title: Nurses' evaluation of physicians' non-clinical performance in emergency departments: advantages, disadvantages and lessons learned.
abstract: BACKGROUND
  Peer evaluation is increasingly used as a method to assess physicians' interpersonal and communication skills. We report on experience with soliciting registered nurses' feedback on physicians' non-clinical performance in the ED of a large academic medical center in Lebanon.
  
  
  METHODS
  We utilized a secondary analysis of a de-identified database of ED nurses' assessment of physicians' non-clinical performance coupled with an evaluation of interventions carried out as a result of this evaluation. The database was compiled as part of quality/performance improvement initiatives using a cross-sectional design to survey registered nurses working at the ED. The survey instrument included open ended and closed ended questions assessing physicians' communication, professionalism and leadership skills. Three episodes of evaluation were carried out over an 18 month period. Physicians were provided with a communication training carried out after the first cycle of evaluation and a detailed feedback on their assessment by nurses after each evaluation cycle. A paired t-test was carried out to compare mean evaluation scores between the three cycles of evaluation. Thematic analysis of nurses' qualitative comments was carried out.
  
  
  RESULTS
  A statistically significant increase in the averages of skills was observed between the first and second evaluations, followed by a significant decrease in the averages of the three skills between the second and third evaluations. Personalized feedback to ED physicians and communication training initially contributed to a significant positive impact on improving ED physicians' non-clinical skills as perceived by the ED nurses. Yet, gains achieved were lost upon reaching the third cycle of evaluation. However, the thematic analysis of the nurses' qualitative responses portrays a decrease in concerns across the various dimensions of non-clinical performance.
  
  
  CONCLUSIONS
  Nurses' evaluation of the non-clinical performance of physicians has the potential of improving communication, professionalism and leadership skills amongst physicians. For improvement to be realized in a sustainable manner, such programs may need to be offered in a staged and incremental manner over a long period of time with proper dedication of resources and timely monitoring and evaluation of outcomes. Department directors need to be trained on providing peer evaluation feedback in a constructive manner.
authors.affiliation: Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut (AUB), Riad El-Solh, 1107 2020, Beirut, Lebanon. ma164@aub.edu.lb.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Alameddine
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, American University of Beirut Medical Center (AUBMC), Riad El-Solh, 1107 2020, Beirut, Lebanon. am66@aub.edu.lb.
authors.forename: Afif
authors.initials: A
authors.lastname: Mufarrij
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, American University of Beirut Medical Center (AUBMC), Riad El-Solh, 1107 2020, Beirut, Lebanon. ms206@aub.edu.lb.
authors.forename: Miriam
authors.initials: M
authors.lastname: Saliba
authors.affiliation: Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut (AUB), Riad El-Solh, 1107 2020, Beirut, Lebanon. yam03@aub.edu.lb.
authors.forename: Yara
authors.initials: Y
authors.lastname: Mourad
authors.affiliation: Nursing Administration, Department of Emergency Medicine, AUBMC, Riad El-Solh, 1107 2020, Beirut, Lebanon. rj10@aub.edu.lb.
authors.forename: Rima
authors.initials: R
authors.lastname: Jabbour
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, American University of Beirut Medical Center (AUBMC), Riad El-Solh, 1107 2020, Beirut, Lebanon. eh16@aub.edu.lb.
authors.forename: Eveline
authors.initials: E
authors.lastname: Hitti
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007857:Leadership; D007861:Lebanon; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D010819:Physician's Role; D010820:Physicians / Q000523:psychology*; D011361:Professional Competence; D011795:Surveys and Questionnaires