Cath Lab Design/ Cath Lab Management

A Look at Peer Evaluations in the Cath Lab

Laura Waddington, RN, BSN, Syracuse, New York
Laura Waddington, RN, BSN, Syracuse, New York
We explore four areas pertaining to peer evaluations. These areas include a look at potential problems in an evaluation performed solely by management, the positive and negative aspects of peer evaluations, suggestions on how to implement a peer evaluation and a brief look at change theory. This article will help those interested in implementing a form of peer evaluation for the cardiac catheterization laboratory, taking into consideration how employees may react to the plan. Problems That May Occur With Management-Performed Evaluations In most facilities, management is solely responsible for doing annual performance evaluations of staff. This can lead to any number of problems and ultimately cause the staff member to reject the validity of the evaluation. An employee who perceives his or her evaluation to be biased, (accurately or not) may refuse to sign the evaluation, or go further and chose to pursue legal action regarding the bias. Following are some issues that can arise with management-only evaluations: 1. Managers may make the mistake of comparing an employee’s performance to their own, called the “similar-to-me effect.”1 Setting unreasonably high standards is not fair practice. Staff members should not be compared to, nor evaluated against, the performance of management. The work a staff member does and the work management does are two different areas of practice. 2. Personality conflicts can exist between management and employees. These conflicts can cause a manager (consciously or not) to become biased in the evaluation, basing it on “like” versus “dislike.” In this scenario, an employee’s action that normally would not affect the overall evaluation has a negative impact. For example, because of a personality conflict between management and the employee, the manager could focus on an employee’s singular incidence of tardiness and fail to acknowledge positive contributions the employee made over the course of the year. This practice is known as the “horn effect.”1 The opposite of the horn effect is the “halo effect,”1 when a manager takes one positive aspect of an employee and generalizes it into an overall positive evaluation. 3. Managers often have limited contact with staff members. When the manager is present, staff performs at their optimal level of performance.1 What a manager may view one day may not necessarily be how the employee truly performs. Managers tend to evaluate from one perspective and omit aspects they do not witness. Such a performance evaluation may fail to recognize how a staff member reacts in an emergency, if the employee embraces the opportunity to teach others and if that employee works well in a team situation. All these are important in an overall performance evaluation. In being evaluated solely by management, the employee receives, in essence, an incomplete evaluation. Positive and Negative Aspects of Peer Evaluations A peer evaluation is a means of obtaining accurate information about an employee, based on the idea that peers will know the employee’s work ethic and behavior better than management, and ultimately resulting in a more useful and accurate evaluation. Yet the concept of peer evaluations is not well studied nor is it well developed. Many organizations that have attempted to implement the practice of peer evaluation have found that it was met with low acceptance. Perhaps it is because employees find the process of evaluating a peer to be time-consuming and damaging to personal relationships. Some staff members find the process places them in uncomfortable situations and it causes confusion as they wonder, “Am I a colleague or am I am judge?” Staff do not wish to be involved in taking on the role of evaluator for fear it will damage pre-existing relationships.2 There is also the reality that (as with management) personality conflicts may exist. If a staff member is asked to evaluate the performance of a co-worker with whom he or she has an existing conflict, this will place both team members in an uncomfortable situation, as well as cause the evaluation to be subject to bias. An evaluation cannot be objective if one employee is out to sabotage the other.3 Some staff members view the idea of peer evaluations as political, increasing resentment. Others believe that evaluating an employee is the sole responsibility of management, noting that one reason management occupies the position it does is to perform evaluations and that no one except management should perform them. Peer evaluations also require training, necessary for staff to perform the evaluations in the correct manner. Those who oppose peer evaluations feel the training is time-consuming and that there is not enough time to tend to patient issues let alone learn how to evaluate the performance of others.4 Nursing is an example of a career where in a given selection of co-workers, there will be a wide range of years of experience among fellow nurses. Some have disputed the idea of peer evaluations by arguing that older staff members may have a difficult time accepting an evaluation from a younger peer.5 These cited objections generally lead the evaluation process to be completed by management. Yet some do view peer evaluation positively, citing the benefits it may offer. A peer evaluation can be used as a tool for improvement and professional growth. This form of evaluation is also believed to promote professionalism. Having to evaluate a peer and be evaluated similarly can enforce staff accountability. By nature, people are predisposed to put less effort into a group task than an individual one, simply because individuals do not believe their efforts are being monitored.4 Known as “social loafing,” one of the best ways to prevent it is to make each team member accountable for his or her actions.2 Evaluations from co-workers (who are teammates) help to promote accountability. It is important to note that a management-performed evaluation is not necessarily a negative experience and therefore, a peer evaluation does not have to be a negative experience either. Peer evaluations can provide an avenue for peer support. In the cath lab, the value of teamwork and support is learned very early on in one’s career. Having to evaluate a peer can serve as a way for staff to work together as well as improve communication skills. The evaluating member has to put his or her comments into written form in a professional manner and is then held accountable for those written thoughts. A common complaint among staff members is that they feel they do not have a say in what happens in the unit as to who is hired and who is disciplined. A peer evaluation process enables each staff member to feel as if he or she truly has a say in what occurs in his or her work area.6 This can be an extremely empowering concept. Another positive aspect of the peer evaluation is the fact that no one will know better how an employee works than the staff working side by side with him or her every day. Team members are the ones who truly see the performance and behavior of their peers.7 A peer evaluation also allows management to assess whether staff members agree with the manager’s perspective regarding an employee. Management can have little contact with the staff and in order for a more meaningful evaluation to exist, peer evaluations should be part of practice. How to Present Peer Evaluations A peer evaluation should be viewed as a positive experience and should be presented in a positive manner. Acceptance of the peer evaluation system is vital to its success.8 If not, staff may find ways to reduce the evaluation’s effectiveness by (for example) refusing to participate or by providing consistently low or high ratings to peers that are not in agreement with others’ perceptions. Since implementing the peer evaluation will initially be a new experience for all involved, adequate training must be provided. The training needs to include a written statement addressing the purpose of the peer evaluation. Upon completion of the training, the manager must remain available to answer any questions the staff may have regarding the evaluation. Management must also provide each employee with a checklist addressing each employee’s responsibilities. Management should also provide a deadline for when the evaluations need to be completed to avoid late reviews.9 Any employee interacting with the to-be-evaluated employee on a regular basis should be required to participate in the employee’s evaluation.3 To ensure confidentiality, all evaluations must be anonymous, which will also help to avoid feelings of discomfort and any worries about damaging relationships among team members. For the final evaluation, management should incorporate all participants’ responses. All responses need to be reviewed for signs of bias and ratings that are significantly different from the general consensus.8 Management should still perform the final evaluation, but with the input from peers, the evaluation will be more complete. When reviewing the final evaluation with the employee, management should not reveal specifically what co-workers have said. The evaluation should always be objective and should never be used as a tool to lower an employee’s self-confidence.7 Utilizing “Change Theory” for the Implementation of Peer Evaluations To formulate a method of peer evaluation, change theory may be a useful guide. Rogers’ theory of change moves through five phases, which include awareness, interest, evaluation, trial and adoption:10 1. Staff are aware that the need for change exists. 2. Staff demonstrate an interest in being a part of the change. 3. Staff evaluates the need for the change to occur. Is it truly necessary? 4. The change is implemented and all involved evaluate it. 5. Adoption of the change occurs. Rogers believed that each member of the team involved in the change can accept or reject it, placing additional emphasis on the need for teamwork. If each team member does not accept the change, it will not succeed. Each member must be truly invested in the change to ensure its success. In addition, Rogers believed that even if change is initially accepted, it can later be rejected, and vice versa — change can be rejected at first and later accepted. Conclusion: Personal reflection Figure 1 is a sample we developed of a peer review evaluation form. Change is an essential aspect of our work in the cath lab, but human nature is to resist change. Implementing a method of peer review in the cath lab is an enormous change, but well worth the effort. People can be comfortable with change as long as it comes at a reasonable rate. Peer review in the cath lab opens lines of communication that are too often closed. It allows the staff to feel valuable and have their capabilities recognized by their peers. Once implemented, the system of peer review needs to be open to feedback and suggestions. All staff needs to be involved in the process of planning and implementing, which would also serve as motivation. Ultimately, using a peer review system in the cath lab teaches staff that everyone has their niche and supports the team concept. Laura Waddington can be contacted at
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