Giving meaningful evaluations

Rob Chang writes…

It’s the end of the year and evaluation time has come around again.

It’s a laborious process.  Self-assessments, peer assessments, nursing assessments, patient assessments, director assessments….  Thick stapled sheets of papers coated with numbers and ratings lay stacked and scattered across the lined dark carpet and desk in my office, each pile somehow representing the culmination of a year’s worth of effort.  The sheer amount of paperwork could likely reconstitute a small forest.

Cajoling physicians to rate their peers, tracking down missing resident teaching assessments and moderating the evaluations from patients and nurses are all part of the whirlwind at the end of the year.  Weighing out the relationship between patient commentary of “my food was cold” and a physician rating is 2 out of 5…are they related?  Are they not?  Everything else is a 5…how do I couch that to the physician?

It’s still one of my most favorite times of the year as a medical director.

This is the opportunity to really sit down and reflect on the growth that has occurred over a year, the areas that need attention and pruning and talking about future goals.  We’re in the middle of giving evaluations right now and there are several things we include that have made this successful thus far.

1.    The purpose is to grow people: whether emphasizing their strengths or pointing out weaknesses, it is absolutely essential that the goal is to help the recipient grow.  In academic settings, this often translates into teaching skills and opportunities, professionalism and research.

2.    Clear expectations: our physicians know what points they arebeing evaluated on and what the sources of their evaluation are – for us, we assess clinical acumen, quality of care and professionalism as well as research strengths.  We use multiple sources ranging from peers, patients and nursing staff to give a multifaceted assessment.

3.    Include strengths: there is virtually always something good to say– it’s worth saying.

4.    Include weaknesses: there is virtually always something that needs work – it’s worth saying.  The most beneficial feedback that I have received has been candid suggestions on how to improve my organizational skills and how to teach residents.

5.    Familiarity with the physician: knowing the person you are evaluating makes your evaluation far more meaningful.  Knowing what people face in their daily work also lends legitimacy to your evaluation.

6.    Learn from who you evaluate: find out what it is that the physicians recognize that they need to become better clinicians, researchers, administrators, etc.

7.    Give them a direction to grow.  Whether the direction includes the next steps to assistant professor, growing the vision for improving nursing/hospitalist communication or sharing with a physician that they are fantastic and need to further develop their interest in teaching, all of these point them towards the next steps.

8.    Lastly, if there are serious issues about a physician’s performance, the end-of-the-year evaluation should not be the first time that someone hears about it (unless it was very recent) and it should not be the last time.  Setting up your evaluations such that you can recall what needs improvement from year to year is the only way to really set up your physicians to improve.

We still have lots of room to grow.  We’ll be moving to a computerized system since some of our physicians receive eight evaluations and others receive none.  We discharge 6000+ patients a year and received only a few hundred patient evaluations.  But those are administrative issues, not motivational ones, and are easy to fix.  Hopefully these key points can keep your evaluations directed and yet truly meaningful.

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