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Consultant appraisal
Current Obstetrics & Gynaecology (2000) 10, 53–54 © 2000 Harcourt Publishers. Ltd doi:10.1054/cuog.2000.0054, available online at http://www.idealibrary.com on
Clinical governance
Consultant appraisal
N.J. Naftalin and D. Grafton
only diminishes the whole but removes focus from areas of performance which are below that individual’s mean. Consultant career development does occur, but how often is it planned, focusing on strengths, aspirations and service needs, rather than being simply opportunistic? Few opportunities exist for a midcareer move or retraining. The energy and interests of an obstetrician and gynaecologist at the time of appointment in his/her early 30s should not be the same 15 or 20 years later, and surely we all have a responsibility to nurture this essential human resource and maximize potential to the benefit of both individual and service. Succession planning for roles with the Royal College, post-graduate Deaneries, clinical leadership or other areas should start early, ensuring the necessary competencies are obtained along the way and also ensuring that aspirations are appropriate and achievable. The new generation of trainees and recently appointed consultants have grown up with appraisal. Clinical academics use appraisal in relation to their academic endeavours. Management, both within and outside the Health Service, has long used appraisal as a means of supporting, motivating and aligning staff and for promoting career development.2 Why have consultants been so reluctant to adopt appraisal for themselves? Perhaps it harks back to an atavistic feeling of fierce individualism and independence which denies the existence of line management and protects the illusion that, certainly within one’s own patch, clinical performance is above criticism. There may also be reluctance on the part of some clinical leaders to grasp the nettle—particularly when dealing with more senior departmental colleagues or friends. The consequence of this is a lost opportunity for positive feedback, career development and, where required, early corrective action, and a likelihood of confrontation and conflict if issues ultimately precipitate. In the world of evidence-based medicine,
Hospital corridors will not be exempt from the modernization of the UK. Delivery of clinical excellence, life-long learning and continual improvement as incorporated in clinical governance will be accompanied by demands that the profession demonstrate that these ends are delivered. Health Authority, undergraduate and postgraduate contracts have experienced such scrutiny progressively over the last 10 years, but accountability has tended to remain at the corporate rather than the individual level. This is likely to change. Senior hospital doctors are key determinants of the success of any department, and clinical leaders need mechanisms to ensure the effective working and vitality of this group of staff. Clinical leaders have responsibility for the delivery of local, regional or national initiatives and for resource management, and will need to know and understand their colleagues and clinical teams intimately if they are to lead their departments successfully. The pressures of clinical practice are ever increasing. There is evidence that some doctors are stressed and in need of support.1 Adjusting to increasing technology, greater patient expectation, perceived loss of clinical freedom and a more litiginous environment, particularly in acute specialties such as obstetrics and gynaecology, may be difficult for established consultants. How, then, can the needs of consultants be balanced with the need to show the public that we are achieving across the broad range of competencies? Too few consultants have the detailed information about their performance to enable them to benchmark themselves and identify areas for improvement. Many would be unable to identify the current objectives of their department, and their role in their fulfilment. This results in a kind of limbo in which individuals may perform, often to a very high standard, but in isolation from their department. This not N. J. Naftalin, Consultant Gynaecologist/Medical Director, D. Grafton, Director of Human Resources, Leicester Royal Infirmary, UK.
53
54
Current Obstetrics & Gynaecology
Table 1 Requirements for a successful appraisal programme Required by appraiser
Provided by organization
Courage Listening skills Giving and taking feedback Counselling skills Dealing with confrontation and conflict Dealing with difficult colleagues Objective-setting skills Communication skills Knowledge of the organization and available resource
Strategic goals A record-keeping system Training Information Continuing professional development Project management skills
doctors should be equally open to evidence-based management. Appraisal for consultants is becoming established in an increasing number of trusts. Setting up such a system requires careful planning and harm may be done if it is suddenly imposed or perceived to be a policing exercise. Peer appraisal requires additional skills to those needed for appraising trainees. The exigencies of clinical governance may make appraisal compulsory and may also mean that the outcome is known to others outside the department. Nonetheless, agreement with the hospital medical staff committee or the directorate management group is a sine qua non and joint planning enhances the probable success of the initiative. To be meaningful, appraisal requires organization and training. A recent audit of the Annual Consultant Planning Programme at the Leicester Royal Infirmary
revealed 78% take-up of this voluntary appraisal system, now in its sixth year. It was overwhelmingly felt to be of value by all clinical leaders, and was largely endorsed by the consultant body. Both groups, however, felt that it could give a better return and the major deficiency was in training, predominantly of the appraisers but also of the appraisees. The existing training programme was clearly inadequate to the evolving needs of the organization. What, then, is required to deliver a successful appraisal programme? Developing a training programme must have involvement of senior consultants. The challenge is to design a programme that builds on enthusiasm created for the principles of appraisal and demonstrably enables the consultant to deliver objectives. More important than the competencies and structures underpinning any programme (Table 1) is clinical leadership and a culture shift amongst consultants which will make appraisal acceptable and valued for the benefits if can bring. Royal College, British Medical Association and other institutional support is apparent and public reassurance that self-regulation can work in an environment of clinical governance may be the prize. REFERENCES 1. 2.
Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between stress and lowered clinical care. Soc Sci Med 44: 1997; 1017–1022. Orsburn J D, Moran L, Musslewhite E, Zenger J W. Self directed work teams. In: Peer Performance Appraisal Part 3, Chapter 17. Irwin, Illinois: Business One, 1990; 318–325.
