Making your employee reviews more effective

Management in Practice

Maithily Nandedkar

Dr. Nandedkar is a member of the AAD Business and Operations Support Task Force who built a thriving solo practice.

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In my last column I focused on hiring employees; this month I’ll focus on employee reviews. While a policy and procedure manual is essential to delineating your overall needs, employee reviews are essential to clarify your needs for each employee.

A successful employee review can rectify negative interactions. I have an employee with whom I was constantly at odds. She is a reliable employee but somehow we just kept having a series of miscommunications. The situation escalated, because as a busy physician, who has time to do a review? When I finally made the time, the review process revealed why we clashed. After I clarified my expectations, she finally understood my needs — and our relationship improved dramatically because now she understands what I expect of her and diligently works to meet those expectations. Both she and I are happier in our work relationship. I wish I had done the review sooner! Lesson learned.

Employee reviews should be a way to either give positive feedback or illuminate concerns about job performance. I knew a practice owner who never conducted reviews and only gave raises when an employee threatened to leave. The quietly hardworking employees never got one. How do you think that went over? Giving raises to reduce turnover ultimately leads to high turnover, because the other employees feel slighted. Approach a review as an opportunity to give employees verbal praise, which makes them feel valued and less inclined to leave. It can also be used as a chance to consider monetary compensation for a job well done and allows you to withhold monetary rewards until performance goals are met. [pagebreak]

Standardize the format

I use a standard review form for all employees. I bought one from a company that specialized in human resource tools but you can easily find these online or make your own. (The American Academy of Dermatology offers a review form as part of its Dermatology Employment Manual, available online at Any review form should cover core behaviors such as collaboration/teamwork, communication, dependability, judgment/decision making, problem solving, initiative, innovation, productivity, and quality of work/personal responsibility. In my opinion, the two key core values, dependability and ability to work as part of a team, are skills that few employers can or should teach. The ideal hire walks into the job with these skills. The rest is about training the person and building a knowledge base so that the quality of work can improve; decision making and judgment will follow.

Using the standard form, I review the employee and the employee reviews him or herself on a scale from one to five, with five being outstanding, three meaning expected performance and one signifying unsatisfactory performance in the category. My office manager also reviews the employee. The three of us work as a team to see where our perceptions overlap. Often that is where reality lies. When perceptions are disconnected we work as a team to see whether misunderstandings, mistakes, or intentions have led to the disparate review marks. We do summaries of professional development and areas of improvement. I have learned to standardize raises, base them on job performance, and do reviews regularly. Once a year is usually sufficient — more often if the employee is new and just before the three-month new hire probation period or if there is a problem such as a superb employee who suddenly becomes subpar. [pagebreak]

Deal with poor performance

What happens if you have done a stellar review and the employee subsequently becomes a poor performer? Find out why. Investigate what could have gone wrong. Sometimes a temporary personal problem can manifest as poor performance. However, if the person was superb before, once the personal issue is resolved it is likely he or she has the ability to be one of your star players again.

Document specific aspects of the poor performance in writing. Every employee review is a legal document. Good reviews from the past can haunt you as an employer if you have to fire the person and have not documented the current inept behavior. Give the employee every chance to improve the outcome. If you need to place the employee on probation, do so but do so in writing, with specific incidences of poor performance documented.

The US Equal Employment Opportunity Commission (EEOC) has a great website on requirements and statutes that you must follow to safeguard you from an employment lawsuit: The website is clean, clear, and not overwhelming. It clearly states that should you terminate an employee, you must keep all employment records on that person for one year and payroll records for three years. It also tells you how to handle charges against you should that occur. Follow the EEOC guidelines for recordkeeping and proper employment practices so you maintain compliance. [pagebreak]

As physicians we get tired and frustrated by both patients and staff. We are human. However, to have the team that most reflects you and maintain high morale, you must keep verbally guiding your players — using employee reviews as a way to put the direction in writing. Ultimately, you are responsible for the team’s success and a good employee review for all employees should be your goal. Being an employer is like being an NFL coach. You are in charge of your team and when your team loses you need to identify why you lost and correct the mistakes. If you have to remove some players, so be it. However, the best overall teams have the least turnover. Daily success depends on the quality of the daily coaching. Every day is an opportunity to go out on the field and play the game again. Look at the Green Bay Packers: Sixth seed and they still won the Super Bowl. Now that’s a tribute to great coaching!

Steps to follow for all employee reviews

I suggest following the five pearls below for conducting an effective employee review:

  • 1. Use a standard format. Everyone should fill out the same form. It should at least cover the most important topics like initiative, professionalism, reliability, judgment, and interpersonal skills.
  • 2. Do not surprise your employee with a negative review. There is a great saying that if you give the person a chance to have an open mind, a worthwhile thought can be dropped in. Giving your employee the completed review the day or even week before so he or she can read it and mull it over provides the best chance to address the concerns in a meaningful manner. You would not like to be surprised with negative information, so you should not do it to your employees.
  • 3. Give concrete examples and be very precise, referring to your policies. If a prerequisite of the job is good interpersonal skills and the employee has demonstrated a lack of tact then specifically state an example of this to illustrate the point during the review. Everyone tends to understand specifics rather than vague points. Your staff represent you so provide an example of a specific negative outcome (i.e., patient complained to the manager) that resulted from the staff’s behavior. Provide alternative scenarios for better behavior and a desired outcome. Some staff are simply not aware of how their behavior affects others.
  • 4. Do not be the judge and jury. All staff need to feel a part of the team. Let the employee review him or herself. I have learned that most employees give themselves the lowest scores for “problem solving.” As physicians, our problem-solving skills trump theirs but I am often impressed with the amount of critical thinking and knowledge employees learn over time. However, because medicine can be quite challenging and employee self-doubt so pervasive, I find that most often I give a better review for problem-solving performance than the employees give themselves. This is a great opportunity to build your employee’s self esteem. He or she knows she is not the physician, but giving that extra pat on the back for a knowledge base acquired is very meaningful for your staff. You are acknowledging their efforts. The best way to criticize constructively is to always focus on the results of the performance rather than the person performing the duties. An example of one performance review bullet point would be “post surgical inquiry.” In this example, if a staff member failed to provide expected follow up care such as inquiring how the patient is faring post surgically whilst simultaneously providing the patient with pathology results then the performance review on this point would be “poor” or “negative.” The employee is not “bad” or “uncaring” but simply did not perform what the practice delineates as appropriate follow up care. Clarify what is expected and the employee should be able to correct the error.
  • 5. Be professional. Never discuss personal information during the review. Although you may perceive it as an “ice breaker” or endearing yourself to staff (e.g. inquiring “So, how’s the family?”), it can be perceived as discrimination. That kind of personal inquiry has no place in a review.



Steps to follow for all employee reviews
Steps to follow for all employee reviews