Birmingham Heartlands and Solihull Hospital NHS Trust (Teaching), Solihull, UK.
Correspondence to:
R. G. Palmer, Clinical Director of Rheumatology, Birmingham Heartlands and Solihull Hospital NHS Trust (Teaching), Lode Lane, Solihull, West Midlands B91 2JL, UK. E-mail: Robert.Palmer{at}heartsol.wmids.nhs.uk
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Abstract |
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Methods. Seventeen team members completed an anonymous questionnaire to give confidential opinions about the clinical, humanistic and other skills of their colleagues. Results and comments were collated and given as feedback to each individual. Before feedback, participants were asked to predict their perceived strengths and weaknesses. After feedback they evaluated the process.
Results. A profile of abilities was established for each team member and discussed privately with the clinical director. Often team members had good insight into their perceived strengths and weaknesses. Some participants were hurt by negative comments made about them even if this was balanced by positive comments. There were mixed views on the relevance and usefulness of the process, and whether or not it should be repeated. Some team members found the process threatening.
Conclusion. The 360-degree assessment can be used in a multidisciplinary setting, the questions being the same for all individuals. It is a very powerful tool that must be handled carefully so that it does not cause more harm than good.
KEY WORDS: 360-degree assessment, Multidisciplinary team
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Introduction |
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There is developing interest in this method within medicine, where it has also been shown that peer ratings are reliable if at least 10 or 11 raters are used [2]. Interestingly, the outcome is not affected by the person assessed choosing his or her own raters; the relationship between the rater and the subject does not affect the results [3]. A recent pilot study has suggested that 360-degree assessment of senior house officers was a practical and acceptable method for gathering information on humanistic qualities. Participants were able to choose their own raters and the majority found the process fair and helpful [4].
We report our experience of using the 360-degree assessment in a multidisciplinary team setting to inform the annual appraisal process that occurs in a rheumatology directorate in a teaching hospital. Ethics approval was not required.
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Methods |
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Gets on very well with patients;
Gets on very well with staff;
Is always attentive to the needs of others in the team;
Gives a high-quality clinical opinion;
Always responds in a timely manner;
Is always well organized;
Dictates high-quality clinical letters;
Works well even under pressure;
This person is very good at his/her job;
Always inspires others and is appropriately ambitious.
The same statements were considered applicable to every member of staff, except that for the secretaries the respondents were asked to ignore the statements relating to clinical opinion and dictation of letters. Participants had the choice of completing the form in print or by hand, returning it anonymously to the clinical director using the hospital mail; the intranet was not used for returning responses because anonymity would not have been maintained. Self-scoring was discouraged with a warning that outlying results would be ignored. The e-mails were distributed in three phases over a 6-week period to prevent overload and to increase compliance: first the doctors, followed by the allied health professionals, and then the secretaries.
The clinical director collated the results and comments and fed them back to each participant in a one-to-one interview that lasted up to 25 min. In an effort to make this a less threatening process, the clinical director's own results, both positive and negative, were discussed first. An individual was not aware of the results of others. Each person was given a histogram of his/her own results together with the mean results for his/her own professional group. Comments from colleagues were discussed. Prior to the feedback the participants were asked to predict their two highest and two lowest scores to give a measure of insight into how others perceived them.
After completion, the process was evaluated by the use of a questionnaire to seek the participants views on the assessment: Was it relevant? Was it useful? Was it threatening, Should it be repeated?
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Results |
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It was not possible for some members of staff to respond to all 10 questions about other individuals, especially if they worked on the other hospital site (e.g. a secretary from one site might not know how well a doctor from the other site related to patients). There were 1014 responses for doctors, 911 responses for nurses, occupational therapists and the physiotherapist, and 69 responses for the medical secretaries. Each individual received between two and 11 comments. There was no relationship between the number and attitude of comments and an individual's mean score for each question. The lowest mean score for any single question was 2.6 and the highest was 5. Most scores were between 3 and 5. An example of typical results that could apply to a colleague with good clinical skills but poor communication skills is shown in Fig. 1.
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After the feedback, all 17 team members completed a brief evaluation questionnaire. The findings are shown in Fig. 2. There was an almost even split between positive and negative responses to the suggestion that the assessment was relevant and useful, and should be repeated. The majority of participants did not find it threatening, although a small group did feel threatened by the process.
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The process was time-consuming for the organizer, particularly the analysis of results.
A comment was made that the anonymous nature of the assessment led people to make more personal comments than were appropriate. Indeed, for some individuals a single negative comment was hurtful even if it was balanced by several positive comments.
The potential difficulty of using the same questions for all team members irrespective of discipline was raised.
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Discussion |
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The assessment was undertaken in three stages to make it more acceptable to staff, starting with the doctors. It was hoped that this would also reduce the chance of it being threatening to non-medical staff. In addition, it was hoped that the staging would help maximize cooperation. Nevertheless, the numbers of responses declined with each stage, which could reflect diminishing enthusiasm for involvement.
The evaluation revealed divided opinions on the process. Three team members had already expressed concerns about the assessment before it started and some felt threatened by the process, gaining little from it. This may simply have been due to lack of familiarity with the new process, and with time and repeated assessments the concern may diminish. In a pilot study involving junior doctors, most of the participants found the process to be helpful [4]. It is possible that some NHS personnel are more able to adapt to a new assessment process than others. Direct involvement of all staff in the development of the process, possibly with the input of professional line managers, may make the 360-degree assessment more acceptable.
Some participants found it hurtful to receive anonymous negative comments. Clearly, this assessment is a very powerful tool that needs to be handled with care so that it does not cause more harm than good. There was no relationship between the overall scores received and the number of comments or the nature of the comments, whether positive or negative. This suggests that respondents were trying to be fair, finding good things to say about the weaker team members whilst being willing to be critical of the stronger team members.
There are several important learning points. It might be preferable for future assessments to be organized by an independent person who is not a member of the team, and for the completed forms to be scannable, to reduce time and effort. Another possibility would be for feedback to be given by an individual's line manager at the time of appraisal rather than by the clinical director. The overall feeling is that the 360-degree assessment has been reasonably successful and that its role will become more important in a multidisciplinary team setting in the future.
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Conflict of interest |
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Acknowledgments |
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References |
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