Table 3 The facilitated review session

Overall Impression: PPs indicated they found the facilitated meeting valuable and the ability to go through their results with their DCs as helpful. It was seen as an opportunity to discuss their interests and possible career goals. DCs also felt that the participants responded well to the review session and that overall the experience was a positive one.

After a while we stopped talking about it, had probably half an hour to talk about what are my medium and longer-term objectives, what’s working? What’s not working? What are am I happy about, and so on? It was, I think, a very good experience in that sense. PP2

I asked them if they felt it was worthwhile and they all did. DC5

It was a nice opportunity. Some people were very receptive for feedback. They welcomed it. They viewed that as a way to move forward. There’s a couple of people in my division who really believe that. I think people were interested on their marks or how they scored and how they’re perceived. DC5

Setting Goals: DCs struggled to facilitate development for physicians with strongly positive feedback and DCs felt more equipped to work with physicians that had clear areas for improvement but questioned the authenticity of the conversation and true engagement those physicians who received negative feedback.

With the outstanding one, we found it very hard to develop a plan to perpetuate his outstandingness; whereas, I think for the one that had more criticism could reflect on the criticism- this is what I have to do to improve. What I have to do to sustain versus what I have to do to improve. DC3

For some of the good ones…It was just time-wise. I think some people didn’t see the value in it. DC5

I find that sometimes, as a defence, physicians can sometimes be overly conciliatory and polite and agreeable as a way of maybe a defence of being reflectively honest, an honest reflection. I don’t know if I was prepared for that. I’m not sure if I have the skills or not, in how to get a physician to be more open. DC3

Building Relationships and Understanding: DCs found the process strengthened their understanding, was found to be relationship building. DCs indicated the report review was an opportunity to begin a conversation about areas for improvement that they were unable to engage in previously.

In that sense, I found the coaching sessions to be quite good. It’s not my comfort zone to be like I’m the boss and you should do what I do or say or anything. My divisions are all very, very high performing people. It’s really not my place to tell them how to do a good job, especially when they’re all above average or superstars. It’s a little bit different dynamic of trying to guide or explore things with people. In general, I found it a very positive experience. DC2

I think it has positively affected. I think they got a sense that I was genuinely interested in how they’re doing. I certainly told them that I want to be able to help them as professionals and that that’s the purpose. Certainly I don’t often meet with them one on one, so three meetings one on one, it enhanced our relationship. I think it was positive. DC3

I think it affected my relationship with the staff in a good way. I think that ideally we should meet with the staff on a regular basis…It’s rare to have a conversation which is about what are your longer-term objectives; what’s going on in your life and so on? … We actually had time. DC2

The one negative exploration I had came about with respect to the single faculty member who scored on the self-assessment of lower score in something. I used that to begin a conversation about an area that I thought that that faculty member was not strong in myself. Regardless of what they thought, I thought they weren’t that good in that area. I said, ‘Oh, you marked yourself low. Tell me about that. What do you think? What can I do to help?’ It was a way to bring up a subject, which actually I was somewhat tentative to bring up in any other circumstance or with any other introductory context. DC1

Accountability: DCs indicated that the PQII allowed for introduction of oversight that did not exist previously within the organization.

I’ve given them feedback over the years, because we have a re-appointment process. It’s usually been absence of negative feedback is all that’s been there. There were no complaints against you this year, as opposed to, and there were maybe one or two accolades that came along to the program that may have identified you or may not have identified you. We really didn’t have a robust method. …. It’s nice to see that we’ve got an accountability process. DC1

I think it is important that there is some oversight and that people really realize that this kind of, the perceptions of your colleagues and of your patients is going to be taken into account and that there are ways to improve physician behaviour. Sometimes it has to be done. DC4

I think it also puts individuals on notice that it’s not just me looking over their issues; there’s some sort of third party hospital, there’s some officialness. Even though we don’t work for the hospitals, we have to apply for privileges every year and this is part of the credentialing process. Knowing that they’re looking at it allows you, because otherwise you’re self-employed, you’re self-disciplined. Self-discipline is good, but it’s not good for everybody. Some people need more. They need Big Brother occasionally. DC2

Department-Wide Initiatives: The PQII gave DCs the ability to review the department as a whole, evaluate strengths and weakness and consider implementation of department wide initiatives to improve care. Identification and leverage of physician’s strengths were seen as an opportunity for knowledge translation and transferring best practices.

The things that we talked about were, number one, about the positive things that people got good scores on. We would try and figure out if there’s something in that good score that we could do more of as a division that other faculty people could do. For example, one of my faculty got a good score for communication with patients. We talked about how he draws a diagram for every single patient, no matter how complicated or simple the operation is and gives it to them. I relayed that story to one of my other faculty members. He said, ‘Oh I always do a diagram too, but I keep it in the chart.’ We discussed the relative benefits of that and so on. I think it was helpful as a way of transferring best practices between people. DC2