At Xytal, we specialise in healthcare quality improvement and process optimisation, working with leaders and teams to maximise personal and professional efficiency through leadership development and coaching. For healthcare managers and leaders, ensuring high-quality performance is of the utmost importance. However, when you notice suboptimal performance, do you sometimes find yourself quickly jumping to negative conclusions about the individual, team or situation?
Although there may be some truth in our initial reactions, many of us know that a subsequent conversation, approached with a non-judgemental and curious attitude, often reveals more complex, underlying issues. This enhanced understanding enables us to then lead more compassionately and effectively to support the required shift in performance.
In this blog, we explore how a coaching tool can facilitate greater insight and promote positive change in response to observing suboptimal performance.
Why is it important to have effective and supportive clinical performance conversations?
Effective and supportive clinical performance conversations are firstly essential for patient safety reasons. Suboptimal performance can lead to:
- Adverse incidents, such as claims of clinical negligence or cases of medication errors, which cost the NHS significantly every year.
- Interprofessional issues, such as significant unresolved conflict with colleagues, or dysfunction within a team. A dysfunctional healthcare team can seriously impact patient safety levels.
The second reason it’s essential for healthcare leaders to have supportive performance conversations with their staff is for professional wellbeing. There may be underlying health reasons behind poor performance, and these need to be addressed early wherever possible.
We know that there are high levels of burnout amongst healthcare professionals currently. Studies have indicated that clinicians who are burnt-out have approximately double the risk of involvement in patient safety incidents. Burnt-out healthcare professionals are also far more likely to receive low satisfaction ratings from patient surveys and demonstrate unprofessional behaviours, further impacting their wellbeing and adding to the disharmony of their team.
How to address clinical performance effectively
Think about a patient safety incident that occurred in your workplace recently. Could it have been predicted or avoided? Often, significant event analyses and complaint investigations reveal three main themes for improvement: issues with information sharing, documentation, and communication. These issues are frequently linked to preventable performance problems.
To address these issues early on, leaders must navigate several obstacles.
Avoid assumptions
It’s easy to jump to conclusions about what you’ve observed, but you might be missing the full picture. It’s far more effective to ask open questions about the incident to clarify the underlying factors.
Take responsibility
Sometimes, it’s unclear who should address the issue and so it goes unchallenged – possibly because we either overestimate the risk of challenging what we’ve seen, or underestimate the benefit of discussing it constructively. It’s always better to take responsibility and address issues quickly, otherwise they will be left to develop in the background.
Make time for it
Amidst all the pressures and demands of being a healthcare leader, finding time for these performance conversations can be difficult. But it’s time that you, your patients, and your team will thank you for taking later.
Review and monitor your actions
Taking the time and effort to review and monitor your own actions ensures accountability to your staff, whilst being a supportive and compassionate leader.
The Performance Equation
Tim Gallwey’s book, The Inner Game of Work, presents the Performance Equation: Performance = Potential – Interference. This highlights that suboptimal performance often stems from underlying “interferences”. Identifying and addressing these interferences early can help improve performance and reduce patient safety errors.
The Yerkes-Dodson curve illustrates the relationship between pressure and performance. This bell-shaped curve shows that an optimal level of pressure can motivate us to perform better, but too much pressure can decrease performance.
Working on clinical performance starts with considering where you and your team fall on this curve.
Putting the Performance Equation into practice
NHS Resolution categorises clinician performance issues into clinical, health, and behavioural factors – and often more than one category applies to a particular case.
Early conversations about performance, using tools such as the pressure-performance curve, can address underlying interference factors constructively. Ask questions like:
- Where are you on this curve?
- What’s going on for you?
- How would you like things to be?
- What could you do?
- How can I best help?
Creating psychological safety in a workplace, as Amy Edmondson suggests, is vital. People need to feel safe to admit their struggles and accept support. Leaders can promote this environment by being appropriately vulnerable, maintaining a non-judgemental attitude, and communicating compassionately.
Applying these principles to teams involves collective problem-solving and action planning. Ask your team where they are now, where they want to be, and what’s holding them back. This encourages greater ownership, reflection, and open discussion.
In summary, managing performance effectively involves understanding underlying “interference factors” accurately, fostering psychological safety, and using coaching questioning tools – such as the Performance Equation and related open questions – to support positive, lasting change.
