Performance appraisal for doctors: A case of paperwork compliance

Abstract

This paper discusses the findings of research exploring the conduct of portfolio-based performance appraisal within medicine. Portfolios are now used throughout medical school and junior doctor training, in later specialist training, as well as to support the implementation of annual NHS appraisal of doctors as part of their employment contract. They will also play a role in the new medical governance quality assurance process known as revalidation, when it is implemented in 2010. The paper discusses how the growth of portfolio-based performance appraisal within medicine is bound up with the growth of managerial systems of surveillance and control within western health care systems. Theoretically, it draws upon a Governmentality perspective to analyse doctor's accounts of the appraisal process. This views appraisal as an information panopticon that to better enable social control seeks to construct appraisees as calculable and administrable subjects. However, the paper highlights how the doctors interviewed used the tacit dimensions of their expertise to engage in creative game-playing toward appraisal, adopting a stance of paperwork compliance toward it. Paperwork compliance leaves a paper trail that makes it appear doctors have complied with the technical requirements of performance appraisal when in fact they have not. The paper concludes that current reforms to medical governance introduced to ensure the general public is protected from medical error and malpractice, provide sociologists with an invaluable opportunity to undertake a dedicated research program into the performance management of medical work.

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