By: 2 September 2015
Performance evaluation helps surgeons improve teamwork skills

Performance evaluation helps surgeons improve teamwork skills

A new study published online by the American College of Surgeons reports that a multisource feedback process used in industry is accurate and well-accepted by surgical teams.

The performance evaluation process, used widely by Fortune 500 companies, accurately and effectively assesses surgeons’ adherence to core standards of excellence and spurs changes in behaviour to improve surgical practice and teamwork, according to the study.

Researchers at Ariadne Labs in Boston applied multisource feedback methodology in 2011–2013 to query all 385 surgeons who practise in the eight Harvard Medical School-affiliated hospital surgical programmes. They gathered feedback from 2,928 surgical and nursing colleagues, supervisors and subordinates so that surgeons could identify gaps between their own performance and desired goals, involving not only technical proficiency but interpersonal and communication skills. The study is believed to be the first use of so-called 360-degree feedback in a large-scale, multi-institutional assessment of surgeons.

“Multisource feedback does not give people grades or try to regulate behaviour. It provides tools for identifying how we can be better at what we do every day. In this study we assessed not only how well surgeons perform the technical aspects of surgery but also how they interact with people in the operating room who contribute to patient safety and care and the individuals who guide the patient from the physician’s office to the hospital, from one part of the hospital to the operating room, and from recovery to home,” said lead author and surgical oncologist Alex Haynes, associate director for the Safe Surgery Program at Ariadne Labs.

Multisource feedback is a key method of professional development for many industries; up to 90 per cent of Fortune 500 companies use it on a regular basis. The Harvard Medical School study is the first to apply the method to such a large group of surgeons across multiple facilities.

Established in 2011, the study evaluated the degree to which surgeons in Harvard-affiliated surgical programmes met an institutional code of excellence (COE) that is based on the American College of Surgeons Statement on Principles and defines a minimum standard of conduct in 11 domains: service, respect, teamwork, excellence, ethical discipline, personal responsibility to patients, openness, education, humility, health, and conflict of interest.

A high percentage of surgeons were found to be adhering to COE principles. The mean COE score for all surgeons was 87.6, and the factors that contributed the most to the composite score were service, openness and humility.

Surgeons nevertheless were altering practice patterns to improve performance. Notably, the follow-up survey indicated that 63 per cent of surgeons had changed behaviour as a result of the 360-degree evaluation and 60 per cent of department heads noted overall improvement in surgeons’ behaviour, particularly in the areas of communication and professionalism.

The 360-degree evaluation process was well-received by participants, with 87 per cent of surgeons and 80 per cent of surgical department heads believing the information was accurate.

“Many professionals do not get as much feedback about their performance as they would like. This study shows that people are energised by the opportunity to turn a mirror on themselves and that 360-degree feedback is an effective tool for providing opportunities for self-evaluation and improvement,” said author William Berry.

Source: American College of Surgeons


Nurudeen, S., Kwayke, G., Berry, W., et al. (2015) Can 360 degree reviews help surgeons? Evaluation of multisource feedback for surgeons in a multi-institutional quality improvement project. J. Am. Coll. Surg. doi: