Definition  Evaluation tool that utilizes opinions of many different people that interact with the employee on a routine basis  Generates more accurate feedback by “gathering information from people about an individual’s performance as seen by the standards and expectations of their boss, self, peers, direct reports, and customers.”

Key Features  Usually based on a questionnaire, possibly web-based  Feedback is usually anonymous  Appraisal is normally followed up with actions for individual improvement and development  Not to be used for decision-making, only purpose is for employee growth  Utilizes many stakeholders inside, and outside of, the organization

Inappropriate Uses  Rarely linked to decisions on pay  Not recommended for promotion decisions  Should not be a heavy determinant in bonus awards  In small organizations where anonymity is unlikely or there are a lack of enough peers and direct reports to reduce outlying opinions

Is The Environment Appropriate?  Ask yourself the following questions: ◦ What is the desired outcome of the feedback? ◦ Do we have enough raters? ◦ Is this applicable to all of our employees or an employee group? ◦ Are our employees mature enough to handle the feedback and to give feedback? ◦ Is there openness and trust between supervisors and their direct reports?

Is The Environment Appropriate?  More questions to ask yourself ◦ Are our employees and “managers willing to listen and learn and to effect any necessary changes as a result?” ◦ Are we willing to devote the time and energy to make this system work? (It won’t work unless everyone in the organization is on board from the “get-go”) ◦ What do we want to do with the information that is gained? Help the employees grow or are we looking for a way to determine pay and promotion?

 360 degree reviews establish a culture for continuous learning and provide more global feedback for employees, which leads to improved performance  In 1995:40% of American companies used 360 degree feedback  in 2000 : 65%  2002, 90% of Fortune 500 companies were using a 360 degree

 review process is purported to be superior to traditional forms of evaluation and feedback because it provides more complete and accurate assessment of the employee’s competencies, behaviors and performance outcomes

 it offers feedback on observed behaviors and performance from a circle of raters, as opposed to subjective viewpoints from a single individual  similar feedback will send a reinforced message to the learner about what is working well and what needs to be improved  Feedback is more difficult to ignore when it is repeatedly offered by multiple sources

 While traditional performance reviews offer a single or limited viewpoint, the 360 degree review offers feedback from many sources that often times send repeating and consistent messages.  When a learner sees a consistent pattern of feedback, that feedback is more likely to become reinforced and is more difficult to write off as invalid.  There is a possibility that multi-rater feedback from a 360 degree review is more likely to be accepted by the employee  Once an individual accepts feedback there is an increasing likelihood of behavioral change and performance improvement

 Nothing happens until a person wants something to happen  the acceptance of feedback is the catalyst to behavioral change.  Feedback provides individual motivation if the learner accepts it  Not all learners feel as if they are capable or are interested in change.  If and when the learner becomes truly motivated, this energy will serve as the elixir to change.

 Precontemplation stage, at which there is no intention to change behavior in the foreseeable future. This is when learners are unaware of problems or that there is a need for change.  Contemplation stage, in which individuals have identified a problem, deciding whether or not there is a need to take action to correct the problem.  Preparation stage, the learner discusses the trends of the feedback with their coach and identifies common themes. Specific plans of action are developed as the learner chooses among potential solutions.  Action stage is where the learner actually put their plan to work and begins to change behavioral patterns.  Maintenance stage where the learner works to prevent relapse and are motivated to sustain progress.

 An experienced feedback coach is familiar with many of the typical reactions to feedback and can assist the learner with handling their reactions appropriately  While positive feedback is typically aimed at enhancing feelings of psychological safety and reinforcing selected behaviors, negative feedback is seen as aimed at shaking one loose from one’s self satisfied concept of oneself and at stimulating one to try new behaviors.  In a 360review, negative feedback can be reframed as corrective feedback.

The 360-degree evaluation tool would seem to have some appeal to residency programs in that it could help to assess physician competence in all six general competencies  6 general competencies for residents are: medical knowledge,  patient care  professionalism  practice- based learning and improvement  systems-based practice  interpersonal and communication skills.

peer physicians,faculty, nurses, and patients can reliably rate physicians’ humanistic behaviors. It has been estimated that ratings from 10–11 peer physicians, 5–15 nurses, 20–50 faculty supervisors,or 50–147 patients are needed to get reliable ratings of physicians’ humanistic qualities.

 Collecting data using paper surveys is burdensome and expensive  Because feedback is recall dependent, raters should be asked to evaluate learner close to the time when they have worked with the learner.  This requires frequent sampling, again adding to the burden of data collection and data management  all faculty must have free access to Web-based system that allows raters to complete surveys online

 توسط پرسشنامه صورت می گیرد ( پرسشنامه های متعددی بر اساس نوع ارزیاب تهیه میشود و در اختیار انان قرار میگیرد )  در اكثر اين پرسشنامه ها از مقياس هاي درجه بندي شده براي اندازه گيري اينكه يك رفتار تا چه ميزان در فرد مشاهده مي شود ،استفاده مي شود ( به عنوان مثال : از ٥ به مفهوم در تمام موارد تا ١ به مفهوم هرگز )‌  پس از تكميل پرسشنامه ها توسط ارزيابان ، نظرات آنهابر حسب موضوع جمع بندي وخلاصه مي شود و به فرد باز خورد داده مي شود. ممكن است مقياس به صورت پايين تر از سطح انتظار، لب مرزي ، سطح انتظار و بالاتر از سطح انتظار باشد. در اين صورت تعاريف هر مورد بايد مشخص و مورد توافق و استفاده تمام ارزيابان باشد.

