title: Performance assessment in health care providers: a critical review of evidence and current practice.
abstract: OBJECTIVE
  To evaluate methods of performance assessment through an international literature review and a survey of current practice.
  
  
  BACKGROUND
  Over the past two decades health care organizations have focussed on promoting high quality care in conjunction with retaining motivated staff. Cognisant of such initiatives, we sought to evaluate assessment methods for qualified staff according to their utility in the working environment.
  
  
  METHODS
  A systematic literature search was completed and each paper independently reviewed. All health care organizations in Northern Ireland submitted details of their performance assessments. Each was critically appraised using a utility index.
  
  
  RESULTS
  Performance was not universally defined. A broad range of assessments were identified, each method had advantages and disadvantages. Although many lacked rigorous testing, areas of good practice were also noted.
  
  
  CONCLUSIONS
  No single method is appropriate for assessing clinical performance. Rather, this study endorses proposals for a multi-method strategy to ensure that performance assessment demonstrates all attributes required for effective nursing and midwifery practice.
authors.affiliation: National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK. karen.hamilton@npeu.ox.ac.uk
authors.forename: Karen E Stc
authors.initials: KE
authors.lastname: Hamilton
authors.forename: Vivien
authors.initials: V
authors.lastname: Coates
authors.forename: Billy
authors.initials: B
authors.lastname: Kelly
authors.forename: Jennifer R P
authors.initials: JR
authors.lastname: Boore
authors.forename: Jill H
authors.initials: JH
authors.lastname: Cundell
authors.forename: Jacquie
authors.initials: J
authors.lastname: Gracey
authors.forename: Brian
authors.initials: B
authors.lastname: McFetridge
authors.forename: Mary
authors.initials: M
authors.lastname: McGonigle
authors.forename: Marlene
authors.initials: M
authors.lastname: Sinclair
mesh_terms: D054869:Clinical Audit; D002983:Clinical Competence / Q000592:standards*; D003362:Cost-Benefit Analysis; D004282:Documentation; D004650:Employee Performance Appraisal / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D030141:Feedback, Psychological; D006281:Health Occupations / Q000193:education / Q000592:standards*; D006801:Humans; D020380:Needs Assessment; D009660:Northern Ireland; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D009745:Nursing, Supervisory; D019370:Observation; D010348:Patient Care Team; D011594:Psychometrics; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012107:Research Design; D012647:Self-Assessment; D011795:Surveys and Questionnaires