & Fottler, 2008). In addition, the Malcolm Baldridge National Quality Awards best business practices includes a model that is being increasingly followed by the healthcare industry that addresses key human resource practices directed toward creating a high performance workplace and toward developing staff by performance management systems (Kuzmits, Adams, Sussman & Rabo, 2004).

As cost stabilizes and becomes more aligned across providers, quality will become more important in deciding which organization or provider to use. According to the Joint Commission on Accreditation of Healthcare Organizations, “accurate, complete and relevant performance data can provide users of organizational services with objective evidence on which quality judgments can be based. ” Patients and consumers now consistently assess the performance history of healthcare providers, organizations and systems. Therefore, those providers should be assessing their performance to help identify opportunities for improvement (Popovich).

Performance Assessment and Management

Having a well-functioning performance management system can help the organization determine several things, including the effectiveness of their selection process, the effectiveness of their training mechanisms and whether the organization’s compensation program is effective at driving employees to perform at a higher level.

Performance management refers to a set of tools and practices that consists of setting goals with employees, designing strategies to make and sustain improvement, monitoring progress toward achieving goals, ongoing feedback and coaching by supervisors and peers, and measuring individual performance. Supervisors and employees tend to be uneasy about performance management and reviews, considering the process uncomfortable, highly unproductive and sometimes even unnecessary.

Managers are often uncomfortable with sitting down to discuss concerns about performance with employees and employees often feel as though their managers are being critical and condescending during the process. Complicating matters is that performance appraisals and reviews can be extremely emotional, especially when directly tied to an employee’s potential compensation. Traditional performance appraisals have involved the employee’s manager collecting information about the employee, observing their performance and then sharing that information back with the employee.

The review may include discussions about promotion, change in compensation, disciplinary action, transfer or recommendations for training. One concern with these types of assessments is that they are often subject to the biases and subjectivity of a single individual. Given the complexity of most healthcare jobs, it is often unrealistic for one individual to accurately describe the employee’s performance. In addition, traditional performance appraisal done purely for administrative reasons may be less than adequate for encouraging development, career planning or performance improvement (Jackson & Greller, 1998).

Another concern with the traditional single source performance appraisal is that supervisors only view performance from one perspective and often cannot directly observe employee performance. Furthermore, supervisor-based appraisal systems do not easily capture many important employee contributions, such as helping and training coworkers and being good team players (Fedor, Bettenhausen & Davis, 1999).

Multi-Source, or 360-degree, Performance Reviews

Assessing performance in today’s complex health care environment resents a challenge to the healthcare profession. In order to effectively evaluate performance within this complex and evolving environment, evaluation from multiple sources is required. Among the most useful ways to collect job performance information is to use multiple sources, or 360-degree feedback. This method recognizes that for most positions, relying on one source of information about an employee’s performance leads to incomplete and often inaccurate information. This is especially important when one person (i. e. the employee’s supervisor) does not have the opportunity to observe all areas of the employee’s performance. Those working alongside the employee, along with the supervisor, are generally able to provide a more comprehensive look at the employee’s behavior and/or performance. Feedback is a vital part of performance, growth and development. Understanding ourselves and how we interact with others helps us to understand what impact we have on those around us. A 360-degree assessment provides a comprehensive summary of an employee’s skills, abilities, styles and job-related competencies.

The logic underlying 360-degree feedback is that there are many sources of information in organizations, and much of that information is available both to the manager and to the employee. Co-workers, customers, other managers and even the employee themselves can be sources of feedback (Jackson & Greller). Simply put, 360-degree feedback is a method for evaluating an employee’s performance based upon feedback from everyone with whom the individual comes in contact – supervisors, coworkers, partners, subordinates, even the general public.

This type of feedback helps employees see themselves as others see them and allows them to seriously examine their behavior. It allows them to understand how others view their effectiveness and become more cognizant of how their effectiveness as an individual, co-worker or employee is perceived by others. It can reveal areas in which employees are performing particularly well and those areas in which there is room for improvement. 360-degree feedback provides the employee and the organization with a wealth of information including the following:

• an increase in self-knowledge for the employee encourages continuous learning
• stimulates the employee to enhance their strengths
• identifies areas that need development or improvement
• provides guidance for positive change
• supports coaching and mentoring initiatives

This information helps to build a partnership between the individual and the organization to maintain the process of continuous growth (Bentley, n. d. ). This review process is also helpful for the supervisor – it can provide a more accurate assessment of an employee’s performance and help eliminate accusations of favoritism.

The process provides greater objectivity and because it is submitted anonymously, it provides a supervisor with the most unbiased and accurate information from which to draw performance conclusions. This new level of understanding is invaluable as employees develop professionally. Recent studies suggest that a large percentage of workers who have participated in 360-degree reviews feel that the feedback was more accurate and more reflective of their performance than feedback from just one supervisor (Gallagher, 2008).

Additionally, this information provides great benefits to the healthcare organization as well:

• it enhances employee morale
• aids in assigning work
• stimulates employees to improve their work
• provides a basis for employment termination for sub-standard performers
• assists in determining who should be promoted, transferred or given additional compensation
• reveals exceptional employee talents and skills
• uncovers weaknesses in the training program
• promotes confidence in employer’s fairness
• helps resolve disputes in arbitration cases
• offers a basis for employee guidance and counseling (Harrison, 1978).

In healthcare organizations, multisource appraisal, or 360-degree feedback, can play a significant role in understanding the other side of performance, those skills that are not directly tied to day-to-day, job-specific ability. These include such things as how well the individual collaborates with other health professionals to achieve desired outcomes, how well they improve their knowledge and understanding of their own performance, how they keep up to date with new developments and the degree to which they are aware of their own strengths and weaknesses (Council of Academic Hospitals of Ontario, 2009).

Partly in response to concerns about performance and patient safety, and partly in response to demands for accountability to patients and funding agencies, the assessment of healthcare employee competence has received much attention. These concerns have shifted the concept of competence from a narrow definition of “clinical competence” or the ability to perform technical medical acts to “behavioral competence” which includes interpersonal and communication skills, judgment, relationship management and professionalism (Lockyer, 2003).

Healthcare worker performance is recognized as being complex, multi-factorial and non-linear in nature. It is clearly influenced by the fact that healthcare workers perform within teams and systems and that their performance oftentimes is a reflection of the performance of the broader environment in which they work (Council of Academic Hospitals of Ontario). While there is wide acknowledgement that faulty systems and processes within the delivery of health care may adversely affect patient safety, individual failures can also contribute to patient injuries and complications.

At a minimum, healthcare worker competency must be assured to maximize patient safety, as well as to ensure that the highest quality of patient care is provided. In addition, providing feedback that helps coworkers develop their interpersonal and task-related skills can improve work unit performance and, possibly, make one’s job easier and their environment more pleasant (Fedor, Bettenhausen & Davis). As a result of individual performance assessments, 360-degree performance feedback in healthcare has the added advantage of identifying organizational improvement opportunities.

Individual performance problems may identify larger systems or team challenges within a department or organization. The identification of these issues may be useful in guiding quality improvement initiatives that can be undertaken by the healthcare organization (Council of Academic Hospitals of Ontario). Multisource feedback is seen as potentially more useful than supervisor-only evaluations, especially in environments like healthcare organizations where the organizational structure is more flat and team-based (Rynes, Gerhart & Parks, 2005).

Most 360-degree feedback programs are strategic initiatives resulting in a tested method of improving productivity and job satisfaction. They are designed to support increased competitive advantage, development of leaders, increases in productivity, improved morale and job satisfaction and retention of high-performing employees (Bentley). Using 360-degree performance review models provides for ongoing measurement of healthcare delivery performance and subsequent assessment of the quality of that care.

In addition, the models can be revised as needed to reflect the changes in the healthcare system and in the perspectives of the different sources that determine the standards that must be met and the resulting performance assessment. The 360-degree evaluation will help employees identify their strengths so they can build on them at the same time it addresses their skill gaps. It is a process that leads to continuous learning, team building, growing self-confidence and improved productivity.

Conclusion

A changing healthcare environment has resulted in an increased focus on performance, both at the organizational and individual levels. Healthcare managers and leaders face an increased need to focus on both operational, or clinical, performance as well as non-clinical performance such as communication, leadership and interpersonal skills. Performance measured solely from a clinical skills perspective misses a critical factor – behavior skills, or the “soft-side” of performance (Maylett & Riboldi, 2008). Managers lacking in the non-clinical/non-functional side of leadership typically experience significant issues that eventually lead to decreased overall performance.

On an organizational level, this could potentially result in high turnover, disengaged employees and lack of teamwork which will eventually impact patient care. Healthcare leaders are under increased pressure to raise the performance bar. Consumers and patients are demanding healthcare organizations deliver superior customer service and patient care in an often difficult environment. It is vital that healthcare leaders look at both elements of performance – the clinical AND the interpersonal. Each element plays a critical role in the overall effectiveness of the employee, manager and the organization and ultimately in the organization’s competitive advantage.

Bibliography

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