title: Doctors' perceptions of why 360-degree feedback does (not) work: a qualitative study.
abstract: OBJECTIVE
  Delivery of 360-degree feedback is widely used in revalidation programmes. However, little has been done to systematically identify the variables that influence whether or not performance improvement is actually achieved after such assessments. This study aims to explore which factors represent incentives, or disincentives, for consultants to implement suggestions for improvement from 360-degree feedback.
  
  
  METHODS
  In 2007, 109 consultants in the Netherlands were assessed using 360-degree feedback and portfolio learning. We carried out a qualitative study using semi-structured interviews with 23 of these consultants, purposively sampled based on gender, hospital, work experience, specialty and views expressed in a previous questionnaire. A grounded theory approach was used to analyse the transcribed tape-recordings.
  
  
  RESULTS
  We identified four groups of factors that can influence consultants' practice improvement after 360-degree feedback: (i) contextual factors related to workload, lack of openness and social support, lack of commitment from hospital management, free-market principles and public distrust; (ii) factors related to feedback; (iii) characteristics of the assessment system, such as facilitators and a portfolio to encourage reflection, concrete improvement goals and annual follow-up interviews, and (iv) individual factors, such as self-efficacy and motivation.
  
  
  CONCLUSIONS
  It appears that 360-degree feedback can be a positive force for practice improvement provided certain conditions are met, such as that skilled facilitators are available to encourage reflection, concrete goals are set and follow-up interviews are carried out. This study underscores the fact that hospitals and consultant groups should be aware of the existing lack of openness and absence of constructive feedback. Consultants indicated that sharing personal reflections with colleagues could improve the quality of collegial relationships and heighten the chance of real performance improvement.
authors.affiliation: IQ Healthcare, University Medical Centre St Radboud, University of Nijmegen, 6500 HB Nijmegen, The Netherlands. k.overeem@iq.umcn.nl
authors.forename: Karlijn
authors.initials: K
authors.lastname: Overeem
authors.forename: Hub
authors.initials: H
authors.lastname: Wollersheim
authors.forename: Erik
authors.initials: E
authors.lastname: Driessen
authors.forename: Kiki
authors.initials: K
authors.lastname: Lombarts
authors.forename: Geertje
authors.initials: G
authors.lastname: van de Ven
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
authors.forename: Onyebuchi
authors.initials: O
authors.lastname: Arah
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003253:Consultants / Q000523:psychology; D004502:Education, Medical, Continuing / Q000379:methods*; D004521:Educational Measurement / Q000379:methods; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education* / Q000523:psychology / Q000592:standards; D009426:Netherlands