Performance Reviews - We need more time
In a previous post I talked about general practice not doing “performance reviews” well enough. Not having enough time seemed to be the main obstacle. Many people thought being able to slow down reflect/ review what they were doing with a senior or peer would be really valuable.
Part of the problem is making the business case that investing the money/time would reap rewards in terms of productivity - perhaps we need a trial/pilot of this. I know HEE and or others have put money into careers coaching and mentoring but perhaps clinincal review could be an area worth testing.
A few years ago my local GP federation ran a project we called Peer2Peer referrals. Every practice uploaded in redacted form a proportion of its referrals. Some months it was X% of all - some months it was all Cardiology or all paediatrics. The referrer was anonymised. Each referral was reviewed by 2 reviewers who were experienced GPs but not GPSIs who has some training on feedback. The practice was encouraged to have meetings where the practices referrals comments were reviewed to stimulate learning.
The idea was partially to induce the Hawthorne effect. This whole process was along side the referral - we were clear it wasn’t a vetting or triage. The reviewers all met monthly to feed back to the project lead who collated key themes - often systemic issues and pathway design problems.
We think it worked well. Some GPs felt that it was just a way of getting people to think twice about referrals and hey it was! some felt that because we were grading the quality of the referral - it encouraged people to write more and more and there was no real benefit to the hospital for this extra info. However we were clear there was a line - satisfactory was fine.
What was interesting was some of the reviewers started giving loads of feedback - links to articles - suggesting alternatives - all in a nice way but perhaps providing a learning resource that was more useful that a consultant letter saying - referral rejected.
The reviewers were paid a small amount - but the work could be done evenings/weekends and we never had any issues getting it done. Which tends to make me think that there is a large workforce out there that might work extra is that extra work isnt just doing more of the same - endless surgeries.
How do we tap into this capacity? could we use it for quality improvement? education? would it help retain? motivate? and deliver productivity.