Individual and job-related determinants of bias in performance appraisal: The case of middle management in health care organizations

Abstract

Background Accountable care has changed organizational models adopted by health care organizations profoundly and, consequently, the skill set required for doctor-managers who have become middle managers and must deal with the operational management of their units. Doctor-managers must carry out clinical tasks as well as tasks related to budgeting, goal setting, and performance evaluation. The performance evaluation bias, defined as the misalignment between a ward unit’s objective performance (as assessed by technical bodies or agencies) and self-assessed performance by the head of the unit, may have serious consequences for individuals and organizations. Purpose The aim of this study was to identify determinants of performance appraisal bias based on the mismatch between self-reported and official performance data. Specifically, we analyzed the role played by managerial behavior, training, engagement, and perceived organizational support at the individual level, as well as the particular unit’s task diversity, complexity, and predictability. Methodology We collected primary and secondary data referable to a population of ward unit heads in the Italian National Health Service. A linear regression model predicting performance appraisal bias was employed. Findings High levels of engagement and perceived organizational support were associated with reduced performance appraisal bias, whereas high levels of predictability and task diversity were associated with increased degree of error. Doctor-managers attending training programs in health care management and ward unit task complexity did not affect bias significantly. Practice Implications Policy makers and hospital managers should provide heads of units with tools that enable them to conduct ongoing monitoring and accurate appraisal of performance. Doctor-manager performance appraisal bias may be diminished by a perception of having support of the organization and direct superiors. Training programs can be revised to incorporate performance appraisal, and good performance may be incentivized with rewards.

Exploration of the mediating role of physicians’ managerial attitude in the relationship between their self-efficacy and workplace performance

“…The dependent variable was workplace performance, measured as the percentage of beds occupied by patients in a defined time period, usually a year (Harper and Shahani, 2002; Morandi et al. , 2021).…”

“…It is a fact that this reorganization has deeply changed both careers and job characteristics (Llewellyn, 2001), creating “doctor-managers” with new and challenging tasks and responsibilities (Elina et al. , 2006; Morandi et al. , 2021; Veronesi et al.…”

“…, 2021; Veronesi et al. , 2014), and that have become so central for the accountability of healthcare organizations (Morandi et al. , 2021).…”

“…These new organizational arrangements have consequently led to the introduction of new managerial roles, assigned to clinicians, who have been enrolled as midlevel managers, and to whom has been asked to act as links between operational and strategic hospital levels (Kirkpatrick et al, 2013). It is a fact that this reorganization has deeply changed both careers and job characteristics (Llewellyn, 2001), creating "doctor-managers" with new and challenging tasks and responsibilities (Elina et al, 2006;Morandi et al, 2021;Veronesi et al, 2014), and that have become so central for the accountability of healthcare organizations (Morandi et al, 2021).…”

The Microfoundations of Physicians’ Managerial Attitude

“…Unlike clinical directors, who are responsible for the general vision of an entire organization, unit heads act as a link between the operational and strategic levels of a hospital [3]. In their hybrid roles, they are responsible for clinical and managerial activities, including technology management, the control of clinical mistakes, the management of discharge programmes, budget negotiations, and the evaluation of results [4].…”