Dr Sean O’Kelly, Medical Director of University Hospitals Bristol NHS Foundation Trust, tells us how high-quality appraisals support better quality care.
Responsible officers have an important role in making sure medical revalidation achieves its aims and effectively maintains the continuing fitness to practice of doctors.
One of the key challenges responsible officers face is helping medical staff gain the maximum benefit from their engagement with appraisal and revalidation – preventing any tendency for these to be regarded as sterile bureaucratic tasks. This is especially important when workloads are demanding, as time spent away from clinical duties represents precious resource and must clearly add value to patient care, directly or indirectly.
The CQC emphasises that a values-based leadership culture generates strong staff engagement, and that measures of staff engagement are important predictors of the quality of care.
Building strong staff engagement with appraisals
In its recent report The state of care in NHS acute hospitals, the CQC concludes that the overarching message from its inspections is: effective leadership delivers high quality care and does this by creating a culture where staff feel valued and empowered.
The CQC emphasises that a values-based leadership culture generates strong staff engagement, and that measures of staff engagement are important predictors of the quality of care. So there is a clear opportunity here for medical appraisal. It is a key formal engagement opportunity between the individual and the organisation. And it can play a role in improving the quality of patient care, by being fashioned as a tangible element of a strong, values-based and learning culture.
In my experience, the strong staff engagement benefit of appraisal is more likely to be realised when focus is given to the manner in which appraisals are approached and conducted. These are both areas that responsible officers can and should have much influence with.
Getting the right leaders to nurture effective appraisals
My experience is that commitment to recruiting, developing and supporting skilled appraisers is time well spent. If well-trained appraisers and well-prepared appraisees approach appraisals as an opportunity to not only reflect on individuals’ professional objectives and developmental needs, but also to understand these alongside the wider organisational vision and strategic development, then a true sense of belonging, purpose and ownership can be nurtured.
A primary focus now for responsible officers should be to… help unleash the improvements medical staff already have the motivation to deliver.
Appraisal discussions that demonstrate, for example, the principles of compassionate leadership expressed in Michael West’s King’s Fund paper How compassionate leadership can stimulate innovation in health care [PDF] (summarised as: listening, understanding, empathising and helping), would be consistent with this approach, and promote action-oriented discussion.
The effective appraisal should strike the optimum balance between the appraisee’s agenda and that of the trust, and explore how potential synergies between these can be realised.
Unlocking the potential of appraisals
There are of course many outputs from appraisal. Some are necessarily technical and associated with the governance that helps assure the quality of medical practice. However, there are also less tangible outcomes, which may influence the trajectory and pace of quality improvement progress within organisations.
Part of a responsible officer’s purpose is to enable these outcomes to be as positive as they can be. And to make sure appraisal and revalidation are understood by all as an opportunity to help medical staff recognise their value and potential in generating improvements in patient care.
Appraisals that have relevance, meaning and direction, and that align with a trust’s strategic goals, will make sure appraisees recognise their worth, feel supported in their professional development, and engage more successfully with patient care quality improvement work.
A primary focus now for responsible officers should be to evaluate and improve the quality of appraisal outcomes – from both the individual and organisational perspective – and to help unleash the improvements medical staff already have the motivation to deliver.