Quality and impact of appraisal for revalidation: the perceptions of London’s responsible officers and their appraisers

Abstract

BackgroundTo evaluate NHS England London region’s approach to the revalidation appraisal of responsible officers in London, exploring perceptions of the quality and impact of the appraisal process. Revalidation is the process which aims to ensure doctors in the UK are up-to-date and fit to practice medicine thus improving the quality of patient care. Revalidation recommendations are largely premised on the documentation included in annual appraisals, which includes the professional development a doctor has undertaken and supporting information about their practice.MethodsA pan-London qualitative study exploring the views of responsible officers and their appraisers about the revalidation appraisal process. The study aimed to gain an in-depth understanding of the experiences and perceptions of the participants. Responsible officers were purposefully sampled to represent the broadest range of designated bodies. Data analysis generated themes pertaining to quality and impact of appraisal for revalidation with the potential to feed into and shape the evolving system under investigation.ResultsThe central importance of highly skilled appraisers was highlighted. Both groups reported educational opportunities embedded within the appraisal process. Independent appraisers, not matched by clinical speciality or place of work, were considered to take a more objective view of a responsible officer’s practice by providing an ‘outsider perspective’. However, covering the breadth of roles, in sufficient depth, was challenging. Participants reported a bias favouring the appraisal of the responsible officer role above others including clinical work. Appraisal and revalidation was perceived to have the potential to improve the healthcare standards and support both personal development and institutional quality improvement.ConclusionsResponsible officers play a central role in the revalidation process. Getting responsible officer appraisal right is central to supporting those individuals to in turn support doctors and healthcare organisations in continuous quality improvement. The complexity and importance of the role of responsible officer may make achieving an appraisal of all roles of such individuals problematic. This evaluation suggests responsible officer appraisal was perceived as educational and effective.

Towards an understanding of how appraisal of doctors produces its effects: a realist review

“…The skills of the appraiser (context) were reported as being crucial to an effective appraisal . The success of appraisal partially depends on the quality of the feedback provided by the appraiser .…”

“…The skills of the appraiser (context) were reported as being crucial to an effective appraisal. 14,33,34,[47][48][49][50][51][52] The success of appraisal partially depends on the quality of the feedback provided by the appraiser. 50 Thus if the appraiser is highly skilled (context) and able to effectively deliver feedback (context), this triggers the dissonance mechanism, which is more likely to lead to the appraisee developing insight (outcome).…”

Reflective Practice for Patient Benefit: An Analysis of Doctors' Appraisal Portfolios in Scotland

“…Written reflection was often brief and lacking in detail and interview data suggested that many doctors would rather reflect verbally, either at the time with colleagues or with their appraiser in the appraisal meeting, a finding backed up by the wider literature. 1,6,26,27 For their part, appraisers wanted doctors to be selective in the documents they chose to include in their portfolios and would prefer to see a few examples of high quality reflection rather than many documents submitted somewhat indiscriminately and with no commentary on their impact or meaning for a doctor's practice. There are already moves to support a focus on quality over quantity when submitting supporting information.…”

The McDonaldization of appraisal? Doctors’ views of the early impacts of medical revalidation in the United Kingdom

“…If so, revalidation cannot only be dehumanizing, but also misses an opportunity to address problems. This would be a manifestation of the dehumanizing potential of rational systems, when paradoxically there is evidence that to achieve desired behavioral change it is the very nature of 'the personal' within appraisals, two people coming together to reflect on data, that helps to accomplish positive action (41,42).…”