IQ Healthcare, University Medical Centre St Radboud, University of Nijmegen, 6500 HB Nijmegen, The Netherlands.
Med Educ. 2009 Sep;43(9):874-82. doi: 10.1111/j.1365-2923.2009.03439.x.
Delivery of 360-degree feedback is widely used in revalidation programmes. However, little has been done to systematically identify the variables that influence whether or not performance improvement is actually achieved after such assessments. This study aims to explore which factors represent incentives, or disincentives, for consultants to implement suggestions for improvement from 360-degree feedback.
In 2007, 109 consultants in the Netherlands were assessed using 360-degree feedback and portfolio learning. We carried out a qualitative study using semi-structured interviews with 23 of these consultants, purposively sampled based on gender, hospital, work experience, specialty and views expressed in a previous questionnaire. A grounded theory approach was used to analyse the transcribed tape-recordings.
We identified four groups of factors that can influence consultants' practice improvement after 360-degree feedback: (i) contextual factors related to workload, lack of openness and social support, lack of commitment from hospital management, free-market principles and public distrust; (ii) factors related to feedback; (iii) characteristics of the assessment system, such as facilitators and a portfolio to encourage reflection, concrete improvement goals and annual follow-up interviews, and (iv) individual factors, such as self-efficacy and motivation.
It appears that 360-degree feedback can be a positive force for practice improvement provided certain conditions are met, such as that skilled facilitators are available to encourage reflection, concrete goals are set and follow-up interviews are carried out. This study underscores the fact that hospitals and consultant groups should be aware of the existing lack of openness and absence of constructive feedback. Consultants indicated that sharing personal reflections with colleagues could improve the quality of collegial relationships and heighten the chance of real performance improvement.
360 度反馈在再认证计划中被广泛应用。然而，很少有研究系统地确定哪些变量会影响评估后是否能实现绩效提升。本研究旨在探讨哪些因素会激励或阻碍顾问实施 360 度反馈中的改进建议。
2007 年，荷兰的 109 名顾问接受了 360 度反馈和组合学习评估。我们对其中 23 名顾问进行了定性研究，采用半结构化访谈，根据性别、医院、工作经验、专业和之前问卷调查中的观点进行了有针对性的抽样。使用扎根理论方法对转录的录音带进行分析。
我们确定了四个可能影响顾问在 360 度反馈后实践改进的因素组：（i）与工作量、缺乏开放性和社会支持、医院管理层缺乏承诺、自由市场原则和公众不信任相关的背景因素；（ii）与反馈相关的因素；（iii）评估系统的特征，如鼓励反思的促进者、具体的改进目标和年度跟进访谈以及（iv）个体因素，如自我效能感和动机。
如果满足某些条件，例如有熟练的促进者鼓励反思、设定具体目标并进行跟进访谈，360 度反馈可以成为实践改进的积极力量。本研究强调了医院和顾问团体应该意识到现有的缺乏开放性和缺乏建设性反馈的事实。顾问表示，与同事分享个人反思可以提高同事关系的质量，并增加实际绩效提升的机会。
