Multi-source or “360” reviews in hospitalist performance appraisals

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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 review.

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 hospitalist work.

Author disclosures: None








David Michael Gallagher

Professor of Medicine

I am currently the Chief Medical Officer at Duke University Hospital. As CMO I am a member of the senior leadership team that positively impacts the strategies, goals, and objectives at our hospital. I also help support Duke Clinical Automated Laboratories in a clinical consultant role. I am a Professor of Medicine at Duke University. My faculty career track is as a Clinician Leader – Administrator with an emphasis on Clinical Practice Advancement. I have 25+ years of physician leadership experience with previous roles as Chief of Duke Hospital Medicine Programs and Associate CMO of Duke University Hospital. As a clinically active hospitalist, I actively teach learners as an attending physician for Duke Hospital General Medicine Teaching Services caring for patients at DUH and other venues. I am board certified by the American Board of Internal Medicine with a Focused Practice in Hospital Medicine, current in that board’s Maintenance of Certification Program, and have achieved the designation and recognition as a Senior Fellow in Hospital Medicine through the Society of Hospital Medicine. The themes of my scholarly output include readmissions reduction, venous thromboembolism risk in hospitalized older adults, physical activity in hospitalized older adults, mentorship programs for hospitalists, quality improvement teaching to residents, and hospitalist workflow improvements.

My Twitter handle is @DGallagherMD

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