Medical performance management

According to news on the BBC’s Today programme this morning, General Practitioners in the UK are soon to be subjected to annual performance reviews in similar fashion to most people working in a corporate environment. An interview with Niall Dixon, Chief Executive of the General Medical Council as to the reasons why made for amusing listening; the question of “why?” when it comes to performance management systems (in the socio- rather than software sense) it seems to me to be one of the big emperor’s new clothes issues of modern business.

We all know that we should do performance reviews and appraisals and the like. But try finding good evidence as to where the benefits are for either the employee, the employer or the business – well, I’ve certainly found it somewhat hard to come by. Mostly it seems circumstantial (and that’s not surprising, because it’s incredibly difficult to assess such processes through scientific method because it is so hard to establish control groups and so on).

If you know me, you won’t find it a surprise that I’m a bit cynical towards performance management systems. But in the car this morning I had a moment of reflection on what would make for a better approach. And it dawned on me that maybe we have our methods of appraisal the wrong way around. Most of the time we revert to hierarchy, with the “superiors” delivering judgement on their subjects. If one, though, takes the the view that a manager’s job is to get the most out of their team, then assessment of that performance could be better approached by the people in the team, as you could see that the manager is their to provide them a service (coaching, appropriate task allocation, etc, etc). In the doctor’s case, it’s the patients who should be doing the assessing…

I know that most places incorporate elements of “360” feedback these days, but it’s usually just documentary evidence to help the superior assessor to make judgments.  What would be the impact of a world where all of our performance assessment was done from the bottom-up, or outside-in?