Appraisals
What should it really look like?
Written by: Dr Sara Watkin. Published: 3rd June 2010
Reducing the psychological impact on participantsAppraisals are now firmly a fundamental partof NHS life. Despite their vital contribution toeffective performance at both an individualand an organisational level, they are oftenseen as having no valuable purpose, oftenno more than a quick chat, possibly even atick box exercise and all too commonly as anegative, control-orientated process. Whatis clear, is that the value of an appraisal isfundamentally linked to the perceptionsarising about it or within it and the impactit has the on the individuals concerned.Get it right and it can deliver enhancedperformance and sustained individualgrowth. Get it wrong and it can destroymorale, cause frustration and undermine thevery performance it is designed to enhance.
If appraisal is to be successful we need to beclear of its true purpose for the individual,their patients, the department and theorganisation. Appraisal in isolation of cleargoals, objectives, standards & measuresat an organisational, departmental andpersonal level is essentially worthless, aswithout meaningful markers what is canthe appraiser appraise? More importantly,lack of clear goals may cause significantpsychological distress to the appraisee whofeels they are being “criticised” or “judged”against invisible standards or things they didnot know they had to do.
Greater objectivity improves appraisalperformance
A variety of tools have been developed tohelp improve the quality of appraisal andparticularly objectivity when assessingperformance. However, it is also worthremembering that these too come withlimitations which may, if not handledappropriately, have their own negativepsychological effect on the appraisee:-
360 degree feedback
Well designed 360 feedback tools whichgive useful information to help improveperformance can make appraisal andself reflection a more successful process.These tools are particularly useful whereconcerns are being mooted but perhaps notactively voiced. Systems using broad, singlequestions such as “Is he a good leader” or“Is he a good team player” are to be avoidedas they are highly subjective and offer nopractical learning benefit to the appraisee. Ascore of “only sometimes” gives little insightinto how a person may improve or indeedwhere the problem actually lies, if indeedthere is one and so tend to incite poorreactions from the person being appraised.
Patient satisfaction surveys
Well designed patient satisfaction surveyscan offer a great deal. However, in anorganisation where many people are wiredto want to help and always do their best forothers less than perfect results can oftenhave a devastating effect on morale andpsychological wellbeing. It is one thinghaving your appraiser discuss your bedsidemanner but another completely for 30patients to tell you it is not what you thinkit is. Furthermore, 1 poor result alongside29 perfect ones can cause certain typesof people to overly focus on the negativeaspects, requiring the feedback processto be handled with sensitivity and a goodworking knowledge of how different peoplemight respond.
Audit data
Data such as number of patients seenin outpatients, number of operations,mortality and morbidity collected as aservice is necessary to make appraisalmeaningful. Recognise, however, that itis easy for someone to be below averagewhen data is collected at a local leveland therefore the ability to compare withnational data or norms is essential to preventunnecessary psychological distress. A goodappraiser will take ownership along withthe team in acquiring robust, meaningful,appropriate audit data which allows effectiveimprovement in performance.
Recognition of difference is vital
If appraisal is to be successful and not causefrustration or inappropriate distress to theappraisee the appraiser must recognisethat he and the appraisee are not the sameperson. All of us see life through a pair oftinted glasses – the glasses we wear beingdependent on our internal wiring as to whatis important to us. This means two differentpeople can witness the same event and takeaway too different meanings.
For example, two people witness the policedealing with a road traffic accident. The 1stperson’s wiring means they like structureand process, they like risks to be reducedand if evidence exists, for this to be collectedand utilised. This person comment s on howwell organised the police are in diverting thetraffic and how efficient and detailed theyare in collecting their evidence. In his mindthe police involved in this incident are goodat their job. The other person has not noticedthis aspect and instead is really angry atthe poor quality of policing. In his mindthe police should have been much moreempathetic and comforting to the peopleinvolved in the incident. Imagine now ifthese two individuals were formal appraisers.
When not considered carefully, appraisal isdone from the appraiser’s own world. Weall naturally like and have empathy withpeople who see the world in the same waywe do. We find they do things in the way welike, communicate in a way we understandand recognise the same things as us asimportant. Without careful reflection weimmediately think that people who are notlike us are not performing as well or areas good at their job. Without significantinsight we are likely to appraise people fromour world “prescribing” activities to makethem more like us. This can be significantlydetrimental to the appraisal process andhave a significant psychological impact onthe appraisee.
A good appraiser will step into theappraisee’s shoes when facilitating theappraisal discussion but also knows whenit is important to help the appraiseeunderstand how their internal wiring mightplace limitations on their performance orresult in them being seen in a certain way bycolleagues and patients alike.
Finally the appraiser’s own wiring canhamper the appraisal. If an appraiser iswired to want to help and support othersthey will find it difficult to tell someonethey are not doing something well, perhapsinstead smoothing things over so as to avoidwhat they might see as conflict. Althoughapparently good at the time, the appraiseris likely to suffer sustained anguish that they did not deal withthe problem adequately even though they preserved therelationship.