 اين ابزار توسط افراد متعدد از جمله خود فرد تكميل مي گردد. معمولاً افرادي كه فرم ها را تكميل مي كنند شامل افراد زير مي باشد :  افراد بالاتر از فرد  افراد زيردست فرد  افراد هم سطح فرد  بيماران  خانواده بيماران

 هدف از تهيه فرم ارزيابي بايد مشخص باشد.  سوال هايي كه در فرم گنجانده مي شود بايد براساس هدف مشخص شده باشد.  سوالات فرم بايد شفاف و مشخص باشد ،  پاسخ دادن به سوال ها و تکميل فرم ارزيابي آسان باشد ( فرم نبايدخيلي طولاني باشد ).

 حيطه هاي مورد بررسي مشخص شده باشند و حتي الامکان حيطه ها مستقل از يکديگر باشند.  بايد مشخص شود که چه فردي فرم را پرکرده است تا در صورت وجودمشکل پاسخگويي وجودداشته باشد و نيز اگرنياز به کسب اطلاعات بيشتر بود ،بتوان پيگيري نمودو به اطلاعات دست يافت.  مقياس درجه بندي بايد با هدف تهيه فرم متناسب باشد.

 آموزش دادن ارزيابان، فراگيران، و مسئولين آموزشي بسيار اهميت دارد.

 بازخوردي كه پس از ارزيابي توسط اين ابزار به فرد مورد نظر داده مي شود ، بهتر است داراي ويژگي هاي زير باشد : - چهره به چهره باشد. - پيش از شروع گفتگو در اين باره چند لحظه فرصت به فرد داده شود تا خود وي به نتيجه ي ارزيابي نگاه كند و از آن اطلاع يابد.

- به ارزيابي نقاط قوت و ضعف هر دو بپردازد. - به فرد اجازه اظهار نظر داده شود. - خود ارزيابي را در فرد ترغيب نمايد.  به وي كمك كند تا با مشخص كردن اهداف خود براي اصلاح خويش ، يك برنامه براي به كار بستن نتايج ارزيابي ( (Action plan تهيه نمايد.  البته در اين ارزيابي ها ، جملاتي كه ارزيابان مختلف در باره ي فرد نوشته اند ،بدون ذكر نام ارزياب و به صورت كتبي به فرد بازخورد داده مي شود.

 ، فراگير چند ارزياب را از ميان استادان خود ، دستياران سال بالاتر ، پرستاران مجرب و ارشد ،... انتخاب مي كند تا پرسشنامه ارزيابي وي را تكميل نمايند. فراگير خود نيز يك فرم خود ارزيابي را تكميل مي نمايد. فرم هاي ارزيابي بطور مستقيم و بدون دخالت فراگير براي ارزيابان ارسال مي شود تا نظرات ارزيابان براي فراگير ناشناخته بماند. سپس نظرات گرد آوري و پس از حذف نام ارزياب به صورت مكتوب به فراگير بازخورد داده مي شود. در چارت هاي مربوطه نمره اي كه خود فرد به خود داده است ، ميانگين نمراتي كه اساتید ارزياب به او داده اندو ميانگين نمرات ساير دستياران مشخص مي گردد.. اين ارزيابي ٢ بار در سال انجام مي شود.

 موارداستفاده اين ابزار :  هنگامي كه هدف از اين ارزيابي دادن بازخورد تكويني و نه تصميم گيري نهايي است ، ارزيابان با دقت بيشتر و چشم پوشي كمتر ارزيابي مي كنند. بنابر اين ابزار خوبي براي ارزيابي هاي تكويني Formative assessment مي باشد.  ازاين ابزار مي توان براي ارزيابي موارد زير استفاده نمود :  - مهارت هاي برقراري ارتباط بين فردي  - رفتارهاي حرفه اي professional Behaviors  - برخي جنبه هاي مراقبت از بيمار  - برخي از جنبه هاي طبابت مبتني بر سيستم System- based

 در عمل ، دو نكته استفاده از اين ابزار را دشوار مي سازد  ١ - ساختن و تهيه پرسشنامه خوب بگونه اي كه براي همه افراد ي كه بايد آن را تكميل نمايند ( استاد ، بيمار ،.... ) ، مناسب باشد.  ٢ - جمع بندي و خلاصه كردن نتايج حاصل از تعداد زيادي فرم كه بايد جهت بازخورد دادن ، به اطلاع دستيار رسانده شود  استفاده از روش هاي الكترونيك مي تواند كمك بسيار مفيدي در اين راستا باشد.

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