Intended for healthcare professionals


How can good performance among doctors be maintained?

BMJ 2002; 325 doi: (Published 28 September 2002) Cite this as: BMJ 2002;325:669

Department of Health's proposals are wise but need to be implemented with care

  1. Michael West (, professor of organisational psychology.
  1. Aston Business School, University of Aston, Birmingham B4 7ET

    See also p 704

    The Royal College of Physicians, the BMA, the Patients' Association, and the Institute of Health Care Management (among others) have backed the Department of Health's call for doctors to have annual appraisals, for continuing professional development, and for the revalidation of doctors.1 The collective concern of these bodies is to ensure that doctors continue to develop their competence and provide a high standard of care for patients. What evidence is there that these strategies make a difference?

    Feedback on performance and objective setting are the two fundamental components of appraisal. The evidence is strong that feedback on individuals' job performance is associated with improvements in performance and reductions in error rates across all employment sectors.2 Moreover, setting goals is associated with improved performance, particularly where the goals are set collaboratively with professionals and where they are specific and challenging (rather than vague or “do your best” goals).2 Training (or continuing professional development) has been shown to improve job performance, quality, and organisational performance and service across employment sectors, and to reduce costs.3 In health care, …

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