Some notes for GPs
- This is a process whereby feedback on your performance is elicited from a range of colleagues who work with you. In General Practice this would include GPs you work with, as well as nursing and administrative staff colleagues. Secondary Care or PCT colleagues could also be included.
- This is going to become an evidence requirement for GP re-licensure-one externally validate multi-source feedback exercise which you have discussed, reflected on and acted upon , every five years. Several commercial packages are currently being piloted in primary care. It is likely that a number will be approved for the purposes of re-licensure , in the same way that QoF has approved two patient feedback surveys.
- There is also an argument to consider the introduction of a less formal 360 feedback system within your own team, as an aid to both individual and practice development , and some sample templates for this are also included in this pack.
- The most important point to make about any form of 360 feedback is that it should be introduced into an organisation with care, making sure that all respondents know how to make their responses constructive not destructive. It is also critically important to ensure there is a robust mechanism for each individual to be supported in discussing and acting on their own feedback.
- The following notes describe the development of the concept of 360 feedback and its potential benefits, as well as some of the drawbacks and difficulties, especially if it is introduced without adequate preparation. Some guidance is given on how to introduce this into your practice team.
- The same principles apply to non-practice based GPs, although they might to choose to elicit feedback from a range of settings in which they work.
The development of the concept of 360 Feedback
- 'Full circle' feedback-developed in the commercial sector to elicit feedback from bosses, peers and juniors.
- Aim of the feedback is to highlight areas of strength + those in need of improvement.
- Do you know what your colleagues at work think about you?
- Do you see yourself as others see you?
- Initially introduced as a tool in the commercial sector for performance management but rarely used for this now
- Now seen as a developmental tool to examine behaviours key to a job such as teamwork, communication and interpersonal skills
- Looks less at what people do, and more at how they do it
- Used extensively for Doctors in North America as part of re-accreditation -some evidence of changed performance following feedback
- Has been shown to have credibility in assessing areas of performance traditionally difficult to assess
- Can achieve high levels of reliability if 10-15 raters are used- If at least ten responses are obtained the results are not affected by whether the raters are chosen by the appraisee or randomly selected from a group of colleagues
Methods of obtaining 360 feedback
- Computer based commercial packages —most of which combine 'tick box' responses with some free text examples include Edgecumbe consulting www.doctor360.co.uk, 360 clinical from St Thomas Hospital www.360clinical.corn and the Client Focused Education Program www.cfep.net. These packages currently cost £80 to £100 per GP but costs may drop if a PCT negotiates a 'bulk contract with an individual provider
- Free text informal comments on strengths and development needs in key areas- an example at the end of this document. These have no financial cost attached but do require administrative time to collate and type up the comments and to feedback the findings to each GP or other member of the clinical team.
- Both methods are most useful if the individual concerned uses the same tool to self rate their performance, and discrepancies between self assessment and raters' assessment is discussed when the feedback is received
Commercial packages - pros and cons
- Usually quite quick to fill in with only small free text sections
- Easy to summate and graph the tick box section responses
- Provides the required documentation for re-licensure [once approved providers are identified]
- Allows easy comparison between individuals or practices
- Respondent's anonymity guaranteed
- Sensitive areas such as communication skills are not easy to reduce to tick-box statements
- Comments are reproduced verbatim by a commercial package —these can occasionally be destructive or hurtful
- Respondent should not just receive their computer generated feedback without the opportunity to discuss it with someone experienced in handling and responding to 360 feedback
Free-text in house' feedback - pros and cons
- Free text often produces 'richer' and more useful information
- Responses more likely to be tailored specifically to the individual
- Allows for more space to comment on specific areas for change
- Negative, destructive free text comments can be edited to prevent hurt
- Respondents may fear identification from hand writing or wording, especially in a small organisation- typing up aggregated comments is really important
- Time consuming, both in typing up responses and delivering the feedback, especially in large organisations
- Difficult to compare non standard responses5
Potential benefits of 360 feedback
- You don't know how others see you until you ask - all methods should compare your own feedback on yourself with the views of others
- Can be a very powerful a learning experience
- Self assessment of communication skills, team relationships, leadership skills etc is very inaccurate
- Some evidence of this, and actions taken in response to it, likely to be required for revalidation
- Destructive feedback can be very damaging to the individual and the team
- Anonymity may be used to express grudges or personal animosity
- 360 feedback without facilitated discussion unlikely to change behaviour
- Time consuming and respondents may get 'feedback fatigue
Criteria for successful delivery of 360 appraisal
- Clear discussion of the process by all involved before undertaking 360-
- Discussion of the benefits and risks as well as the pros and cons of formal vs informal approaches
- Ensure the process is understood by all and that fears and concerns are expressed and addressed
- Sign up by the whole team is critically important for the success delivery of 360
- Clear instructions on how to fill in the feedback forms
- Clear guidelines on anonymity and how feedback will be collated and by whom [if done in house]
- If using free text comments give clear guidance on constructive not destructive criticism with possible behaviour changes to be suggested.
- Overtly personal or destructive comments to be avoided
- Feedback should not just be returned to the individual outcomes should be discussed with facilitator , including comparison of self and raters' assessments
- Very useful to compare your own views of yourself with those of your colleagues
- Facilitator can help prepare an action plan to address any agreed areas for change
Dr Di Jelley March 2007 [updated]
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