Better approach needed to supervise, enhance performance of practice providers
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“It is an immutable law in business that words are words, explanations are explanations, promises are promises — but only performance is reality.”
– Harold S. Geneen
“If it’s your job to eat a frog, it’s best to do it first thing in the morning. And if it’s your job to eat two frogs, it’s best to eat the biggest one first.”
– Mark Twain
Clients, especially in larger practices that have a mix of partner and associate providers, but even in modest two-doctor settings, often ask us for tips to improve doctor performance.
Sometimes the desired improvement is clinical — a change in surgical assertiveness or better adherence to agreed care pathways. Sometimes senior doctors want colleagues working under them to be more productive or efficient, or to interact with patients and staff in a more effective manner.
Figuring out how to help in settings like this starts with simple questions: “Who do your doctors work for, specifically? Who is their boss? Do they have a written position description? Is there a clear organization chart? How often are they formally reviewed? Is there a written code of provider conduct?”
The answers are rarely surprising.
In settings in which provider performance is lagging, the supervising physician will report:
- “There are not really any clear reporting lines. The doctors here don’t have a ‘boss,’ per se. They are just kind of accountable to the organization generally.”
- “There are no written performance standards for doctors, except perhaps their employment contracts.”
- “Reviews? We don’t really have these. If a doctor needs to be talked to, someone on the board might volunteer to intervene.”
In practices with generally good provider performance, the opposite is the case. A written organization chart spells out reporting lines. Suggested care pathways are written for the most common presenting conditions. Documents make it clear that paperwork has to be kept up and meetings have to be attended. And formal performance reviews are held at least annually, for associates and partner-level doctors alike.
Let’s examine these classic annual reviews in more detail.
Formal job performance reviews have a relatively short history, emerging after World War II, and an even shorter history in the medical profession, with the rise of ever-larger clinics and health systems.
Most people would agree that some kind of periodic performance review is probably useful. But the majority of doctor reviewers and doctor reviewees dislike the process. As a result, while most practices conduct annual lay staff performance reviews, few practices formally review provider performance.
The key to overcoming this resistance is a simple two-part instruction:
- Do not withhold performance feedback.
- Do not react defensively to performance feedback.
Accountable, brave communication like this should ideally be taking place throughout the course of the year, with clinic doctors and their peer supervisors checking in regularly. Rather than a high-stakes annual review (and silence the rest of the year), in the best ophthalmology practices, doctors and their leaders (generally the managing partner or clinic president) meet every few months to check in with each other.
In such settings, the formal year-end review is ideally the culmination of ongoing positive feedback and improvement discussions, not an anxiety-provoking surprise.
It is in that spirit that this sample provider performance review template has been created. Every practice is different, and every practice should use this sample tool only as a starting point for fostering better communication about expectations, behaviors, performance and results.
Source: John B. Pinto
Instructions:
- Before being used, this template should be distributed to all practice providers and senior lay staff for comment and suggested improvements; these should be incorporated before use.
- This template should then be filled out by each provider (typically on their anniversary date) and by each provider’s direct peer supervisor. The completed templates should be shared between the two doctors — reviewer and reviewee — and then used as a discussion agenda for the annual review.
- Of course, the supervising physician will also benefit from an annual review. In the common setting in which there is one managing partner and several providers supervised by that partner, the shareholder providers in the group should fill out this review template for the managing partner, and a group discussion should follow, typically at the practice’s board meeting.
- Please note that the last question asks each doctor to provide feedback and suggested improvements on this template, so it can be improved over time.
- At the bottom of the survey form is space to enter any agreed “corrective actions” and their deadlines.
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