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Performance management is a valid tool

I am compelled to write because of the widespread misunderstanding regarding performance management resulting from your news item.

What cannot be measured cannot be improved and this is true for any service.

The real question is what are we trying to measure and what we are trying to improve.

The end product of all we do in healthcare has to benefit the patient, and performance management should simply try and improve outcomes.

The newspaper coverage of your story suggested organisations were asking GPs to see patients quickly and send them home rather than to hospital. This is far from true.

Performance management in out-of-hours settings deals with the performance of clinicians in a holistic way (certainly in my organisation).

A clinician can never be judged by how fast he or she works or how many patients are referred. We look at the full picture, including quality of medical records, prescribing behaviour and patient feedback.

What is being advocated is appropriate treatment for optimal outcome. So, if it is right for a patient to be consulted at home for 45 minutes, then it is right. But it may not be appropriate to do that for all patients when some can be managed with simple advice.

The performance management framework allows clinicians to have a look at their own performance without bias and compare it with the average of their peers.

We advocate a blame-free culture and try to learn from each other and our patients. If patients suggest they did not receive good explanations, the clinician must use that feedback to improve. If reports suggest a clinician's average consultation time is 40 minutes, they may have communication problems with their patients, and can be supported accordingly.

There is a danger in drawing inferences simply based on data, as no two patients are the same and it is impossible to standardise healthcare delivery beyond a certain extent.

But performance management is a tool that allows organisations to help understand their training and development needs, and helps clinicians understand how they could do better.

Dr Ashish Dwivedi, Chief executive officer, SELDOC

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