Nurses’ evaluation of physicians’ non-clinical performance in emergency departments: advantages, disadvantages and lessons learned

BMC Health Services Research

Eveline Hitti¹  Rima Jabbour²  Yara Mourad³  Miriam Saliba¹  Afif Mufarrij¹  Mohamad Alameddine³ 

[1] Department of Emergency Medicine, Faculty of Medicine, American University of Beirut Medical Center (AUBMC), Riad El-Solh, Beirut, 1107 2020, Lebanon;Nursing Administration, Department of Emergency Medicine, AUBMC, Riad El-Solh, Beirut, 1107 2020, Lebanon;Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut (AUB), Riad El-Solh, Beirut, 1107 2020, Lebanon

关键词: Lebanon;    Emergency Department;    Physicians;    Nurses;    Peer evaluation;   

Others  :  1131625
DOI  :  10.1186/s12913-015-0733-3

 received in 2014-10-03, accepted in 2015-02-12,  发布年份 2015

【 摘 要 】

Background

Peer evaluation is increasingly used as a method to assess physicians’ interpersonal and communication skills. We report on experience with soliciting registered nurses’ feedback on physicians’ non-clinical performance in the ED of a large academic medical center in Lebanon.

Methods

We utilized a secondary analysis of a de-identified database of ED nurses’ assessment of physicians’ non-clinical performance coupled with an evaluation of interventions carried out as a result of this evaluation. The database was compiled as part of quality/performance improvement initiatives using a cross-sectional design to survey registered nurses working at the ED. The survey instrument included open ended and closed ended questions assessing physicians’ communication, professionalism and leadership skills. Three episodes of evaluation were carried out over an 18 month period. Physicians were provided with a communication training carried out after the first cycle of evaluation and a detailed feedback on their assessment by nurses after each evaluation cycle. A paired t-test was carried out to compare mean evaluation scores between the three cycles of evaluation. Thematic analysis of nurses’ qualitative comments was carried out.

Results

A statistically significant increase in the averages of skills was observed between the first and second evaluations, followed by a significant decrease in the averages of the three skills between the second and third evaluations. Personalized feedback to ED physicians and communication training initially contributed to a significant positive impact on improving ED physicians’ non-clinical skills as perceived by the ED nurses. Yet, gains achieved were lost upon reaching the third cycle of evaluation. However, the thematic analysis of the nurses’ qualitative responses portrays a decrease in concerns across the various dimensions of non-clinical performance.

Conclusions

Nurses’ evaluation of the non-clinical performance of physicians has the potential of improving communication, professionalism and leadership skills amongst physicians. For improvement to be realized in a sustainable manner, such programs may need to be offered in a staged and incremental manner over a long period of time with proper dedication of resources and timely monitoring and evaluation of outcomes. Department directors need to be trained on providing peer evaluation feedback in a constructive manner.