Clinical governance
Consultant appraisal
N.J. Naftalin and D. Grafton
only diminishes the whole but removes focus from areas of performance which are below that individual’s mean. Consultant career development does occur, but how often is it planned, focusing on strengths, aspirations and service needs, rather than being simply opportunistic? Few opportunities exist for a midcareer move or retraining. The energy and interests of an obstetrician and gynaecologist at the time of appointment in his/her early 30s should not be the same 15 or 20 years later, and surely we all have a responsibility to nurture this essential human resource and maximize potential to the benefit of both individual and service. Succession planning for roles with the Royal College, post-graduate Deaneries, clinical leadership or other areas should start early, ensuring the necessary competencies are obtained along the way and also ensuring that aspirations are appropriate and achievable. The new generation of trainees and recently appointed consultants have grown up with appraisal. Clinical academics use appraisal in relation to their academic endeavours. Management, both within and outside the Health Service, has long used appraisal as a means of supporting, motivating and aligning staff and for promoting career development.2 Why have consultants been so reluctant to adopt appraisal for themselves? Perhaps it harks back to an atavistic feeling of fierce individualism and independence which denies the existence of line management and protects the illusion that, certainly within one’s own patch, clinical performance is above criticism. There may also be reluctance on the part of some clinical leaders to grasp the nettle—particularly when dealing with more senior departmental colleagues or friends. The consequence of this is a lost opportunity for positive feedback, career development and, where required, early corrective action, and a likelihood of confrontation and conflict if issues ultimately precipitate. In the world of evidence-based medicine,
Hospital corridors will not be exempt from the modernization of the UK. Delivery of clinical excellence, life-long learning and continual improvement as incorporated in clinical governance will be accompanied by demands that the profession demonstrate that these ends are delivered. Health Authority, undergraduate and postgraduate contracts have experienced such scrutiny progressively over the last 10 years, but accountability has tended to remain at the corporate rather than the individual level. This is likely to change. Senior hospital doctors are key determinants of the success of any department, and clinical leaders need mechanisms to ensure the effective working and vitality of this group of staff. Clinical leaders have responsibility for the delivery of local, regional or national initiatives and for resource management, and will need to know and understand their colleagues and clinical teams intimately if they are to lead their departments successfully. The pressures of clinical practice are ever increasing. There is evidence that some doctors are stressed and in need of support.1 Adjusting to increasing technology, greater patient expectation, perceived loss of clinical freedom and a more litiginous environment, particularly in acute specialties such as obstetrics and gynaecology, may be difficult for established consultants. How, then, can the needs of consultants be balanced with the need to show the public that we are achieving across the broad range of competencies? Too few consultants have the detailed information about their performance to enable them to benchmark themselves and identify areas for improvement. Many would be unable to identify the current objectives of their department, and their role in their fulfilment. This results in a kind of limbo in which individuals may perform, often to a very high standard, but in isolation from their department. This not N. J. Naftalin, Consultant Gynaecologist/Medical Director, D. Grafton, Director of Human Resources, Leicester Royal Infirmary, UK.
53
54
Current Obstetrics & Gynaecology
Table 1 Requirements for a successful appraisal programme Required by appraiser
Provided by organization
Courage Listening skills Giving and taking feedback Counselling skills Dealing with confrontation and conflict Dealing with difficult colleagues Objective-setting skills Communication skills Knowledge of the organization and available resource
Strategic goals A record-keeping system Training Information Continuing professional development Project management skills
doctors should be equally open to evidence-based management. Appraisal for consultants is becoming established in an increasing number of trusts. Setting up such a system requires careful planning and harm may be done if it is suddenly imposed or perceived to be a policing exercise. Peer appraisal requires additional skills to those needed for appraising trainees. The exigencies of clinical governance may make appraisal compulsory and may also mean that the outcome is known to others outside the department. Nonetheless, agreement with the hospital medical staff committee or the directorate management group is a sine qua non and joint planning enhances the probable success of the initiative. To be meaningful, appraisal requires organization and training. A recent audit of the Annual Consultant Planning Programme at the Leicester Royal Infirmary
revealed 78% take-up of this voluntary appraisal system, now in its sixth year. It was overwhelmingly felt to be of value by all clinical leaders, and was largely endorsed by the consultant body. Both groups, however, felt that it could give a better return and the major deficiency was in training, predominantly of the appraisers but also of the appraisees. The existing training programme was clearly inadequate to the evolving needs of the organization. What, then, is required to deliver a successful appraisal programme? Developing a training programme must have involvement of senior consultants. The challenge is to design a programme that builds on enthusiasm created for the principles of appraisal and demonstrably enables the consultant to deliver objectives. More important than the competencies and structures underpinning any programme (Table 1) is clinical leadership and a culture shift amongst consultants which will make appraisal acceptable and valued for the benefits if can bring. Royal College, British Medical Association and other institutional support is apparent and public reassurance that self-regulation can work in an environment of clinical governance may be the prize. REFERENCES 1. 2.
Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between stress and lowered clinical care. Soc Sci Med 44: 1997; 1017–1022. Orsburn J D, Moran L, Musslewhite E, Zenger J W. Self directed work teams. In: Peer Performance Appraisal Part 3, Chapter 17. Irwin, Illinois: Business One, 1990; 318–325.