Nurudeen Suliat M, Kwakye Gifty, Berry William R, Chaikof Elliot L, Lillemoe Keith D, Millham Frederick, Rubin Marc, Schwaitzberg Steven, Shamberger Robert C, Zinner Michael J, Sato Luke, Lipsitz Stuart, Gawande Atul A, Haynes Alex B
Ariadne Labs, Boston, MA; Brigham and Women's Hospital, Boston, MA; Harvard School of Public Health, Boston, MA.
Ariadne Labs, Boston, MA; Brigham and Women's Hospital, Boston, MA.
J Am Coll Surg. 2015 Oct;221(4):837-44. doi: 10.1016/j.jamcollsurg.2015.06.017. Epub 2015 Jul 23.
Medical organizations have increased interest in identifying and improving behaviors that threaten team performance and patient safety. Three hundred and sixty degree evaluations of surgeons were performed at 8 academically affiliated hospitals with a common Code of Excellence. We evaluate participant perceptions and make recommendations for future use.
Three hundred and eighty-five surgeons in a variety of specialties underwent 360-degree evaluations, with a median of 29 reviewers each (interquartile range 23 to 36). Beginning 6 months after evaluation, surgeons, department heads, and reviewers completed follow-up surveys evaluating accuracy of feedback, willingness to participate in repeat evaluations, and behavior change.
Survey response rate was 31% for surgeons (118 of 385), 59% for department heads (10 of 17), and 36% for reviewers (1,042 of 2,928). Eighty-seven percent of surgeons (95% CI, 75%-94%) agreed that reviewers provided accurate feedback. Similarly, 80% of department heads believed the feedback accurately reflected performance of surgeons within their department. Sixty percent of surgeon respondents (95% CI, 49%-75%) reported making changes to their practice based on feedback received. Seventy percent of reviewers (95% CI, 69%-74%) believed the evaluation process was valuable, with 82% (95% CI, 79%-84%) willing to participate in future 360-degree reviews. Thirty-two percent of reviewers (95% CI, 29%-35%) reported perceiving behavior change in surgeons.
Three hundred and sixty degree evaluations can provide a practical, systematic, and subjectively accurate assessment of surgeon performance without undue reviewer burden. The process was found to result in beneficial behavior change, according to surgeons and their coworkers.
医疗机构越来越关注识别和改进那些威胁团队绩效和患者安全的行为。在8家具有共同卓越准则的学术附属医院对外科医生进行了360度评估。我们评估了参与者的看法,并为未来的使用提出建议。
385名各专科的外科医生接受了360度评估,每位医生的评估者中位数为29名(四分位间距为23至36)。在评估开始6个月后,外科医生、科室主任和评估者完成了后续调查,评估反馈的准确性、参与重复评估的意愿以及行为改变情况。
外科医生的调查回复率为31%(385名中的118名),科室主任为59%(17名中的10名),评估者为36%(2928名中的1042名)。87%的外科医生(95%置信区间,75%-94%)同意评估者提供了准确的反馈。同样,80%的科室主任认为反馈准确反映了其所在科室外科医生的表现。60%的外科医生受访者(95%置信区间,49%-75%)报告称根据收到的反馈改变了自己的做法。70%的评估者(95%置信区间,69%-74%)认为评估过程有价值,82%(95%置信区间,79%-84%)愿意参与未来的360度评估。32%的评估者(95%置信区间,29%-35%)报告察觉到外科医生有行为改变。
360度评估可以在不给评估者带来过多负担的情况下,对外科医生的表现提供切实、系统且主观准确的评估。外科医生及其同事认为,这一过程能带来有益的行为改变。