MedEconomics: How to ... Appraise practice staff effectively

A good appraisal system will motivate individuals and remove obstacles to efficiency, says Patricia Gray.

You have just come back from your holiday and find out that while you were away, you have been volunteered as the 'staff' partner.

You naively ask what is involved and one of your partners replies: 'Nothing much, just listening to the staff's moans and getting involved in their annual appraisals.'

You are now feeling rather alarmed. You have not been trained to carry out appraisals and the only experience you have is your own GP appraisal. 'It's nothing like that,' your practice manager chips in. 'These are normal appraisals.'

None the wiser, you agree to take on this new chore and promise to be guided by those who know more about normal appraisals than you do.

Some systems rank performance on a scale of one to 10

Benefits
A successful appraisal system has many benefits. These include reinforcing standards, acknowledging and valuing good work, challenging poor performance, removing obstacles to efficiency, understanding what motivates individuals and exploring your staff's hidden talents.

Pitfalls
There are also some potential hazards. The appraiser may not be objective, may avoid difficult issues or be over-critical. They may be anxious that the appraisee will express strong feelings or expectations - for example, about their salary.

One of the most common complaints from staff about appraisals is that although they raised various issues and the appraiser appeared sympathetic, nothing changed. Ensure good follow-up and if you make promises, keep them.

How to prepare
Careful preparation is key to a successful appraisal system. This includes reviewing job descriptions and last year's appraisals, careful timing and planning an appropriate venue.

Most systems include an appraisal preparation form to be completed by the employee beforehand. This provides a structure for the process and ensures consistency. It also records the appraisee's and appraiser's comments as well as action and development plans.

Documentation
There are many different forms available. There are sections for recording the employee's main achievements over the previous year, any difficulties that have been experienced, what parts of the job are performed best and why, and which areas require improvement.

Also included might be any skills or knowledge not being used, new skills that have been acquired, what training could help improve performance and the appraisee's personal goals or targets for the coming year.

It is helpful to finish with a section for the employee to add any other issues they would like to discuss. This form will provide you with useful insight into the issues that might come up.

Rating systems
Some appraisal systems include a rating against certain performance criteria, such as on a scale of one to 10.

This is often broken down to a list of competencies. For practice staff, these might include interpersonal skills with patients, telephone communication skills, time management, using the practice computer system, adhering to confidentiality and so on.

The advantage of a rating system is that it requires both appraisee and appraiser to systematically evaluate different aspects of job performance.

Research has shown that employees tend to rate themselves lower than their manager, so using a rating system could reinforce good performance and confidence. The disadvantage is that ratings are a subjective tool and low scores can demotivate the employee.

Appraisal meeting
It is often helpful to think of the appraisal as a meeting rather than an interview, as this sets an expectation about a two-way exchange. Ensure that you have read through the employee's preparation form and, if relevant, made notes.

Allow enough time for an unhurried meeting, ensure you will not be disturbed and meet in a neutral, confidential room - preferably one without a desk or other barrier.

Make sure that the meeting is well structured. Greet and thank your appraisee for attending. Use the preparation form as a guide and run through each section.

Add your own comments and feedback as appropriate. Include a summary at the end of agreed targets and action points with timescales.

To enhance communication, use open questions that start with 'how', 'what' and 'why'. Wait for a response and allow for pauses.

Listen to what the appraisee has to say as this is valuable feedback. Avoid feeling defensive: you are entitled not to agree with the appraisee's views, but expressing your opinion is not the point of the meeting.

Giving feedback
Make sure that your feedback is objective. It is easy to give positive feedback but negative feedback can be more challenging.

Prepare any sensitive comments carefully. Be clear about what you think and base your views on facts, not emotions, providing examples if appropriate.

Give constructive suggestions for improvement and be sensitive to your employee's perceptions and needs.

Finally, do not overlook how important appraising the practice manager is. This should be a meaningful and rewarding experience.

You as appraiser
Do

  • Prepare carefully.
  • Allow enough time for an unhurried meeting.
  • Be positive and supportive.
  • Appreciate good work.
  • Give balanced feedback and provide constructive suggestions.
  • Carry out follow-up and training.

Don't

  • Get too hung up over the paperwork.
  • Arrive late or allow any disturbances.
  • Do all the talking.
  • Avoid issues or be over-critical.
  • Take things personally or be defensive.
  • Make promises that you fail to keep.

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