While healthcare organizations can learn from the 360-degree feedback systems successfully used by businesses, it is not advisable to use their surveys and protocol, but rather to select one that is designed for healthcare and hospitals.
The following are four essential healthcare-specific criteria for measuring and increasing the practice and people skills of physicians:
1. The 360 assessment questions must be aligned with Joint Commission/CanMEDS core competencies
Physicians operate in a unique environment quite unlike any business, and any assessment of physicians needs to reflect the unique skills required for the practice of medicine. Physicians don’t have customers, they have patients. Physicians don’t just have to deal with financial outcomes, they have to worry about clinical outcomes…and in this era of CMS-mandated CAHPS (patient satisfaction surveys), they have to worry about patient perceptions as well.
The Joint Commission and CanMEDS have added non-technical skills to the list of required core competencies for physicians, placing such skills on nearly equal footing as technical skills. For maximum benefit (clinical as well as financial), the assessment must align with all required Joint Commission/CanMEDS core competencies.
2. Physicians need to be benchmarked against other physicians
Unlike business, physicians are all focused on the same ‘product’: the human body. Physicians are highly specialized, and each specialty is highly standardized. It is crucial for physicians to know where they stand against other physicians, and even better to see how they benchmark whenever possible against others within their specialty, clinic, and/or hospital. A healthcare organization’s 360-degree feedback system must rely on relevant physician benchmarks.
3. Facilities and specialties should standardize the 360 survey and protocol
Ideally, there should be standardization in how the 360-degree survey process is implemented. This can be achieved through a software-driven system that automatically requires, for example, that each physician in a particular specialty to select the same minimum number of raters, enables physicians to select from various healthcare groups, that written feedback is analyzed to help de-identify raters’ comments to enhance anonymity, and that norms are used for the particular rater category, such as nurses compared to physicians.
Specialty-specific surveys ideally should be used in order to create benchmarks across institutions, and best practices should guide: how each physician selects raters, how to reduce rater selection bias, and how feedback data are reported back to the physician. For example, one version of the Quality PULSE 360 was validated by having over 100 subject-matter-expert orthopaedic surgeons from around the country rate the extent to which each questions is associated with quality of care, and studies are underway to assess how questions are correlated with a variety of outcomes. [1]
4. The 360 system must include physician-centric training & coaching to develop professionalism skills
When a healthcare organization discovers a gap in a physician’s technical skills, there are many available solutions, such as re-training and mentoring. However, addressing training gaps for professionalism and communication skills has been more elusive, and most healthcare organizations have little (if any) experience other than the collegial intervention or the threat of disciplinary action. The middle ground between discussion and discipline is development.
An effective 360-degree system must include developmental training that is tailored towards physicians. The 360 system should include structured goal-setting, educational modules that enhance physician communication skills, periodic feedback to reinforce improvements, and the availability of 360-trained coaches to provide ongoing developmental coaching for physicians.