【 授权许可】

   
2015 Alameddine et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Landon BE, Normand SL, Blumenthal D, Daley J: Physician clinical performance assessment: prospects and barriers. JAMA 2003, 290(9):1183-9.
• [2]Margolis MJ, De Champlain AF, Klass DJ: Setting examination-level standards for a performance-based assessment of physicians’ clinical skills. Acad Med 1998, 73(10 Suppl):S114-6.
• [3]Leonard M, Graham S, Bonacum D: The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004, 13(Suppl 1):i85-90.
• [4]Patterson F, Ferguson E, Lane P, Farrell K, Martlew J, Wells A: A competency model for general practice: implications for selection, training, and development. Br J Gen Pract 2000, 50(452):188-93.
• [5]Sherbino J, Bandiera G, Frank JR: Assessing competence in emergency medicine trainees: an overview of effective methodologies. CJEM 2008, 10(4):365-71.
• [6]Abdulla A: A critical analysis of mini peer assessment tool (mini-PAT). J R Soc Med 2008, 101(1):22-6.
• [7]Crossley J, Davies H: Doctors’ consultations with children and their parents: a model of competencies, outcomes and confounding influences. Med Educ 2005, 39(8):807-19.
• [8]Manser T: Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand 2009, 53(2):143-51.
• [9]Epstein RM, Hundert EM: Defining and assessing professional competence. JAMA 2002, 287(2):226-35.
• [10]Lockyer J: Multisource feedback in the assessment of physician competencies. J Contin Educ Health Prof 2003, 23(1):4-12.
• [11]Young GJ, Charns MP, Desai K, Khuri SF, Forbes MG, Henderson W, et al.: Patterns of coordination and clinical outcomes: a study of surgical services. Health Serv Res 1998, 33(5 Pt 1):1211-36.
• [12]Morey JC, Simon R, Jay GD, Wears RL, Salisbury M, Dukes KA, et al.: Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 2002, 37(6):1553-81.
• [13]Flin R, O’Connor P, Crichton M: Safety at the sharp end: a guide to nontechnical skills: Aldershot. Ashgate, UK; 2008.
• [14]Ramsey PG, Wenrich MD, Carline JD, Inui TS, Larson EB, LoGerfo JP: Use of peer ratings to evaluate physician performance. JAMA 1993, 269(13):1655-60.
• [15]Bracken DW, Timmreck CW: Success and sustainability: a systems view of multisource feedback. The handbook of multisource feedback: The comprehensive resource for designing and implementing MSF processes 2001, 478:494.
• [16]Al Ansari A, Donnon T, Al Khalifa K, Darwish A, Violato C: The construct and criterion validity of the multi-source feedback process to assess physician performance: a meta-analysis. Adv Med Educ Pract 2014, 5:39-51.
• [17]Brinkman WB, Geraghty SR, Lanphear BP, Khoury JC: Effect of multi-source feedback on resident communication skills and professionalism: a randomised controlled trial. Arch Pediatr Adolesc Med 2007, 161:44.
• [18]Pressel DM, Rappaport DI, Watson N: Nurses’ assessment of pediatric physicians: are hospitalists different? J Healthc Manag 2008, 53(1):14-24. discussion 24–5
• [19]Miller A, Archer J: Impact of workplace based assessment on doctors’ education and performance: a systematic review. BMJ 2010, 341:c5064.
• [20]Nofziger AC, Naumburg EH, Davis BJ, Mooney CJ, Epstein RM: Impact of peer assessment on the professional development of medical students: a qualitative study. Acad Med 2010, 85(1):140-7.
• [21]Norcini JJ: Peer assessment of competence. Med Educ 2003, 37(6):539-43.
• [22]Bret J, Atwater L: 360-degree feedback: accuracy, reactions and perceptions of usefulness. J Appl Psychol 2001, 86:930.
• [23]Cosby KS, Croskerry P: Profiles in patient safety: authority gradients in medical error. Acad Emerg Med 2004, 11(12):1341-5.
• [24]El-Jardali F, Makhoul J, Jamal D, Ranson MK, Kronfol NM, Tchaghchagian V: Eliciting policymakers’ and stakeholders’ opinions to help shape health system research priorities in the Middle East and North Africa region. Health Policy Plan 2010, 25(1):15-27.
• [25]Fallowfield L, Jenkins V, Farewell V, Solis-Trapala I: Enduring impact of communication skills training: results of a 12-month follow-up. Br J Cancer 2003, 89(8):1445-9.
• [26]Sargeant J, Mann K, Sinclair D, van der Vleuten C, Metsemakers J: Challenges in multisource feedback: intended and unintended outcomes. Med Educ 2007, 41(6):583-91.
• [27]Sargeant J, Mann K, Sinclair D, Van der Vleuten C, Metsemakers J: Understanding the influence of emotions and reflection upon multi-source feedback acceptance and use. Adv Health Sci Educ Theory Pract 2008, 13(3):275-88.
• [28]Evans R, Elwyn G, Edwards A: Review of instruments for peer assessment of physicians. BMJ 2004, 328(7450):1240.
• [29]Seago J: Professional communication. In Patient safety and quality: an evidence-based handbook for nurses Hughes RD edition. Edited by Hughes R. Agency for Healthcare Research and Quality, Rockville (MD); 2008.
• [30]Fletcher C: Performance appraisal and management: the developing research agenda. J Occup Organ Psychol 2001, 74:473-87.
• [31]Knowles MS, Holton EF, Swanson RA: The adult learner. Houston, Gulf Publishing; 1998.