Learning through examples
Let’s look at these psychological challenges in more detailby understanding the potential negative impacts of Steveappraising Peter. Steve is an Orthopaedic Surgeon. He isregarded as a higher flyer and is the youngest Clinical Directorthe Surgery Department has had. He is a very proactiveindividual, who dislikes bureaucracy, makes decisions quicklyand then fights for them. His communications are alwaysdirect and to the point and he often leaves colleagues with theimpression that he has not really listened to what they have tosay. Peter is a paediatric surgeon. He is an incredibly friendlyindividual who likes being part of the wider paediatric teamwhere everyone gets on very well. He tends to shy away from hissurgical colleagues who he finds somewhat over assertive andoften not as caring as he feels they should be.
- Peter undertakes a multi-source feedback for his appraisal. Hereceives 12 responses from parents, most of which are lovely but2 of which suggest he didn’t get it right for those families becausethey wanted more time to discuss things. Steve (appraiser) says“your patient feedback is great and we never get enough timeanyway” but Peter seems devastated by the response and rapidlywithdraws during the rest of the appraisal discussion. Steve doesnot pick up on the clues that Peter is devastated, in fact he thinkshis comment was appropriately very positive. Peter spends thenext few weeks mulling over his multi-source feedback and howbadly he has done.
- In feeding back further, Steve says “you need to be more in controland directive. Say ‘no’ when you need to and don’t be afraid todelegate...” Peter is unclear where this information has come from.No concerns have been raised as far as he is aware. He feels confusedand unclear if change is necessary. He feels that Steve thinks his wayof approaching problems is better than his. He also wonders whetherSteve is telling me all this because he does not really like me. Maybenone of the staff like me...
- Steve spends three quarters of theappraisal talking. When Peter does speakhe often does not finish his sentencebefore Steve tells him what he woulddo and what Peter’s objectives shouldbe. Peter feels un-listened to and almostbullied into his actions. He certainly hasno ownership of them. He will complybecause he doesn’t like to rock the boatwith colleagues but is not truly committedto the actions not quite agreed.
The above example illustrates howimportant the underlying psychology ofappraiser and appraisee is and how thatcan influence the experience of appraisal,the perceived outcome and the subsequentbehaviour if this is not actively managed bythe appraisee. Had Steve been feeding backto Steve or Peter to Peter, the exchangeswould have been very different.
The learning journey for appraisers
Appraisers must develop a number ofinsights and skills if the appraisee is goingto benefit positively from the appraisalprocess. Skills include, among other things,the ability to step into the appraisee’s shoes,active listening, paraphrasing, advancedquestioning and reframing problemsto allow the appraisee to find their ownsolutions.
The no 1 key to a good appraisal is for theappraiser to put themselves firmly in theshoes of the appraisee and see the worldfrom their point of you. To do this theappraiser must actively observe the personthey are apprising to fully understand whatis important to that individual, how do theytick, how do they react and to what. A goodappraiser constantly asks themselves “whatdo I want the appraisee to do as a result ofthis appraisal or this piece of information” e.g.acknowledge that his assertive behaviour maybe seen by others as bullying and intimidation.
Once, as the appraiser, you are clear what itis you want the appraisee to do, ask yourselfwhat does this specific individual need to“Think” and “Feel” in order to do this thing.When considering the “Think” and “Feel” askyourself what would be important to theappraisee, not what is important to you, ingetting this outcome. The answer to this willcome from putting yourself in the appraisee’sshoes but the true challenge to the appraiseris knowing what to look for, what that meansin behavioural or wiring terms and how touse the information most purposefully.
A good appraiser recognises the importanceof not trying to turn the appraisee intoanother version of them, which comes partlyfrom a healthy respect for difference. In theabove example Steve was trying to makePeter more like him rather than looking atthe positive benefits Peter’s behaviour bringsto the team and organisational performancein general. The challenge for Steve, in thisexample, is that he probably doesn’t evennotice what he is doing or the impact it has,let alone having the self awareness and selfcontrol to manage his own internal feelingswhilst objectively delivering a performanceenhancing appraisal for Peter. If that soundsunkind, ask a few people what repeatedbody language or mannerisms they notice inyou and then ask yourself how many of themyou are aware of at the time.
Finally an appraiser’s internal wiring canmake the appraisal unsuccessful if they fail torecognise how there own natural behavioursimpact the appraisee. In the above example,Steve’s need to take action and do thingsnow meant he preferred to tell Peter what todo rather than allow Peter to reach his ownsolutions. This short-changes the learningprocess for Peter and is likely to only result incompliance with any personal developmentplan, not enthusiastic engagement.In conclusion, appraisal done well can havea significant impact on both individual andorganisational performance. Without carefulconsideration by the appraiser of both theirown and the appraisee’s psychological wiringand without taking the time to see thingsfrom the appraisee’s point of view, arisinglargely out of a simple lack of comprehensiveappraisal training, the untrained appraiserhas the potential to undermine the veryperformance appraisal is meant to enhance.What’s more, they may never even notice.
