360 degree appraisal A personal view Only part of the jigsaw puzzle of team development Remit: Exploring the pros and cons of 360 with some tools demonstrated perhaps, and some space for chat
Back to basics - What's the Vision? • Better care • Through effective teams • Working • Learning • Planning together
The evidence? • Can teams improve practice? JAMA March 2004 Cohesive teams have 5 key characteristics: • Clear goals • Measurable outcomes • Clinical & administrative systems • Division of labour • Training of all team members • Effective communication Barriers • chiefly the challenge of human relationships & personalities. • (NHS stuff)
1983 Team 2005
The problem Team cohesion is limited because… • History of primary care in the NHS • Different employers • Different lines of accountability • Different management arrangements • Off site base/working • More work • Integrating wider team & networks • Surviving massive externally imposed change • Needing to play every game that brings in resources
Corbridge principles to improve team cohesion • Value every opinion – just as good as the next person • Involve everyone – the more brains the better • Communicate – tell everybody everything all the time • Skill up current team members • Skill mix & skill sharing (don’t be precious!) • Focus on the practice team development plan
Our answer to ensuring team cohesion • Team focus balanced with • Individual focus • Team meetings • PHCT • Educational • Uniprofessional • SEA • Multidisciplinary working groups with clear remit e.g. CHD, asthma/copd, Diabetes, dispensary. • Team away day • Team plan • Multidisciplinary appraisal within the team • Aim to develop the individuals to help implement the plan
Theory - Focus of appraisal • Job vs person • Performance (in the past) vs development • Performance vs competence • Summative vs formative
Theory - Appraisal styles - continuum • Tell • Tell & sell • Tell & listen • Problem-solving Tells &sells &listens &shares
Theory - purposes of appraisal • Evaluate recent performance + • Formulate job improvement plan + • Identify problems/opportunities in the job + • Improve communication + • Provide feedback on job performance + • Identify training & development needs + • A rationale for salary review - • Promotion possibilities -
History of implementation of appraisal in Corbridge. • Lucky as all in one building • GP training since 1983 when assessment & feedback of performance defined “training” • Appraisals began in 1987 after a King’s Fund Course of staff • 1990’s became more team orientated • MD approach involving doctors & PNs • As inclusive as possible • Since PCG days try to incorporate Community Staff • Feedback always a feature – sought from all team members • Evolution of appraisal as a result of NHS requirements • Danger of highjack?
Who? nurses receptionists secretaries GPs appraisee Dispensers Appraisal team • Practice Manager/admin • GP • Nurse manager
Our Policy Corbridge Health Centre System for Appraisal Who will be appraised? All members of the PHCT will be offered an annual appraisal to be undertaken by the practice. Members of the community staff will be encouraged to participate in the process, particularly with respect to training needs, in order that these may be incorporated into the Practice Professional Development Plan (PPDP) for the following year. All practice staff will have an annual appraisal. Who will give Feedback? Having established those members of staff who require an appraisal, feedback forms (see Appendix 1) will be sent out to around 6 members of the team per individual appraisee. This will be co-ordinated by the Practice Manager and the Partner responsible for the process (currently Dr Hudson). The PM will maintain a list of who has been asked for feedback in order to vary this from year to year if possible. This feedback is confidential and anonymous and great care will be taken to reassure team members of this. The six team members will be selected in order to provide 360º feedback for each person. In addition, the GPs will also receive personal feedback about their consultations from the GPAQ patient satisfaction survey completed earlier in the year. What preparation must be done in advance of the appraisal? Prior to the appraisal itself each appraisee will be given a copy of the appraisal form (Appendix 2 for GPs and Appendix 3 for all other staff) to complete and (for practice staff), a copy of their latest job description. The appraisal form should be brought to the appraisal and used as a framework for the discussion. The Appraisers will compile a summary of the feedback to be referred to during the appraisal discussion. What will happen during the appraisal? Each appraisal will be undertaken by a team comprising of the following: One Partner Practice Manager or Practice Administrator or Reception Manager Practice Nurse or District Nurse or Health Visitor During the appraisal, the team will work through the appraisal document making notes on each section. Finally, a comment will be added by the appraisee and appraisers to summarise the discussion and the document will be signed by both. After the Appraisal. The training needs will be incorporated into a personal development plan (PDP) alongside any targets, job objectives or practice developments which were identified during the discussion. One copy of the appraisal document will be retained by the appraisee and one copy will be kept in the appraisee’s personal file in the practice Manager’s office. The NHS ‘Form 4’ for GP appraisal will be completed and signed and a copy sent to Northumberland Care Trust to be used for GP revalidation.
Documentation • PERFORMANCE APPRAISAL • Please complete sections A to C of this form and return to the appraiser the day before your appraisal. • A. NAME: JOB TITLE DATE OF APPRAISAL: APPRAISER(S): LENGTH OF SERVICE: TIME IN CURRENT POST: APPRAISAL PERIOD: FROM: TO: • Is the job description still correct? If not, how should it be amended? • What are your main strengths? Have you made any significant contribution(s) during the appraisal period? • Are there any areas in which your performance could be improved?
The aim of this exercise is essentially to provide positivefeedback and, if necessary, to provide pointers for further development particularly where these may have been highlighted by several members of the team. Once again, complete anonymity is absolutely assured • Time-keeping 1 2 3 4 5 6 excellent very poor Comments: • Availability • Organisational Skills • Approachability • Communication Skills • Contribution to the Team • Professionalism Any additional general Comments:
But GPs now have their own paperwork… • Good clinical care • Maintaining good medical practice • Relationships with patients • Working with colleagues • Teaching and training, appraising, and assessing • Probity • Health and performance of colleagues
Benefits • The catalyst for developing the individual so the team benefits • Positive feedback promotes job satisfaction, self esteem - motivation • One of the many factors that promotes the positive team ethos • Peoples aspirations, interests and expertise is reviewed and played to if it fits what is needed • Community staff see it as more relevant • They see it based on fact, not ignorance
Outstanding issues • Tie in • Personal vs. team • Community staff development • The management vacuum on the ground • CT vs. practice • GPA, revalidation, GMC, Dame Janet, Sir Liam’s review……….!! portfolios RCGP? • Link to CPD, audit, research • ET opportunities • A4C
5 things to consider before you start 360 degree appraisal • Purpose • clarify why and what • communicate to everyone. 2. Culture – are you ready? • Do you have a mature enough team dynamic? • Are you open enough? • Those involved need to feel comfortable & supported. 3. Timing of introduction – also link with the planning cycle. 4. Roll out – champion? • How to generate buy-in? • Involve everyone early. 5. Confidentiality for appraisees and raters – non-attributable.
Conclusion • Links the individual to the team • 360 - Based on observations of work colleagues of the real you! • Part of a cycle of change & development • Jobs constantly change, roles need to develop so does the individual • Team ethos paramount • Need all the components to be effective in achieving the wider vision
Implementation of the plan • MD Subgroups • IT, software, audit activity • Remit • Responsible to PHCT
7 deadly sins of managing an organisation Thinking that: • You can control everything • You can make your future happen • All meaningful results can be measured • Everyone must accept the decisions from above • People must give an account of their actions to anyone who is more senior • You need to extract maximum effort & energy from each individual • The interests of the individual are subordinate to the organisation
How - 2000 • More selected input but still MD
Work in subgroups with clear remits • Build from ground up from the individual • The role and task • The development review • Feedback • Development needs
today • History • How it fits in to the wider picture • Theory • Who &How we do it? • Reflections