Multi-source or “360” reviews in hospitalist performance appraisals
David Gallagher MD, Duke University, Durham, North Carolina
Background: Physician performance appraisal programs are used to evaluate competence
in important behaviors and skills. Multi-source or 360-degree surveys could be an
effective and efficient method of assessing these competencies for hospitalists. Since
2006 we have used a multi-source feedback survey to evaluate hospitalists at Duke-Durham
Regional Hospital (DRH). This feedback has been incorporated into the annual review
for our hospitalists which also includes performance metrics in quality, productivity,
patient satisfaction, and academics. With this year’s multi-source survey we have
added questions on the satisfaction and usefulness of this tool. Although multi-source
surveys have been tested in other physician specialties and in resident education,
there are no definitive studies of it’s use with hospitalists.
Methods: The multi-source survey used is web-based, confidential, and administered
as part of the annual review process for DRH hospitalists. The survey is “multi-source”
and sent to fellow hospitalists (physicians and non-physician providers), nurses,
pharmacists, and care managers asking them to give feedback to the individual hospitalist
(physician or non-physician provider) named for the survey. The survey uses questions
with a Likert scale response (1-5) with comment fields. There are 16 questions which
focus on medical knowledge, decision making, efficiency and management, documentation,
responsiveness, communication skills, teamwork, dependability, and professionalism.
This year we received IRB approval to add questions asking survey respondents and
recipients about their satisfaction and perceived usefulness of this type of multi-source
Results: The response rate for the 2010 multi-source feedback survey was 63% (133
surveys returned on 22 hospitalists; 211 surveys sent). Overall satisfaction with
the survey was very high. Of all respondents, 99.2% answered “yes” that giving feedback
to hospitalists through the survey was useful. Of hospitalists that were receiving
the feedback, 97.3% found the feedback from the survey useful as part of their annual
review process. 92.4 % of all respondents felt the survey asked the right questions.
The comments also reflected high satisfaction levels with the survey instrument and
process. Estimated time to administer this survey was 8 total staff hours (22 minutes
per hospitalist reviewed).
Conclusions: We have shown that a web-based multi-source feedback survey can be successfully
used in a hospitalist program as part of the annual review process for hospitalists.
This can be accomplished with high satisfaction from those participating in the review
process with a reasonable time investment. Further refinement and validation of a
multi-source survey tool for hospitalists is recommended given the unique nature of
Author disclosures: None