Eight do's and don'ts for performance reviews

By Peter Small, Contributor

It’s physician performance review season, and hospital leaders should make sure there are no surprises when they summarize the year’s successes and failures, Toronto health lawyer and coach Kate Dewhirst tells

“Performance reviews don't only happen once a year,” says Dewhirst, founder and principal of Kate Dewhirst Health Law and Law2Life Coaching.

“When you have an early warning system you don't hold all those reports until the end of the year. You look for proactive ways throughout the year to support and address issues,” she says.

Now is the time when many hospitals decide whether to reappoint those professionals whose privileges must be renewed annually — mainly physicians and, depending on the institution, dentists, midwives, or independent nurse practitioners.

Dewhirst has eight do’s and don’ts for department heads and chiefs of staff who typically conduct these reviews:

Do recognize people’s successes

“Everybody gets busy and, depending on the size of the group you oversee, it may be impossible to acknowledge everybody’s minor achievements through the course of the year,” she says.

The hospital environment is high-paced and high-stress, but physician leaders need to reinforce positive messages as a key part of their job.

“If you don't have a history of recognizing people successes, then when you recognize people’s problems it comes across that your only role is to break people down,” Dewhirst says. “You want to have a history and experience of being positive and building them up.”

Don’t wait for once a year to raise concerns

“If there is an issue of concern it should be raised in the moment,” she says.

Do provide a summary of problems if there have been any

While you don’t want to surprise the physician with a buildup of previously undisclosed concerns, you do need to summarize the issues at the performance review, Dewhirst says.

If their shortcomings are sufficiently small, they can be coupled with a list of successes.

You can say: “Here is the list of your successes and here are the concerns, and we’re going to work together on addressing the concerns,” she says.

However, if any medium-to-serious concerns have been addressed during the year, don’t underplay their weight during the annual review, Dewhirst says.

Don’t use a template

“Many hospital leaders have one letter that they send to everybody over whom they are responsible to recognize the successes of the year,” she says.

It goes something like this: “I am thrilled with what we've been able to achieve in 2018. We are the most high-functioning department in the province … Thank you for being such a vital participating positive member of the team.”

The problem is that not everyone on the team is a vital, participating, positive member, Dewhirst says.

The template letter can undermine the hospital’s position if it raises issues with the physician in the future, such as rudeness or incompetence, she says.

“I have seen that template letter used in dozens of cases where an issue arises about the action of a physician or other professional staff member,” Dewhirst says. “In their defence, they say, ‘But look, I have in my record eight glowing annual performance reviews.’”

If there are sufficient problems, they must be referred to in any documentation sent to the professional, she says, even a one-line acknowledgement like: “We will continue to work to improve the issues as we have discussed this year.”

That one sentence alone is sufficient as a place marker.

Don’t overstate problems

“Just be truthful about what’s going on,” Dewhirst says.

Do be proportionate

“If you’re going to have a consequence about what happened in the past year, it needs to be proportionate to the mistakes, problems, behaviour or capabilities. It can’t be unrelated,” she says.

Do treat people fairly and consistently

“In any human relationships of more than two or three people there will be favourites, friendships, and alliances that are not evenly distributed among the group,” Dewhirst says.

So, in any documentation or performance review be careful with people with whom you have a distant or difficult relationship. Ask yourself, “If my absolute best candidate had that same behaviour, would I have the same response?”

Do report concerns

Department leaders need to report brewing concerns up the chain of command, she says.

Sometimes they try to manage low-lying, negative behaviour for years without reporting it to the Medical Affairs team and chief of staff, or the vice-president of Medicine. Then the matter erupts into a huge issue demanding an immediate response.

When department heads identify a negative theme concerning an individual or group, they should seriously consider making a general or specific report to the chief of staff or Medical Affairs department. Otherwise, they may feel isolated and without support, Dewhirst says.

The basic principle for performance reviews is that they should be part of an ongoing process, she says.

“And then performance review season is really just a formalization of that which has already been addressed over the course of the year,” Dewhirst says.

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