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EDITORIALS: Michael West How can good performance among doctors be maintained? BMJ 2002; 325: 669-670 [Full text]

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opportunity squandered

douglas salmon   (30 September 2002)

Greater caution needed in interpreting research evidence

Nick Black   (3 October 2002)

opportunity squandered 30 September 2002
douglas salmon, gp partner birmingham b20 3he Send response to journal: Re: opportunity squandered	The introduction of appraisal is an object lesson in how not to introduce change or motivate staff. 1. Make it compulsory and antagonise the victims ( if it was any good it would not need compulsion ). 2. Ask detailed personal information of doubtful relevance ( your health, interests, financial arrangements )and commit to writing. GPs all know what NHS confidentiality means in reality. 3. Link appraisal to revalidation; instead of a supportive and career enhancing process it now becomes a threatening,and potentially career- ending, ordeal. 4. Link appraisal to revalidation and put its control into the hands of the employers; give appraisers and organisations a superb tool to intimidate "awkward" doctors. 5. Consult as few of the potential victims as possible beforehand: " poor little dears don't know whats good for them, do they... ? 6. Ensure there is as much paperwork to be completed as possible; GP's just lurve all that paper. 7. Give overall control to the NHS bureaucracy, so the whole scheme can be turned into a wonderful opportunity to generate vast amounts of career enhancing statistics for management. 8. Choose a time when morale is already low and jobs vacant, just to maximise the damage. Which is a shame, because appraisal really could be a force for good.
Greater caution needed in interpreting research evidence 3 October 2002
Nick Black, Professor of Health Services Research London School of Hygiene & Tropical Medicine, London WCIE 7HT Send response to journal: Re: Greater caution needed in interpreting research evidence	Michael West asks, what evidence is there that human resource strategies such as annual appraisal make a difference. (1) Unfortunately, one of the principal pieces of research evidence he cites has not yet been published (2), making it impossible for the reader to judge. If it refers to the study presented at the NHS Service Delivery & Organisation Annual Meeting in March 2002, then greater caution is needed in drawing any conclusions. The study in question related human resource strategies in hospitals to measures of patient mortality. The problem is the latter were derived from Hospital Episode Statistics which are insufficiently detailed, complete and accurate to allow meaningful risk-adjusted outcomes to be determined. This is not the first time such data have been used inappropriately in this way. (3,4) While human resource strategies may well have a beneficial effect on health outcomes for hospital patients, more sophisticated and higher quality data need to be used to provide reliable scientific evidence to support such policies. 1. West M. How can good performance among doctors be maintained? BMJ 2002;325:669-70 2. West MA, Borrill CS, Dawson JF, Scully J, Carter M, Anelay S et al. The link between management of employees and patient mortality in acute hospitals. Int J Human Resource Manage (in press) 3. Jarman B, Gault S, Alves B, Hider A, Dolan S, Cook A et al. Explaining differences in English hospital death rates using routinely collected data. BMJ 1999;318:1515-20 4. Bunker JP, Black N. Data are inadequate basis for drawing conclusion of paper (letter). BMJ 1999;319:854-5